Fatty Liver Disease: How You Can Slay This Silent Killer
- 10 Mins Read
- Health Conditions
- Written by: Reshma Pathare
- Reviewed by: Blessing Maduelosi, Pharmacist
- Fatty liver is caused by excessive accumulation of fatty lumps in the liver.
- There are two types of fatty liver disease, viz. alcoholic and non-alcoholic.
- A small part of fatty liver disease is also attributable to hepatic metabolic dysfunction, arising out of malnutrition or eating disorders.
- An unhealthy diet leads to a fatty liver by deposition of excessive fats in the liver, derived directly from the unhealthy foods.
- Excessive alcohol consumption causes fatty liver disease by excessive deposition of triglycerides, owing to problems with hepatic lipid metabolism.
- Symptoms of fatty liver disease include yellowing of eye whites, loss of appetite, and swelling of feet, among others.
- Symptoms show up only at a later stage, but are more probable in older people, who have genetic complications, eat an unhealthy diet, or have infections like Hepatitis C.
- Prevention of the fatty liver requires foods rich in protein, fiber, and vitamins. Coffee, walnuts, flaxseed, and garlic are all good for fatty liver.
- Meats like beef, lamb, and pork that are high in saturated fats are best avoided to prevent fatty liver. White meats like chicken and turkey, and fish like salmon and tuna are better choices.
- Fatty liver, if allowed to continue for long, can lead to scarring and then cirrhosis.
The liver, when healthy, has a smooth surface. When suffering from fatty liver disease, this organ has a sickening appearance, lumps of fat pushing against its surface from inside, like warts.
So called because of the deposition of fat inside the liver, this disease is the first stage of liver trouble, and it can be of two types: alcoholic and non-alcoholic fatty liver disease (NAFLD).
Fatty liver disease progresses to hepatitis and then comes cirrhosis. The first two stages are reversible, the third is not. Cirrhosis may even lead to death.
Decoding fatty liver disease
Simply put, fatty liver disease is a health condition caused by the accumulation of excessive fats in the liver. Usually, a small amount of fat is stored in the liver. But, when more than 5% of the liver is composed of fat, the liver is said to be fatty.
In the initial stage, this does not alter the function of the liver as the body has mechanisms in place that allows the liver cells to regenerate. However, over time the liver may degenerate.
The excess fats lead to extra pressure on the liver, making it difficult to produce bile and remove toxins. This eventually leads to inflammation of the liver.
Usually, there are three stages through which a fatty liver disease progress:
• Stage 1: Inflammation of the liver leading to tissue damage (steatohepatitis)
• Stage 2: Formation of scar tissue in areas where the liver is damaged (fibrosis)
• Stage 3: The scar tissue takes over healthy liver tissue, leading to cirrhosis. Cirrhosis is what leads to liver cancer and liver failure.
In the first two stages, the liver functions well despite the damage. In the third stage, things take a critical turn.
According to data:
- Globally, around 4.5%-9.5% of the general adult population suffers from cirrhosis. Two of the three main factors for this cirrhosis are Alcoholic, and Non-Alcoholic steatohepatitis (NASH).
- Globally, around 20% of the people having NAFLD, suffer from NASH, which is an inflammatory form of NAFLD.
- Red meats and processed meats increase the chances of getting NAFLD by 50%.
- While comprehensive data about the non-alcoholic fatty liver disease (NAFLD) in Africa is less, a meta-analysis has pegged the prevalence of NAFLD in Africa to be 13%, with Nigeria having a 9% prevalence of the same.
- Liver cirrhosis, a complication of fatty liver disease, is responsible for between 53,000-103,000 deaths per year in Africa.
- Globally, around 4.5%-9.5% of the general adult population suffers cirrhosis. Two of the three main factors for this cirrhosis are alcoholic and nonalcoholic steatohepatitis (ASH & NASH), which are advanced stages of fatty liver disease.
- Globally, around 20% of people having NAFLD suffer from NASH, which is an inflammatory form of NAFLD.
