What has fatty liver got to do with metabolic syndrome?

If one has at least 3 of the 5 following conditions, one has metabolic syndrome, that is all there is to it.

1. Abdominal girth is 40 inches or more for men (or 35 inches or more for women)
2. Fasting triglyceride level of 150 mg/dL or higher
3. HDL cholesterol level of 40 mg/dL or lower for men （or 50 mg/dL or lower for women)
4. Blood pressure of 130/85 or higher
5. Fasting blood sugar of 110 mg/dL or higher (some say 100 mg/dL)

No wonder having metabolic syndrome is a serious matter as it indicates one has many risk factors for cardiovascular disease and potentially will have multiple diseases.

Insulin resistance and obesity drive metabolic syndrome

Metabolic syndrome was unheard until 1988, I recall it was initially called Syndrome X, (the name suggests the unknown mystery, after 15-20 years of research, much has been known) it is also called insulin-resistant syndrome; insulin resistance is the culprit of metabolic syndrome. When one eats excessive amount of carbohydrates that leads to elevated blood sugar, the pancreas will pour out insulin in an attempt to bring down blood sugar level. Having excessive amount of insulin around makes our cells become less responsive to it, sort of becoming complacent, so to speak, thus called insulin-resistant. The job of insulin is to push glucose into cells to burn as fuels to produce energy and also store the fat for the rain days and even covert glucose/fructose to fat (triglycerides) and store.

Type 1 diabetes is the pancreas can not make insulin, whereas the hallmark of type 2 diabetes is insulin resistance.

Whether obesity causes insulin resistance or insulin resistance causes obesity is the chicken or egg causality dilemma of which one came first. It is generally believed that insulin resistance precedes obesity.

Understanding insulin resistance is the key
When cells become less responsive to insulin, the pancreas responds by pouring out more insulin in a futile attempt to overcome the resistance, resulting a situation of having lots of insulin yet the body behaves like not having enough insulin. (One needs to grab this concept in order to fully understand insulin resistance.)

So we'll see the following conditions when insulin resistance happens (almost the same as insulin deficiency):

1. Glucose cannot enter cells efficiently resulting high blood glucose level (if glucose cannot enter cells, it will continue to flow in the blood stream.)
2. Increased  fatty acids release from body fat store (as insulin inhibits fatty acids release from body fat store to the stream) resulting in increased triglyceride and low HDL (good cholesterol)
3. Decreased nitric oxide release, raising blood pressure.

Insulin is essential to maintain life, but too much of a good thing is not good, details of which is beyond the scope of this post.

How to tackle metabolic syndrome: Exercise, diet and weight loss

The most effective treatment of metabolic syndrome is exercise and weight loss (or maintain ideal body weight). Eat right kinds of carbohydrates may reduce insulin surge (I'll have a post talking about glycemic index); exercise increases (doubles) cells responsiveness to insulin up to 48 hours. Increased abdomen girth is due to accumulated fats, which are called visceral (internal organ) fats, deep inside abdomen and may disrupt the functions of organs. Liposuction will not help, though, but exercise can reduce the belly fat.

Waynesburg Gym: EQT REC Center

Is carbohydrate the "enemy" and sugar "toxic"?

We declared fat was the "enemy" in 1960s and 1970s, and had a second thought after the resultant obesity epidemic, which was attributed to eating too much carbohydrates.  Remember the days when Dr Atkins was being ridiculed and severely criticized by mainstream medical establishment.  Nonfat is not nonfattening obviously.  There is vicissitude of fortune (風水輪流轉), now carbohydrate is the "enemy", it has come a long way, we read an article in N.Y. Times back on 2/8/1995: "So it may be true after all: Eating pasta makes you fat". Ketogenic diet indeed has its merits, but may be too radical and extreme for most people.  General speaking one should prefer complex carbohydrates (such as vegetables, fruits, nuts, beans, whole grains) to simple carbohydrates (such as sugar, high fructose corn syrup, sucrose) and avoid refined flour products and soft drinks.

What is the fatty liver

Fatty liver means excessive fats accumulate in the liver, biopsy of which looks the same as alcoholic fatty liver (i.e. if one cuts a tiny piece of liver for examination, it looks the same fatty change seen in one with excessive alcohol consumption) so the official name of fatty liver is non-alcoholic fatty liver disease (NAFLD).

Non-alcoholic fatty liver vs non-alcoholic steatohepatitis: Not all fatty livers are the same

It is estimated that 30% of Americans have fatty liver (70-90% of those with obesity or diabetes have it）Fatty liver doesn’t cause health problems of consequence, unless the excessive fats inside liver cells cause inflammation, in which case, it is called non-alcoholic steatohepatitis (steato- means fat; hepatitis means inflammation of liver) or NASH. It is unknown why 5-10 % (some says up to 20%) of non-alcoholic fatty liver turn to NASH, it is apparently nothing to do with how much fats contain inside liver cells.

NASH may progress to fibrosis, then cirrhosis of liver, which may turn to liver cancer. It is estimated that only 3% of NASH progress to liver cirrhosis (one report says as high as 26%, though). But the potential risks of cardiovascular complications, such as heart attack or stroke, is essentially the same as that of metabolic syndrome. Thus it is safe to say one needs to be more concerned about one’s heart than liver when one has fatty liver.

Culprits of fatty liver: insulin resistance and fructose

Like metabolic syndrome, Insulin resistance is also the underlying mechanism. In fact, it can be perceived that fatty liver is the manifestation of metabolic syndrome in the liver.

Complex carbohydrates have to be digested/broken into glucose and fructose (fruit sugar) to be absorbed by body cells. Virtually every kind of body cells can handle glucose, which, with help from insulin, enters cell to be burned to produce energy.

Only liver cells can handle fructose, which is converted to fats (triglycerides) in the liver. Excessive fructose use leads to accumulation of fats inside liver cells, thus fatty liver.  In fact, liver can turn carbohydrates (in the form of glucose or fructose) into fat/triglyceride, a process called lipogenesis.

How to cut down fructose use

There are 3 sources of fructose in our diets:

1. Fruits
2. Sweetened soft drinks and juice
3. Refined flour products: pastries, cereals, cakes, desserts, etc.

Fructose is sweeter and cheaper than glucose, this is why high fructose corn syrup (55% fructose, 45% glucose) has been used to sweeten the soft drinks and refined flour products. So avoid sweetened soft drinks/juice and pastries is the way to go.  No need to cut back fruits intake as the benefit outweighs the harm。

The average consumption of high fructose corn syrup nowadays is 4-5 times that of 1960s, especially the teenagers.  High fructose corn syrup was invented in Japan in 1966 and began to market in the U.S in 1975, some said this is the Japanese revenge for the defeat of WWII.

Waynesburg Gym: EQT REC Center

Waynesburg Gym: EQT REC Center