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A mysterious case of fatty liver disease

Recently, I had a patient who was diagnosed with fatty liver disease. This woman was in her late 40s and somewhat overweight, but she didn’t have the typical habits associated with fatty liver disease. Fatty liver can come from alcohol consumption, but she wasn’t a drinker. It can come from fructose, most commonly in the form of high fructose corn syrup, which is added to so many things, especially soft drinks, but she has never been much of a soda drinker either and her diet was “pretty clean.” The only dietary vice she had was “overeating” or “binge eating,” which she did on occasion. But her “binging” was not on junk food, she just liked to eat.

I wondered about medications that impact the liver, but she wasn’t on any medications at all. I was left believing that her fatty liver was as a result of overeating, which was hard to imagine. There had to be something I was missing. And then, in reviewing her health history, she told me she had liposuction on multiple areas of her body, including her abdomen, legs and upper back when she was in her 20s and 30s. I dug in on this and found research that reveals that liposuction results in visceral adiposity (fatty organs).

A 2012 study that appeared in The Journal of Clinical Endocrinology and Metabolism revealed that indeed, the removal of subcutaneous fat cells causes a compensatory increase in visceral fat. The study went on to conclude that this can be counteracted by exercise.

We are very good at storing fat. How do we know? Because we are here. Our human predecessors who were not able to store fat died from malnourishment when food was not available, and we descended from those who could store fat and that ability was passed on to us.

Stated another way, the only reason the human body stores fat is to have fuel for functioning when there is no food. The ability to store fat is a strong “survival mechanism.” Our body is trying to store any excess energy (calories) we eat as fat, “just in case,” and heaven knows with the standard American diet, we get plenty of excess calories, mostly in the form of carbohydrates (sugars). Our body turns the excess into fat by converting the carbohydrates to fat. It does this through triglycerides and fatty acids and is done in the liver.

Elevated triglycerides are an early sign that the body is storing fat. One of the things I look at is the triglyceride to HDL cholesterol ratio. As your triglycerides go up, your HDL (frequently referred to as “good cholesterol”) goes down. Usually at this point the liver is beginning to accumulate fat. Ultrasound is the best way to access this, but the triglyceride to HDL ratio correlates very highly with fatty liver.

These are signs that the body is struggling to handle the sugar in the system. If we measured insulin, it would also be high (insulin will rise before the blood sugar does). Eventually, we won’t be able to produce enough insulin to maintain a “normal” blood sugar level and then it too rises along with glycosylated hemoglobin (HbA1c). When this gets high enough, a diagnosis of diabetes is made.

The first place we store fat is just below the surface of the skin. This is known as “subcutaneous” fat. It is the fat we measure with the “pinch an inch” test. Measuring this fat and using a mathematical equation, the overall fat on the body can be estimated pretty accurately under normal conditions.

Liposuction actually removes subcutaneous fat cells. One of the “selling points” of liposuction is that those cells don’t come back and the fat cells that remain are far fewer, so less fat can be stored under the skin. But what happens if you continue to have excess energy to store? The body still wants to store it so it goes to alternative storage sites including the liver and other organs. By limiting the body’s ability to store fat below the surface of the skin we are forcing it to store the fat elsewhere. While the study recognized the loss of fat cells from liposuction, any procedure that removes or destroys fat cells would have the same effect.

If you have had a fat removing procedure, all is not lost. There is some good news, specifically that exercise can compensate for the loss of the fat storage space and can correct many cases of fatty liver. Dietary modifications to eat less and better quality would also be wise.

If this patient had sought my advice prior to her procedure, I would have advised against it, but people don’t always follow the advice they are given, even when it is good. This is especially true in our quest for beauty.

Michael Buyze, L.Ac. is a healthcare entrepreneur with nearly 40 years of experience in healthcare and expertise in acupuncture, traditional Chinese medicine, functional medicine, clinical exercise physiology, and nutrition. He owns and operates East Wind Healthcare, an acupuncture and wellness clinic with a 20-year history of helping people in the Fox Valley with offices in Appleton, Oshkosh and Fond du Lac. He holds Master of Science Degrees in Chinese Medicine, Business Administration and Exercise Physiology. He and his team offer acupuncture as well as wellness programming for acute and chronic pain as well as many chronic disease states. Acupuncture consultations and wellness consultations are available by appointment. Contact information: East Wind Healthcare, 3000 N Ballard Road, Unit#3, Appleton, WI 54911; 404 N. Main St., Suite 201, Oshkosh, WI 54901 and 180 Knights Way, Fond du Lac WI 54935 (inside Fox Valley Wellness); Tel: 920-997-0511; Website: eastwindhealthcare.com.

“By limiting the body’s ability to store fat below the surface of the skin we are forcing it to store the fat elsewhere.”

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