Multaq Warnings : Insulin, the substance that keeps our glucose (blood sugar) levels from becoming too elevated, guides glucose from our bloodstream into the body’s muscle, fat, and liver cells. The cells convert the glucose into energy, but if the glucose isn’t metabolized correctly (i.e., if the cells resist the insulin and won’t allow it to do its job), then we produce less energy and feel fatigued.
People who are insulin-resistant can’t use insulin efficiently, and glucose builds in the blood, prompting the pancreas to produce even more insulin in an attempt to rid the body of the excess glucose. The result is an abundance of fatty acids that are converted to fat, which is stored in the liver, creating nonalcoholic fatty liver disease. Almost all people with NAFLD are insulin-resistant. Although overweight people are more likely to exhibit insulin resistance than people of normal weight, a sedentary lifestyle and a high-fat, high-sugar diet triggers insulin resistance regardless of body weight or body mass index.
The combination of factors and related disorders of metabolism (obesity, insulin resistance, diabetes, hypertriglyceridemia, and hypertension) comprises the group of findings known as the metabolic syndrome. People with the metabolic syndrome generally also have NAFLD, which in some cases will have progressed to NASH.
An easy way to distinguish between nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) is to put them into alphabetical order: NAFLD, or fatty liver disease, comes before NASH, or nonalcoholic steatohepatitis. This mnemonic is helpful because it reflects the order in which the two diseases occur: fatty liver disease arises first and can progress to nonalcoholic steatohepatitis.
Here are some facts at a glance:
• Simple fatty liver (which is, just as its name describes, an accumulation of fat in the liver) is the beginning stage of nonalcoholic fatty liver disease. It is caused by insulin resistance, meaning that the insulin produced in the body is less effective than it should be. The primary factor in the development of insulin resistance is obesity, especially central obesity, or the accumulation of a disproportionate amount of weight in the abdomen. Simple fatty liver is relatively harmless and often disappears with weight loss.
• The next stage of nonalcoholic fatty liver disease is nonalcoholic steatohepatitis. When NASH occurs, the liver is still fatty, but it also becomes inflamed (hepatitis) and liver cells can be destroyed. It can progress to scarring of the liver (fibrosis) and development of severe liver diseases, including cirrhosis, which is the last stage of NAFLD.
The Centers for Disease Control estimates that an astonishing 90 percent of people who are obese or have been diagnosed with type 2 diabetes also have simple fatty liver. About 20 percent of them have NASH, and 10 percent have cirrhosis.
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A high-fat diet, obesity, and insulin resistance are the most common causes of nonalcoholic fatty liver disease, but there are other, less common causes. One is drug-induced steatohepatitis, or more precisely drug-induced fatty liver, which is caused by medications such as prednisone (a steroid), tamoxifen (used in treating breast cancer), estrogen (a female hormone), methotrexate (used to treat
cancer and autoimmune conditions), amiodarone (used to treat heart conditions), or Arimidex (used to treat breast cancer).
Early symptoms of fatty liver disease are vague and nonspecific and include fatigue, malaise, and/or an ache in the upper right abdomen (where the liver is located).
Symptoms that appear in the advanced stages of nonalcoholic steatohepatitis mimic those of cirrhosis and include fluid in the abdominal cavity (ascites), severe itching, swelling (edema) of the legs and feet, weakness, nausea, easy bruising, yellowing of the skin and eyes (jaundice), dark (cola-colored) urine, and mental confusion.
To diagnose the problem, a physician may prescribe blood tests to rule out other liver-damaging conditions, including hepatitis B and C. Because excessive alcohol consumption can can cause fatty liver and alcoholic steatohepatitis (ASH), you may be asked about how much alcohol you consume. Excessive quantities are defined as three or more drinks a day for men and two or more drinks for women.
If fatty liver is suspected, the doctor will probably order further tests, including a liver-function blood test to measure whether enzymes are elevated (signaling possible liver damage), an ultrasound or a CT scan, and possibly a liver biopsy.
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One of the great health-care myths in our society is that iron supplements will pep you up and harmlessly make you a more energetic person. Most adults remember television commercials for breakfast cereals, tonics, and pills packed with iron that promised to cure our iron-poor blood. But few people realize that for anyone whose blood is already rich in iron, the addition of ferrous sulfate or iron supplements can do severe, irreparable damage to the liver and heart.
It is true that iron is essential to good health. Iron helps to form oxygen-carrying hemoglobin in our red blood cells, boosting brain function, producing energy, and giving us strong muscles and immune systems. For people who suffer from iron deficiency, anemia, or whose iron stores become diminished during pregnancy, iron supplementation is essential.
Normally, our bodies absorb only about 10 percent of the iron that we consume in food. Most iron circulates in the body in the form of hemoglobin, but some is also stored in the liver, bone marrow, and spleen. People with hemochromatosis, though, can absorb up to 20 percent or more of the iron they take in—twice as much as they need to replace iron lost from the body.
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