Fatty Liver

A liver is deemed fatty if it is more than 5% fat. This disorder is of two types, one caused due to excessive alcohol consumption (alcoholic liver disorder) and non alcoholic fatty liver disorder (NAFLD) caused due to other lifestyle factors such as unhealthy diet, obesity, diabetes etc. NAFLD can be reversed at initial stages but if left untreated it may further progress into non alcoholic steatohepatitis or liver cancer.


Causes

Obesity: overweight adults, adults with higher visceral fat as well as children are at higher risk of developing fatty liver.

Refined carbohydrates: diets rich in refined carbs such as packaged foods, baked goods and sugary beverages promote accumulation of fat in the liver especially in obese individuals.

Diabetes: higher insulin levels and increased insulin resistance in cells have been shown to promote NAFLD.

Gut health: impaired gut health, imbalances in gut bacteria and other intestinal issues can aggravate fatty liver.


Symptoms

  1. Fatigue and weakness

  2. Pain in abdominal area

  3. Elevated levels of liver enzymes

  4. Elevated levels of triglyceride and insulin

Diet recommendations

It may seem that reducing fat from the diet may be beneficial in reversing NAFLD but multiple studies suggest that excess carbohydrate intake, especially in processed form, leads to fat buildup in liver through a biological process called de novo lipogenesis. Shedding excess body fat is a crucial step in reversing NAFLD and studies have found that cutting back about 500 calories a day promotes weightloss as well as decreases fat stored in liver of obese individuals. Diets such as the Keto, Mediterranean and Atkin’s are usually recommended by dietitians due to their restricted carb proportions.


Foods to have:

Unsaturated fats (MUFA & PUFA): food such as vegetable oils, fatty fish, seeds, nuts and nut butters.

Soluble fiber: oats, oat bran, rice bran, barley, citrus fruits, apple and potatoes.

Whey: milk and dairy products are the best sources of whey.


Foods to avoid:

Alcohol: major cause of fatty liver and liver cirrhosis.

Processed foods: white bread, pasta and rice contain high amounts of processed carbs.

Fried foods: rich in saturated fats, salt and calories.

Red meat: high in saturated fats.


Superfoods for NAFLD:

Walnuts: Good source of omega-3 fatty acids which aids in liver function.

Green tea: good source of antioxidants and may help in reducing fat absorption.

Olive oil: good source of omega-3 fats and helps in regulating liver enzymes.

Coffee: helps decelerate liver damage in sufferers of NAFLD.

Tofu: good source of protein and may help reduce fat buildup in liver.



References and further reading


American Society for Biochemistry and Molecular Biology. "Soy protein alleviates symptoms of fatty liver disease, study suggests." ScienceDaily. ScienceDaily, 22 April 2012.

<www.sciencedaily.com/releases/2012/04/120422162417.htm>.


Arslanow A, Teutsch M, Walle H, Grünhage F, Lammert F, Stokes CS. Short-Term Hypocaloric High-Fiber and High-Protein Diet Improves Hepatic Steatosis Assessed by Controlled Attenuation Parameter. Clin Transl Gastroenterol. 2016;7(6):e176. Published 2016 Jun 16. doi:10.1038/ctg.2016.28


Browning JD, Baker JA, Rogers T, Davis J, Satapati S, Burgess SC. Short-term weight loss and hepatic triglyceride reduction: evidence of a metabolic advantage with dietary carbohydrate restriction. Am J Clin Nutr. 2011;93(5):1048-1052. doi:10.3945/ajcn.110.007674


Chitapanarux T, Tienboon P, Pojchamarnwiputh S, Leelarungrayub D. Open-labeled pilot study of cysteine-rich whey protein isolate supplementation for nonalcoholic steatohepatitis patients. J Gastroenterol Hepatol. 2009;24(6):1045-1050. doi:10.1111/j.1440-1746.2009.05865.x


Eating, Diet, & Nutrition for NAFLD & NASH | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/eating-diet-nutrition. Published 2016. Accessed February 25, 2021.


