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Guide to fatty liver disease and is it hindering your health?

Fatty liver disease is a common condition characterised by the accumulation of excess fat in the liver. If left untreated, it can lead to liver inflammation, scarring, and impaired liver function. In this guide, we will explore effective strategies, backed by clinical trials, to help you manage and improve fatty liver disease. By incorporating these recommendations into your daily routine, you can support liver health, alleviate symptoms, and promote hormone balance.

Understanding Fatty Liver Disease:

Fatty liver disease can be diagnosed through various methods, including blood tests. If you suspect you may have fatty liver disease, consult with a nutritionist or health care practitioner who can evaluate your symptoms and order the appropriate tests. Blood tests commonly used to assess liver health and detect fatty liver disease include:

Alanine Aminotransferase (ALT):

Elevated ALT levels in the blood may indicate liver damage or inflammation. Higher than normal levels can be a sign of fatty liver disease. When ALT is more than AST it is indicative of liver disease. Furthermore, when AST/ALT is < 0 then indicates non-alcoholic liver disease. Overall, in fatty liver disease usually AST, ALT, ALP are elevated and GGT is normal. This marker for optimal health should be between 10-30.

Aspartate Aminotransferase (AST):

Elevated AST levels may suggest liver damage or inflammation. While AST levels can be elevated in various conditions, including liver diseases, an elevated AST-to-ALT ratio can be indicative of fatty liver disease. This marker for optimal health should be between 10-30.

Alkaline Phosphatase (ALP):

ALP is an enzyme found in various tissues, including the liver. High indicates liver disease, blocked bile ducts (when coupled with high GGT), heart failure, bone disease, leaky gut, vitamin c deficiency, excessive fat and protein intake. This marker for optimal health should be between 70-100.

Gamma-Glutamyl Transferase (GGT):

GGT is an enzyme found in liver cells. It is a sensitive indicator of hepatobiliary disease and heavy/chronic alcohol use. Also can also indicate parasites and excess free radicals. This marker for optimal health should be between 10-30.

What are some indications you may have fatty liver disease:

  • Fatty liver disease can lead to persistent fatigue and a lack of energy, making it challenging to perform daily activities.

  • Some individuals with fatty liver disease may experience discomfort or a dull ache in the upper right side of the abdomen. This discomfort can range from mild to moderate.

  • Fatty liver disease is often associated with weight gain or difficulty in losing weight, especially around the abdomen.

  • Some people with fatty liver disease may experience a reduced appetite or a feeling of fullness even with small meals.

  • Blood tests, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT), may reveal elevated levels. These enzymes are released into the bloodstream when liver cells are damaged or inflamed.

  • Fatty liver disease can contribute to weakness and a general feeling of malaise, making physical activities more challenging.

  • Some individuals with fatty liver disease may experience difficulty concentrating, mental fog, or memory problems.

  • Fatty liver disease can manifest in various skin conditions such as jaundice (yellowing of the skin and eyes), itchy skin, or dark patches on the neck and underarms (acanthosis nigricans).

  • Digestive issues such as bloating, excessive gas, and constipation may occur in individuals with fatty liver disease.

  • Fatty liver disease is closely linked to insulin resistance, which can result in elevated blood sugar levels and an increased risk of developing type 2 diabetes.

Why is having a healthy liver so important:

  • Detoxification: The liver is responsible for detoxifying harmful substances, such as toxins, chemicals, drugs, and alcohol, from the body. It converts these toxins into less harmful forms that can be eliminated through urine or faeces. A healthy liver ensures efficient detoxification, helping to protect the body from potential damage.

  • Metabolism: The liver plays a central role in metabolism. It metabolizes nutrients from food, including carbohydrates, proteins, and fats, and converts them into energy or stores them for later use. Additionally, the liver produces bile, which aids in the digestion and absorption of fats.

  • Nutrient Storage: The liver serves as a storage site for several essential nutrients, including vitamins (such as vitamins A, D, and B12) and minerals (such as iron and copper). It releases these nutrients into the bloodstream as needed to support various bodily functions.

  • Protein Synthesis: The liver is responsible for synthesizing proteins, including clotting factors that are necessary for proper blood clotting, albumin that helps maintain fluid balance in the body, and various enzymes and hormones that regulate essential physiological processes.

  • Immune Function: The liver plays a crucial role in immune function by producing immune factors and removing bacteria, viruses, and other foreign substances from the bloodstream. A healthy liver helps support a robust immune system, protecting the body against infections and diseases.

  • Blood Sugar Regulation: The liver helps regulate blood sugar levels by storing excess glucose as glycogen and releasing it when blood sugar levels drop. It also plays a role in gluconeogenesis, the production of glucose from non-carbohydrate sources, to maintain adequate blood sugar levels.

