Dr Mirkin.com

 
 
New Studies on Fatty Liver
A liver full of fat can be caused by anything that damages the liver. Doctors used to separate liver damage into that caused by alcohol and that not caused by alcohol (non-alcoholic fatty liver disease or NAFLD). Now we know that a liver damaged by excess alcohol has the same harmful consequences as a liver damaged by anything else, such as obesity or excess sugar intake (Gastroenterology, May 31, 2019).
The most common cause of liver damage used to be alcohol, but today it is far more likely to be caused by eating a lot of sugar-added foods or drinking anything with sugar in it. A fatty liver is common even in people who never drink alcohol. Up to 12 percent of people with a fatty liver keep on adding fat to eventually develop Non-Alcoholic Steato-Hepatitis (NASH), which is liver inflammation and permanent liver damage, called cirrhosis, that can cause liver cancer (Gastroenterology, August 23, 2018).
Excess Belly Fat Increases Heart Attack Risk, Even If You are Not Overweight
Another report shows that post-menopausal women who store fat primarily in their bellies are at increased risk for having heart attacks, even if they are not overweight (Eur Heart, June 30, 2019). Researchers followed 161,808 healthy women, aged 50–79 for 17.9 years and found that 291 developed heart disease during that period. Women with the highest percentage of belly fat had double the risk for heart disease, compared to those with the lowest belly fat. Furthermore, those with the lowest percentage of hip fat and highest percentage of belly fat (apple shape) had three times the risk for heart disease than those with lowest percentage of belly fat and highest percentage of hip fat (pear shape). The researchers concluded that reducing the amount of belly fat by itself would help to reduce heart attack risk significantly, even if the amount of hip fat was not reduced.
A Fatty Liver can Lead to Diabetes
People who store fat primarily in the belly are most likely to also store a large amount of fat in the liver. You can often diagnose diabetes just by looking at a person. People who have a big belly and small buttocks are at very high risk for being diabetic and suffering heart attacks (JAMA, 2017;317(6):626-634). To prevent your blood sugar level from rising too high after you eat, your pancreas releases insulin which is supposed to lower high blood sugar levels by driving sugar from the bloodstream into the liver. However, if your liver is full of fat, the excess fat prevents the liver from accepting the sugar and blood sugar levels can rise even higher (Eur J Gastroenterol Hepatol, Dec 2016;28(12):1443-1449). A high rise in blood sugar causes high blood insulin levels that convert blood sugar to a type of fat called triglycerides. Then insulin drives triglycerides into your liver. Having high triglycerides and a fat belly are signs of high blood insulin levels, and high blood levels of insulin constrict arteries to cause heart attacks. Insulin also acts on the brain to make you eat more, and on your liver to manufacture more fat, and on the fat cells in your belly to store that fat.
Fatty Liver Disease and Diabetes
Non-alcoholic fatty liver disease occurs when excess fat is stored in your liver. The most common cause of liver disease used to be alcohol, but now it is far more likely to be caused by eating sugar-added foods and drinking anything with sugar in it. Up to 12 percent of people with fatty livers keep on adding fat to their livers to develop Non-Alcoholic Steato Hepatitis (NASH), which is liver inflammation and permanent liver damage called cirrhosis and can cause liver cancer (Gastroenterology, August 23, 2018). The simple sugar, fructose, is the most likely food component to end up as fat in your liver (Dig Dis Sci, May 2016;61(5):1282-93).
How Does Sugar Cause a Fatty Liver?
After you eat, your blood sugar level rises, which causes your pancreas to release insulin, which converts the sugar to a type of fat called triglycerides. To prevent your blood levels of triglycerides from rising too high, your good HDL cholesterol is used to carry triglycerides to your liver where they are stored to cause a fatty liver.
High levels of triglycerides (>150) predict diabetes and in diabetics, high triglycerides predict increased risk for premature death (Diabetes Care, 2017;40(4):529-537). The more fat you have in your liver, the higher the rise in blood triglycerides after you eat (Clin Sci (Lond), Sept 18, 2017). People who eat a lot of foods with added sugars have more than double the risk of heart disease than those who eat the least (Am J of Clin Nutr, April 7, 2010; Arch of Int Med, May 2010).
