Insulin Resistance and the Liver
Few middle-aged men realize that it is very likely their liver is under assault. NAFLD (non-alcoholic fatty
liver disease) affects a huge percentage of the population over 40 and can lead, literally, to
a "hardened liver". No, that's not a good thing.
This is something that every male over 40 (and some under) needs to watch
carefully. One study of 503 consecutive car accident fatalities - pretty
morbid, eh? - found that
24 percent of all victims had fatty liver disease and 40 percent that were over
the age of 60.  And don't forget that men have a much higher prevalence than
women, so "epidemic" is no exagerration: it is
very likely that a third of the men reading this site have non-alcoholic fatty
liver disease of one stage or another (and many do not even know it yet). Somewhat similar results were found in
a study of Japanese adults and the National Liver Foundation estimates about a
quarter of the U.S. has NAFLD. 
What makes NAFLD particularly worrisome is the fact that it exists for months or
even years with no real symptoms or issues. So then who cares if your liver is a little chunky,
right? Well, eventually you will care if that is your condition: fat
stored in the liver triggers a cascade of nasty hormonal and endocrinological
changes, which we will cover below. Even worse, fat in the form of triglycericdes builds up
in the liver - thus the name - and, in some cases, leads to cirrhosis, i.e.
actual organ damage occurs.
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In fact, in many patients, the patient eventually ends up with NASH
(non-alcoholic steatohepatitis), which is
a polite way to say "scarred and damaged liver". Everyone fears hepatitis, but NASH leads to
some of the same issues: inflammation and cirrhosis of the liver that can
lead to permanent damage. And NASH, by the way, is not uncommon:
estimates are between 1-3% of the general population at any given time.  But,
again, it is likely much more common in men over 40 and, undoubtedly, many
reading this page are afflicted with it. Furthermore, it has been
estimated that about 20%of those with NAFLD will progress to NASH and
that is also likely to be much higher in middle-aged and older males. 
Some of the symptoms of low testosterone and chronic fatigue can tie with the
early stages of NASH, including fatigue, mental fog and memory issues. So
get tested! (You can also experience fluid retention and swelling of the
CAUTION: There is a related disease called alcoholic fatty liver disease.
This is yet another reason not to drink more than 1-2 drinks per day.
So what causes this type of fatty liver disease?
Insulin resistance. Insulin resitance. Insulin resistance.
Yes, genetics plays a role, but so far the #1 factor that shows up in the
research is insulin resistance, which you'll remember is the hallmark of
Metabolic Syndrome and
Insulin resistance leads to elevated triglycerides and other changes that
literally send fats into the liver like a guided muscle. Your liver is
packed with insulin receptors and when these get "out of whack", things get ugly
Evidence of this theory is backed up by the fact that prediabetes, the other name
for Metabolic Syndrome, can eventually lead to full-fledged type II diabetes if
not stopped in its tracks. And 70% of diabetics have been found to have
fatty livers! 
So, of course, to avoid non-alcoholic fatty liver disease, one should avoid
insulin resistance (and diabetes). Let's start with the four big guns of Insulin
1) Exercise. This is king. Nothing unlocks insulin resitance like
exercise. Physical activity forces your body to utilize both glucose and
insulin and, once again, I state, "We were born to move." This is yet another
example as to why
Sitting Is So Deadly.
2) Proper Weight. A huge risk factor for Metabolic Syndrome, insulin
resistance and NAFLD (non-alcoholic fatty liver disease) is being overweight. About
three quarters of the obese have fatty liver disease. 
One study found that reducing weight by as little as 5 percent can substantially
improve fatty liver disease. 
3) Sleep. One recent study found that reducing patients sleep from 8
hours to 5.5 hours substantially increased insulin resistance.  And, of
course, we know that lack of sleep is extremely common in modern societies with
TVs, computers and a hundred other things to distract us from our pillow time.
4) Testosterone. It is not that well-known that low testosterone generally raises
insulin levels and predisposes men to insulin resistance, Metabolic Syndrome and
Type II Diabetes. For more details, see my book
Low Testosterone by the
Numbers. Researchers recently found in mice that low testosterone + insulin
resistance = NAFLD.  More remarkably, when they gave the (castrated) mice
testosterone, it eliminated the liver disease.
Wait! There are many, many other ways to avoid insulin resistance as well.
In fact, I cover over 20 of them in my link on
Syndrome Solutions. If you can't solve the problem naturally, the doctor may
put you on Metformin, a diabetes medication that can help with NAFLD in some
So, again, the picture is this: insulin resistance (prediabetes) sets in,
due to lifestyle factors primarily, which then sets off a cascade of nasty
medical conditions including non-alcoholic fatty liver disease, heart disease,
erectile dysfunction and dementia. And it is also associated with
low testosterone: see my link on Insulin Resistance, Metabolic Syndrome
and Testosterone for more information. And, it it develops into full-blown
diabetes, then aging accelerates and a whole host of other major issues begin to
Scand J Gastroenterol, 1977, 12(5):593-7, "Liver histology in a 'normal'
population--examinations of 503 consecutive fatal traffic casualties"
2) J Gastroenterol Hepatol, 2002 Oct, 17(10):1098-105, "Fatty liver in
non-alcoholic non-overweight Japanese adults: incidence and clinical
4) Journal of Hepatology, Dec 2005, 43(6):1060–1066, "Effect of changes on body
weight and lifestyle in nonalcoholic fatty liver disease"
5) J of Clin Endocrin & Metab, Nedeltcheva, A.V. , published online ahead of
print, June 30, 2009
7) European Review for Medical and Pharmacological Sciences, 2005; 9:273-277, "
The natural history and risk factors for progression of non-alcoholic fatty
liver disease and steatohepatitis"
http://jwk.ucsf.edu/course/things/Tilg.pdf, HEPATOLOGY, 2010, 52:1836-1846,
"Evolution of Inﬂammation in Nonalcoholic Fatty Liver Disease: The Multiple
Parallel Hits Hypothesis"
10) Metabolism, 2013 Jun, 62(6):851-60, "Testosterone deficiency induces markedly
decreased serum triglycerides, increased small dense LDL, and hepatic steatosis
mediated by dysregulation of lipid assembly and secretion in mice fed a high-fat