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Fatty Liver: Facts We Should All Know and How to Fix It

Liver is the largest organ in our body, weighing about 1500g. In addition to performing hundreds of functions for nutrient metabolism and storage, liver also forms and excretes bile. Liver health is also intricately linked to skin health. Fatty liver is a common health condition caused due to excess and unintentional build-up of fat in the liver. Mostly, it’s asymptomatic until it’s quite severe. Though it’s not fatal but often, it can lead to liver damage when fat reaches 5% to 10% of your liver’s weight. It is also the beginning of several dangerous health conditions such as insulin resistance and inflammation leading to Diabetes, Hypertension, High cholesterols, Abdominal and visceral obesity, etc.

Why is fatty liver disease bad?

Fatty liver disease doesn’t acutely prevent your liver from functioning normally. But for 7% to 30% of people with the condition, fatty liver disease gets worse over time. It progresses through three stages:

  1. Liver becomes inflamed, which damages its tissue. This stage is called STEATOHEPATITIS.

  2. Scar tissue forms where the liver is damaged. This process is called FIBROSIS.

  3. Extensive scar tissue replaces healthy tissue. At this point, people will end up with a condition called CIRRHOSIS OF LIVER.

Cirrhosis of the liver

Cirrhosis of the liver is a result of severe damage to the liver by diffused necrosis and regeneration, leading to an increase in fibrous tissue formation disrupting the normal liver structure .The hard scar tissue that replaces healthy liver tissue slows down the liver’s functioning. Eventually, it can block liver function entirely. Cirrhosis can lead to liver failure and liver cancer if not treated and managed on time.

What are the forms of fatty liver disease?

There are two main forms of fatty liver disease:

  1. Alcoholic Liver Disease: Alcoholic fatty liver is a condition resulting from excessive alcohol ingestion, characterized by fatty liver (hepatic steatosis), hepatitis, or cirrhosis. (Moderate drinking is defined as one drink a day for women and up to two drinks per day for men.)

  2. Non-Alcoholic Fatty Liver Disease: Non-Alcoholic Fatty Liver Disease (NAFLD) is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. When we have fatty liver, the liver starts exporting the fat in the form of VLDL to the rest of the body through blood resulting in high cholesterol and triglycerides. This fat gets deposited around the viscera and we get visceral fat, high waist size and metabolic syndrome. The insulin resistance from the liver because of liver fat causes hyperinsulinemia which causes the rest of the body to also become insulin resistant and then develop prediabetes and type 2 Diabetes. The condition affects one in three adults as per the latest studies conducted. Some individuals with NAFLD can develop Non-Alcoholic Steatohepatitis (NASH), an aggressive form of fatty liver disease, which is marked by liver inflammation and may progress to advanced scarring (cirrhosis) and liver failure. This damage is similar to the damage caused by heavy alcohol use. Factors, such as obesity and diabetes, etc can increase your risk.

Harmful effects of NAFLD

  • Obesity when fat is concentrated in the abdomen

  • Type 2 diabetes and insulin resistance.

  • High BMI and Waist circumference

  • High triglycerides and low HDL cholesterol level: Low serum concentration of HDL-C and higher concentrations of triglycerides, the key features of insulin resistance dyslipidemia, were significantly different between patients with and without NAFLD.

  • Other conditions of metabolic syndrome - high blood pressure, high LDL cholesterol

Causes of NAFLD

  • Excessive dietary intake of the following

    • Fructose in added sugar

    • Trans fats

    • BCAAs in processed proteins, especially animal-based

    • Alcohol

  • Exposure to the following environmental factors

    • Chemicals found in micro plastics

    • Air and water pollutants

    • Some prescription medications

What are the symptoms of fatty liver disease?

People with fatty liver disease often have no symptoms until the disease progresses to cirrhosis of the liver. If you do have symptoms, they may include:

  • Abdominal pain or a feeling of fullness in the upper right side of the abdomen (belly).

  • Nausea, loss of appetite or weight loss.

  • Yellowish skin and whites of the eyes (jaundice).

  • Swollen abdomen and legs (edema).

  • Extreme tiredness or mental confusion.

  • Weakness

Possible signs and symptoms of NASH and advanced scarring (cirrhosis) include:

  • Enlarged blood vessels just beneath the skin's surface

  • Enlarged spleen

  • Red palms

Liver and Skin Health

Did you know that our skin health is inextricably linked to our liver health? Our liver is the main centre of detoxification in our body and any injury to our liver through consuming too many toxins shows up in all associated organ systems in our body, including notably on our skin. Too many toxins can leave our liver overwhelmed and unable to effectively carry out its job of eliminating used hormones, leading to an excess of certain types of hormones that can cause skin issues like acne. Also, when the liver is unable to break down toxins, our bodies try to remove these toxins through other ways, such as via our skin and this can cause inflammation showing up as eczema, psoriasis, acne, rosacea and rashes. If we want to have a glowing skin, we need to start by improving our liver health.

