Links between diabetes and liver disease

Research at the University of Edinburgh
has shown that people with diabetes are more likely to develop serious liver disease: death from liver disease is a whopping 70% more likely in those with diabetes.

How can this be?  What are the processes that lead to a build up of fat in the liver? Well, it all boils down to how the body processes sugar, and while this might differ depending upon the type of sugar, excess sugar consumption can readily lead to fatty liver syndrome.

First, let’s define “excess” when talking about sugar consumption.  Glucose is the substance the body needs for fuel – to provide the energy for every one of our bodily processes and functions.  We might get this glucose from sugar or from other carbohydrate foods, but as soon as we take more than we can burn as energy our livers have to get involved to remove the extra glucose from our blood streams, and we can say we have consumed excess sugar indeed carbs.

The liver processes different sugars in different ways.

Glucose which isn’t required to meet our immediate energy needs has to be stored.  First the liver stores this as a substance called glycogen in specialist cells sited around the liver and in our muscles.  Once these specialist cells are full – and they do have a finite capacity – then the liver converts the excess into fat, which it deposits in and around its own tissues.  This is one route to the build up of fat within the liver.

New research shows that fructose metabolism is quite different.  Whilst the body has the capacity to convert any carb into glucose, this new research, led by Professor Robert Lustig, shows that very little of the fructose we eat is actually converted into glucose to meet our energy needs.  The rest is converted directly to fat which finds its way into our liver and into our bloodstream directly.  This is a worry for diabetics – because traditionally fructose is equated with low GI and has been thought to affect blood sugar to a lesser degree.  However, the association with fatty liver syndrome is 2-fold: first it causes disease in the liver itself, and secondly this type of body fay is associated with higher levels of inflammation. Molecules called cytokines are produced by the fat cells and released into the blood stream, carrying the potential for inflammation around the body, and being linked with insulin resistance.  The double whammy for diabetics – i.e. liver disease and further insulin resistance, is therefore more inked with fructose than glucose consumption.  Of course it is fructose that finds its way into many low-fat food products.  The fat may not be present in the food itself, but your body will convert it to fat nonetheless – and the most dangerous kind of body fat!

Ordinary table sugar is a combination of glucose and fructose – so both routes to fatty liver syndrome and further liver disease will apply.  The recent bad press for sugar is more than warranted – and it doesn’t impact just on those living with diabetes!

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