  • Hormone Metabolism: The liver metabolizes hormones, including oestrogen, testosterone, and thyroid hormones, helping to maintain hormonal balance in the body. Proper liver function is essential for hormone regulation and preventing hormonal imbalances.

Key things you can implement in your diet to assist

Include Turmeric in Your Diet:

Turmeric, a vibrant yellow spice, possesses powerful anti-inflammatory properties that can help reduce hepatic tissue damage caused by inflammation. Curcumin, a compound found in turmeric, has been studied extensively for its beneficial effects on liver health. In a systematic review and meta-analysis of clinical trials, it was found that curcumin significantly reduced liver enzymes in patients with non-alcoholic fatty liver disease (NAFLD) (1). Incorporate turmeric into your daily diet, and for better absorption, combine it with black pepper. Examples: Turmeric lattes, turmeric and ginger shots, turmeric curry

Follow an Anti-Inflammatory Diet:

Adopt an anti-inflammatory diet to support your liver health and reduce inflammation. Include an abundance of dark leafy greens, such as spinach and kale, as they contain beneficial compounds that help combat liver inflammation (2). Cruciferous vegetables like broccoli and collard greens provide essential nutrients (including Diindolylmethane, glucoraphanin and sulforaphane) and have been associated with improved liver function (3). Additionally, incorporate high-antioxidant fruits like berries, which help protect liver cells from oxidative stress.

Limit Salty and Fatty Foods:

Minimise your consumption of salty and fatty foods, as they can contribute to the progression of fatty liver disease. High intake of saturated and trans fats has been linked to an increased risk of developing fatty liver disease and have been shown to increase ALP levels (4). Avoid deep-fried foods, red meat, whole-fat dairy products, butter, and commercially baked goods. Instead, opt for healthier fats like those found in olive oil, nuts, and avocados.

Embrace the Cleansing Benefits of Lemon Water:

Start your day with a glass of lemon water to support liver detoxification. Lemon water helps stimulate the production of bile, a substance produced by the liver that aids in digestion and waste removal (5). It also contains vitamin C, a powerful antioxidant that supports liver health and helps combat oxidative stress. Sip on lemon water throughout the day to stay hydrated and promote liver function. You can also add in ginger or mint if you do not like the taste of lemon water.

Incorporate Sulforaphane-Rich Broccoli Sprouts:

Add 1 tablespoon of broccoli sprouts to your diet per day. Broccoli sprouts are a rich source of sulforaphane, a compound that activates enzymes in the liver, aiding in the elimination of toxins (6). Additionally, sulforaphane has shown potential in reducing levels of glutamate, a compound linked to disorders like depression (7). It also contains fiber, protein, and detoxification support packed into these sprouts.

Boost Vitamin E Intake:

Enhance your dietary intake of vitamin E by incorporating nutrient-rich foods like sunflower seeds, almond butter, hazelnuts, and avocados. Vitamin E, a potent antioxidant, has remarkable anti-inflammatory properties that combat oxidative stress and support improved liver function (8). Scientific studies have revealed a correlation between reduced vitamin E levels and the presence of fatty liver (8). A quarter cup of sunflower seeds provides over 70% of your recommended daily vitamin E intake.

Increase Omega-3 Foods for Liver Health:

Include omega-3-rich foods in your diet, such as flaxseeds, chia seeds, and walnuts. A recent meta-analysis of controlled clinical trials demonstrated that supplementation with omega-3 polyunsaturated fatty acids, particularly docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), significantly reduced circulating levels of liver enzymes (9). These healthy fats can support liver health and contribute to the management of fatty liver disease.

Include at least 2 apples a day:

Apples, considered a "superfood," offer potential benefits for liver health based on findings from clinical trials. Studies have shed light on why apples are beneficial for the liver. Clinical trials have demonstrated that regular apple consumption can contribute to reducing liver fat content in individuals with non-alcoholic fatty liver disease (NAFLD) (10). Apples are rich in antioxidants and phytochemicals, which possess anti-inflammatory properties and combat oxidative stress in the liver. These properties have been shown to increase antioxidant enzyme activity and reduce markers of liver tissue inflammation (10). The high fibre content of apples, particularly pectin, has been associated with protective effects on liver health. Pectin aids in toxin and cholesterol removal from the body, lightening the liver's load (13). Incorporating apples into a balanced diet can be a simple and enjoyable way to support liver function.

Supplements:

Milk Thistle (Silybum marianum):

Milk thistle, derived from the plant Silybum marianum, has long been used for its hepatoprotective properties. Clinical trials have demonstrated the potential benefits of milk thistle extract, particularly silymarin, in managing fatty liver disease. Studies have shown that silymarin can significantly reduce liver enzyme levels, improve liver function, and decrease liver inflammation in individuals with fatty liver disease (14).

