Your liver is your largest internal organ. It is also one of your most important organs that helps to remove waste and toxins and support blood sugar levels, hormonal health, and immune function. Fatty liver disease is one of the most common liver problems that may affect over a quarter of the population.
Let’s talk about fatty liver. In this article, I want to discuss what fatty liver is, its types, symptoms, causes, and risk factors. I will offer my best natural strategies to support liver health and improve fatty liver.
What Is Fatty Liver?
Your liver is your largest internal organ. It helps your body to process nutrients and remove waste and toxins from your blood. Fatty liver is also referred to as hepatic steatosis. You may develop fatty liver if there is a fat buildup in your liver.
A normal liver contains a small amount of fat, which is not a problem. Too much fat in your liver may lead to inflammation, liver damage, and scarring. This, eventually, may lead to liver failure, in serious cases.
Types of Fatty Liver
- Alcoholic fatty liver disease (AFLD): You may develop fatty liver if you drink alcohol excessively. This is called alcoholic fatty liver disease. According to a 2019 research paper published in JAMA Network, alcoholic fatty liver disease affects about 4.7% of the population and leads to about 250,000 deaths per year in the United States alone (1).
- Nonalcoholic fatty liver disease (NAFLD): You may also develop fatty liver without drinking alcohol. This condition is called nonalcoholic fatty liver disease. According to a 2017 study published in the World Journal of Gastroenterology, nonalcoholic fatty liver disease may affect up to 25 to 30 percent of the population in the United States and Europe (2). According to a 2020 study published in Translational Gastroenterology and Hepatology, it affects about a quarter of the population globally (3). Some people with nonalcoholic fatty liver disease may develop nonalcoholic steatohepatitis (NASH), which is a very aggressive type of fatty liver, associated with inflammation of this organ.
- Acute fatty liver during pregnancy: Some women may experience fat buildup during pregnancy. This is called acute fatty liver of pregnancy. According to a 2006 review published in the Canadian Journal of Gastroenterology, this condition is rare. It is a rather serious complication that may develop during the third trimester (4). Upon giving birth, your liver health should return to normal.
Stages of Fatty Liver
There are four stages of fatty liver disease:
- Simple fatty liver: This refers to fat buildup in the liver. At this stage, fatty liver is harmless as long as it doesn’t progress.
- Steatohepatitis: At this stage, there is inflammation in the liver along with fat buildup.
- Fibrosis: At this stage, there is persistent inflammation and scarring of the liver tissue. At this stage, the liver may still function mostly normally.
- Cirrhosis: At this stage, the scarring of the liver is widespread, severe, and irreversible, which can seriously impair liver function.
Symptoms of Fatty Liver Disease
Symptoms of alcoholic and nonalcoholic fatty liver disease are both similar. In many cases, especially at early stages, there are no symptoms. Some may only experience some discomfort in the upper area of the right side of the abdomen. Cirrhosis may cause more serious symptoms.
Potential symptoms of cirrhosis may include:
- Pain in the abdomen
- Loss of appetite
- Nausea
- Weight loss
- Weakness
- Fatigue and tiredness
- Yellow eyes and skin (jaundice)
- Itchy skin
- Bruising easily
- Bleeding
- Dark-colored urine
- Pale stools
- Edema (swelling) in the legs
- Ascites (accumulation of fluid in the abdomen)
- Web-like blood vessel clusters under the skin
- Confusion
- Enlargement of breasts in males
Risk Factors and Causes of Fatty liver
Fatty liver is caused by the accumulation of excess fat in the liver. Drinking too much alcohol is one of the main causes of fatty liver and can lead to alcoholic fatty liver diseases. Drinking too much alcohol may change the metabolic processes of the liver and may also cause your body to metabolize fat less effectively.
According to the Centers for Disease Control and Prevention (CDC), 15 or more drinks per week for men and eight or more for women is considered heavy drinking, which is the main risk factor for alcoholic fatty liver disease (5). According to a 2017 study published in Alcohol Research, drinking more than 40 to 80 grams of alcohol per day in men and more than 20 to 40 grams in women increases the risk of alcohol-related liver disease (6).