Why Sugared Drinks Cause Such High Rises in Blood Sugar
When you take in liquid sugar, you get a much higher rise in blood sugar than when you take in the same amount of sugar in a solid food. Solid foods stay in your stomach until they are converted into a liquid soup, while liquids can pass directly into your intestines, so sugared drinks cause the most rapid passage of sugar into your intestines and the highest immediate rises in blood sugar. Compared to sugar in food, sugar in drinks is more strongly associated with increased risk for excess belly fat (Circulation, January 11, 2016; Quart J Med. Apr 26, 2017), obesity (Nutr J, Aug, 2017;22;16(1):48), and diabetes (Am J Clin Nutr, Jun 28, 2017; Curr Opin Cardiol, Sept, 2017;32(5):572-579). All sugar-sweetened beverages are associated with a significantly increased risk for developing a fatty liver and metabolic syndrome, which is also called pre-diabetes (Int J Clin Pract, Jan 10, 2017)
How a Fatty Liver Causes Diabetes
Your blood sugar level is supposed to rise after you eat. To prevent your blood sugar level from rising too high, your pancreas releases insulin which is supposed to lower high blood sugar levels by driving sugar from the bloodstream into the liver. However, if your liver is full of fat, the excess fat prevents the liver from accepting the sugar and blood sugar levels can rise higher and higher. Many diabetics or prediabetics will have “normal” fasting blood sugar levels below 100 mg/dl (In Canada and UK, convert to the U.S. number by multiplying the Canadian or UK number by 18). The correct definition of diabetes is having a rise in blood sugar one hour after a meal to more than 140 mg/dl (Diabetes Care, 2001;24 (8):1448-1453).
How Can You Tell If You Have a Fatty Liver?
You are likely to be at high risk for a fatty liver and diabetes if you have a big belly and small hips. People who store their fat primarily in the belly are also prone to storing fat in the liver. Your doctor can do a liver sonogram to determine whether you have excess fat in your liver (Nutrition, Metabolism & Cardiovascular Diseases, Dec 30, 2015).
How Do You Get the Fat out of Your Liver?
Exercise: Exercise can markedly reduce the amount of fat in your liver (World J Gastroenterol, Jul 21, 2016;22(27):6318-27). It does so by lowering blood sugar which then lowers triglycerides, the fat that forms in your liver (J of Funct Morph and Kines, 2017;2(4):35). Resting muscles draw almost no sugar from your bloodstream and the little that they do draw requires insulin to do so. On the other hand, contracting muscles draw tremendous amounts of sugar from the bloodstream and don’t even need insulin. This effect that exercise has of rapidly drawing sugar from the bloodstream is maximal during exercise and for up to an hour after you finish exercising and rapidly tapers off after 17 hours. Then muscles can draw sugar only with insulin (Am J Clin Nutr, 2008(July);88(1):51-57). Exercise reduces liver fat even if a person does not lose weight (Metabolism, Mar 2017;68:119-132).
Diet: Avoid foods that cause a high rise in blood sugar, such as all sugar-added foods and all drinks with sugar, including fruit juices. Restrict other refined carbohydrates such as foods made from flour. Most people with a fatty liver are overweight and will need to lose weight to get the fat out. I recommend intermittent fasting.
Signs of a Fatty Liver
You can often tell if people have diabetes just by looking at them. A person with a big belly and small buttocks is at very high risk for being diabetic, because those who store fat primarily in the belly are most likely to also store a large amount of fat in the liver. Having excess fat in your liver markedly increases risk for diabetes and heart attacks (JAMA, 2017;317(6):626-634), and also increases all markers of inflammation that are associated with increased risk for heart attacks (Clinical Gastroenterology and Hepatology, February 28, 2019). You can reduce the amount of fat in your liver and the inflammation it causes by severely restricting sugared drinks, fruit juices and foods with added sugars (JAMA, Jan. 22, 2019).
How a Fatty Liver Leads to Diabetes
Your blood sugar level rises after you eat, but to prevent it from rising too high, your pancreas releases insulin which is supposed to lower high blood sugar levels by driving sugar from the bloodstream into the liver. However, if your liver is full of fat, the excess fat prevents the liver from accepting the sugar and blood sugar levels can rise even higher (Eur J Gastroenterol Hepatol, Dec 2016;28(12):1443-1449).
