Natural Approaches for Fatty Liver Disease
Fatty Liver Disease
Fatty liver disease can be caused by alcohol or by metabolic dysfunction related to high cholesterol, insulin resistance, and diabetes. Fatty liver disease develops when excess functional liver tissue is replaced by fatty deposits. Non-alcoholic fatty liver disease (NAFLD) is the most common type and affects up to 100 million people in the United States.
Fatty liver disease occurs when the body is unable to properly metabolize and store fats. This defect in fat metabolism and storage is often related to insulin resistance in the body. Insulin resistance is very common in the United States and is directly related to certain dietary patterns and lack of exercise. Over time, insulin resistance causes increased storage of fat in liver cells.
In fatty liver disease, functional liver tissue is gradually crowded out by stored fat. This can lead to enlargement of the liver and inflammation in the liver tissue. Fat accumulation along with inflammation is called steatohepatitis. Inflammation in the liver can eventually progress to more serious and complex disease like cirrhosis and even liver cancer.
Symptoms and Diagnosis of Fatty Liver Disease
Fatty liver disease may cause no symptoms at all. Some people may feel tired or have a sense of discomfort or pressure in the right upper abdomen but most people who have fatty liver disease have no symptoms at all until the disease has become advanced. When fatty liver disease progresses to steatohepatitis, symptoms can include easy bruising or bleeding, itchy skin, yellowing of the skin or eyes, abdominal pain, nausea or vomiting, and changes in color and consistency of stool and urine.
Your doctor may use a comprehensive history, physical exam, lab tests, and imaging to diagnose fatty liver disease. Lab testing usually starts with measuring liver enzyme levels in the blood. Elevated levels of alanine transaminase (ALT) and aspartate transaminase (AST) can indicate inflammation or liver damage. Other lab markers including bilirubin, alkaline phosphatase (ALP), lactate dehydrogenase (LD), and gamma-glutamyl transferase (GGT) may be elevated in fatty liver disease.
Imaging usually beings with a liver ultrasound. This test can show changes in the consistency of liver tissue that indicate fatty liver disease. Sometimes, more advanced imaging or procedures like a CT scan or liver biopsy will be ordered to confirm findings.
The Importance of Liver Health
The liver is involved in over 500 vital functions of the body. The liver helps us digest food, manage our blood sugar, produce blood clotting factors, process hormones, detoxify foreign substances, and store nutrients.
When the liver is damaged, it can regenerate itself, unlike other organs in the body. This means that if we remove whatever is damaging our liver (alcohol, sugar, toxins), it can replace damaged tissue with healthy cells, starting in as little as a few days. This amazing ability is an important aspect of healing fatty liver disease.
Nutrition for Fatty Liver Disease
Because the liver is able to regenerate itself, removing substances that irritate, inflame, or damage the liver is key to healing fatty liver disease. NAFLD is related to insulin resistance and dysfunctional fat metabolism, so our food choices can make a big difference in disease progression and liver function.
The Mediterranean Dietary pattern, based on observations of the traditional diets of Greece and southern Italy in the 1960s, is the most well-researched diet in history. Researchers noted that populations following these dietary patterns had less chronic disease than other European or American populations.
The Mediterranean Diet focuses on vegetables, fruits, whole grains, and olive oil.
The diet may prevent cardiovascular disease, heart attacks, stroke, diabetes, and certain types of cancer. There are also studies showing that the diet may be beneficial in treating erectile dysfunction, depression, and menopausal symptoms like hot flashes. There are numerous studies showing benefit in people with NAFLD who follow this dietary pattern.
The Mediterranean Diet is a whole foods diet, meaning it focuses on unprocessed, natural foods. The diet follows a few basic principles:
Base your diet on plentiful servings of vegetables, fruits, nuts, seeds, legumes, and whole grains
Incorporate fish and seafood into the diet regularly
Include olive oil into all meals
Eat poultry, eggs, cheese, yogurt, and dairy products in moderation, a few times a week
Eat red meat and sugar rarely
Avoid processed and refined carbohydrates, meats, and fats
Olive oil is one of the staples of the Mediterranean Diet. Research has shown that simply incorporating more olive oil into the diet can help reduce severity of NAFLD. In one study, participants on a reduced calorie diet were supplemented with approximately 1.5 tablespoons of olive oil or sunflower oil daily. Participants in the olive oil group showed reduced NAFLD severity at the end of the 12-week trial.
Exercise for Fatty Liver Disease
Exercise is important for everyone. Movement keeps our bodies healthy in many ways, including improving our response to insulin and ability to properly metabolize fats, proteins, and carbohydrates. Movement is medicine and research shows both aerobic exercise and resistance training (weight lifting) can benefit people with fatty liver disease.
Resistance training has been shown to improve hepatic fat content in fatty liver disease.
