October 7, 2023
Have you received a diagnosis of fatty liver from your doctor? If so, you might have been told that it’s not a cause for immediate concern, but that you should take care of it and have regular check-ups. This is a common scenario I encounter in my clinic, in which patients with fatty liver disease have progressed to more advanced stages if they do not make changes to their lifestyle choices, specifically their diet.
The liver, the largest solid organ in the body located beneath the ribcage on the right side, performs over 500 vital functions to maintain a healthy body. It detoxifies the bloodstream, regulates blood sugar levels, controls blood clotting, and more.
Fatty liver disease occurs when the liver becomes inflamed, leading to the abnormal accumulation of fat in liver tissue. Various factors can trigger this condition, including viral hepatitis, certain medications like tamoxifen or steroids, and excessive alcohol consumption.
On the other hand, Non-Alcoholic Fatty Liver Disease (NAFLD) is primarily caused by metabolic risk factors associated with lifestyle choices. NAFLD is more prevalent among individuals with high blood pressure, high cholesterol, insulin resistance (prediabetes), or type 2 diabetes. It’s also common in overweight or obese people.
NAFLD prevalence rose more than 50% globally from 1990 to 2019, with the African and Middle Eastern regions identified as hotspots. This is according to data presented at the ACG Annual Scientific Meeting.
NAFLD encompasses a spectrum ranging from Non-Alcoholic fatty liver (NAFL), a milder form, to Non-Alcoholic steatohepatitis (NASH), a more severe condition. In NAFL, the liver has excess fat without signs of inflammation, while in NASH, hepatic steatosis (fatty liver) is accompanied by lobular inflammation and apoptosis, which can lead to fibrosis and cirrhosis.
Since NAFLD often presents no symptoms, it typically comes to medical attention when other tests performed for unrelated reasons reveal a potential liver issue. This could be due to an abnormal ultrasound scan or elevated liver enzyme levels.
Currently, there are no specific medical treatments for non-alcoholic fatty liver disease as per medical guidelines. The primary approach to addressing this condition is to make positive lifestyle changes, including adopting a healthy diet and exercising regularly. In essence, the solution to this complex problem lies in treating the root cause of the disease. This often results from poor lifestyle choices leading to weight gain, high blood pressure, inflammation, and insulin resistance, ultimately culminating in NAFLD.
In other words, the best strategy to prevent liver damage from starting or reverse liver disease once it’s in the early stages is to start with research-based dietary solutions
Here I have listed 6 key recommendations to prevent and reverse NAFLD
The Mediterranean diet, characterized by low saturated fat and animal protein intake, high levels of antioxidants, fiber, and monounsaturated fatty acids (MUFA), along with an appropriate balance of omega-3 to omega-6 fatty acids, represents a healthy dietary pattern. Extensive research has demonstrated its effectiveness in reducing the risk of cardiovascular disease (CVD), metabolic syndrome (MetS), and type 2 diabetes. The latest evidence strongly suggests its pivotal role in the prevention and potential reversal of fatty liver disease.”
Fructose is a natural sugar found in fruits, fruit juices, certain vegetables, and honey. When consumed in these natural forms, fructose can be a healthy part of your diet.
It’s important to be aware that fructose makes up 50 percent of table sugar (sucrose), which is a combination of glucose and fructose. However, a large portion of your dietary fructose today comes from high-fructose corn syrup, an industrial form of sugar, which is added to many processed foods such as sodas, candies, ketchup, chips, and various other products that you may not even know about.
While naturally occurring fructose can be part of a balanced diet, excessive consumption of added fructose, especially in the form of sucrose or high-fructose corn syrup, can lead to health issues. Based on the accumulating evidence, it has become evident that excessive dietary intake of added fructose is a significant contributor to the development of Non-Alcoholic Fatty Liver Disease (NAFLD) and its associated complications.
