Understanding fatty liver disease

Recently Joan Block as been talking about fatty liver disease and it’s implications. I have also have an opportunity to read in-depth on the on the same.
There are issues that are clear r are coming to me . However what I don’t understand so far is where some folks like us who are lean, not over weight, with normal cholesterol and normal triglycelides get fatty liver. Where does the excess fat that is stored in the liver come from.

I believe it comes from a high carb diet. If you are eating lots of rice, bread,pasta, grains and oats and are not super active then all that carbs turns into sugar then gets stored in body as fat.

Eat meat, fish and vegetables and pretty much nothing more. They say a very low carb diet for about 3-6 months should decrease fatty liver. If you eat 2 slices of bread and a cup of rice, then you are pretty much over your limit.

If you eat a bowl of cereal for breakfast, sandwich for lunch and pasta for dinner, then you are probably over your limit about 3 x.

Diet is hard bc it’s a lifestyle change and most do not last more than a month.

They say if you can eat chicken/ fish and broccoli for 1-2 months you will see feel a huge difference

Hi Neptune
Thank you for coming in handy for me.
But tell me, if carbs are converted into sugar and stored in the body as fats, how comes cholesterol and triglycerides are normal, LDL HDL normal and normal body weight/BMI?

Search : carb sugar and cholesterol or/and carbs sugar and triglyceride.

Sugar and carbs are directly related to both.

Are just a few out of many articles

Hi Neptune
I have read the articles you have send me and sincerely appreciate.
I like the explanation that eating more calories than one needs lead to storage of fats(triglycerides) for use when required. Further, this leads to increase in LDH consequently high cholesterol. This is very scientific and logical. But, it doesn’t explain why some folks have normal totall cholesterol, normal triglycelides, HDL and LDL but still have fattly liver.
Mine are: Results. Normal ranges
Total cholesterol 2.5. 2.2- 5.60
Triglycerides. 0.54. 0.50- 2.00
HDL 0.8. <0.8
LDL. 0.0061 <4.90

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I don’t know either. Maybe you fast before your blood test. Maybe it’s just store in your body. For some they can be obese and out of shape and can have great blood work.

I guess blood work reports are indications of what could be wrong, but not tell all.

Eat right and exercise. It doesn’t happen over night. I read it takes about 3-6 months before your adjusted to years if not decades of poor eating habits.

I don’t know anything beyond what I read and told through internet searches.

As I have always said, nutrition and metabolism is not always that simple. For some context of why, please visit this website for a (simplified) overview of what we know about metabolism so far: http://biochemical-pathways.com/#/map/1 (by the way, you can order this as a wall poster. Probably something @john.tavis would love :slight_smile:). Just one change in one step and the balance of what comes out can be altered. These processes are acting in each of our cells, which also interact with each other, complicating things even more.

This diagram doesn’t even take into account differences in enzyme activity for each of these steps that are affected by a person’s DNA make-up (both cellular AND mitochondria), the gut bacteria (which can alter what is absorbed by the body based on THEIR metabolism), the gut viruses (most of which infect bacteria and so alter how THEY metabolise), someone’s mental state (which can alter stress hormones, hunger signals, etc). All of these are interacting and contribute to someone’s end state. Exactly which factor is actually causing the state at the end, you’ll probably never know without some trial and error with lifestyle changes.

There are general things you can say (e.g. the Western diet probably has too much salt and sugar to be healthy), but anything more specific is really hard. This is basically the reason I’ve stayed out of research in metabolism, it’s just too hard!

To address a query from @Kinoti, I believe there is research showing that peripheral fat (seen in the arms, legs, belly, etc.) is actually quite different to visceral fat (which surrounds and is within our organs). They are regulated differently, use different cells, and importantly have different health outcomes. Visceral fat is probably worse for our health than peripheral fat.


Hi Thomas
By defining the implications of peripheral and visceral fat, you get me somewhere.Always thanks you for your time and knowledge.

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Hii @ThomasTu
How do you explain the situation where one has cholesterol within normal range but with fattly liver?

Dear Kinoti,

I’m not really an expert in this area as mentioned above, but here’s my understanding of it.

Cholesterol levels reflect how much the liver is releasing fat into the blood. This is an important function that the liver does because it means that cells around the body are able to get their energy, but too much means that they start building up and clogging blood vessels.

