Fatty liver disease, medically known as hepatic steatosis, develops when excessive fat accumulates in the liver. If a person consumes little or no alcohol, it is non-alcoholic fatty liver disease (or NAFLD). The prevalence of NAFLD is on the rise worldwide, especially in Western countries, where it is the leading cause of chronic liver disease.
Currently, an estimated 25% of Americans have NAFL. About 20% of individuals with NAFL develop non-alcoholic steatohepatitis (or NASH), which is a more aggressive form of fatty liver disease that may progress to liver cirrhosis, cancer, or liver failure.
Fatty liver causes
Scientists believe that a combination of genetic, environmental, and lifestyle factors contribute to fatty liver. Factors that contribute to NAFL and NASH include excess weight, insulin resistance, diabetes, and high triglyceride levels in the blood. Other related conditions that may increase the risk of fatty liver include polycystic ovary syndrome (PCOS), sleep apnea, and low thyroid hormones (hypothyroidism). NASH is more likely.
Certain environmental chemicals, including volatile organic compounds, pollutants, and metals like arsenicum, lead, and mercury, are linked to the development of NAFL in some cases.
Fatty liver symptoms
NAFLD usually causes no signs and symptoms until the disease progresses to NASH. In this case, a person may experience pain and sensation of fullness in the upper right of the abdomen, right below the ribs; this is where the liver is located. If the disease progresses, abdomen swelling, enlarged spleen, and yellowing of the skin and eyes may occur. Fatigue and weakness are common complaints in advanced fatty liver disease (NASH).
Fatty liver diagnosis
Since fatty liver symptoms are not present in many cases, doctors may suspect this condition when liver enzymes are higher than normal. The levels of liver enzymes rise when the liver is injured, and additional tests like ultrasound or CT scans can further evaluate the liver injury. Fibroscan is a special form of ultrasound that can be used as an alternative to liver biopsy to assess how much fat or scar tissues are in the liver.
Blood tests, including CBC (complete blood count), testing for hepatitis A and C, blood sugar levels, and lipid profile can help provide more information relevant to the diagnosis and rule out other conditions.
Fatty liver treatment
According to experts, the most effective fatty liver treatment involves lifestyle changes, not medication. There is no FDA-approved drug currently on the market, but a few drugs are being researched. As for supplements, studies suggest that vitamin E and omega 3 may help manage fatty liver. Lifestyle changes that can help include:
- Healthy weight loss. Shedding those extra pounds can make a huge difference in managing fatty liver. Simply losing 5% of the body weight can help reduce liver fat and improve liver enzyme levels. If you lose up to 10% of your body weight, you reduce inflammation and injury of the liver and potentially reverse the damage caused by cirrhosis (liver scars). For best results and long-term weight loss maintenance, doctors recommend losing no more than 2 pounds per week. Losing more than 1.6 kg per week, meaning a bit over 3 pounds, may trigger more inflammation and worsen this condition.
- Stay active. Any form of exercise can help improve fatty liver, but moderate aerobic exercise and high-intensity workouts are particularly beneficial. Consistency is key because the benefits of exercise come when you work out regularly. Aim for 30-60 minute exercise most days of the week.
- Follow a fatty liver diet. The research found that a Mediterranean diet could be a great choice, particularly effective in decreasing the fat in the liver and helping with associated conditions. It promotes weight loss and improves blood sugar levels and lipid profile.
Fatty liver diet
While there is no special “fatty liver diet”, using the principles of the Mediterranean diet is a good start. This diet emphasizes the consumption of whole foods: plenty of fresh vegetables, whole grains, fruits, legumes, some nuts and seeds, and healthy oils like olive oil. You can also consume cheese, yogurt, and other dairy products daily in small amounts. Eat fish and poultry a few times a week, while red meat should be consumed rarely and in small amounts. Consider eliminating processed foods, and replacing salt with herbs and spices to add flavor to your food. Fresh fruits can replace cakes or candies for deserts.
Beyond a simple dietary pattern, the Mediterranean plan emphasizes staying active, socializing, and enjoying meals with loved ones.
What foods help repair fatty liver?
Researchers have examined several foods from the Mediterranean diet. For example, green leafy vegetables in general, and spinach, in particular, support a healthy liver due to the high content of polyphenols, nitrates, and vitamins. Fish, olive oil, nuts, and seeds are rich in omega-3 fatty acids, which help reduce liver inflammation and improve digestion and cholesterol levels. Whole grains, particularly oats, can help manage fatty liver and associated conditions like diabetes and high cholesterol.
To drink or not to drink coffee? If you enjoy your cup of java, go ahead and continue to drink it. Some research suggests that those with NAFLD who have about two cups of coffee daily have a lower risk to develop scars (fibrosis) in the liver.
To have or not to have an occasional glass of wine? You can have a glass of wine with meals following the Mediterranean diet. Although some studies suggest that low/moderate alcohol consumption may protect against developing NAFLD, alcohol is not beneficial for those who already have fatty liver. Consuming alcohol even in modest amounts may promote disease progression, and slow the improvements. Avoid drinking any alcohol in case of alcoholic fatty liver disease.
Vital liver functions
The liver has over 500 vital functions in the body. It plays a key role in digestion because it produces bile, and is involved in the metabolism of fats, proteins, and sugar helping convert nutrients into energy. It detoxifies the body, supports the immune system, stores iron, and regulates blood clotting.
While fatty liver rarely causes serious problems, it can complicate NASH and lead to liver cirrhosis, cancer, or liver failure. The good news is that the liver has an amazing ability to repair, and simple lifestyle changes can help reverse this condition.
Armand, W (2020). Fatty liver disease: What it is and what to do about it. Harvard Health Publishing.
Fatty Liver Foundation. Fibroscan.
John Hopkins Medicine. Liver: Anatomy and Functions.
Sookoian, S., Pirola, C. J., Valenti, L., & Davidson, N. O. (2020). Genetic Pathways in Nonalcoholic Fatty Liver Disease: Insights From Systems Biology. Hepatology.
Suárez, M., Boqué, N., Del Bas, J. M., Mayneris-Perxachs, J., Arola, L., & Caimari, A. (2017). Mediterranean Diet and Multi-Ingredient-Based Interventions for the Management of Non-Alcoholic Fatty Liver Disease. Nutrients.
Wahlang, B., Jin, J., Beier, J. I., Hardesty, J. E., Daly, E. F., Schnegelberger, R. D., Falkner, K. C., Prough, R. A., Kirpich, I. A., & Cave, M. C. (2019). Mechanisms of Environmental Contributions to Fatty Liver Disease. Current environmental health reports.
Weng, G., & Dunn, W. (2019). Effect of alcohol consumption on nonalcoholic fatty liver disease. Translational gastroenterology and hepatology.