Fatty liver

Epidemic now.
When I was a medical student, fatty liver was always found in alcoholics. If you had fatty liver and you claimed to be a teetotaler or a “social” drinker, you were pronounced a liar.

By the time I was an intern, the number of “liars” was skyrocketing. And by the time I passed out of med school and started practice, we’d started recognising that some of these patients weren’t actually lying (most of them still were,i swear)

Non alcoholic steatohepatitis(NASH) became a recognised entity in regular clinical practice. And these days, 20 years after I passed out of medical school, we’re seeing more cases of fatty liver due to dietary reasons than due to alcohol. These days if a patient says they’ve not been drinking heavily, I’ll believe them most of the time.

The shift that occurred isn’t them lying less or me believing them more.
Fatty liver is now caused more by diet than alcohol. Of course, alcohol still remains toxic to the liver, so don’t take the above as license to get blitzed.

NAFLD- non alcoholic fatty liver disease if left unchecked can lead to….
NASH(fatty liver+inflammation+detectable biochemical and microscopic damage to the liver).
NASH , if left unchecked, can lead to…. Cirrhosis(visible structural damage to the liver) , and cirrhosis usually leads to…
A horrible death.
On that pleasant note, let’s move on to discussing how to avoid NAFLD.

Excessive fructose consumption
– sugar
– honey(possible if you’re using honey regularly thrice a day, instead of sugar)
– high fructose corn syrup
– processed foods loaded with sugar (check ingredient list)
– fruit juice
– carbonated drinks, packaged drinks

Excessive PUFA consumption
-poly unsaturated fatty acid
-synthetic vegetable oils
-there are short term studies that show PUFAs decreasing fat in the liver
-however, PUFAs are also highly susceptible to oxidation and free radical damage.
-in a liver that is already loaded and primed with fat, adding easily oxidised PUFAs in the form of vegetable oils will push it over from NAFLD to NASH.

Diet deficient in choline
-I’d like to speak about this in detail because this is a lesser known factor compared to sugar and PUFAs
-choline is found in egg yolks, meat, liver, cruciferous vegetables
-choline is what doctors prescribe in the form of ursodeoxycholic acid tablets for liver disease
-I’d prefer to eat real food than tablets
-I’m not saying avoid the tablets your doctor has prescribed, I’m just trying to illustrate the importance of choline
-choline is essential for transport of fat out of the liver
-choline requirement is variable, according to genetics and enzyme variants
-some people need upto 1200mg a day. Rare.
-RDA is around 100mg, an egg contains 130

Abdominal obesity
-worsens fatty liver
-main mechanism is that the visceral fat pad empties directly through the portal vein into liver
-a person with visceral obesity will develop fatty liver even if they don’t eat any fat, because, the visceral fat is constantly sending fatty acids to the liver

-is a choline precursor
-is an amino acid
-therefore useful in reducing fatty liver

Oxidative stress
-or, just plain stress
-caused by a diet high in artificial foods
-poor sleep
-physical and mental stress
-consumes ApoB which is necessary for the packaging and exporting of fat from the liver to the rest of the body where it can be used

Artificial foods
-have an excess of sugar and PUFAs
-a lesser amount of choline and methionine
-that’s a double whammy

Excessive carbohydrate consumption
– glucose by itself doesn’t cause a lot of fatty deposition
– fructose (which is also a carbohydrate) in combination with large amounts of glucose, tends to divert more of the glucose into the fat deposition pathway.
– which means, even a normal amount of starch, when consumed with sugar or fructose containing foods will have the effect of increased fat deposition.
– is that why Ayurveda recommends keeping fruit seperate from the rest of your meals?

Rate of consumption of fructose, carbs
-mainly fructose
-the faster the fructose is absorbed, the more pronounced the effect it has on the liver
-a fruit that is chewed is safe, if it is converted to a juice, even without added sugar, it will tend to cause increased fat deposition
-sugar in your tea/coffee -bad idea. The fructose in it gets delivered in a rapid fashion to your liver
-carbonated drinks, sugary packaged drinks are pure poison, because of the same reasons
-sports energy drinks are for atheletes. Even for them, at their elite levels of energy consumption, it is toxic. You are not an athelete, okay? Just don’t drink that stuff. You don’t need it. It’s doing a massive amount of damage to your metabolism

Fatty liver just leaves the liver vulnerable
Not *all* cases need to result in cirrhosis
But inflammation or stress can now easily lead to Cirrhosis, because the liver is already on edge because of the excess fat it’s carrying.

You’ve got all the information. You’ve got all the logic. Are you now going to act on that information? Otherwise it is meaningless.

How are you going to fix it?
Here’s where I start to sound like a broken record.

(emphasis on fasting and eating an early dinner).
(8hrs a day at the same time, preferable to start atleast at 10pm)
(combination of zone 2 cardio+ sincere strength training)
Stress reduction
(Fix your life, meditate, find a fulfilling hobby, better relationships)

And of course, avoiding the above damaging habits. Up to you.

Leave a Reply