Is there a connection between a fatty liver and a candida infection?  How would –or how could that happen?

What is Fatty Liver?

Fatty liver is also known as non-alcoholic fatty liver disease (NAFLD).  The more severe form of NAFLD is called non-alcoholic steatohepatitis or NASH.  NAFLD cases are increasing worldwide and appear to be related to the rise in obesity and type 2 diabetes.  In the US, it is estimated that some form of fatty liver occurs in about 20% of the population with about 5% of people affected with the more serious form, NASH.  Fatty liver is a good name because the main problem in NAFLD is the accumulation of the types of fat called triglycerides.

Triglycerides are a type of fat (lipid) that is stored in your fat cells to be used when you need energy.  If you take in more calories than you use, these triglycerides are not needed as an energy source and the fat is stored in fat cells and begins to build up.  Triglycerides are also in the blood and are often measured in blood tests to determine your risk for heart disease.  It may be particularly important to emphasize that the liver damage associated with NAFLD is quite different than the damage associated with the liver when the person has abused alcohol for years—in fact, most people with fatty liver have no history of alcohol abuse.[1]

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What Causes Fatty Liver?

We don’t know all the details of what causes fatty liver.  At this point, most researchers believe that fatty liver requires two “hits” for it to develop.  There are also environmental (eg. dietary, lifestyle factors) and genetic influences (your genes and your family history) that may put you at higher risk for fatty liver.

• The first “hit” is believed to be an increase in the blood levels of triglycerides. This may occur because of poor diet (eg. a high fat diet with few fruits and vegetables or a reliance on fast foods or processed foods), low physical activity (eg. a job that requires you to sit for prolonged periods of time) or because of a genetic tendency to have increased triglycerides (TGs).
• The second “hit” is believed to be some form of stress that acts on the liver. This stress can be:
  • Oxidative stress where a build-up of free radicals and other oxidizing agents begin to seriously damage cells and organelles within the cells, most importantly the mitochondria and the nuclear DNA. It is believed that some form of oxidative stress is always present in fatty liver disease.
    • Free radicals are highly reactive naturally produced substances that are normally neutralized by natural antioxidants such as glutathione, Vitamins C, E and beta-carotenoids and others. Free radicals can damage mitochondria and DNA and are a main underlying cause of inflammation. DNA contains all the genetic information for the sum total of the biochemical and biological activities the cells do 24 hours a day, 7 days a week.
      • The mitochondria are often referred to the “powerhouses” of the cell. Mitochondria produce all the cellular energy.  It is believed that the mitochondria—and the damage done to mitochondria—is always part of the development of fatty liver disease.
    • Metabolic stress can also be involved in the development of fatty liver. Metabolic stress could be the result of inflammation, biochemical abnormalities (such as uncontrolled high blood sugar levels, high levels of inflammatory cytokines, an autoimmune response, insulin resistance and other alterations), infections, altered bacterial populations in the digestive system, poor diet and nutrition as well as hormonal imbalances.
    • Overgrowth of bacteria in the intestines has been associated with an increase in intestinal permeability, known as Leaky Gut Syndrome. This basically means that many of the toxins and metabolic by-products that should stay inside the intestines can leak out and damage the liver.[2]
    • Many researchers believe that NAFLD is the result of insulin resistance or prediabetes and metabolic syndrome, particularly because of the well-known relationship between obesity, diabetes, metabolic syndrome and NAFLD.[3]

The liver is that rare organ that can repair itself to a large extent. The two “hits” are essential to overcome—or overwhelm—the liver’s natural ability to repair itself.  After the two “hits”, the liver begins to lose this ability.  Once that ability to repair itself is reduced, fats in the form of triglycerides begin to accumulate and slowly, the function of the liver begins to decrease more and more.  You may know that the main functions of the liver include:

