Updated: Dec 17, 2019
Fatty liver disease has been estimated to affect about 25.2% of the population worldwide. Non-alcoholic fatty liver disease or NAFLD is often a precursor to colon cancer making it common practice now to screen all fatty liver diagnosis for bowel cancer.
What is NAFLD?
Fatty liver is just that. The normal cells of the liver have been replaced with fat cells that cannot do the job of a liver cell. Thus, the total mass of the liver is decreased which impacts the quality of job a liver can do which is to filter the blood coming from the gastrointestinal tract and to detoxify toxins from food, the environment and from oxidative stress within the body.
Weighing in at 3 lbs., the liver is the workhorse of the digestive system and performs over 500 functions to keep the body healthy.
What Causes NAFLD?
Most chronic diseases are impacted by lifestyle choices and NAFLD is no exception. The primary aggravators of fatty liver disease are:
· Being overweight or obese
· Being insulin resistant
· Having abnormally high levels of blood fats, especially triglycerides
· Having metabolic syndrome or symptoms of such
· Being diagnosed with Type 2 diabetes
Knowing the causes and contributors of fatty liver disease help practitioners in individualizing a comprehensive care plan to reverse the disorder. Although no established treatment protocol exists for NAFLD, several treatments have shown to reverse the damage and restore healthy liver functioning again. Specifically, there are ten different approaches to restoring the liver to a healthy metabolic balance.
1. Losing weight
Excess weight causes inflammation and insulin resistance, both contributors to fatty liver disease. Studies show that a weight loss of just 10% can dramatically improve NAFLD indicators and function. Even losing 3-5% of one’s body weight can improve liver function and insulin sensitivity.
With exercise there is an increase in fatty acid oxidation (thus taking it out of the liver), improved insulin sensitivity in the cells, decreased fatty acid synthesis and a reduction in liver and mitochondrial damage. Mitochondria are the powerhouses of the cell and the main determinant of our metabolic rate (in conjunction with the thyroid). Physical exercise remains a powerful keyway to reversing fatty liver disease.
The American Heart Association recommends 150 minutes of cardiovascular exercise per week. Or, 75 minutes of vigorous physical activity per week will produce the same beneficial results. Even handicapped and elderly individuals can participate in low impact exercise such as sitting exercises, walking, aqua therapy, Tai Chi, or other creative forms of movement.
Berberine is an herbal extract that has been used successfully to decrease blood glucose and cholesterol in studies where berberine was compared to pharmaceutical interventions. Recent studies have shown it to be beneficial in NAFLD although more research is needed to determine effective dosage.
Berberine promotes fatty acid oxidation, inhibits fat generation and positively alters gut microbes. It has been used as a pharmacological replacement for Metformin ( a standard glucose lowering drug) and for statin medications (used for cholesterol reduction) with great outcomes.
Berberine is safe with few, if any, side- effects aside from some mild gastrointestinal discomfort occasionally reported.
Dosage of Berberine most effective has been found to be 500 mg three times daily.
4. Omega-3 fatty acids
Studies have shown the administration of omega-3 fatty acids to improve liver enzyme levels, normalize blood triglycerides, lower the enzyme GGT, increase HDLs and to decrease fat in the liver. These are all positive changes indicative of liver regeneration. Recent studies suggest that treatment with omega-3 fatty acids may be a new pharmacological approach due to their positive impact on liver inflammation, fibrosis and liver injury.
Studies using omega 3 supplements have achieved positive results with 450 mg – 4 gms/day. Most studies use 1 gram twice per day of omega-3 fatty acids to achieve effects while avoiding fishy aftertastes or unpleasant gastrointestinal upset.
Foods high in omega 3 fatty acids include salmon, sardines, flaxseeds and walnuts.
5. Milk Thistle
In a recent study the obtained results indicated that silymarin (milk thistle) appears to be effective in reducing the biochemical, inflammatory and ultrasonic indices of hepatic steatosis. Some parameters indicative of early stage of atherosclerosis were also lowered.
Milk thistle also decreased insulin resistance.
The most effective dose to achieve liver improvement is 420 mg/day.
6. Beet root
Beet root is effective due to its betaine content which is known to control the inflammation and fibrotic changes within the liver. Beet root is also super high in antioxidants and nutrients aside from the betaine content.
Beets can be enjoyed as a food or purchased as a food supplement. It comes as a powder to make beet juice or in capsules in the root form. Beetroot juice 80-140 ml daily or 200 grams baked or simmered beets can be used for therapy.
Increasing nutritional fiber has been shown to reduce liver enzymes and improve fatty liver infiltration. Increasing vegetables and complex carbohydrates should help, but if on a weight loss program and especially if constipation is a problem a fiber supplement may be in order.
PGX is a water-soluble fiber that can be taken before or with meals to increase satiety, decrease blood sugars and fats and positively affect the liver. If FODMAPS are a problem, taking Benefiber might be a better choice and two servings a day provide only 6 grams of fiber – not enough to cause the common side effects of adding a fiber supplement of bloating and gas.
The fiber recommendations for NALFD are at least 21 grams per day. Dosing should start low and go slow to avoid bloating and cramps.
8. High Fructose Corn Syrup
Fructose is poorly metabolized in NAFLD. Foods high in fructose should be limited. Fresh fruits can be limited to two per day. Sugar, which is part fructose and glucose also needs to be avoided due to the fructose content. Then there is high fructose corn syrup, an additive in pop and many processed foods. Avoid at all costs. Read labels but do not consume high fructose corn syrup.
High fructose corn syrup (HFCS)-containing beverages were associated with metabolic abnormalities and contributed to the development of NAFLD in human trials. Ingested carbohydrates are a major stimulus for hepatic de novo lipogenesis (DNL) and are more likely to directly contribute to NAFLD than dietary fat.
9. Vitamin D
New evidence suggests that low serum Vitamin D may cause nonalcoholic fatty liver disease (NAFLD). Hypovitaminosis D is associated with the severity and incidence of NAFLD.
A test of vitamin D status should be run on every patient with a diagnosis of NAFLD. Furthermore, levels less than 30 should be repleted with supra-optimum doses for a period such as the repletion protocol of 10,000 IU for 5 days for 6 weeks and then retest and adjust dosage.
10. Emphasis on low glycemic index carbohydrates
A low glycemic Mediterrean type diet was found to decrease the indicators of fatty liver in a short amount of time in a recent randomized clinical trial. It was concluded that this type of intervention should be pursued as part of all lifestyle interventions for NAFLD.
Many of these changes are fairly easy but some may require some education. Don’t be afraid to reach out to your Registered Dietitian for guidance on how to make these changes.