What are some of these toxins? These come in the form of alcohol, excess sugar, excess animal proteins and trans fats. These food items are not acute toxins but they do cause injury to the liver in the long run. Other chemical toxins are pesticides, antibiotics and growth hormones in our food supply chain, microplastics in food containers, air and water pollutants, food additives and preservatives, cigarette smoke, certain medications and pathogens in the air. Over time these toxins build up and our liver is no longer effective at purging our bodies of these chemicals.

So, what should we do? Let’s follow a three-pronged strategy:

1. Avoid foods that are harmful for the liver such as alcohol, added sugars, trans fats, branched chain amino acids rich proteins and processed and refined foods in general. We should also avoid red meats, large fish because they can contain heavy metals like mercury, lead and cadmium

2. Increase foods that are liver-protective such as natural fibre rich foods such as vegetables, fruits, legumes, beans and whole grains. Foods which are rich in antioxidants and micronutrients like nuts, berries, amla and pomegranate, etc. also support and protect the liver. They also have micronutrients such as Vitamin E for skin health. As much as possible, look for locally and organically grown foods

3. Make lifestyle changes such as quit smoking, exercise regularly, get proper sleep, manage stress through yoga and meditation and get adequate sunshine and nature exposure. From a skin health perspective, avoid excessive cosmetics and keep the skin clean, chemical-free and moisturized.

Lastly, if you are having any skin issues or liver health issues, please consult a physician immediately and follow their medical advice.

How is fatty liver disease diagnosed?

Because fatty liver disease often has no symptoms, your doctor may be the first one to spot it. Higher levels of liver enzymes (elevated liver enzymes) that turn up on a blood test for other conditions may raise a red flag. Elevated liver enzymes are a sign your liver is injured. To make a diagnosis, your doctor may order:

  • Ultrasound or computed tomography (CT scan) to get a picture of the liver.

  • Liver biopsy (tissue sample) to determine how far advanced liver disease has progressed.

  • Fibro Scan, a specialized ultrasound sometimes used instead of a liver biopsy to find out the amount of fat and scar tissue in the liver.

How is fatty liver disease treated?

There is no medication specifically for fatty liver disease. Instead, doctors focus on helping you to control factors that contribute to the condition. They also recommend making lifestyle changes that can significantly improve your health. Treatment includes:

  • Avoiding alcohol, added sugars, branched chain amino acids in processed proteins and trans fats

  • Losing weight through exercise and more physical activity

  • Following a low saturated fat healthy balanced diet practices

  • Taking medications to control diabetes, cholesterol and triglycerides (fat in the blood)

  • Taking vitamin E and certain supplements such as milk thistle to lower liver fat

How can fatty liver disease be prevented?

The best way to avoid fatty liver disease is to do the things that maintain overall health:

  • Stay at a healthy weight. If you’re overweight or obese, lose weight gradually

  • Follow a healthy personalized meal plan to lose weight, control diabetes and cholesterol levels

  • Exercise regularly

  • Limit your consumption of alcohol, added sugars, branched chain amino acids in processed proteins and trans fats

Role of Fiber in Liver Health

Foods high in fiber can help protect your liver from building liver fat, inflammation and insulin resistance. They also help keep your blood sugar and electrolytes in range. Choose foods that contain natural dietary fiber, especially the water-soluble forms of dietary fiber that are found in legumes, vegetables, fruits and whole grains. A soluble form of fiber called beta-glucan can lower the rise in your blood glucose level following a meal.

Additionally, soluble fibers are fermented in your colon to produce short-chain fatty acids that help prevent your liver from secreting too much glucose into your blood overnight. The liver produces, stores and releases glucose depending on the body’s need for glucose, a monosaccharide. This is primarily indicated by the hormones insulin – the main regulator of sugar in the blood – and glucagon. In fact, the liver acts as the body’s glucose reservoir and helps to keep your circulating blood sugar levels and other body fuels steady and constant.

Can fatty liver disease be reversed?

The liver has an amazing ability to repair itself. If you avoid alcohol, follow a healthy lifestyle by having a healthy balanced meal plan and physical activities, it’s possible to reduce liver fat and inflammation and reverse early liver damage.

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