- Consumption of red and processed meats increases the chances of getting NAFLD by 50%.
Non-Alcoholic Fatty Liver Disease
NAFLD is caused by a diet heavy in saturated fats and the person carrying an excessive amount of body fat.
Saturated fats put a lot of pressure on the liver. They’re found in food items like butter, beef, cream, and bacon, as well as in foods that are deep-fried, processed, or contain high levels of artificial sweeteners.
Being overweight or obese leads to excessive intrahepatic triglycerides (IHTG), a condition medically known as steatosis. This condition can be with or without inflammation. Either way, prolonged burdening of the liver with IHTG can lead to Type 2 diabetes, cardio-metabolic abnormalities like hypertension, and cardiac diseases.
When the volume of IHTG reaches more than 5% of the liver’s weight, it is said to be the onset of fatty liver disease. As the IHTG starts shooting up, it skews the metabolism of lipoproteins, fatty acids, and glucose. This disrupts the liver’s metabolic activities, leading to a ripple effect on the health of several organs.
NASH, the sub-type of NAFLD, is of greater concern because it causes inflammation of the liver. If not treated in time, NASH can lead to fibrosis, cirrhosis, and liver cancer.
Alcoholic Fatty Liver Disease
This is caused when the liver is tasked with metabolizing excessive amounts of alcohol. Heavy drinking for many years or frequent binge drinking over a shorter period puts a huge strain on the liver. This organ is primarily responsible for metabolizing ethanol, which is the main component of any alcoholic drink. The strain leads to scars and lesions, and other problems.
To begin with, excessive amounts of alcohol can lead to a rise in IHTG. That’s because more alcohol disrupts the ethanol oxidation process, and the hepatic lipid metabolism is messed up to the extent that the liver becomes a lipid-storing organ instead of a lipid-burning one.
Over time, these fat deposits can progress to inflammation, also because alcohol converts into formaldehyde, a toxic systemic inflammation-causing poison.
Without due intervention, an alcohol-burdened liver can suffer from various complications ranging from an enlarged liver, enlarged spleen, fluid build-up in the belly, alcoholic cirrhosis, alcoholic hepatitis, and liver failure.
Other causes of fatty liver
In very rare cases, a woman may develop acute fatty liver of pregnancy (AFLP). This is a genetic complication that arises in the third trimester of pregnancy. If it arises, imminent delivery of the child is the only way to treat the issue.
Surprisingly, malnutrition or eating disorders like anorexia can also lead to fatty liver disease. The sharp drop in food intake causes mitochondrial and metabolic dysfunction in the liver. Severely inadequate intake of proteins leads to a reduction in plasma triglycerides and phospholipids, along with an increase in free fatty acids. Taken together, these factors lead to a fatty liver.
Read more: Signs Your Liver Is Not Doing So well
Symptoms of fatty liver disease
Quite often, the fatty liver disease does not make itself obvious till it progresses to the stage of hepatitis and maybe even cirrhosis. There are a few symptoms, which must be recognized and responded to without waiting. They are:
- Pain in the upper-right side of the abdomen
- Yellowing of eye whites, nails, and skin (could be a sign of jaundice)
- Water retention and swelling in the ankles and feet
- Loss of appetite for many days on end
- Nausea and vomiting
- Drastic weight loss
- Fatigue and sluggish mental state
The symptoms can more often manifest in:
- People eating an unhealthy diet full of saturated fats
- People drinking excessive alcohol
- Menopausal women developing visceral fats
- Overweight or obese people
- Older individuals
- Diabetes patients
- People with high cholesterol
- People experiencing chronic stress
- People taking certain medications
- People with genetic complications that affect the liver
- People with infections like Hepatitis C
The best diet for Non-Alcoholic Fatty Liver
Fats are essential to the human body for the insulation of organs and as a storehouse of energy. However, excessive fats (especially, saturated fats) can mark the onset of fatty liver disease, even in people who are otherwise in good health.
Lifestyle management is the best way to reduce the deposition of fats in the liver in the early stages, while it’s still reversible.