The leading cause of fatty liver used to be alcohol, but now it is far more commonly caused by drinking sugared drinks and eating sugar-added foods. The simple sugar, fructose, is the most likely food component to end up as fat in your liver (Dig Dis Sci, May 2016;61(5):1282-93). A fatty liver comes from:
• high rises in blood sugar, which cause
• high blood insulin levels that
• convert blood sugar to a type of fat called triglycerides, and
• insulin drives triglycerides primarily into the fat cells in your belly and its organs such as your liver.
Having high triglycerides and a fat belly are signs of high blood insulin levels, and having high blood levels of insulin increases risk for heart attacks. Insulin also acts on the brain to make you eat more, on your liver to manufacture more fat, and on the fat cells in your belly to store that fat. People who store fat primarily in the belly have higher blood insulin and blood sugar levels, which raise LDL (bad) cholesterol and lower HDL (good) cholesterol.
Having a normal fasting blood sugar level does not rule out diabetes. A high rise in blood sugar after meals can damage every cell in your body. If your blood sugar level one hour after eating is greater than 140, your cells are being damaged and your life is being shortened (Atherosclerosis, Jan 2017;256:15-20).
Why Sugared Drinks Cause the Highest Rises in Blood Sugar
When you take in liquid sugar, you get a much higher rise in blood sugar than when you take in the same amount of sugar in a solid food. Solid food is not allowed to pass into your intestines because when you eat, the pyloric muscle at the end of the stomach closes and allows only a liquid soup to pass into the intestines. Sugared drinks can pass right through into your intestines, so they cause the quickest rises in blood sugar. Compared to sugar in food, sugared drinks are more tightly associated with increased risk for excess belly fat (Circulation, January 11, 2016; Quart J Med, Apr 26, 2017).
All sugared drinks are associated with increased risk for developing a fatty liver, pre-diabetes (metabolic syndrome), diabetes, inflammation, abdominal obesity, high triglycerides, and increased waist circumference (Int J Clin Pract, Jan 10, 2017; J of the Acad of Nutr and Dietetics, Feb 2013;113(2):219-227; Am J of Clin Nutr, March 23, 2011).
What Can You Do About a Fatty Liver?
Your doctor can order a liver sonogram to see if you have excess fat in your liver (Nutrition, Metabolism & Cardiovascular Diseases, Dec 30, 2015).
Diabetes can be treated and often cured with a diet that removes fat from the liver (Diabetologia, 2011 Oct; 54(10): 2506-2514) and with exercise that removes excess fat from the liver and muscles (Scandinavian Journal of Medicine & Science in Sports, March 13, 2017;27(5)).
Diet: Avoid the foods that cause high rises in blood sugar, especially sugared drinks and sugar-added foods, and restrict other refined carbohydrates. Restrict red meat and processed meats, which block insulin receptors (JAMA Intern Med, 2013;173(14):1328-1335), and fried foods.
Exercise: Resting muscles draw almost no sugar from your bloodstream and the little that they draw requires insulin to do so. On the other hand, contracting muscles draw tremendous amounts of sugar from the bloodstream and don’t even need insulin to do so. This effect that exercise has of rapidly drawing sugar from the bloodstream is maximal during exercise and for up to an hour after you finish exercising, and rapidly tapers off for about 17 hours. Then the resting muscles can draw sugar only with insulin (Am J Clin Nutr, 2008(July);88(1):51-57). Exercise can reduce liver fat even if a person does not lose weight (Metabolism, Mar, 2017;68:119-132).
My Recommendations
• If you have a big belly or your blood sugar is greater than 140 one hour after a meal, I recommend that you lose weight (if overweight) with intermittent fasting; check with your doctor.
• Since most liver fat comes from sugar, avoid or severely restrict all sugared drinks and sugar-added foods.
• Restrict other refined carbohydrates such as foods made from flour (bakery products, pasta, many breakfast cereals and so forth).
• Restrict red meat, processed meat and fried foods.
• Eat plenty of vegetables, seeds and nuts which are rich sources of soluble fiber.
• Try to exercise every day.
Caution:Intense exercise can cause heart attacks in people who already have blocked arteries. Check with your doctor before starting an exercise program or increasing the intensity of your existing program.
 
 

 

Add new comment

CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
3 + 1 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.