Very often I get that question: “What is a fatty liver, I keep on reading about that?” or “Could I have a fatty liver? And if so, what does it mean for my health in general and can you get rid of it?”
Yes you can, is the answer.
The liver is a very important organ. It processes anything you eat or drink. It “repackages” what you ingest for your body to use, or helps eliminate what is toxic. It has to be healthy for you to be healthy.
Fatty liver, as we call it, is a “silent disease” that is growing at an alarming rate and now not only affects adults but also children. In the US, it is the most common form of chronic liver disease, affecting an estimated 80 to 100 million people – which comes out to almost a third of the population!
It covers a range of liver conditions affecting people who drink little to no alcohol, meaning that you can develop fatty liver even if you don’t drink any alcohol at all.
There is a distinction to be made between NAFLD, which is “non-alcoholic fatty liver disease,” and NASH, which is “non-alcoholic steatohepatitis.”
The main characteristic of NAFLD is too much fat stored in your liver cells. Hence the analogy with the duck or goose-based “foie gras”, a French food delicacy – for some, which is a form of liver pâté which literally means “fatty liver.” The geese are fed excessively against their will until, well, you know the end (It is a barbaric custom and some US states like California even forbid its sale). And this is exactly what is happening to your liver when you eat too much of the bad stuff.
NASH, on the other hand, is marked by liver inflammation, which may progress to scarring and eventually, irreversible liver damage. This damage is similar to the one caused by heavy alcohol use, which is why NASH can progress to cirrhosis and ultimately liver failure.
NASH occurs in every age group but especially in people in their forties and above who are at high risk because of such factors:
-Type 2 diabetes
-Metabolic syndrome, a combination of issues such as increased abdominal fat, insulin resistance, high blood pressure and high blood levels of triglycerides (which are a type of fat roaming in your blood).
NASH usually causes no signs and symptoms initially.
When it does, they may include:
-Enlarged liver – a doctor could initially detect this via palpation
-Pain in the upper right abdomen
-Difficulty losing weight
Possible signs of an advanced disease include more severe symptoms such as abdominal swelling, enlarged spleen and signs of jaundice, or yellowing of the skin.
What Are the Causes?
Experts don’t know exactly why some people accumulate fat in the liver. Similarly, there is limited understanding of why some fatty livers develop inflammation that progresses to cirrhosis. But the causes are mostly:
– Being overweight or obese
– Having an unhealthy diet – high in calories, sugar, processed foods and unhealthy fats
– Insulin resistance
– High blood sugar indicating pre-diabetes or Type 2 diabetes
– High levels of fats, particularly triglycerides, in the blood
These combined health and lifestyle problems appear to promote the deposit of fat in the liver. This excess fat acts as a toxin to liver cells, causing liver inflammation.
How Can I Prevent a Fatty Liver?
It is a lifestyle choice!
Choose a healthy diet, mostly plant-based that’s rich in fruits, non starchy vegetables, proteins, real whole grains and healthy unsaturated fats. Favor organic fresh food and home-cooked meals because you control the source and the ingredients.
Try to limit or avoid alcohol, fried foods, processed foods, excess sugar and sodas. In fact if you have a fatty liver, you really should totally eliminate them!
Maintain a healthy weight. If you are overweight or obese, reduce the number of calories you eat each day and get more exercise. Make sure to do this safely and sustainably with the help of your doctor or nutritionist.
If you are already at a healthy weight, maintain it and build muscle mass. Remember that the waist/hip ratio or WHR (waist circumference divided by hips circumference) for a healthy person should not exceed 85% for a woman and 90% for a man. And a healthy fat versus body weight ratio for an average person should not exceed 32-35% (women) and 25-28% (men). Do you know your numbers?
Exercise at least 5 days or 5 X 30 minutes a week. Make sure to get approval from your doctor first if you have not been exercising regularly recently. It doesn’t have to be a marathon… even 30 minutes of walking a day will make an impact. If you are able, working on strength training in addition to cardio will help you achieve your goals by building muscle mass, which will make you burn more calories at baseline. I talk about all the nitty-gritty details in my book, in Chapter 6!
How to Diagnose It
This is a question I get a lot. “I am not losing weight, could it be my thyroid (we covered this in the last newsletter), my hormones, insulin resistance?”
Well, it could be your liver. But for your liver, it is not just a question about losing weight, it is also a question of doing it by eating properly! And potentially having to eliminate alcohol.
NASH is not well understood or diagnosed because it has recently been discovered and does not present with any symptoms initially.
My gastroenterologist diagnosed me with a fatty liver at age 45. It was an incidental finding while I was being investigated for abdominal pain. I underwent a CT scan and my doctor told me I had a fatty liver. At that time I was overweight, and eating quite unhealthily.
If you’re worried you might have a fatty liver, start by talking to your primary care provider and ask for some blood tests. These might include:
– Complete blood count
– Liver enzyme and liver function tests
– Fasting blood sugar
– Hemoglobin A1c
– Lipid profile, which measures blood fats, such as cholesterol and triglycerides
Doctors may also check for other issues such as chronic viral hepatitis (hepatitis A, hepatitis C and others) or perform a celiac disease screening test.
The next stage may meet resistance for cost control issues. But if your bloodwork indicates you may have NASH, imaging is the next step and may include:
– Ultrasound, which is often the initial test when liver disease is suspected.
– CT scanning – this is what I had done – or MRI These techniques lack the ability to distinguish NASH from NAFLD but will still help you.
If other tests are inconclusive, your doctor may recommend a liver biopsy.
Treatment and Lifestyle Options
The good news is that it is reversible if treated early enough.
The first line of treatment is usually weight loss through a combination of a healthy diet and exercise. Ideally, a loss of 10 percent of body weight is desirable. However, any weight loss will greatly help even if it is initially under 10%.
No alternative medicine treatments are proved to cure nonalcoholic fatty liver disease. But clinical trails are going on and new drugs could be approved in 2019-2020. In the meantime, the treatment is lifestyle based.
You heard me: there is no miracle pill.
And even when these treatments will hit the market, do you think this is really the solution?
Take good care of your diet and lifestyle. Some plants and supplements can help your liver but are not a panacea or a cure for fatty liver:
– Milk thistle, a supplement, contains silymarin, which as an anti-oxidant has been used widely for liver cleansing. But there is no clinical data to support such claim.
– Artichoke, as a whole. This wonderful vegetable offers many health benefits including 6-10g of fiber per artichoke. But it also contains cynarin that helps increase the production of bile to break down food.
– Dandelion, another plant that can be eaten as a salad or drunk as a tea and offers similar benefits to artichokes.
Drinking a lot of water is important too. I am saying water, not coffee or sodas.
As always, I’m here for any questions about this or any other health concerns. Email me to set up a consultation. I hope you have a happy and healthy first post-Labor Day week!
All my best, Veronique
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