Gupta V, Mah XJ, Garcia MC, Antonypillai C, van der Poorten D. Oily fish, coffee and walnuts: Dietary treatment for nonalcoholic fatty liver disease. World J Gastroenterol. 2015;21(37):10621-10635. doi:10.3748/wjg.v21.i37.10621


He X, Ji G, Jia W, Li H. Gut Microbiota and Nonalcoholic Fatty Liver Disease: Insights on Mechanism and Application of Metabolomics. Int J Mol Sci. 2016;17(3):300. Published 2016 Mar 15. doi:10.3390/ijms17030300


Nigam P, Bhatt S, Misra A, et al. Effect of a 6-month intervention with cooking oils containing a high concentration of monounsaturated fatty acids (olive and canola oils) compared with control oil in male Asian Indians with nonalcoholic fatty liver disease. Diabetes Technol Ther. 2014;16(4):255-261. doi:10.1089/dia.2013.0178


Paglialunga S, Dehn CA. Clinical assessment of hepatic de novo lipogenesis in non-alcoholic fatty liver disease. Lipids Health Dis. 2016;15(1):159. Published 2016 Sep 17. doi:10.1186/s12944-016-0321-5


Pallayova M, Taheri S. Non-alcoholic fatty liver disease in obese adults: clinical aspects and current management strategies. Clin Obes. 2014;4(5):243-253. doi:10.1111/cob.12068


Ramon-Krauel M, Salsberg SL, Ebbeling CB, et al. A low-glycemic-load versus low-fat diet in the treatment of fatty liver in obese children. Child Obes. 2013;9(3):252-260. doi:10.1089/chi.2013.0022


Romero-Gómez, Manuel, Shira Zelber-Sagi, and Michael Trenell. "Treatment of NAFLD with diet, physical activity and exercise." Journal of hepatology 67.4 (2017): 829-846.


Ryan MC, Itsiopoulos C, Thodis T, et al. The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. J Hepatol. 2013;59(1):138-143. doi:10.1016/j.jhep.2013.02.012


Sakata R, Nakamura T, Torimura T, Ueno T, Sata M. Green tea with high-density catechins improves liver function and fat infiltration in non-alcoholic fatty liver disease (NAFLD) patients: a double-blind placebo-controlled study. Int J Mol Med. 2013;32(5):989-994. doi:10.3892/ijmm.2013.1503


Schwarz JM, Noworolski SM, Wen MJ, et al. Effect of a High-Fructose Weight-Maintaining Diet on Lipogenesis and Liver Fat. J Clin Endocrinol Metab. 2015;100(6):2434-2442. doi:10.1210/jc.2014-3678


Spritzler F. Fatty Liver: What It Is, and How to Get Rid of It. Healthline. https://www.healthline.com/nutrition/fatty-liver. Published 2016. Accessed February 25, 2021.


Tajima R, Kimura T, Enomoto A, et al. Association between rice, bread, and noodle intake and the prevalence of non-alcoholic fatty liver disease in Japanese middle-aged men and women. Clin Nutr. 2017;36(6):1601-1608. doi:10.1016/j.clnu.2016.09.034


Tendler D, Lin S, Yancy WS Jr, et al. The effect of a low-carbohydrate, ketogenic diet on nonalcoholic fatty liver disease: a pilot study. Dig Dis Sci. 2007;52(2):589-593. doi:10.1007/s10620-006-9433-5


Watson S. Fatty Liver Diet: What Foods to Eat and What Foods to Avoid. Healthline.

https://www.healthline.com/health/fatty-liver-diet. Published 2019. Accessed February 25, 2021.


Yoshimura E, Kumahara H, Tobina T, et al. Lifestyle intervention involving calorie restriction with or without aerobic exercise training improves liver fat in adults with visceral adiposity. J Obes. 2014;2014:197216. doi:10.1155/2014/197216