Fatty Liver
The liver is our largest internal organ and our body's workhorse. It participates in multiple important tasks: converting food into energy, processing fat from blood, clearing harmful toxins, and making proteins that help our blood clot. However, this hard-working organ is susceptible to a dangerous and often hard-to-diagnose condition called nonalcoholic fatty liver disease, or NAFLD.
NAFLD is the presence of fat in more than 5% of liver cells. It is the most common liver disease and affects up to 25% of American adults, 60% of whom are men.
The disease raises the risk of heart disease and left untreated, NAFLD also can lead to an inflamed liver, a condition called nonalcoholic steatohepatitis (NASH). Distinguishing between NALFD and NASH is essential. 40% of people with NAFLD develop NASH. NASH can lead to scarring of the liver; severe scarring, called cirrhosis, increases the risk of liver cancer. NASH and alcoholic liver disease (ALD) have overtaken hepatitis C as the most common causes of advanced liver disease among people awaiting liver transplants in the USA.
CAUSES
With the explosion of the obesity epidemic, the prevalence of NAFLD is rising exponentially. The liver is the first organ to metabolize the foods we eat. Eating a lot of high-sugar, high saturated-fat foods can lead to fatty liver disease. Although drinking too much alcohol can cause fat buildup in the liver, NAFLD affects people who consume little or no alcohol. Instead, the main offender is
excess weight — causing extra fat to get stored in the liver
abnormal cholesterol (abnormally high LDL cholesterol levels, low HDL levels, or both)
high blood pressure
diabetes.
consumption of highly processed food
high carbohydrate (simple sugars, high fructose corn syrup) intake
high saturated fat and trans fat intake
high animal protein (red meat) intake
low fiber intake
sedentary lifestyle
some medications
genetic / inherited: some people with fatty livers have none of the above risk factors, which suggests that genes can play an important role.
DETECTION
NAFLD is difficult to detect as it usually silent without any symptoms. However, NAFLD is sometimes associated with fatigue, weakness, loss of appetite, nausea, weight loss, and abdominal pain. NAFLD is suspected when a blood test reveals elevated liver enzymes. Usually, diagnosis becomes clear after ruling out other causes, such as viral or drug-induced hepatitis. However, a definite diagnosis requires a liver biopsy — an outpatient procedure in which a needle is inserted into the right side of the abdomen to extract a small piece of liver tissue.
TREATMENT
Although currently, no drug treatment is available, it's possible to stop further liver damage and even reverse NAFLD's effects if addressed early enough. Treating underlying conditions - abnormal cholesterol, diabetes mellitus, obesity, is the most effective way of reducing or preventing further fatty buildup in the liver. The best way to do that is by weight loss and proper exercise and meal planning.
Sugar (carbohydrates) can be a sweet poison for the liver. A study published online Oct. 17, 2017, by Clinical Science found that when healthy men with a low level of liver fat consumed at least 650 calories from sugar daily for 12 weeks, not only increased their liver
Fat but also showed changes in their fat metabolism associated with a higher risk of cardiovascular disease and stroke. The most significant risk for people with a fatty liver is still cardiovascular disease.
PREVENTION
NAFLD is preventable. A recent study found that cardiovascular exercise lowers elevated liver enzyme levels in people with NAFLD. While any cardio activity helps, the researchers cited 90 minutes of brisk walking, or 30-45 minute cycling sessions three times a week, as beneficial.
The dietary recommendations for NAFLD are similar to weight loss and maintenance. For example, follow a plant-based diet like the Mediterranean or DASH diets, and refrain from alcohol — or at least limit your daily intake to 20 to 30 grams (about an average glass of beer or a small glass of wine).
Limit added sugar to no more than 6 (24g) teaspoons for women and 9(36g) teaspoons for men each day. Limit foods with any added sugars, which go by many names, including high-fructose corn syrup, sucrose, honey, turbinado sugar, dextrose, evaporated cane juice, and concentrated fruit juice. High fructose corn syrup is found in juice, soda, sports drinks, sweet tea, breakfast cereal, yogurt, salad dressing, nutrition bars, bread, protein bars, ketchup, jams, jellies, syrups.
Limit intake of fats. Avoid trans fats ( commercially baked goods such as cookies and cakes), fried foods ( doughnuts, French fries).
Emphasize monounsaturated fats ( olive, peanut, and canola oil) and polyunsaturated fats (found in corn, soybean, and safflower oil), and emphasize omega-3 fatty acids( in walnuts, salmon, and flaxseed oil).
Consume low-glycemic foods ( most fruits, vegetables, and whole grains) and limit high-glycemic foods ( white bread, white rice, potatoes).
Treatment
Weight loss: for patients with overweight and obesity, the more weight they lose, the better it is. However, even losing a little can have an impact. JAMA Internal Medicine recently published a study demonstrating that people who lost just 3% to 6% of their body weight reduced their liver fat levels by 35% to 40%. Another Hepatology study confirmed that losing 7% to 10% of total body weight can lead to NASH remission. Weight loss of roughly 5% of your body weight might be enough to improve abnormal liver tests and decrease the fat in the liver. Losing between 7% and 10% of body weight seems to reduce the amount of inflammation and injury to liver cells, and it may even reverse some of the damage of fibrosis. Target a gradual weight loss of 1 to 2 pounds per week, as very rapid weight and fibrosis. Avoid excessively rapid weight loss.
Manage blood lipids ( triglycerides, etc.) if they are elevated. Statins appear to be safe and might also reduce cardiovascular events in patients with fatty liver.
Unfortunately, there are no FDA-approved medications for fatty liver disease. So far, the two best drug options affirmed by the American Association for the Study of Liver Diseases for biopsy-proven NASH are vitamin E (an antioxidant) and pioglitazone (used to treat diabetes). However, not everyone will benefit from these treatments, and there has been some concern about safety and side effects.
Drink coffee: It is second only to water as the world’s most popular beverage and has been consumed for many centuries. Few studies indicate that patients with NAFLD who drank (black) coffee (about two cups every day) had a decreased risk of fibrosis. However, one should also take into consideration the downsides of regular caffeine intake.
Drinking coffee is just one way to keep your liver healthy. It’s also important to get vaccinated against hepatitis A and hepatitis B viruses, which both damage the liver.
BOTTOMLINE
To keep your liver healthy, you should
Eat an appropriate diet.
Exercise
Get to and maintain a healthy weight.
Limit alcohol.
Get vaccinated to protect against liver viruses hepatitis A and B.
Control other health conditions that might also affect your liver, and check with your doctor if you might have other underlying, treatable diseases contributing to your fatty liver.
Published 7/25/2020
Updates 2/28/2021; 11/15/2021
About Us
Dr. Amar Singh, MD, and Dr. Poonam Singh, MD, are board-certified by the American Board of Internal Medicine and American Board of Obesity Medicine. They specialize in preventing, treating, and reversing chronic diseases using an evidence-based holistic approach. They are specifically interested in weight management, hormone re-balancing, and longevity. The American College of Physicians has recognized them as Fellows, FACP, for their excellence and contributions to medicine and the broader community. They enjoy teaching, volunteering, and advocating for their patients. Their mission is to share simple, effective, and proven strategies that lead to meaningful, sustainable, and long-lasting well-being.