Measuring fatty liver reflects how much fat is being stored by the liver itself.

Both of these are regulated by related, but different processes in the liver.



Hi Thomas
Kudos for your input.
I also have pleasure to let you know I have managed to cut 10%of my body weight since September last year. I have not changed my menu save reduction on the amount I take per serving. I am excited by this.


Hi Thomas–you are right! I love those complex metabolic pathway maps. Even heavily simplified as they must be, they point out to me the exquisite complexity of life. It keeps me humble when I’m feeling good about progress in my lab! There is always so much more to learn.



Body weight lost doesn’t mean so much sometimes. People can lose 5-15 lb in a week or 2 bc it’s mostly water loss. Unless your bmi gets smaller, weight lost is just superficial.

You ll probably have to be on some sort of ketosis for about 6 months to lose some fat out of the liver. Most peoples body will burn excess energy from stored carbs. You have to tweak your body to burn fat and not stored carbs and sugar.

Caloric deficit and exercise, while having high protein diet from natural foods with limited carbs will be only way to lose weight.

Hi Neptune
Kindly let me know how possible is it to loss weight without BMI getting smaller if BMI=body weight in kg/height in meters squered

You don’t really have to lose any fat to lose 5-10 lbs. water loss, pooping out waste, and not eating as much for couple days, could be the reason.

I use to go from 175-180 lbs to 160-175lb just by not eating as much. I probably just carried about 5-10 lbs of waste in my system and lose some water weight. Now if I did not fluctuate and a month later I was down 15 lbs and stayed that way then it’s actually weight loss.

Even if you stop eating, you body adapts in burning fat to not burning as quickly. It almost self preserves it self

Why keto dieting is so effective is, your body doesn’t self persevere but changes the way it burn fat as energy. With caloric deficit dieting, you would have to work out to burn the extra fat. Almost tricking your body to keep burning fat.

But if you just stop eating you will get lower bmi.

Hi Neptune
Thanks for keeping me informed.
Dr Gish (for Hepb foundation)has done a research on weight lose for fatty liver. He advises five mails a day with a tea cup plate without a second serving. He advises that one to stay clear of saturated fats and sugar. I think that is enough.
My concern has been why does the liver store fat even when there’s no excess fat in the body.And that measurements for cholesterol and triglycerides can’t be used to test steatosis.


I couldn’t rest today. Had to go and do the abdominal uss.
My suspicion that something is wrong with my liver has been confirmed.
Finding was that of fatty liver grade 3 which I know it’s very bad.
Pain under the right rib and right side of the abdomen increasing in intensity.
I have some questions which I hope I will get answers to here because I am at my wit’s end.
1 What kind of treatment will I undergo including drugs and will it reverse it
2 Although the report said no lesions seen, is it possible that the fatty liver could be obstructing the lesions or cirrhosis if it’s actually present.

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The result
Liver measures 15.1cm. It has smooth outline. The parenchymal echogenicity is diffusely increased with poor visualisation of the intrahepatic portal venous wall reflectivity and diaphragmatic outline. No focal lesion is seen within the parenchymal .
The intrahepatic ducts and vascular channels are normal in calibre .
The gall bladder is preserved
No ascitis.

Is it possible I am already cirrhotic due to the pain and malaise.
I am having pain and discomfort on the right side of the abdomen, chest and back

Hi @Tsbs,

I have moved this query to the fatty liver disease thread where I think it could help other people going through the same thing and it’ll be easier to search for.

I’m sorry to hear about your experience, but the good thing is that grade 3 fatty liver is reversible. If you take away the underlying cause of inflammation (in this case, it is likely that build-up of fat in the cells) then your liver can recover from this over time. There is no specific drug treatment available for fatty liver, and doctors will likely suggest you make lifestyle changes (e.g. diet, exercise, good sleep) to give your body the best chance to repair itself.

Regarding whether it may be hiding other masses, I am not sure, though other @HealthExperts may be able to contribute.

If you have been categorised as Grade 3 fatty liver, this is not cirrhosis.

Regarding the pain, it’s best to talk to your doctor about possibilities of pain relief that are right for you in this situation.

Hope this helps,


Thanks. I appreciate your response. The inflammation is caused by the fatty liver and hbv. I will likely get treatment for the 2. Thanks once again. Still looking forward to other contributions.

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