Hence, dietary changes are the best way to salvage a non-alcoholic fatty liver.
- An apt diet for reducing the burden on a fatty liver includes foods rich in vitamins, proteins, good carbohydrates, fiber, and natural sugars.
- The ideal diet has no artificial sweeteners, processed foods, deep-fried foods, and refined foods, because all of these only put extra pressure on the liver, apart from increasing obesity.
- Certain foods are particularly prescribed to prevent or repair a fatty liver. These include decaffeinated coffee, foods like walnut and flaxseed that are rich in Omega-3 acids, garlic, and cruciferous vegetables like broccoli.
- While NAFLD develops in people who drink little to no alcohol, any individual with this condition has to completely stop drinking. A fatty liver is already overburdened by fat; it’s not in a position to deal with the additional fats from alcohol, however, small the quantity. A person with NAFLD could return to their very limited alcohol consumption once the fatty liver disease has been reversed.
Is meat good for fatty liver?
While most prescribed diets for fatty liver comprise plant foods (fruits, vegetables, nuts), those with a preference for meat often wonder what meat is good for fatty liver.
The answer is, that meats that are low in saturated fats can work for a fatty liver management diet (and a fatty liver prevention diet). These include white meats like chicken/turkey and fish. Beef, lamb, and pork are high in saturated fats, and best avoided.
Of course, the method of preparation matters, too. For instance, deep-fried fish or processed chicken will only add saturated fats to originally less-fatty meat. Cooking with less oil and using techniques like steaming, roasting, and boiling can help preserve their goodness, and taste, and not load them with fats.
Fish (such as salmon, tuna, and sardines) are excellent sources of Omega-3 fatty acids, which are beneficial for liver health as they reduce liver fat and IHTG.
Can fatty liver cause cirrhosis?
Liver cirrhosis is one of the complications arising from both types of fatty liver disease. It happens after many years of having a fatty liver, but once it sets in, liver cirrhosis is irreversible.
Cirrhosis means scarring of the liver, which happens when the liver tries to repair itself after every injury inflicted on it. In the process, scar tissues get formed. Beyond a certain level of scar tissue formation, it becomes increasingly difficult for the liver to carry out its functions; thus, the organ moves closer to liver failure.
Cirrhosis can be treated if detected in time, but its symptoms may not become very clear until the liver has already got very damaged. The likelihood of cirrhosis is very high in heavy alcohol drinkers, so they should proactively try to cut down on alcohol and, optionally, get a medical consultation about liver function, even if symptoms aren’t visible.
Obesity and viral hepatitis are other causes of cirrhosis. Obesity requires an urgent weight-loss plan, and viral hepatitis can be prevented to a large extent through hygienic personal habits.
The symptoms of cirrhosis include the symptoms of fatty liver disease, and it may additionally manifest itself through mental confusion. The damaged liver may not be able to process all the food and beverage toxins, and those may reach the brain through the bloodstream.
You must see a doctor if you start noticing signs such as your skin/nails yellowing, a loss of appetite and/or fatigue, ankles/feet swelling, and so on.
- Blood flow to the liver slows down
- Difficult for the body to fight infections
- Hepatic encephalopathy, a state where blood toxins reach the brain
- Enlargement of the spleen
- Drastic weight loss, as the body cannot process nutrients to the optimum
Cirrhosis goes through 3 stages: A, B, and C, which are mild, moderate, and severe, respectively. In the first two stages, the liver can function normally even though there’s damage. In the third stage, things can take a critical turn.
Diagnosis and treatment of fatty liver disease
The symptoms of fatty liver disease are not very conspicuous until the problem grows to a certain proportion. The best way to get an early diagnosis is to visit a doctor if you start seeing certain symptoms repeatedly or more often than normal.
A doctor will start the diagnosis process with a simple physical examination, followed by blood tests to check if the liver enzymes are above the normal range. An ultrasound and/or biopsy is prescribed if the problem seems grave.
Prevention is the best treatment for the fatty liver disease since the symptoms don’t show up until considerable damage is done to the liver.
