Potential liver treatments abound.

An array of potential therapies besides the insulin-sensitizing drugs is being tested against fatty liver disease. They range from surgery to bonus bacteria and include some that have shown promise in people in at least one clinical trial.

WEIGHT-LOSS Researchers are evaluating the effect of gastric-bypass surgery on fatty liver disease. That procedure shrinks the stomach and leads to reduced calorie intake and weight loss, which is known to reverse the liver condition. The weightloss medication orlistat (Xenical), which blocks intestinal fat absorption, has also decreased volunteers' liver fat in pilot trials. However, excessively rapid weight loss that the surgery or orlistat might cause could paradoxically aggravate fatty liver.

HERBS AND SPICES Chinese and Japanese scientists have collaborated to test several traditional Asian herbal remedies in rats that are predisposed to fatty liver. Last October at a meeting of the American College of Gastroenterology in Las Vegas, researchers led by Hisao Takayama of Tottori University in Japan reported that a diet composed of 6 percent cinnamon by weight decreased the fat in the animals' livers.

VITAMIN ANTIOXIDANTS Studies suggest they might prevent inflammation and therefore reduce formation of scar tissue in the liver. A 2003 trial of 45 people found that a combination of the antioxidant vitamins E and C reduced liver scar tissue over a 6-month period. Researchers, however, observed no change in inflammation. Now, some volunteers in trials of pioglitazone or metformin are receiving vitamin E in addition to one of the drugs.

GOOD FATS In a yearlong Italian study of 56 people, liver fat declined in those who each day took a capsule containing 1 gram of polyunsaturated fatty acids. The report appeared in the April 15, 2006 Alimentary Pharmacology & Therapeutics. Animal data from other studies suggest that these healthful fatty acids act as pioglitazone and rosiglitazone do.

IRON-DEPLETION THERAPY Doctors conducting a small U.S. study are bleeding patients--although, unlike medieval physicians, they're extracting blood with sterilized needles rather than leeches or lacerations. The rationale behind the study, which is sponsored by the National Institutes of Health in Bethesda, Md., is that removing excess iron from the body by withdrawing blood may improve insulin activity.

BENEFICIAL BACTERIA Preliminary studies hint that disturbances in naturally occurring bacteria in the gut may contribute to fatty liver disease. Last year, for example, researchers at Imperial College London and the University of Oxford in England found that unidentified intestinal microbes tend to use up the dietary supply of the nutrient choline in a strain of mice that's susceptible to fatty liver. Choline deficiency has been linked to fatty liver in lab animals, so the bacteria may contribute to that strain's high rates of fatty liver disease. However, researchers at Johns Hopkins University in Baltimore recently conducted a trial that tested a probiotic bacterium--a harmless bug that might control harmful ones--in people who have fatty liver disease. The researchers found no benefit from the bacterial strain that they used.