The Analyst™

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Healthy

  Fatty Liver  
 
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Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | Recommendations

 

Fatty liver is the build-up of fat in the liver cells. Although this is not a normal condition, fat in the liver usually causes no damage by itself. However, on some occasions it can be a sign that other more harmful conditions are at work. It would seem logical that eating fatty foods would cause a fatty liver, but this is not the case. The liver does play an important role in the metabolism or breakdown of fats, but something goes wrong in this process of metabolism, although it is still not known what does cause fat to build-up in the liver. This condition is usually reversible when the underlying causes are treated or removed.

There are usually no symptoms that are noticeable to the patient. In fact, fatty liver is frequently uncovered during a routine physical examination. There may be a rise in certain liver enzymes found in the blood, and sometimes the liver is slightly enlarged. Fatty liver may also be discovered while the physician is evaluating a patient for other illnesses. For example, an ultrasound exam of the abdomen done for other reasons may show fat in the liver. To be certain of a diagnosis of fatty liver, the physician may recommend a liver biopsy. Under local anesthesia, a slender needle is inserted through the right lower chest. A small piece of liver tissue is taken out with the needle and examined under a microscope.

Steatohepatitis is inflammation of the liver related to fat accumulation. Heavy alcohol use can lead to fatty liver and inflammation, usually called alcoholic hepatitis. Steatohepatitis resembles alcoholic hepatitis, but it can and does occur in people who seldom or never drink alcohol. In this instance, it is often called nonalcoholic steatohepatitis or NASH. Both alcoholic hepatitis and steatohepatitis can lead to serious liver damage and cirrhosis.

Studies have shown that many people who are significantly overweight have developed, or will develop, steatohepatitis. It can also occur with rapid weight loss. Steatohepatitis has been connected to estrogen hormones in some women.

In most instances, treatment of fatty liver and steatohepatitis requires control of the underlying conditions. This may include reduction of high blood triglycerides, good control of diabetes, or not drinking alcohol. In some cases, surgical reversal of intestinal bypass for obesity is required.
 

 
 

Signs, symptoms & indicators of Fatty Liver:
 
 
Symptoms - Liver / Gall BladderCounter-indicators:
  Absence of fatty liver
 
 

Conditions that suggest Fatty Liver:
 
 
Organ Health  Cirrhosis of the Liver
 Fatty liver may be associated with or may lead to inflammation of the liver. This can cause scarring and hardening of the liver. When scarring becomes extensive, it is called cirrhosis, a very serious condition.

Uro-Genital

  Male Infertility (Low Sperm Count)
 Researchers in Hong Kong compared mercury levels in fertile and infertile couples. The results were as follows:

Fertile men 15% with high mercury, Infertile men 35% with high mercury
Fertile women 3.8% with high mercury, Infertile women 23% with high mercury

So for infertile men, the chance of mercury toxicity over fertile men was 2.3 times higher and for women, 6 times higher. Mercury disruption of sperm membrane permeability may be responsible for this lose of fertility.

The researchers recorded how much seafood the couples consumed and found that those eating more seafood tended to have higher blood mercury levels. [Fertility and Sterility, 78: 2, August 2002, pp. 426-428]
 
 

Risk factors for Fatty Liver:
 
 
Addictions  Alcohol-related Problems

Autoimmune

  Ulcerative Colitis
 Scientists believe a fatty liver can occur when the immune system triggers inflammation in other parts of the body. These problems are usually mild and go away when the colitis is treated.

Diet

  Protein Deficiency
 Among children and in the developing countries, malnutrition, especially protein and iron deficiencies, are the most common cause of fat buildup in the liver.

Drug Side Effects

  Prescription Drug Side-Effects
 Fatty liver may occurr with the use of certain drugs such as valproic acid (trade names: Depakene/Depakote) and corticosteroids (cortisone, prednisone).

Infections

  Tuberculosis

Lab Values

  Elevated Triglycerides

Metabolic

  Problem Caused By Being Overweight
 It is known that fat accumulates in the liver with a number of conditions, the most common being obesity.

