Ascites vs. Belly Fat: Know the Difference

author avatar Dr. Eric Berg 08/31/2023

A large and distended belly isn’t always caused by excessive fat deposits.

Ascites is the accumulation of excess fluid in the abdominal cavity, and belly fat is caused by visceral and subcutaneous fat around abdominal organs and the abdominal wall. 

While both conditions lead to extended waistlines and weight gain, causes and treatment of excess abdominal fluid and visceral belly fat are distinctly different.         

Let's look at the difference between ascites and belly fat and how to get rid of fluid in the abdomen.

Male distended belly

Ascites vs. belly fat

Ascites and belly fat are two different conditions that cause an enlarged and distended abdomen and increased body weight. 

Ascites can indicate serious liver disease, and it’s important to know how to spot the difference between abdominal fat and fluid accumulation.  

What is ascites?

Ascites is a medical condition that typically develops due to liver disease and is characterized by excessive fluid accumulations in the peritoneal cavity, the space surrounding digestive organs and the liver.

Chronic alcohol intake, liver infections, and hepatitis can cause cirrhosis and scarring of liver tissue. Because liver cells filter blood, liver scarring can lead to elevated blood pressure in abdominal blood vessels, which causes fluid to leak from the portal vein, the liver’s main blood supply, into the abdominal cavity. 

When fluid leaks from blood vessels, blood volume drops and signals a state of dehydration to the kidneys, causing water retention and more fluid accumulations, which worsens ascites. 

What is belly fat?

Belly fat develops due to excessive fat deposits of two different types of fats within the abdomen. 

Visceral fat is linked to central obesity and accumulates around organs. Subcutaneous fat is the layer of fat between your skin and the abdominal wall. 

While subcutaneous fat typically isn’t a cause for serious health concerns, research published in the Journal of Lipids in Health and Disease suggests that visceral fat increases the risk of heart disease, diabetes, and cancer. 

Here are some risk factors linked to excess body fat mass and belly fat.

  • Poor diet and excess calories

  • Lack of physical exercise

  • Liver body type 

  • Stress 

  • Lack of sleep 

It’s important to understand that an enlarged abdomen can indicate potentially serious health problems. 

If you have developed a swollen abdomen or experience rapid, unexplained weight gain, consult with a healthcare provider to determine all possible underlying causes and formulate an appropriate treatment plan based on your individual symptoms and health status. 

Ascites illustration

How do you know if you have ascites or belly fat?

Ascites typically develops over a few weeks or months and is characterized by a significant change in body shape and a smooth belly that feels hard to the touch.    

Common symptoms of ascites include frequent urination, difficulty breathing, swollen feet and legs, hemorrhoids, and nausea. 

In contrast to ascites, belly fat causes a soft belly that tends to develop slowly and is due to poor dietary and lifestyle habits. While belly fat doesn’t cause significant symptoms, excess fat around the organs can impact cardiovascular functioning and cause shortness of breath and hypertension. 

Causes of ascites

Ascites is a serious medical condition that indicates impaired kidney and liver function and may require immediate treatment. 

Different factors can cause or contribute to ascites, including:

  • Hepatitis B or C infections 

  • Chronic alcohol abuse 

  • Fatty liver disease 

  • Genetic predisposition to cirrhosis 

  • Congestive heart failure 

  • Ovarian cancer

  • Portal hypertension 

Watch the video below to learn what steps you can take to ease symptoms of ascites.  

How to get rid of ascites

Depending on the severity of abdominal fluid, conventional ascites treatment includes diuretic medications to stimulate fluid loss, drainage of excess abdominal fluid, and modifications of sodium intake. In some extreme cases, the loss of liver function may require a liver transplant.  

Fortunately, you can take several steps to lower your risk of ascites and support healthy kidney and liver function.  

1. Intermittent fasting 

Intermittent fasting (IF) is a pattern of meal time scheduling that includes prolonged periods without calorie intake. Before embarking on an intermittent fasting journey, understanding your body type first is recommended.

IF involves cycles of eating and fasting, and how your body responds to these periods may vary based on factors like metabolism, energy needs, and daily activities. By knowing your body type, you can tailor your intermittent fasting approach to suit your unique needs and achieve optimal results.