• The synthesis of proteins
  • For example, the liver synthesizes proteins needed for proper blood clotting and the proteins (enzymes) needed for various biochemical functions
• Storage of vitamins such a vitamins B12, folate, Vitamin A, Vitamin D
• Bile production
  • Bile is needed to help break down fats in the diet
• Synthesis of cholesterol
  • While many are concerned about their cholesterol levels, it is important to understand that cholesterol is absolutely necessary in the body. Cholesterol functions, for one, to give cells flexible membranes, allowing for example, blood cells to squeeze through tiny capillaries and distribute oxygen and nutrients to all cells of the body.  Cholesterol is also a starting material for a wide variety of important substances in the body.
• Conversion of blood sugar into its storage form, glycogen
• Clearing drugs and toxins from the body
  • Some of the enzymes in the liver are called the cytochrome P450 enzymes. These enzymes act on all sorts of toxins, metabolic by-products and drugs to reduce their toxicity and function to allow these detoxified substances to be safely excreted.  For example, the liver removes excess ammonia from the body—ammonia is produced as a result of a number of biochemical reactions.
• The liver is involved in removing bacteria from the blood and by producing substances that assist the immune system
• Clearance of bilirubin (a breakdown product of hemoglobin—the oxygen-carrying protein in red blood cells) and processing the iron in hemoglobin.

Needless to say, this is a long—and important—list of functions for the liver.  Once the liver begins to lose some of its functions, all aspects of your health can be affected, from a disruption of protein production, to hormonal unbalance, to digestive disorders, to immune disorders—and if you have recurrent candida infections or suspect a candida overgrowth, anything less than an optimally functioning liver can make regaining your health much more difficult.

What are the Symptoms of Fatty Liver? How is Fatty Liver Diagnosed?

The symptoms of fatty liver disease often do not become evident until quite late in the process.  When symptoms do appear, they tend to be rather generalized fatigue, unexplained weight loss and possible pain or discomfort in the right side of the upper abdomen.  Lab tests can be useful in making the diagnosis of fatty liver—especially if you go for a yearly physical and your doctor can compare your lab values with those of previous years.  Some of the lab tests that can be useful include:

• Blood tests for liver enzymes and other substances that can point to liver health—these are often called liver function tests (LFTs). LFTs most commonly consist of tests for the enzymes referred to as ALT, AST, ALP, GGT, and LD. Other proteins measured include bilirubin, albumin and autoantibodies to determine if there is an autoimmune disease.  Your doctor may also order a prothrombin time (PT) in order to determine if your liver is making the correct clotting proteins.  These test substances, depending on their levels, can give your doctor a better idea of how well your liver is functioning and can help rule in or rule out other liver disorders.[4]
• General blood tests like the CBC which determines the numbers and proportions of various blood cells and a test usually referred to as a CompMetabolic test or more simply, blood chemistries. The CompMetabolic blood test can give your doctor even more information about your general health as well as specific values referring to the liver.
• Imaging tests such as CT scans, MRIs and ultrasounds (US) can provide a visual picture of the state of your liver
• More rarely, a liver biopsy can be taken to determine if your liver has signs of NAFLD or NASH.

How is Fatty Liver Treated?

There is no widely accepted treatment for fatty liver disease, though your doctor is likely to recommend weight loss through better nutrition and increased exercise, especially since being overweight is a major risk factor for NAFLD. [5] It is also generally recommended that your diet should be adjusted to minimize unhealthy fats that can increase your triglyceride levels. Preventing any further damage is also often recommended—this may include getting vaccinated against Hepatitis viruses (Hepatitis A, and B), avoiding alcohol and avoiding any un-necessary medications or substituting medications that may be “kinder and gentler” to the liver.

Dietary treatment generally means increasing your intake of fruits and vegetables and decreasing the amounts of fats—particularly animal fat—in your diet.  Functionally, this usually means increasing the amounts of fish and poultry in your diet and limiting the amounts of red meat to lean cuts of red meat and pork. You can also increase your intake of complex carbohydrates and limit the amount of added sugar in your diet.  Complex carbohydrates are found in un-processed foods—processing breaks down the complex carbohydrates into simpler and often, more easily digestible simpler carbohydrates.  The easier digestion is a plus—but that “plus” is negated by the increase in blood sugar and the easier conversion of those sugars into fats including triglycerides.  Examples of foods with complex carbohydrates are whole grains, beans, legumes and starchy vegetables.

