Dr. Ben Bikman

That's a very common feature.

This is the fasted state, low insulin, high free fatty acids.

In contrast, the fed state, especially if it has some carbs, now insulin has gone up, it's inhibited lipolysis, and so free fatty acids will be down.

This is the normal, it's one or the other.

Unless the fat cells are insulin resistant.

Now you have high insulin reflective of insulin resistance, but it can't inhibit lipolysis.

Thus, we have high free fatty acids.

This is a problem back to the ectopic aspect that you'd mentioned earlier, where normally if free fatty acids are high, the muscle will just burn it.

And the muscle will happily burn free fatty acids or any tissue, any cell with the mitochondria would burn it.

But if insulin is elevated, you can't burn fat.

Then fat burning, beta oxidation has been inhibited at virtually every single step with high insulin.

So now we are storing more fat as triglycerides, which is the ectopic fat deposition.

So that's where you start to have fatty liver.

In fact, the main cause of fatty liver

is spillover from fat from fat cells, especially visceral fat.

That's the main origin of all that fat.

As much as we talk about fructose and other nutritional variables, and those matter, the majority of it is fat that's leaking out from the fat cell.

And because insulin's high, it can't burn it.

Normally, the liver would take those fatty acids and just say, well, I'm going to burn it into ketones.

but if insulin is elevated, it can't happen.