Click to listen to the audio…
When you’re insulin resistant, that is, you’ve got metabolic syndrome, pretty much every chemical in the body is NOT QUITE RIGHT. Some are up. Some are down. Few are actually at physiologically NORMAL levels.
Traditionally the focus is on the big guns.
- And cholesterol
In this series, we take a look at some of the other players.
Who they are, what they’re up to and how they’re part of the state of insulin resistance.
We feature the liver
And it’s state of being – which is FAT.
If you’re insulin resistant, odds are you have fatty liver.
The origins of fatty liver
Now, you can have fatty liver, without metabolic syndrome :
- too much alcohol,
- viral infections e.g. hepatitis C
- several commonly used drugs and supplements,
- hypothyroidism and
- BAD genes,
can all cause liver cells, to accumulate TOO MUCH FAT.
But metabolic syndrome is the BIGGEST driver.
In fact, there is a school of thought that thinks, fatty liver alters the paracrine and endocrine functions, inside the liver, CAUSING insulin resistance.
What’s in a name
The condition is considered to be a hepatic manifestation of metabolic syndrome and there are moves afoot, to give it a new name MAFLD (metabolic associated fatty liver disease).
Currently it is called NAFLD, which stand for non-alcoholic fatty liver disease, to distinguish it from alchoholic fatty liver disease (AFLD). Metabolic associated fatty liver disease, differentiates it, from environmental and genetic causes of liver disease.
And it has a lot less stigma than non alcoholic fatty liver disease.
A silent problem
The thing about fatty liver is odds are, you won’t know you have a problem, until you have a BIG PROBLEM – namely liver disease. Unfortunately, by the time it is recognized, the liver is in SERIOUS TROUBLE, and may be beyond redemption.
The condition, starts off SLOWLY. At first, liver cells are carrying a little extra fat, this is called steatosis. It’s not ideal, but not hugely problematic, the liver is still able to do the “gazillions” of reactions, it’s tasked with.
But, it can create a little angst….
NASHing of teeth
One problem that often arises is portal hypertension i.e. the blood pressure is high in the blood vessel, that connects the gut, with the liver. The increase in pressure – causes damage, endothelial cells i.e. the cells surrounding blood vessels, they turn a little balshy, making it harder for the liver cells to process “new” arrivals. Damage happens, precipitating the enlistment of the immune system, to clean up.
At this stage, the situation is described as NASH.
Generally speaking, the liver muddles through – there are changes in liver chemistry, but the liver is still able to DO it’s job.
The liver fails
But, if the situation, goes on for too long, the damage gets to a point, where liver function, starts diminishing. This is because, there is an on going attempt to “fix” the problem, which involves re-inforcing the foundations, this makes the liver stiff, a condition referred to as fibrosis.
At this point, liver function starts to be OBVIOUSLY compromised.
When there is enough damage, you are considered to have liver cirrhosis, and, you are well on your to liver failure or liver cancer.
So fatty liver is something that should be on your radar and something you should be working to alleviate. So how do you know you’ve got it ?
Spotting the problem
Your doctor has to TAKE A LOOK. Literally !
To confirm you have a “problem”, a piece of liver needs to be extracted (biopsy) and looked at, by a pathologist. The pathologist is looking for the presence of enlarged fat droplets.
- Elevated liver enzymes are usually the trigger to take a DEEPER LOOK. But ironically, these can often be ‘normal’ – some livers are tough cookies !
- The appearance of fat in the liver on an ultrasound, is another sign of trouble. Unfortunately, there has to be quite a bit of fat, in the liver, before it’s spotted.
Is a do-it-yourself measure, you or your physician, can use to access your situation is the tyg index.
It’s not perfect, but the benefit of it, is you don’t need special blood tests, to pick it up, you can use values from a standard blood work up, which typically tests triglyceride and sugar levels. Click here to learn more.
NOTE : A number greater than 4 suggests a problem.
So what’s going on.
Liver cells WORK HARD. They are the hub, that connects the inside of the body ,with the “outside” of the body. As such, they sort through the blood that has arrived from the intestine (outside)..
Everything MUST be assessed and decisions made.
The process of evaluating happens in the liver sinusoids.