Vitamin C:

A randomized controlled trial revealed that vitamin C supplementation improved liver health and glucose metabolism in patients with NAFLD (15). Consider a high-quality vitamin C supplement for example ester-C.

Magnesium:

One study published in the World Journal of Gastroenterology investigated the effects of magnesium supplementation on patients with non-alcoholic fatty liver disease (NAFLD). The results showed that magnesium supplementation significantly improved liver enzymes and reduced liver inflammation in NAFLD patients. The study concluded that magnesium supplementation could be a promising therapeutic approach for managing NAFLD. Another clinical trial published in the Journal of Research in Medical Sciences evaluated the impact of magnesium supplementation on patients with chronic hepatitis C. The findings revealed that magnesium supplementation resulted in a significant reduction in liver enzymes and improved liver function. The researchers suggested that magnesium supplementation may have a protective effect on the liver in chronic hepatitis C patients. Moreover, a study published in the Journal of Clinical Gastroenterology investigated the role of magnesium in patients with alcoholic liver disease (16). The results demonstrated that magnesium supplementation improved liver function tests and reduced liver fibrosis markers in patients with alcoholic liver disease. The researchers concluded that magnesium supplementation may help attenuate liver damage in patients with alcoholic liver disease. These clinical trials highlight the positive impact of magnesium on liver health. Incorporating magnesium-rich foods such as spinach, almonds, and avocados into your diet or considering magnesium supplementation under the guidance of a healthcare professional may contribute to the promotion of liver health and function.

Probiotics:

Promising results from preliminary randomized controlled trials suggest that certain probiotic strains can improve liver function and reduce liver enzyme levels in individuals with fatty liver disease. In one study, the administration of Lactobacillus bulgaricus and Streptococcus thermophilus strains to patients with non-alcoholic fatty liver disease (NAFLD) resulted in significant improvements in liver function tests, including decreased levels of liver enzymes. Similarly, another trial focusing on patients with alcoholic liver disease demonstrated that supplementation with Lactobacillus rhamnosus GG improved liver enzyme levels and reduced liver inflammation (17).

Berberine:

Berberine, a compound found in various plants like Oregon grape and barberry, has shown promise in managing fatty liver disease. Clinical trials have revealed its potential to improve liver enzyme levels, decrease liver fat accumulation, and enhance insulin sensitivity. These findings indicate that berberine may have positive effects on liver health in individuals with fatty liver disease (18).

Omega-3 Fatty Acids:

Omega-3 fatty acids, found in fish oil and certain plant sources like flaxseeds and chia seeds, have been studied for their hepatoprotective effects. Clinical trials have shown that omega-3 supplementation can reduce liver fat content, decrease liver enzyme levels, and improve liver inflammation in individuals with fatty liver disease. These outcomes highlight the potential of omega-3 fatty acids in improving liver health (19).

Vitamin E:

Vitamin E is a powerful antioxidant that may benefit individuals with fatty liver disease. Clinical studies have demonstrated its potential in reducing liver fat accumulation, improving liver enzyme levels, and alleviating inflammation. These outcomes suggest that vitamin E supplementation can support liver health in individuals with fatty liver disease (20).

By incorporating these dietary strategies and supplements into your daily routine, you can take positive steps toward managing and improving fatty liver disease. However, it is crucial to consult with a nutritionist healthcare professional before starting new supplements especially when you are on other medications.

References:

(16) Abolfotouh MA, et al. World J Gastroenterol. 2015;21(15):4753-4763. & Bahrami-Motlagh H, et al. J Res Med Sci. 2017;22:31. & Kharbanda KK, et al. J Clin Gastroenterol. 2016;50 Suppl 1:S50-S53.

(17) Vajro P, et al. Dig Liver Dis. 2011;43(12):945-950. & Wang YW, et al. J Funct Foods. 2015;19:341-352.

Other sources:

  • Brunt EM. Nonalcoholic fatty liver disease. Semin Liver Dis. 2004;24(1):3-20.

  • Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346(16):1221-1231.

  • Frith J, Day CP, Robinson L, et al. Potential strategies to improve uptake of ultrasound scanning for hepatocellular carcinoma in patients with cirrhosis: a cost-effectiveness analysis. J Hepatol. 2011;54(6):1144-1151.

  • Rinella ME. Nonalcoholic fatty liver disease: a systematic review. JAMA. 2015;313(22):2263-2273.

  • Kim D, Kim WR. Nonobese fatty liver disease. Clin Gastroenterol Hepatol. 2017;15(4):474-485.

  • Szabo G, Petrasek J. Inflammasome activation and function in liver disease. Nat Rev Gastroenterol Hepatol. 2015;12(7):387-400.



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