A study published in Aging Research Reviews suggests that IF has profound beneficial metabolic effects and triggers autophagy, a biochemical process that degrades old, damaged cells and stimulates cellular renewal. 

According to Dr. Berg, “IF has been shown to reduce cirrhosis scarring in liver tissues and improves liver function, which is crucial in treating ascites.”   

2. Milk thistle 

Milk thistle is a herb that has potent hepatoprotective properties and supports liver cell function. Milk thistle contains silymarin, a phytochemical that lowers inflammation and protects liver cells from oxidation linked to cirrhosis and loss of liver function.

Human liver illustration

3. Antioxidants 

The liver is the body’s main metabolic and detoxification organ which significantly increases the rate of oxidative stress within liver cells. Energy production, alcohol detoxification, and the breakdown of hormones, drugs, and environmental toxins create free radicals, highly volatile chemical compounds linked to liver cell damage and inflammation. 

Both vitamin E and selenium are potent antioxidant nutrients that have been shown to neutralize free radicals in liver cells and protect liver tissue from scarring.

5. Low-carb diet

A low-carb diet like Healthy Keto® supports liver health and lowers oxidation in liver cells. 

Carbohydrates are quickly metabolized and cause a spike in energy production which increases the formation of free radicals and may contribute to liver inflammation.  

6. Avoid alcohol 

Alcohol, or ethanol, is cytotoxic, meaning it directly impacts cellular health and causes damage to cell structures and DNA. Liver cells detoxify alcohol, making the liver especially susceptible to alcohol-related damage and cirrhosis. 

According to Natalia Osna, Ph.D., a research biologist and lead author of a study published in the Journal of Alcohol Research, “Heavy ethanol consumption produces a wide spectrum of hepatic lesions, the most characteristic being fatty liver (i.e., steatosis), hepatitis, and fibrosis/cirrhosis. Steatosis is the earliest, most common response that develops in more than 90 percent of problem drinkers.”

Large male belly

Key takeaways

Ascites and belly fat cause weight gain, distended bellies, and changes in body shape. 

Belly fat is often caused by consuming too many calories, a high-carb diet, and sedentary lifestyle habits. On the other hand, ascites is excess fluid that leaks into the abdominal cavity and typically indicates a serious liver problem. 

While ascites may require immediate medical attention, intermittent fasting, taking a milk thistle supplement, and boosting antioxidants support liver health and may lower the risk of fluid accumulations in the abdomen. 


1. What does an ascites belly feel like?

Ascites is typically accompanied by a tight and distended belly that feels hard and smooth.  

2. How do you rule out ascites?

It’s important to consult with a healthcare provider to rule out ascites. A combination of liver function tests, CT scans, and physical examinations are typically performed to investigate possible underlying causes of an enlarged abdomen. 

3. How can I check if I have ascites at home?

Performing a fluid wave test can indicate if you have developed fluid accumulations within the abdomen. 

Laying on your back, have a helper apply gentle pressure on your abdomen. Use your right hand to firmly tap the right side of your belly, and use your left hand to determine if you have a wave-like sensation within your left abdomen, which indicates excessive fluid.   

4. What is the difference between beer belly and ascites?

An ascites belly is filled with fluid leaking from the blood vessels in the abdomen. A beer belly develops due to excessive visceral fat deposits around organs. Because visceral fat accumulates beneath stomach muscles and causes a protruding belly, a beer belly can also feel stiff and firm but shows no signs of excess fluid.   

5. How do ascites feel to the touch?

Ascites is typically characterized by a firm, smooth belly that feels tight and may create a fluid-like wave if tapped.  


6. How do I know if I have fat or fluid in my abdomen?

Compared to belly fat, fluid can accumulate within a few weeks or even days. In addition, a hard and smooth belly, abdominal pain, bloating, loss of appetite, and increased urination are common symptoms of ascites but are typically not associated with belly fat.    

7. Do you gain weight with ascites or belly fat?

Belly fat causes weight gain due to increased body fat mass, and ascites increases body weight as a result of excessive fluid retention. 


8. Is ascites fluid?

Yes, ascites is the accumulation of fluid in the abdominal cavity and is most often related to liver damage. 

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