Candida and Fatty Liver Disease

There is some controversy regarding candida and fatty liver disease. Invasive candidiasis is very commonly seen in hospitalized patients. Candidemia, where the yeast is found in blood samples, has been called the 7^th to 10^th most common blood infection.[6] Since the yeast candida (usually Candida albicans) is normally found on the human body (on the surface, in the mouth and the vagina and in the intestinal tract), invasive candidiasis is most often found in people with a weakened immune system—those people whose immune system is damaged by disease or injury.[7]

However, candida can also overgrow the digestive system and alter the gut bacteria, increase intestinal permeability and affect some of the biochemical functions of the liver.[8]  Symptoms of candida overgrowth can include those which resemble fatty liver disease—though it should be mentioned that these are very general symptoms and can reflect other problems as well.  That said, these symptoms include chronic fatigue, a mental fogginess that doesn’t seem to go away, digestive issues such as constipation, diarrhea, gas and bloating, abdominal pain and/or discomfort and sometimes weight loss.

Many people with recurrent candida infections or with candida overgrowth also have problems with a fatty liver.  This does not necessarily mean that the candida causes the fatty liver but it does mean that supporting the liver—as well as dealing with candida overgrowth—can definitely help improve liver function, decrease the risk of fatty liver and support the immune system—which helps in clearing the candida.  Candida overgrowth—especially if it is associated with an altered population of gut bacteria and a leaky gut—can weaken the liver and the immune system.  Candida can also produce various toxins, including acetaldehyde, that can directly cause symptoms of fatigue, mental fogginess and feelings of anxiety and depression.[9]

Supplements to Support the Liver

You can use various herbs and supplements to help support the liver we recommend CanXida range of supplements.  The first step, though, is following some of the dietary steps listed above for the treatment of fatty liver. That is, increase your intake of fruits and vegetables, stick with complex carbohydrates, limit your intake of animal fats – and drink plenty of water.  Avoid as much as possible any foods or beverages with added sugar.

Secondly, you can consider including some herbs that have been shown to support liver function.  These include milk thistle, the roots (not the leaves) of dandelion, beets, radishes and parsley.  (You can also increase the amounts of beet and radishes you include in your diet!)

There are also a number of vitamins, minerals and nutraceuticals that are needed for healthy liver function.  One of the most important of these are the antioxidants, including choline, N-acetyl cysteine (NAC), glutathione and vitamins C, E and the beta-carotenes. B-complex vitamins are vital for liver health as well.

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• Candida Case Studies: Meet My Father
• Is Yoga Beneficial For Candida?

While the relationship between fatty liver and candida is not yet entirely clear, what IS clear is that many people are dealing with both a fatty liver and some form of candida overgrowth.  What is also clear is that if you have problems with candida, boosting your liver health, healing your gut and supporting your immune system can be beneficial for recovering your health and wellness.

References

1. https://my.clevelandclinic.org/health/diseases_conditions/liver-disease/hic_Fatty_Liver
2. https://www.weizmann.ac.il/immunology/elinav/sites/immunology.elinav/files/2013_elinav_advances_in_immunology_0.pdf#page=82
3. https://www.stmconnect.com/sites/default/files/20140821144820.pdf
4. https://labtestsonline.org/understanding/analytes/liver-panel/tab/test/
5. https://www.mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/basics/treatment/con-20027761
6. https://www.nejm.org/doi/full/10.1056/NEJMra1315399
7. https://www.merckmanuals.com/professional/infectious-diseases/fungi/candidiasis-invasive
8. Volynets, V., Küper, M.A., Strahl, S. et al. Dig Dis Sci (2012) 57: 1932.
9. Calderone RA. Candida and Candidiasis. 2002. ASM Press, Washington DC.