High intensity aerobic exercise has been shown to improve liver fat content in individuals with NAFLD. This study compared the effects of 12-week exercise interventions in 61 sedentary men with NAFLD. Resistance training, high-intensity interval aerobic training, and moderate-intensity continuous aerobic training were all effective in reducing hepatic fat content. Each exercise plan reduced hepatic fat content by around 14% over 12 weeks! These improvements were seen even if participants did not lose weight. Researchers theorize that the benefits occurred through changes in the ways fats were metabolized in the body.
In another study, participants received either three months of resistance training at three times weekly or home stretching. After three months, participants in the resistance training group had favorable changes in hepatic fat content, reduced abdominal fat, and improved blood markers. Again, the study results were not related to changes in body weight.
Herbs for Fatty Liver Disease
Milk thistle (Silybum marianum) is a super star herb for liver health. Milk thistle contains silymarin, a compound that has shown numerous beneficial effects including protecting the liver, improving cirrhosis and hepatitis, and facilitating detoxification.
Silymarin supports detoxification by preventing the depletion of glutathione, an important antioxidant compound that helps us detox. In addition to preventing depletion, silymarin may also increase the level of glutathione in the liver. Keeping our liver supported during times of detoxification is important for optimizing its function.
In NAFLD specifically, silymarin has been shown to improve liver enzyme levels. A meta-analysis of eight randomized controlled trials investigating the effects of silymarin in people with NAFLD found significant reductions in liver enzyme levels in participants who took silymarin.
Artichoke (Cynara scolymus) leaves contain cynarin, a bitter constituent that has shown promise as a liver protective and cholesterol-lowering agent. These benefits are especially beneficial for people with non-alcoholic fatty liver disease (NAFLD). While the concentration of cynarin is higher in the leaves, artichokes as a food are also good for the liver. They contain flavonoids and antioxidants like vitamin C, which can help support the many processes of the liver.
Healing Fatty Liver Disease
Fatty liver disease affects up to 35% of adults in the United States but there is no consensus on how to treat this condition. Working with a naturopathic doctor, nutritionist, herbalist, or functional medicine doctor can provide you with more options for improving liver health.
References
Fatty liver disease. MedlinePlus. https://medlineplus.gov/fattyliverdisease.html. Accessed May 3, 2022.
Healthline. 2020. Mediterranean Diet 101: A Meal Plan And Beginner's Guide. [online] Available at: https://www.healthline.com/nutrition/mediterranean-diet-meal-plan. Accessed 20 November 2020.
Medina J, Fernández-Salazar LI, García-Buey L, Moreno-Otero R. Approach to the pathogenesis and treatment of nonalcoholic steatohepatitis. Diabetes Care. 2004 Aug;27(8):2057-66.
Oh S, So R, Shida T, Matsuo T, Kim B, Akiyama K, Isobe T, Okamoto Y, Tanaka K, Shoda J. High-Intensity Aerobic Exercise Improves Both Hepatic Fat Content and Stiffness in Sedentary Obese Men with Nonalcoholic Fatty Liver Disease. Sci Rep. 2017 Feb 22;7:43029.
Panahi Y, Kianpour P, Mohtashami R, et al. Efficacy of artichoke leaf extract in non-alcoholic fatty liver disease: A pilot double-blind randomized controlled trial. Phytother Res. 2018;32(7):1382-1387.
Reddy JK, Rao MS. Lipid metabolism and liver inflammation. II. Fatty liver disease and fatty acid oxidation. Am J Physiol Gastrointest Liver Physiol. 2006 May;290(5):G852-8.
Rezaei S, Akhlaghi M, Sasani MR, Barati Boldaji R. Olive oil lessened fatty liver severity independent of cardiometabolic correction in patients with non-alcoholic fatty liver disease: A randomized clinical trial. Nutrition. 2019 Jan;57:154-161.
Vargas-Mendoza N, Madrigal-Santillán E, Morales-González A, et al. Hepatoprotective effect of silymarin. World J Hepatol. 2014;6(3):144-149.
Zelber-Sagi S, Buch A, Yeshua H, Vaisman N, Webb M, Harari G, Kis O, Fliss-Isakov N, Izkhakov E, Halpern Z, Santo E, Oren R, Shibolet O. Effect of resistance training on non-alcoholic fatty-liver disease a randomized-clinical trial. World J Gastroenterol. 2014 Apr 21;20(15):4382-92.
Zhong S, Fan Y, Yan Q, Fan X, Wu B, Han Y, Zhang Y, Chen Y, Zhang H, Niu J. The therapeutic effect of silymarin in the treatment of nonalcoholic fatty disease: A meta-analysis (PRISMA) of randomized control trials. Medicine (Baltimore). 2017 Dec;96(49):e9061.