There may be other risk factors than drinking, though. According to a 2017 review published in Alcohol Research, besides drinking alcohol, the following issues may increase the risk of alcoholic fatty liver disease (7):
- Obesity
- Smoking
- Genetics
- Older age
- Certain infections, such as hepatitis C
In people that don’t drink alcohol, obesity, insulin resistance, type 2 diabetes, metabolic syndrome, and higher fat levels in the blood may increase the risk of nonalcoholic fatty liver disease. Factors that may increase the risk of nonalcoholic fatty liver disease may include (8):
- Being overweight or obese
- Insulin resistance
- Prediabetes
- Type 2 diabetes
- Metabolic syndrome
- High triglycerides
- High cholesterol
- High blood pressure
- Family history
- Certain infections, such as hepatitis C
- Obstructive sleep apnea
- Polycystic ovarian syndrome (PCOS)
- Certain rare genetic issues, including Wilson disease
- Certain medications, including amiodarone, methotrexate, and tamoxifen
- Older age
- Pregnancy
Diagnosis of Fatty Liver Disease
When you visit your doctor, they will go over your medical history, ask you about your family medical history and family history of liver disease, alcohol consumption, general lifestyle habits, list of medications you take, any recent changes in your health, your symptoms, and your existing medical condition. They will perform a medical exam, including checking for inflammation of your abdomen and signs of an enlarged liver.
They may order some blood tests, including alanine aminotransferase test (ALT) and aspartate aminotransferase test (AST), to look at your liver enzymes. If you have elevated liver enzymes, they will most likely order some other tests, including blood tests to check for inflammation, and imaging tests, such as an ultrasound, fibroscan, CT scan, and MRI scan. To look at the severity of your liver disease and liver scar tissue, a liver biopsy will likely be needed (9).
Preventing Fatty Liver
Following a healthy lifestyle is key to reducing your risk of fatty liver and potential complications from fatty liver disease. Here are some general recommendations that may help to reduce your risks for fatty liver disease:
- Limit your alcohol intake or avoid alcohol completely
- Maintain a healthy weight or lose weight if you need to
- Follow an anti-inflammatory, nutrient-dense diet rich in greens, vegetables, fruits, herbs, spices, nuts, seeds, grass-fed meat, pasture-raised poultry and eggs, wild-caught fish and seafood, and wild game, free from refined sugar, refined oil, additives, artificial ingredients, trans fats, gluten, food sensitivities, and overly processed foods.
- Move your body throughout the day and exercise regularly.
- Manage your blood sugar, cholesterol, and triglyceride levels with your doctor’s help.
- Reduce your risk of insulin resistance and type 2 diabetes, or work with your doctor and follow your treatment plan if you have insulin resistance or diabetes.
How to Improve Fatty Liver
Unfortunately, at this point, we don’t have any approved medications to treat fatty liver disease and there is no cure for this condition. However, dietary and lifestyle changes may help to reverse the condition at most stages or halt the progression of the disease.
Avoid Alcohol
As you know, being a heavy drinker is the biggest risk factor for alcoholic fatty liver disease (10). Combined with a poor diet, smoking cigarettes, taking certain medications, and other poor lifestyle choices, you are increasing your risk even more. I recommend that you cut back on your alcohol intake. Keep alcohol at a moderate level or remove it completely. If you already have nonalcoholic fatty liver disease, eliminating alcohol completely is very highly recommended.
Improve Your Diet
Refined sugar and carbohydrates can lead to an increase of blood sugar and insulin release. Consuming too much refined sugar and carbs may increase your risk of insulin resistance and type 2 diabetes which are some of the major underlying risk factors behind nonalcoholic fatty liver disease (11).
Refined vegetable oils and trans fats may also increase inflammation, liver inflammation, and the risk of nonalcoholic fatty liver disease and chronic liver disease (12). Heavily processed foods are usually full of refined sugar, refined oil, and other inflammatory ingredients. Conventionally-raised animal products may also increase exposure to toxins and hormones, which may promote inflammation.
I recommend avoiding refined sugar, refined oil, additives, artificial ingredients, trans fats, gluten, food sensitivities, and overly processed foods. Limit your sodium intake and saturated fats. I recommend following a nutrient-dense diet rich in greens, vegetables, fruits, herbs, spices, nuts, seeds, grass-fed meat, pasture-raised poultry and eggs, wild-caught fish and seafood, and wild game. Choose organic whenever possible and available.
