“Multi-Hit” is how researchers describe the development of nonalcoholic fatty liver disease. We know it’s strongly linked with diabetes and obesity, but functional medicine goes deeper to understand what mechanisms are involved.
Conventional wisdom says that obesity, diabetes, and metabolic syndrome are all strongly linked with fatty liver disease. The main approach is weight loss.
Here are some of the possible “hits,” or factors that might contribute to fatty liver:
1️⃣Genetics. Some genetic variants make a person more likely to develop fatty liver, and we see a higher risk in Hispanic individuals, followed by non-Hispanic whites and then those of Asian descent.
2️⃣Obesity. With weight gain around the middle (abdominal obesity), fat cells can change and become resistant to fat storage. That means more free fatty acids in circulation, which can accumulate in the liver.
3️⃣Metabolic Syndrome. Insulin resistance is at the center of metabolic syndrome. Cells lose their ability to properly metabolize glucose and fat, again contributing to more free fatty acids being deposited in the liver.
4️⃣Microbiome Changes. Small intestinal bacterial overgrowth (SIBO) has been found in 50% of people with the inflamed version of fatty liver (NASH). Gut dysbiosis may lead to intestinal permeability and the release of endotoxins from the gut—going to the liver where they create inflammation.
5️⃣Mitochondrial Damage. Environmental toxins (like pesticides, heavy metals, or pollutants) can create free radicals that damage liver mitochondria. This can impair fat metabolism in the liver and also lead to inflammation.
6️⃣Impaired Methylation. The cellular process of methylation is involved in exporting fats from the liver. If methylation is impaired (by genetics or exposure to toxins for example), the liver produces less of the antioxidant SAMe, increasing the risk for liver inflammation.
7️⃣Diet & Lifestyle. High intakes of fructose (like high-fructose corn syrup in soda) lead directly to increased free fatty acids that can deposit in the liver. Alcohol is also damaging to liver cells, even if consumed in amounts that are generally considered acceptable.
Conventional wisdom says that obesity, diabetes, and metabolic syndrome are all strongly linked with fatty liver disease. The main approach is weight loss.
We agree that weight loss is extremely important when it comes to fatty liver, but we can offer deeper support by looking for additional factors and mechanisms at play.
✨Watch for my upcoming posts. I’ll be sharing info about nutritional supplements and lifestyle changes that can support liver health.