Fatty Liver and Metabolic Syndrome

“All animals are equal, but some animals are more equal than others.”  

George Orwell.  Animal Farm

That animal is the fatty liver.

As of 2016, 1 in 4 people have fatty liver, also known as Hepatic steatosis or Non-alcoholic Fatty Liver Disease (NAFLD).1 NAFLD is an abnormal accumulation of fat in the liver. It develops from an excessive intake of carbohydrates.

If you want to avoid obesity, Type 2 diabetes and all its complications, hyperlipidemia, hypertension, and metabolic syndrome and all the diseases associated with diabetes, you should avoid developing a fatty liver.1

Fatty Liver Destroys the Liver

The fatty infiltration damages the liver and causes inflammation, nonalcoholic steatohepatitis (NASH) that leads to liver scarring (fibrosis). Eventually, the whole liver becomes scarred and useless (cirrhosis). The liver has an indispensable role in the body’s wellbeing. If the liver is not well, the whole body is not well. No medications are available to treat liver cirrhosis. Only a liver transplant. That is if you can find a willing and matching donor. By 2020,  liver cirrhosis secondary to the fatty liver will be the number one indication for a liver transplant.2, And if that is not enough, the cirrhotic liver can lead to hepatocellular cancer (HCC).

Fatty Liver Destroys the Body

The liver is primarily involved in nutrient processing energy storage and use. It stores glycogen from the carbohydrates or glucose that we eat. Plain sugar and high fructose corn syrup that is used in many processed foods contain fructose that is not used by the body as fuel but is stored as fat in the liver.   Once the liver is full of glycogen, the excess glucose becomes fat and becomes the Very Low-Density Lipoprotein (VLDL) and triglycerides.

Fat cells start to multiply and grow if the carbohydrate ingestion continues with a “no exercise” lifestyle. It is easier to deposit the excess glucose in the visceral fat within the abdomen. As it enlarges, the visceral fat produces more pro-inflammatory substances that spread and cause inflammation to the whole body. Just like the good Dr. Jekyll turning into the evil Mr. Hyde. Or Bruce Banner becoming the unstoppable Hulk.

It is not a mystery that metabolic syndrome can affect the whole body. Read the rest of the ongoing series of this website, Diseases Associated with Metabolic Syndrome.

How will you know if you have a fatty liver?

Imaging, a tape measure, and blood work.

I Have Fatty Liver! What Do I Do Now?!?!

1. No medications are available to treat fatty liver.
2. Avoid further liver damage by double-checking your medications to see any precautions about liver disease. Acetaminophen can induce liver toxicity with concomitant fatty liver. 3
3. Weight loss of at least 3 to 5%. 10% is better.8
4. Bariatric surgery for the morbidly obese.
5. Low Carbohydrate diet. This peer-reviewed study published in Cell Metabolism showed improved fatty liver in the subjects.5

A diagnosis of any disease associated with Metabolic Syndrome should prompt a query if you are at risk of developing ischemic heart disease. Talk to your doctor if there is a need to do a fasting blood sugar, serum triglyceride, and HDL level. Monitor your blood pressure and measure your waistline. Intermittent fasting can reverse insulin resistance.

Fatty Liver arises from other causes like alcohol abuse, Hepatitis C infection, drugs, and other endocrine causes. This article is only about fatty liver as it relates to metabolic syndrome.

Related Readings

• Diseases Associated with the Metabolic Syndrome
• Metabolic Syndrome and the Pancreas
• Gallbladder Diseases and Metabolic Syndrome
• GERD Metabolic Syndrome. Part 11.2 Gastrointestinal, GERD/Heartburn
• How Will You Know if You are TOFI?
• Can You be Skinny and Obese?
• What Does Waist Circumference Really Measure?

References:

1. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016 Jul;64(1):73-84. doi: 10.1002/hep.28431. Epub 2016 Feb 22.
2. Chedid, M.F. Nonalcoholic Steatohepatitis: The Second Leading Indication for Liver Transplantation in the USA. Dig Dis Sci (2017) 62: 2621. https://doi.org/10.1007/s10620-017-4724-6
3. Julie Massart, Karima Begriche, Caroline Moreau, Bernard Fromenty. Role of nonalcoholic fatty liver disease as a risk factor for drug-induced hepatotoxicity. J Clin Transl Res. 2017 Feb 17; 3(1): 212–232. Published online 2017 Feb 12.
4. L A Adams, P Angulo. Treatment of non‐alcoholic fatty liver disease. Postgrad Med J. 2006 May; 82(967): 315–322. doi: 10.1136/pgmj.2005.042200

5. An Integrated Understanding of the Rapid Metabolic Benefits of a Carbohydrate-Restricted Diet on Hepatic Steatosis in Humans. Cell Metabolism CLINICAL AND TRANSLATIONAL REPORT| VOLUME 27, ISSUE 3, P559-571.E5, MARCH 06, 2018

6. 2. Rotonya M, Amanke O, and Vandana K., Non-alcoholic fatty liver disease: Pathophysiology and management. Gastroenterol Clin North Am. 2016 Dec; 45(4): 639–652.

7. Lonardo A, Ballestri S, Marchesini G, Angulo P, Loria P. Nonalcoholic fatty liver disease: a precursor of the metabolic syndrome. Dig Liver Dis. 2015 Mar;47(3):181-90. doi: 10.1016/j.dld.2014.09.020. Epub 2014 Nov 18.

8.  Ferolla, Silva, Ferrari,  Sales da Cunha, Martins,  Couto, and Ferrari. The dietary approach in the treatment of nonalcoholic fatty liver disease. World J Hepatol. 2015 Oct 28; 7(24): 2522–2534. Published online 2015 Oct 28. doi: 10.4254/wjh.v7.i24.2522

Image Attributions:

Liver in the Body  BodyParts3D/Anatomography

Stages of Fatty Liver: The original uploader was Countincr at English Wikipedia. https://commons.wikimedia.org/w/index.php?curid=2310132

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