The hepatocytes are lined up behind the blood vessels, which receive blood from the hepatic artery, this brings oxygen to the hardworking hepatocytes and the hepatic portal vein, brings the nutrients and things, that have arrived, via dinner.
Which hepatocytes get “fat” ?
Now each liver cell can pretty much do ANYTHING.
But, where they find themselves in the line, determines, what they actually do. Cells at the start of the line, are most concerned with clearing, cells at the end of the line, focus their attention on STORING, so as a rule, when fatty liver happens, in MAFLD, these are the cells that get fat first.
Saving for rainy days
The liver STORES lots of things – among them, carbohydrates and fat.
Now, when it comes to carbs, the first mission, is to replenish the liver’s own sugar supplies. The glucose is grabbed and then transformed into glycogen, in the process of glycogenesis.
A percentage of the glucose is allowed to circulate.
Supplying sugars to the rest of the body.
Any excess, must be transformed to fat, contributing to the fat accumulation in the liver, the process is called de novo lipogenesis.
The fat coming in
But this is not the only fat the liver is storing/processing. In fact, in the big picture of things, this is a relatively small fraction of the fat being handled by the liver. Most of the fat is coming in, from dinner and/or from fat stores, particularly, visceral adipose tissue (BELLY FAT).
In fact, the liver is a fat processing MACHINE !
Enormous amounts flow through the liver. When fatty liver happens, it’s because fat flux, is compromised and the jam, is not all on the supply side.
The fat going out
Part of the problem, is less fat is being used by the liver, both personally and professionally. And, there are glitches in the exporting, thanks to wayward signalling and resource issues.
It turns out, the fats, have to be wrapped in a special kind of “bubble” wrap, which requires methyl groups. When methyl groups, are in short supply…. this can put a damper on exports. In fact, creating methyl shortages, is the go to method of giving rodents, fatty liver disease.
NOTE : Modern diets are often choline insufficient.
So can your doctor “stop” it ?
Nope. Right now, there is no pill that addresses the issue. Lots of pharmaceutical companies are looking………
So, if you want to do something about it, AND YOU DO, you’ve got to take the initiative. Fortunately, quite a few things can move the needle on the fat equation.
Fixing the fat flux
As always, it’s an insulin problem, so Reining in insulin is step number 1. If you need a little help getting started, download “The Willpower Report”, it’s free, it will introduce you to the CANDY FLOSS system. Here is the link.
Sending in less fat, will also help.
The best way to do this, is to lose the excess weight – one way or the other. Reducing fructose, especially liquid fructose, will also help. Click here to learn more, about why liquid fructose is a BIG problem.840
Getting the fat out
On the fat out side of things, you want to work at shifting your body chemistry to burn more fat and make sure, you are providing the needed resources, for fat shipments.
NOTE : Finally, don’t needlessly stress your liver through excess alcohol consumption.
Below is a list of some of the journal articles I’ve used to tell the fatty liver story. Fatty liver is the hepatic manifestation of metabolic syndrome, it is just one of hundreds of things in the body that are amiss, when you’re insulin resistant, click here, to discover more “players”.
Nonalcoholic fatty liver disease and portal hypertension. Explor Med. (2020) 1:149-69. Marvin Ryou, Nicholas Stylopoulos, Gyorgy Baffy.
Choline Metabolism Provides Novel Insights into Non-alcoholic Fatty Liver Disease and its Progression. Curr Opin Gastroenterol. (2012) 28(2): 159–165. Karen D. Corbin and Steven H. Zeisel
Hepatic lipid droplet homeostasis and fatty liver disease. Semin Cell Dev Biol (2020) S1084-9521(18)30297-0. Fabian Seebacher, Anja Zeigerer, Nora Kory, Natalie Krahmer.
Heart disease has nothing to do with being apple-shape or pear-shaped but is all about how much fat is present in your liver. Both shapes can be at risk.
Each droplet of fat, is carefully wrapped in bubble wrap so that the high energy fat molecules don’t cause a fire, but in obesity adipose tissue is on fire.
Slower insulin removal results in more insulin entering the circulation. Since more insulin is getting up to mischief, this leads to metabolic mayhem….