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Mind Your Liver
Fatty liver is common, dangerous…and reversible. Here’s how. 07/09/2020 by Temma Ehrenfeld

The liver is both essential and under-appreciated. When we do consider how to care for this vital organ, most people associate liver problems with alcoholism, so it’s easy to assume your liver is fine as long as you drink moderately.

The truth: alcoholism does indeed devastate livers, but your liver can be damaged even if you don’t drink at all. If you sit most of the time, sleep too little or poorly and eat the standard American diet, you can end up with high triglycerides, a type of lipid (or blood fat) that clogs your liver so it looks like a marbled steak. About a quarter of all adults in the U.S. have non-alcoholic fatty liver disease (NAFLD), often hand-in-hand with obesity and type 2 diabetes.

The “apple” body shape is especially dangerous because it means you have fat around the liver and other organs in the abdomen. That situation may accelerate the progression of fatty liver to its more serious form: nonalcoholic steatohepatitis (NASH), when the liver is inflamed (Harvard Health Letter, 2019). About five percent of U.S. adults have NASH, leaving them vulnerable to scars called fibrosis, and ultimately to the potentially fatal condition known as cirrhosis, when scarring becomes so serious that it significantly interferes with liver function. The end result may be liver cancer (Harvard Health Letter, 2019, American Liver Foundation, 2020).

How do you know if you have fatty liver?

Fatty liver is one of those silent problems that creeps up on you. Suspect NAFLD if you are round; up to 90 percent of people with obesity have fatty livers (Parker et al, 2019). But lean people can develop the problem as well.

Doctors may see high triglycerides and high alanine aminotransferase (ALT), a liver enzyme, in a blood test. However, many people with fatty livers have normal liver function tests, so lab testing is not the only path to diagnosis (Harvard Health Letter, 2019).

Some people have symptoms like fatigue and food cravings. But they may not have yellow-tinged skin, which we associate with a failing liver.

Put all this together and you can see why it’s common to learn of a problem only when you have an imaging test of your abdomen for another reason (Harvard Health Letter, 2019).
Useful as imaging is, a biopsy, which permits actually seeing the liver tissue under a microscope, is the “gold standard” for a definitive diagnosis of liver disease (Li, Q et al., 2018).

Diet is key to healthy livers.

We know the foods that are bad for us and pack on the pounds: when it comes to lipid accumulation, the fast-food hamburger-fries-soda meal is a disastrous combination of empty carbs and oxidized soy oil.

People with fatty livers are generally advised to lose five to seven percent of their weight and may need to lose up to 10 percent to reverse liver inflammation (Abenavoli et al., 2019).

But it matters how you lose the weight. Doctors often recommend the Mediterranean Diet, high in fish, olive oil, nuts and vegetables, as it provides the desirable balance of omega-3 to omega-6 fatty acids that our readers know well. Specifically, people on the Mediterranean diet eat at least five servings of fish a week (Abenavoli et al., 2019 and Anania et al., 2018).

A diet designed specifically to lower carbohydrate intake has also been shown to be effective against NAFLD (Mardinoglu et al., 2018).

The omega-3 key

The intense interest among scientists in omega-3 acids dates back to studies of native Greenland populations in the early 1970s, who had lower triglyceride levels compared to people in Denmark. It turned out that the Greenlanders’ relatively rich intake of omega-3 fatty acids made the difference. Salmon, sardines and many other seafoods all synthesize omega-3 acids from marine plants and store them in their flesh, ready for us to consume.

Taking omega-3 supplements has improved liver enzyme numbers and cut liver fat, measured by ultrasound, MRI or biopsy (Gupta et al., 2015, Nogueira, et al., 2015, Lu et al., 2016). The International Society for the Study of Fatty Acids and Lipids recommends that all adults take a minimum of 500 mg. a day of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) combined to maintain their heart health (ISSFAL statement 3, current).

Gut bacteria play a role (Ma et al., 2020). You can shift yours in the right direction with nutrition. Learn to enjoy cruciferous vegetables like kale, cauliflower, broccoli and Brussels sprouts. These vegetables contain a compound called indole. In a small 2020 study from Texas A&M and Chongquing Medical University in China, researchers discovered that people with higher body mass indexes (BMI) tended to have lower blood levels of indole, which is produced by the amino acid tryptophan. The less indole in your blood, the more fat turned up in your liver. The team argued that eating indole would help (Ma et al., 2020). Mice on a high-fat, high-sugar diet accumulate less fat in their livers when they are fed large amounts of broccoli, for example (Chen et al., 2016).

Coffee-lovers are in luck: some research suggests coffee helps prevent liver damage, possibly because caffeine lowers their abnormal liver enzymes (Wijarnpreecha et al., 2017).
Nuts aid weight loss, and walnuts in particular may improve liver function in patients with fatty liver disease (Gupta et al., 2015), most likely because of their relatively high omega-3 content.