Considering that sugar consumption has skyrocketed from a mere 4 pounds per person per year in the 1700s to approximately 120 pounds per person per year today. Therefore, fructose-induced NAFLD should be viewed as a critical public health concern. Reducing added fructose consumption is a crucial recommendation for preventing and managing NAFLD.
3. Replace saturated fat sources with healthy fats in your daily diet
Saturated fats, which are solid at room temperature, are commonly found in animal products such as meat, eggs, chicken, fish, and meat-based products like sausages, bacon, beef, and hamburgers. They are also present in whole milk, butter, cheese, and dairy desserts and certain plant-based foods like coconut oil, palm oil, and cocoa butter. Recent research published in Diabetes Care, a peer-reviewed medical journal, highlights that saturated fat may have a more significant impact on liver fat accumulation than sugar.
The key here is substitution. When reducing your saturated fat intake, it’s crucial to consider what you’re replacing it with. Instead of eliminating saturated fats and replacing them with refined carbohydrates, opt for nutrient-dense foods rich in beneficial fats such as Polyunsaturated Fats (PUFAs), especially those rich in long-chain omega-3 fatty acids, and Monounsaturated Fats (MUFAs). Some examples include nuts, seeds, flaxseeds, chia seeds, olives, avocados, and fatty fish like sardines, salmon, and mackerel. In addition, to plant-based oils like olive oil, peanut oil, and sesame oil.
4. Identify and replace ultra-processed food with whole foods
Over the past four decades, consumption of ultra-processed food products has risen worldwide, irrespective of economic status. These products have infiltrated our supermarket shelves, fast-food establishments, street food vendors, kitchens, and refrigerators. While these foods offer convenience, they come at a significant health cost. A comprehensive population study in China found a 6% increase in NAFLD risk with the consumption of just 60 grams of ultra-processed foods daily. For instance, consuming a 330 ml can of soda could raise the risk by a staggering 33%. It’s essential to recognize these foods in your daily diet and proactively replace them with whole foods that are rich in fiber. These include whole grains, vegetables, fruits, legumes, nuts, and seeds.
5. Keep yourself away from excess alcohol consumption
Moderate or heavy alcohol consumption can exacerbate liver damage and increase fat accumulation in individuals with NAFLD. Consequently, patients with NAFLD should abstain from alcohol entirely whenever possible. If complete abstinence is not feasible, it becomes crucial to minimize alcohol intake to the recommended levels, which are less than 2 drinks per day for men and 1 drink per day for women.
Make it a daily habit to engage in at least 30 minutes of active movement. Lifestyle adjustments, such as shedding excess weight through a calorie-controlled diet and incorporating regular exercise, form the cornerstone of NAFLD treatment when pharmacological interventions are not involved. Increased physical activity and muscle-strengthening exercises have been linked to a reduced risk of NAFLD.
Various forms of physical activity have shown benefits in lowering NAFLD risk. This includes engaging in moderate to vigorous recreational activities, vigorous travel activities, and, to a moderate extent, work-related physical activity. Muscle-strengthening exercises have consistently demonstrated a reduced risk of NAFLD in most cases.
In a study involving 21,015 participants, of whom 4,942 (approximately 23.5%) had NAFLD, it revealed that individuals who committed to a minimum of 150 minutes of total physical activity per week had a decreased risk of NAFLD when compared to those who engaged in less physical activity. The risk of NAFLD was further reduced for individuals who performed muscle-strengthening exercises twice a week.
Bottom Line: If you’ve received a diagnosis of fatty liver disease, it’s essential to take proactive steps to manage and potentially reverse this condition. While NAFLD often remains asymptomatic, it’s crucial to address it early to prevent its progression. Medical guidelines currently do not offer specific pharmaceutical treatments, emphasizing lifestyle changes as the primary approach. By following these evidence-based dietary and lifestyle recommendations listed above, you can take proactive steps to prevent and manage the fatty liver disease.
Engage in a conversation with your nutritionist to tailor your dietary choices according to your unique eating habits, ensuring you derive the maximum benefit from your nutritional plan.