Nutrients

  Vitamin A Toxicity
  Iron Requirement

Organ Health

  Diabetes Type II
 In the case of diabetes mellitus, researchers believe steatohepatitis may develop only in those patients whose diabetes is not properly controlled.

Symptoms - Food - Intake

  High refined white flour consumption
 A new US study on mice suggests that a diet rich in carbohydrates with a high glycemic index (GI) not only expands waistlines but may also lead to fatty liver, a condition that results in liver failure and death.

The study is published in the September 2007 issue of the journal Obesity and is the work of Dr David Ludwig, director of the Optimal Weight for Life program at Children's Hospital Boston, and colleagues.

Fatty liver is increasing in line with rising rates of obesity among Americans. The researchers hope to confirm their findings in a newly launched clinical trial with overweight children and to show that the trend can be reversed through changes in diet.

Fatty liver is becoming especially common among children, said Ludwig. Although many adult cases can be caused by alcoholism, that is not so in children, where between 1 in 4 and 1 in 2 overweight American children are thought to be affected by non-alcoholic fatty liver disease (NAFLD).

That means millions of children are at elevated risk of getting full blown liver disease in adulthood, said Ludwig, who called it a "silent but dangerous epidemic".

"Just as type 2 diabetes exploded into our consciousness in the 1990s, so we think fatty liver will in the coming decade," he added.

High GI foods include white bread, white rice, most processed grains such as breakfast cereals, and concentrated sugar. They raise blood sugar quickly because the starch is broken down into sugar quickly. These are also called rapidly absorbed carbohydrates (RAC).

  High refined sugar consumption
 
 

Fatty Liver suggests the following may be present:
 
 
Diet  Protein Deficiency
 Among children and in the developing countries, malnutrition, especially protein and iron deficiencies, are the most common cause of fat buildup in the liver.

Nutrients

  Vitamin A Toxicity
 
 

Recommendations for Fatty Liver:
 
 
Amino Acid / Protein  Glutamine
 Glutamine is beneficial for the liver, since it cleanses the liver of the waste products of fat metabolism, and helps prevent fatty buildup. It can aid in the treatment of early-stage cirrhosis. Once liver damage is advanced, however, glutamine cannot help since the liver can no longer metabolize it properly.

Animal-based

  Probiotics / Fermented Foods
 Probiotics may interfere with the development of NASH at various levels:
  • Decreases in proinflammatory cytokines, such as TNF.
  • Alteration of the inflammatory effects of pathogenic strains of intestinal bacteria, through changes in cytokine signaling.
  • Replacement of pathogenic strains of bacteria.
  • Improved epithelial barrier function, thereby avoiding excessive exposure of the liver to LPS and bacterial ethanol.
Evidence in experimental animal models of fatty liver disease, as well as clinical data on other gastrointestinal diseases, strongly suggest that probiotics might be beneficial in NASH. [J Hepatol 38:pp. 681-687, 2003] Data from an uncontrolled clinical trial with NASH patients show promising results, with improvement of liver enzymes in treated patients. [Am J Gastroenterol 97:pp. 2144-2146, 2002]

Botanical

  Turmeric Extract, Curcumin
 Obesity and Type II diabetes are often associated with high levels of leptin. This combination is also associated with nonalcoholic steatohepatitis (NASH). NASH can cause hepatic fibrosis. The mechanism of action is through hepatic stellate cells (HSCs) which become active. It has been reported that leptin stimulated HSC activation can be eliminated by the use of curcumin, a phytochemical from turmeric. [ Endocrinology, September 2010; 151: pp. 4168 - 4177]

In other words, the regular use of curcumin may help prevent the liver damage associatted with being overweight and tending toward diabetes.

  Silymarin/Milk Thistle (Silybum marianum)
  Grape Seed Extract / Resveratrol
 Researchers found that alcohol-fed mice given resveratrol had less fat in their livers and the fat broke down more quickly than alcohol-fed mice not give resveratrol. The researchers note that resveratrol has been shown to activate molecules that are also important in fat metabolism in the liver. Chronic alcohol abuse inhibits these molecules.

