Inflammation and the Liver
Non-alcoholic fatty liver disease (NAFLD) is nothing short of an epidemic in the
U.S. and other modern, industrialized countries. If you read my link on
Resistance and the Liver, you'll see that NAFLD is very tied to insulin
Metabolic Syndrome, so it is no
wonder. Again, it is not unreasonable to assume about half of the men reading
this page have NAFLD and that this is a very serious threat to not only their
sex life but their life in general. The moral of the story: you
can't ignore your liver!
Yes, the liver is important and, as you probably remember from your high school biology,
is that the liver performs many
critical functions: detoxification, processing medications, building
proteins - the list could go on and on. And here is why you absolutely MUST take
fatty liver disease very seriously:
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1. NASH. Non-alcoholic steatohepatitis (NASH) is the ugly end point
for some men who develop NAFLD. All men with NAFLD have steatosis, which
simply means fatty acids accumulating in the liver cells. However, in some
men this turns very ugly and you end up with steatohepatitis, or a form of liver
disease that mimics classic hepatitis. NASH is basically a condition that
includes an inflamed liver with classic
cirrhosis that is often debilitating and in some cases life-threatening. 
Scientists have noted that there is little difference between the damaged liver
that results from non-alcoholic fatty liver disease versus alcoholic fatty liver
disease - it's all bad news.
2. Cardiovascular Risk Factors. NAFLD has become one of the many new
risk factors for heart disease. In other words, if you develop this type
of liver disease, you are at increased risk for cardiovascular events and even
death. So one should treat NAFLD as erectile dysfunction, which also is a
new predictor of impending heart problems.
3. Type II Diabetes. A fatty liver also increases your risk for type
2 diabetes. (The two conditions are highly interrelated.)
NAFLD appears to be such a powerful predictor that one recent study out of Japan
found that it even foretold heart disease strongly than Metabolic Syndrome.
Furthermore, it was found to be an independent risk factor for cardiovascular
disease independent of all others. Researchers have noted that it is no
wonder since "the liver, once fatty, overproduces
most of the known
cardiovascular risk factors such as very low density lipoprotein (VLDL),
glucose, C-reactive protein (CRP), plasminogen activator inhibitor-1 (PAI-1),
fibrinogen and coagulation factors." 
All of that said, what makes this type of liver disease
so problematic is that it appears benign to the men diagnosed with it. In fact,
many men have it and do not even know it. NAFLD is definitely not an immediate death warrant
and the great majority of men
with this type of liver disease - 90% and above - do not even have symptoms. It
is somewhat like most prostate cancers: it exists for years often before
it rears its ugly head.
The Role of Inflammation
Researchers now believe that the reason that the liver begins to store fats
(triglycerides) is primarily protective. In other words, the fats stored
in liver cells are "more a marker rather than a cause of insulin resistance."
 So what is the liver trying to protect itself from? You guessed
it: inflammation (and oxidation).
When one overconsumes calories or has an increased oxidative (free radical) load
due to being overweight, the liver begins to accumulate these to protect itself
from toxic triglyceride byproducts. Evidence is mounting in animal studies
that endotoxins, which result from out-of-whack intestinal bacteria and
dysfunctional TLRs (toll-like receptors), which result from being overweight,
increase systemic inflammation and lead to NAFLD.  Several studies have
also shown that adiponectin, a key inflammatory cytokine, regulates liver fat.
 As you put on weight, your body lowers adiponectin levels and your liver
fat increases - it's that simple. Furthermore, adiponectin is strongly
(and inversely) correlated to body fat.  And our old archenemies TNF
alpha and IL-6 also have been found in animal studies to directly cause liver
inflammation, which can accelerate the nasty liver-destroying cirrhosis called
NASH mentioned above. 
The bottom line is that almost every major inflammatory cytokine involved in
disease and cancer plays an active role in the initiation and progression of
non-alcoholic fatty liver disease as well. And these cytokines all become
misaligned through growing body fat. That has lead researchers to observe
that your fat (adipose) tissue literally attacks your liver. Your liver is
ground zero when it comes to the battle for your health.