To prevent fatty liver disease and the subsequent complications, it is best to do the following:
- Eat healthy food enriched with vitamins, fiber, protein
- Use cooking techniques that require very little oil
- Maintain a healthy physique via exercise to avoid the accumulation of abdominal fat
- Consume alcohol minimally or not at all
- Tackle chronic stress that leads to inflammation
In short, the treatment for fatty liver disease is choosing the lifestyle that you should’ve had before developing the disease. If you make this lifestyle change, fatty liver disease can be reversed.
In rare cases, doctors may prescribe medications containing Vitamin E, or medicines to control conditions like diabetes and high triglyceride levels as part of the fatty liver treatment.
Fatty liver is a problem that can be treated and reversed with minimal medication if diagnosed in time. You must not be complacent about taking cognizance of symptoms and getting a liver function test done.
It also takes a long time for fatty liver disease to become hepatitis (unless it’s viral hepatitis) and eventually cirrhosis. But if you don’t utilize this time to undo the damage, then cirrhosis and liver failure could become life-threatening.
Your liver health is largely in your own hands. The best gift you can give your liver is an active-living, healthy-eating, mentally-relaxing lifestyle that’s also perfect for your overall well-being.
- Fabbrini, E., Sullivan, S., & Klein, S. Obesity and Nonalcoholic Fatty Liver Disease: Biochemical, Metabolic and Clinical Implications. Hepatology. 2013, February 18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3575093/
- Natalia A. Osna, Terrence M. Donohue, Jr., Kusum K. Kharbanda. Alcoholic Liver Disease: Pathogenesis and Current Management Alcohol Res. 2017; 38(2): 147–161. PMCID: PMC5513682 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513682/
- Asian Journal of Advances in Medical Science – file:///C:/Users/HP/Downloads/1716-Article%20Text-3142-2-10-20201120%20(1).pdf
- Zobair M. Younossi. Non-alcoholic fatty liver disease – A global public health perspective. Journal of Hepatology. 2018, November 08 DOI:https://doi.org/10.1016/j.jhep.2018.10.033
- Fowler, P. & DerSarkissian, C. Fatty Liver Disease (Hepatic Steatosis). WebMD. 2021, November 04. https://www.webmd.com/hepatitis/fatty-liver-disease
- Johnson, J. & Hodgson, L. What to eat for a fatty liver. Medical News Today. 2021, September 29. https://www.medicalnewstoday.com/articles/320082#foods-to-avoid
- Gordon, S. Red and Processed Meats Linked to Liver Woes. WebMD. 2018, March 20. https://www.webmd.com/digestive-disorders/news/20180320/red-and-processed-meats-linked-to-liver-woes#:~:text=TUESDAY%2C%20March%2020%2C%202018%20(,precursor%20to%20type%202%20diabetes
- Mayo Foundation for Medical Education and Research (MFMER). 2021, February 06. https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-causes/syc-20351487#:~:text=Cirrhosis%20is%20a%20late%20stage,it%20tries%20to%20repair%20itself
- Fatty Liver Disease. Cleveland Clinic. 2020, July 31. https://my.clevelandclinic.org/health/diseases/15831-fatty-liver-disease#diagnosis-and-tests
- Kumar, V. & Ramalingaswami, V. Mechanism of Fatty Liver, in Protein Deficiency. Gastroenterology. 1972, March 01. https://www.gastrojournal.org/article/S0016-5085(72)80153-7/fulltext#:~:text=Protein%20deficiency%20resulted%20in%20a, a%20reduction%20in%20hepatic%20phospholipids
- Vasantha, K. S. & Shanker, G. K. Fatty Liver – Types, Symptoms, Stages, and Treatment. clinic. 2022, April 27. https://www.icliniq.com/articles/liver-diseases/fatty-liver-symptoms-grades-and-diagnosis
- Farooq, M. O. & Bataller, R. Pathogenesis and Management of Alcoholic Liver Disease. Karger. 2016, May 11.https://doi.org/10.1159/000444545