For carbohydrates, I recommend choosing low-glycemic index fruits, such as berries and citrus fruits and sweet vegetables, such as pepper, sugar snap peas, broccoli, carrots, and beets. Instead of refined oil and fat, choose healthy fats, such as avocados, olives, extra virgin olive oil, coconut oil, and organic butter and ghee.
Support your liver with liver-supporting foods. Liver-cleansing foods include turmeric, ginger, garlic, cilantro, milk thistle, and dandelion green, and drinking plenty of water is essential for liver health (13, 14, 15, 16, 17, 18, 19).
Hydrate Your Body
Hydrating your body is essential for proper liver function and overall health. You never want to be in a situation where you become thirsty on a regular basis. According to a 2021 study published in the European Journal of Clinical Nutrition, a higher water intake may reduce the risk of nonalcoholic fatty liver disease (20).
Drink fluids to prevent thirst, not satisfy it. Start your day with 16 to 32 oz (0.5 to 1 liter) of water, then continue drinking throughout the day. One glass of water every hour or so may be the best. If you are sweating a lot, exercising, or sick, you may need more. Incorporate hydrating fruits and vegetables, including citrus, berries, apples, cucumber, celery, radishes, and lettuce.
Maintain a Healthy Weight
Being overweight or obese is among the major risk factors for nonalcoholic fatty liver disease and may even increase your risk of alcoholic fatty liver disease (8). I don’t recommend rapid weight loss and fad diets though. Practice the combination of a healthy diet, exercise, and healthy lifestyle for gradual, healthy, and sustainable weight loss. If you’ve lost weight or you are not overweight, maintaining a healthy weight is just as important as losing it.
Move Your Body Regularly
Moving your body is part of weight loss, weight maintenance, and an overall healthy lifestyle. According to a 2018 review published in Gene Expression, regular exercise may increase fatty acid oxidation, reduce fatty acid synthesis, decrease mitochondrial damage, and offer therapeutic benefits for fatty liver (21). I recommend moving your body throughout the day by stretching regularly, going for a walk, choosing walking or biking over driving whenever you can, rebounding, and playing with your pets or kids. Exercise regularly, at least five days a week for 20 to 30 minutes.
Avoid Certain Medications
Certain medications, including amiodarone, methotrexate, and tamoxifen, may increase your risk of nonalcoholic fatty liver disease. Taking too much of certain over-the-counter medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen (Tylenol) and even supplements, can damage your liver (22). I recommend that you talk to your doctor about the medications, over-the-counter drugs, and supplements you are taking to protect your liver health.
Address Infections
Certain viral infections, including hepatitis, may increase your risk of fatty liver disease (8). Your doctor may recommend vaccination against hepatitis A and B. Screening for hepatitis C may also be recommended. I recommend working with your doctor in preventing, screening for, and addressing any potential infections.
Try Liver-Supporting Supplements
According to a 2015 review published in the World Journal of Hepatology, certain supplements may help to improve nonalcoholic fatty liver disease (23). Some liver-supporting supplements may include:
- Vitamin C and vitamin E
- Resveratrol
- Anthocyanin
- Green tea extract
- Coffee
- Garlic
- Ginger
- Polyunsaturated fatty acids and monounsaturated fatty acids
- Vitamin D
- Probiotics and prebiotics
- Cinnamon
- Curcumin
- Quercetin
- Carnitine
As always, I recommend that you always consult your doctor before taking any of these or any other supplements. While these supplements may be generally helpful for fatty liver, they may not be right for everyone, depending on other health conditions you may have. A knowledgeable functional medicine doctor can also help you with supplement dosage and other important dietary and lifestyle strategies to support your health.
Next Steps
If you are interested in improving your liver health, I recommend that you speak with your doctors first for more personalized health information and support. I invite you to schedule a consultation with me here to see if you can benefit from the strategies listed in this article.
If you are dealing with any chronic health issues, for advice on how to improve your nutrition and health, I welcome you to start a functional medicine consultation with me for further personalized guidance. You may book your consultation here.
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