There is an underappreciated link between fatty liver/NAFLD and gut inflammation/dysbiosis/hyperpermeability.
When the intestinal barrier breaks down, bacterial endotoxins enter the portal vein.
It drains directly into the liver, so hepatocytes are first exposed to things like LPS.
LPS triggers inflammation, ROS, and TNF-alpha release which impairs mitochondrial function.
Then there is also the bidirectional link between bileflow and dysbiosis.
Ethanol or acetaldehyde produced by certain microbes will overwhelm liver detox pathways.
Many people also have a high ammonia burden due to high urease activity in certain bacterial strains -> more pressure on the liver.
To the extent that dysbiosis impairs SCFA production, you get further metabolic dysfunction.