When you put on enough weight, you are literally pitting one organ against
the other and creating a sort of internal war on yourself: the fat tissue
makes war on the liver, which in turn assails both the heart and penis.
So what will your physician do if you are diagnosed with non-alcoholic fatty liver disease? You and
your physician need to agree on a course of action andt there are several common
elements in current treatment. 
1. Treat any underlying diabetes, insulin resistance or Metabolic Syndrome.
This can involve pharmeutical solutions in some cases. Metformin and
thiazolidinediones, insulin sensitizing drugs, have been popular in studies and
done quite well. 
2. Improve insulin sensitivity by encouraging exercise and weight loss.
NOTE: A higher fat diet will also actually induce insulin resistance and so
care must be taken. Although consuming a diet higher than about 40% fat is
probably not that common, care should be taken.
3. Protect the liver through antioxidants and other supplements and agents.
Obviously, this is not where you want to be in the sense that you want to stay
off of pharmaceuticals if at all possible. Phamaceuticals always have side
effects and long term unintended consequences. It is always better to let
the body heal itself if one can and go about things naturally.
Here are some ideas to keep your liver fat free:
1. Insulin Resistance. Read my link
Resistance and the Liver and battle the underlying insulin resistance at the same
time that you battle the underlying inflammation.
2. Dietary Fat. Be very careful with dietary fat levels. Remember
that high fat diets are used in laboratory animals to induce insulin resistance
and high fat diets will often increase inflammation as well. Fat is also
very calorically dense and can lead to weight gain, leading to a viscious cycle
of increasing inflammation and insulin resistance. (By the way, this is yet another
reason that many of the Atkins, Paleo and Low Carb diets can get you into trouble quickly.
They seem like a good idea but can be very hard on the heart and liver.)
3. Weight Loss and a Low Fat Diet. A whole foods
Low Fat Diet can decrease
control and even decrease liver fat content. One study noted that "liver
fat content can be decreased by weight loss and by a low as compared to a high
fat diet." 
4. Fructose. Watch your fructose! It is known for both
increasing insulin resistance and inflammation. Read my links on
5. Anti-inflammation. Yes, a little inflammation is a good things for
figthing infections and basic immunity. However, the vast majority of us
in modern societies have the opposite problem: an overactive inflammatory
response. Read this link on
How to Control Inflammation for many ideas on
how to get out of the inflammation rat race.
1) Postgrad Med J, 2006, 82:315-322 "Treatment of non-alcoholic fatty
2) World J Gastroenterol, 2006 Dec 28, 12(48):7826-31, "Insulin sensitizers in
treatment of nonalcoholic fatty liver disease: Systematic review.
3) World J Gastroenterol, 2007 March 14, 13(10):1579-1584, Nonalcoholic fatty
liver disease is a novel predictor of cardiovascular disease"
4) HEPATOLOGY, 2010, 52(5), "Evolution of Inﬂammation in Nonalcoholic Fatty Liver
Disease: The Multiple Parallel Hits Hypothesis"
5) J Clin Invest. 2003, 112(1):91–100, "The fat-derived hormone adiponectin
alleviates alcoholic and nonalcoholic fatty liver diseases in mice"
6) The Journal of Clinical Endocrinology & Metabolism, Jun 1 2005,
90(6):3498-3504, "Plasma Adiponectin in Nonalcoholic Fatty Liver Is Related to
Hepatic Insulin Resistance and Hepatic Fat Content, Not to Liver Disease
7) J Mol Med (Berl), 2002 Nov, 80(11):696-702, "Adiponectin: a link between
excess adiposity and associated comorbidities?"
8) Ann Med, 2005, 37(5):347-56, "Fat in the liver and insulin resistance"
9) Cancer Cell, 17 Feb 2010, 17(2):115-117, "Obesity, Inflammatory Signaling, and
Hepatocellular Carcinoma—An Enlarging Link"
10) Gastroenterology, Jul 2005, 129(1):113–121, "The Natural History of
Nonalcoholic FattyLiver Disease: A Population-Based Cohort Study"