Upping your consumption of avocado and olive oil also has shown benefits on liver function tests (Gupta et al., 2015).

High omega-3 fish, kale, walnuts, coffee, avocado and olive oil are good for you for any number of reasons, of course. While you slenderize your liver, and your body, you’re helping your heart and mood as well.

Take care of your hardworking liver and it will take good care of you.

Sources:

Abenavoli L, Boccuto L, Federico A, et al. Diet and Non-Alcoholic Fatty Liver Disease: The Mediterranean Way. IJERPH | Free Full-Text. https://www.mdpi.com/1660-4601/16/17/3011/review_report. Published August 21, 2019.

Anania C, Perla FM, Olivero F, Pacifico L, Chiesa C. Mediterranean diet and nonalcoholic fatty liver disease. World journal of gastroenterology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5960814/. Published May 21, 2018.

Chen Y-J, Wallig MA, Jeffery EH. Dietary Broccoli Lessens Development of Fatty Liver and Liver Cancer in Mice Given Diethylnitrosamine and Fed a Western or Control Diet. The Journal of nutrition. https://www.ncbi.nlm.nih.gov/pubmed/26865652. Published March 2016.

Fan JG, Cao HX. Role of Diet and Nutritional Management in Non-Alcoholic Fatty Liver Disease. Journal of gastroenterology and hepatology. https://pubmed.ncbi.nlm.nih.gov/24251710/. Published 2013.

Fatty liver disease: An often-silent condition linked to heart disease. Harvard Health. https://www.health.harvard.edu/heart-health/fatty-liver-disease-an-often-silent-condition-linked-to-heart-disease. Published August 2019.

Gupta V, Mah X-J, Garcia MC, Antonypillai C, van der Poorten D. Oily fish, coffee and walnuts: Dietary treatment for nonalcoholic fatty liver disease. World journal of gastroenterology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4588084/. Published October 7, 2015.

Li, Q., Dhyani, M., Grajo, J. R., Sirlin, C., & Samir, A. E. (2018). Current status of imaging in nonalcoholic fatty liver disease. World Journal of Hepatology, 10(8), 530-542. doi:10.4254/wjh.v10.i8.530

Lu W, Li S, Li J, et al. Effects of Omega-3 Fatty Acid in Nonalcoholic Fatty Liver Disease: A Meta-Analysis. Gastroenterology Research and Practice. https://www.hindawi.com/journals/grp/2016/1459790/. Published August 29, 2016.

Ma L, Li H, Hu J, et al. Indole Alleviates Diet‐induced Hepatic Steatosis and Inflammation in a Manner Involving Myeloid Cell PFKFB3. AASLD. https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/hep.31115. Published January 17, 2020.

Mardinoglu A, Wu H, Bjornson E, et al. An Integrated Understanding of the Rapid Metabolic Benefits of a Carbohydrate-Restricted Diet on Hepatic Steatosis in Humans. Cell Metabolism. 2018;27(3). doi:10.1016/j.cmet.2018.01.005

NASH Definition & Prevalence. American Liver Foundation. https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/nonalcoholic-steatohepatitis-information-center/nash-definition-prevalence/. Accessed June 24, 2020.

Nogueira MA, Oliveira CP, Alves VA, et al. Omega-3 Polyunsaturated Fatty Acids in Treating Non-Alcoholic Steatohepatitis: A Randomized, Double-Blind, Placebo-Controlled Trial. Clinical nutrition (Edinburgh, Scotland). https://pubmed.ncbi.nlm.nih.gov/26047766/. Published May 2015.

Parker HM, Cohn JM, O'Connor HT. Effect of Fish Oil Supplementation on Hepatic and Visceral Fat in Overweight Men: A Randomized Controlled Trial. Nutrients. https://pubmed.ncbi.nlm.nih.gov/30813440/. Published February 2019.
Statement 3. International Society for the Study of Fatty Acids and Lipids. https://www.issfal.org/statement-3. Accessed June 24, 2020.

Wijarnpreecha KC, Thongprayoon C, Ungprasert P. Coffee Consumption and Risk of Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis. European journal of gastroenterology & hepatology. https://pubmed.ncbi.nlm.nih.gov/27824642/. Published February 2017. Accessed June 24, 2020.

Zelber-Sagi S, Radziu V, Oren R. Nutrition and Physical Activity in NAFLD: An Overview of the Epidemiological Evidence. World journal of gastroenterology. https://pubmed.ncbi.nlm.nih.gov/21876630/. Published August 2011. Accessed June 24, 2020.

Li, Q., Dhyani, M., Grajo, J. R., Sirlin, C., & Samir, A. E. (2018). Current status of imaging in nonalcoholic fatty liver disease. World Journal of Hepatology, 10(8), 530-542. doi:10.4254/wjh.v10.i8.530

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