Saturday, October 9, 2010

Does Your Liver Look Like an Eskimo's Dinner? Fatty Liver is a Silent Epidemic

by Chris Masterjohn

Does your liver look like this?

All those white bubbles are fat droplets. 

I'm busier than a bumblebee right now, so unfortunately the high-fructose corn syrup post is going to have to wait till Tuesday.  Today I'll make a quick post about fatty liver disease. 

Someone on the Facebook version of this blog posed the question, "How common is non-alcoholic fatty liver??"

The exact prevalence in the United States is not known, but surveys suggest that far too many Americans' livers look like an Eskimo's yummy dinner plate, stuffed with as much fat as the livers of Campbell's protein-deficient, cancer-free rats

Fatty liver is generally asymptomatic, but can prime a person to develop inflammation, cirrhosis, and in rare cases death.  Most people who have it probably have no idea.  One author used the prevalence of diabetes and obesity to estimate that about 40 million Americans have fatty liver.  A survey of men and women in the multiracial urban population of Dallas County measured fatty liver directly and concluded that fully one third of the population had fatty liver.

Non-alcoholic fatty liver disease (NAFLD) was first described in adults in 1980 and was first described in children three years later.  The rise of the NAFLD epidemic has paralleled the rise in obesity, but you do not have to be obese to have fatty liver.  It's more closely related to insulin resistance and leptin resistance, and some people can even be extra-skinny and have fatty liver.  Over 40 percent of Americans have some form of pre-diabetes suggestive of insulin resistance.  So the true incidence may be closer to 100 million Americans rather than 40 million.

What causes fatty liver?  Dr. Robert Lustig makes an excellent case that fructose is the culprit in Sugar: The Bitter Truth.  However, even as high-fructose corn syrup began replacing sucrose and total sweetener consumption increased, another change happened: the Great Doubling of PUFA consumption during the Oiling of America.  Here's a graph from Stephan Guyenet's Whole Health Source Blog in his article "Have Seed Oils Caused a Multi-Generational Obesity Epidemic?"

I have written several blog posts on fatty liver in the past.  If you missed them, you can check them out by following these two links:

Maternal Intake of "Saturated Fat" Causes Liver Disease -- You Know, the Unsaturated Kind of Saturated Fat

Coconut Oil Not Only Protects Your Liver From Alcohol -- But From a Diet Deficient in Meat and Eggs Too!

In brief, corn oil, but not coconut oil or butter, induces fatty liver in animal experiments.  In the alcoholic model, which according to Lustig's hypothesis is the equivalent of a fructose- or sucrose-feeding model, palm oil is protective compared to fish oil; beef tallow or medium-chain fats from coconut oil are protective compared to corn oil; and cocoa butter is protective compared to corn oil.  In fact, if animals consume 40% of their diet as cocoa butter, they can consume 30% of their calories as ethanol, and they might get mighty drunk but they don't get fatty liver.

Why are PUFA's so damaging?  For a lengthy answer, check out my new article "Precious Yet Perilous -- Understanding the Essential Fatty Acids."  If you're not in the mood for a lengthy read, I describe the relationship between PUFA oxidation and atherosclerosis in my interview with Jimmy Moore.  No reading required.

These deal mostly with heart disease, but the relationship to fatty liver is similar.  Luckily, my obligate bumblebee busy-ness is mostly occupying me with 1) fructose and 2) fatty liver right now, so look forward to a number of blog posts on fatty liver in the next week or two.  Suitable for a bumblebee, my next post will be about honey.

Read more about the author, Chris Masterjohn, PhD, here.


  1. No other comments yet? Great work, Chris; I remembered Stephan referencing the apparent liver-protective nature of sat. fat, and I'm happy that you are expanding on the subject. It is a very interesting subject as it may potentially rehabilitate fructose to some extent; I doubt that many of the studies of fructose were done in the context of a strictly low-PUFA diet.

    And this post makes me feel even better about my strategy of always consuming cocoa butter along with my fructose, for protection of course. :)

    Also, I can't wait to hear what you have to say about honey. I am very interested, indeed.

  2. Despite a healthy paleo/primal diet, no sugar, limited alcohol intake, optimal weight, etc. I was diagnosed with fatty liver in August. I dropped the fish oil intake of 4.2g/day of EPA+DHA and six weeks later my liver enzymes were not normal but much lower. My doctor is ordering a round of tests for autoimmune hepatitis but reducing PUFA, even if it was n-3 PUFA, seems to have had a beneficial effect.

  3. Do you believe then that the current advice for a lot of patients about taking fish oil or flaxseed oil should be abandoned?

  4. is there a difference between fish oil and krill oil, i have looked up both and am not on the fish oil 'band wagon' at all but am curious about krill

  5. Hi Nathaniel,

    Thanks for your comments!


    Thanks for your very interesting anecdote, and I'm glad you're seeing improvement. Continued testing is important because liver enzymes can fluctuate. Please keep us up to date of your progress.


    Yes. I do use small amounts of cod liver oil, however, because of the vitamins A and D, and a *small* amount of DHA in the diet is a good thing.


    The main difference is that krill oil is in phospholipid form, and this gives the omega-3 fatty acids greater bioavailability to the brain. If you are trying to treat a psychological or neurological disorder, krill oil is probably the best bet.


  6. Thank you for the last comment (re: the krill oil). I have been trying to figure out how to reconcile the advice of Dr. Natasha Campbell-McBride (we're starting the GAPS diet/lifestyle) and the information I have learned about the damaging effects of PUFAs. This information has helped a lot. I was about to order a combo oil of flax and borage, but thought I'd better study this more (I haven't trusted flax oil for a long time, and I don't know much of anything about borage). I was also going to order fish oil. Now we'll make that krill oil. Thank you again.


  7. You're welcome, Christie. Thanks for your comments.


  8. So if I understand your point correctly, it would explain this piece of research, "Fish oil prevents sucrose-induced fatty liver but exacerbates high-safflower oil-induced fatty liver in ddy mice."

    1. just don't eat safflower oil, it is highly toxic, like the other (GMO) oils. Fish oils are needed. When I don't take them for a while, I dip into deep depressions. Omega 3's cured my depression. The brain needs them. It doesn't need safflower oil. Just read labels, not that complicated.

  9. Chris, do you have a food guide page or something? The diagram was interesting. I used to eat so much starch, and got borderline high cholesterol from that. I just don't know where to begin, because protein & veg doesn't keep me satisfied or full for long. At the same time, I'd like to gain some muscle mass (128lbs, 5"6 female) without raising my cholesterol more, or hurting my liver. What can I do?

  10. Great Article!
    For more information on the benefits of Fish Oil try


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