In this study, alcohol-fed mice treated with resveratrol also had enhanced activity of these molecules. "Collectively, these results demonstrate that resveratrol treatment protected against the development of alcoholic [fatty liver] in mice," they write.

The authors write that alcohol along with "concentrated resveratrol could be a more potent and efficient way" of getting the health benefits of resveratrol alone. [The American Journal of Physiology-Gastrointestinal and Liver Physiology, October 2008]

Diet

  Alcohol Avoidance
  Weight Loss
 Since being overweight is by far the most critical factor, weight loss is the key to ridding the liver of fat. This is especially necessary if damage to the liver is occurring, and early signs of scarring are present on biopsy. High blood triglycerides and diabetes are also worse with obesity. So, when steatohepatitis is present with these conditions, people gain even greater benefits from losing weight.

Weight loss should be slow, not the result of fasting or ultra-low caloric diets. This is because free fatty acids are mobilized during weight loss and too many can increase the deposition of fat in the liver. Gradual weight loss with reduced caloric intake and exercise is highly recommended. A major attempt should be made to lower body weight into the healthy range.

Other medical conditions often present, such as diabetes, high blood pressure, or elevated cholesterol should be treated also.

Nutrient

  TMG (Tri-methyl-glycine) / SAMe
 The therapeutic indication for SAMe in intrahepatic cholestasis and alcoholic liver disease is based on it's anti-steatotic, anti-inflammatory, anti-oxidant and anti-fibrotic properties. An oral dose of 600 mg/day or intramuscular administration of 50 to 100 mg/day have shown therapuetic benefit regarding biochemical, histological, and echographic parameters of liver steatosis.

  Lecithin / Choline / GPC
 Lecithin protects the cells of the liver and acts as a fat mobilizer, thus helping to prevent a fatty liver.

Vitamins

  Vitamin E
 Alpha-tocopherol is effective in improving the liver biochemistry and histological lesions of NASH because of its actions as an antioxidant agent and as an inhibitor of TGF-, a cytokine involved in liver fibrogenesis.
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended







GLOSSARY

Anesthesia:  Loss of sensation caused by neurological dysfunction or a pharmacological depression of nerve function.

Biopsy:  Excision of tissue from a living being for diagnosis.

Carbohydrates:  The sugars and starches in food. Sugars are called simple carbohydrates and found in such foods as fruit and table sugar. Complex carbohydrates are composed of large numbers of sugar molecules joined together, and are found in grains, legumes, and vegetables like potatoes, squash, and corn.

Cirrhosis:  A long-term disease in which the liver becomes covered with fiber-like tissue. This causes the liver tissue to break down and become filled with fat. All functions of the liver then decrease, including the production of glucose, processing drugs and alcohol, and vitamin absorption. Stomach and bowel function, and the making of hormones are also affected.

Colitis:  Inflammation of the colon.

Diabetes Mellitus:  A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.

Enzymes:  Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.

Epidemic:  Describes a disease occurring in extensive outbreaks, or with an unusually high incidence at certain times and places.

Estrogen:  One of the female sex hormones produced by the ovaries.

Fatty Liver:  Accumulation of triglycerides in the liver.

Gastrointestinal:  Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.

Glycemic Index:  The glycemic index (GI) is a classification of foods based on their blood glucose-raising potential. Consuming foods high on the glycemic index promote a rapid rise in blood glucose. This contributes to the development of several chronic degenerative diseases.

Hepatitis:  Inflammation of the liver usually resulting in jaundice (yellowing of the skin), loss of appetite, stomach discomfort, abnormal liver function, clay-colored stools, and dark urine. May be caused by a bacterial or viral infection, parasitic infestation, alcohol, drugs, toxins or transfusion of incompatible blood. Can be life-threatening. Severe hepatitis may lead to cirrhosis and chronic liver dysfunction.

Hormones:  Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.

Immune System:  A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.

Iron:  An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.

Metabolism:  The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.

Protein:  Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.

Triglyceride:  The main form of fat found in foods and the human body. Containing three fatty acids and one unit of glycerol, triglycerides are stored in adipose cells in the body, which, when broken down, release fatty acids into the blood. Triglycerides are fat storage molecules and are the major lipid component of the diet.