If you have excess fat in your liver, you can be at great risk for diabetes, even if you are not overweight. Several recent articles show that:
• Storing fat in your belly is a stronger risk factor for diabetes than just being overweight and is arguably the most common cause of diabetes in North America today (BMC Public Health, November 18, 2019). Eleven percent of 5,228 non-obese people had excess belly fat and these normal-weight people with big bellies had significantly higher levels of blood pressure, fasting blood sugar, total cholesterol and triglyceride levels indicative of increased risk for diabetes and heart attacks.
• Measuring a person’s waist circumference is a simple and efficient way to see if people who are not overweight still are at increased risk for diabetes (Arch Med Sci Civil Dis, July 22, 2019;4:e64–e71). Men are at increased risk for being diabetic if their waist circumference is greater than 38.7 inches, and women if it is greater than 36 inches.
• People with excess fat in the liver are at increased risk for being deficient in iron that causes them to have less energy, be less active and far less likely to exercise than people with normal amounts of liver fat (Clinical Gastroenterology and Hepatology, Dec 1, 2019).
• Low glycemic index diets that restrict refined carbohydrate foods such as bakery products, pastas and most dry breakfast cereals and foods with added sugar help people to reduce the amount of fat in their liver, decrease insulin resistance and lower triglycerides and cholesterol (Metab Syndr Relat Disord, 2019;17(8):389-396).

Diabetes Often Caused by Excess Fat in Liver and Muscles
Most people you see with a large belly and small buttocks already have high blood sugar levels that are caused by excess liver fat and inability to store much fat in their buttocks and thighs. Excess fat in the liver and muscles prevents your body from responding to insulin (called insulin resistance), which causes blood sugar levels to rise so high that they can damage cells throughout your body.

Your blood sugar rises after meals. When blood sugar levels rise, the pancreas releases large amounts of insulin to lower blood sugar by driving sugar into the liver. However, if you have too much fat in your liver, the liver refuses to accept sugar from the bloodstream and blood sugar rises to high levels.

Why Skinny Thighs and Buttocks are Linked to Diabetes
A study from Cambridge University in England showed that not being able to store excess fat in your buttocks and thighs can cause diabetes (Nature Genetics, November 14, 2016). An international team studied more than two million genetic variants in 200,000 people and found 53 regions of genes associated with insulin resistance, diabetes and heart attacks. They then did CT scan X rays on 12,000 people to see where they stored fat and found that people who are genetically susceptible to diabetes lack the ability to store much fat in their thighs and buttocks. That means that if you genetically lack the ability to store much fat in the lower part of your body, you are at increased risk for storing most of your fat in your liver and becoming diabetic if you gain any weight at all.

Overweight people who are shaped like pears, with a flat belly and large buttocks, are at far less risk for heart attacks and diabetes than people who are shaped like an apple, with a big belly and small buttocks. You are likely to be prediabetic or diabetic if you:
• can pinch more than three inches of fat under the skin at the front of your belly, even if you are thin everywhere else
• have a high fasting blood sugar (>95)
• have high blood sugar one hour after eating (>145)
• have high triglycerides (>150)
• have low good HDL cholesterol (<40)
• have a high HBA1C (>5.5), a test that shows too much sugar stuck on cells
• have a lot of fat in your liver (shown on a sonogram)

Dramatic Lifestyle Changes Can Save Your Life
I believe that everyone should follow an anti-inflammatory lifestyle that helps to prevent excess fat from being deposited in the liver.
• avoid sugar-added drinks and foods
• avoid red meat, processed meats and fried foods
• avoid smoking, drinking alcohol, and recreational drugs
• eat lots of fruits and vegetables
• try to exercise every day
If you have a large belly, you should also severely restrict all refined carbohydrates such as those found in bakery products, pastas, and most dry breakfast cereals.