Fatty liver: fight it with coffee

Fatty liver, or non-alcoholic fatty liver disease (NAFLD) and when more advanced non-alcoholic steatotic hepatitis (NASH) is a common depredation of insulin resistance and a growing public health concern as the major cause of liver disease in the world with more people progressing to cirrhosis. There is a massive body of scientific evidence documenting the hepatic benefits of coffee, including coffee's helpful effect on fatty liver. A paper just published in the journal Liver International includes fatty liver in its survey of coffee's medicinal benefits:

"Coffee is one of the most commonly consumed beverages in the world. Its health benefits including improved overall survival have been demonstrated in a variety of disease states. To examine the association of coffee consumption with liver disease, a systematic review of studies on the effects of coffee on liver associated laboratory tests, viral hepatitis, nonalcoholic fatty liver disease (NAFLD), cirrhosis and hepatocellular carcinoma (HCC) was performed."

They found a dose-dependent effect—in other words, up to a certain point the more you drink the greater the benefit:

"Coffee consumption was associated with improved serum gamma glutamyltransferase, aspartate aminotransferase and alanine aminotransferase values in a dose dependent manner in individuals at risk for liver disease. In chronic liver disease patients who consume coffee, a decreased risk of progression to cirrhosis, a lowered mortality rate in cirrhosis patients, and a lowered rate of HCC development were observed. In chronic hepatitis C patients, coffee was associated with improved virologic responses to antiviral therapy. Moreover, coffee consumption was inversely related to the severity of steatohepatitis in patients with non-alcoholic fatty liver disease."

Their conclusion is straightforward:

"Therefore, in patients with chronic liver disease, daily coffee consumption should be encouraged."

Also just published in the journal Hepatology are two papers that elucidate the mechanism by which coffee benefits fatty liver. The authors of the first study note:

"Recently, several studies showed that its consumption is associated with lower risk for non-alcoholic fatty liver disease (NAFLD), an obesity-related condition that recently has become the major cause of liver disease worldwide. Although caffeine is known to stimulate hepatic fat oxidation, its mechanism of action on lipid metabolism is still not clear. Here, we show that caffeine surprisingly is a potent stimulator of hepatic autophagic flux."

Essentially, they showed that coffee stimulates the liver to burn fat:

"Using genetic, pharmacological, and metabolomic approaches, we demonstrate that caffeine reduces intra-hepatic lipid content and stimulates β-oxidation in hepatic cells and liver via an autophagy-lysosomal pathway. Furthermore, caffeine induced autophagy involved down-regulation of mTOR signaling and alteration in hepatic amino acids and sphingolipid levels. In mice fed a high fat diet, caffeine markedly reduces hepatosteatosis and concomitantly increases autophagy and lipid uptake in lysosomes."

Another paper in the same journal also asserts that coffee fires up the fat-burning capacity of the liver: "Drinking coffee burns hepatic fat by inducing lipophagy coupled with mitochondrial β-oxidation."Have a patient with NAFLD, NASH, Hep C, or HCC? Unless there's a good reason not to (allergy or other mode of intolerance, SNS hyperarousal, etc.), evidence supports the therapeutic effect of coffee.