There is a fairly quiet epidemic brewing. While we all know about diabetes, heart disease, and dementia, many Americans haven’t heard about fatty liver disease. They might have heard their doctor mention it when reviewing their yearly physical labs, or when incidentally discovered on an ultrasound. But most folks don’t understand the seriousness of the issue. Back when I was a family medicine intern, in 2004, we didn’t think too much of it. But actually, fatty liver is a really big deal after all.
Metabolic dysfunction associated steatotic liver disease (MASLD), or fatty liver, for short, is the most common liver disease in America, affecting about one third of US adults. Fatty liver has been called the next global epidemic, and there is even a Global Fatty Liver Day (this year it lands on June 12). Rates of inflammatory fatty liver have tripled since I was an intern. Now, projected to be diagnosed in 100 million people by 2030, and costing over a 100 billion dollars every year, we are realizing it’s time to pay attention. Unfortunately, fatty liver is now the most common form of liver disease in children as well. If things don’t change soon, fatty liver disease is predicted to be the leading condition causing the need for a liver transplant by 2030.
Why are we seeing so many people now with this diagnosis? Fatty liver is largely due to consuming excess unhealthy saturated fat and ultra-processed carbohydrates (think double bacon cheese burger, super-sized soft drink, and a deep fried apple pie). At its root is insulin resistance (the state of metabolic dysfunction that is also at the core of type 2 diabetes) and a damaged gut microbiome. Fat deposits in the cells of the liver, and the cells become inflamed, often leading to liver damage, and in some cases cirrhosis (scarring of the liver), liver cancer, and liver failure.
What can we do to avoid or possibly even cure this affliction? Follow these 4 steps: focus on weight loss, switch to a healthy plant-based diet, try some intermittent fasting, and make movement a daily habit.
The cornerstone of therapy, which can lead to reversal of the condition if caught early enough, is weight loss. There are many approaches to weight loss, such as bariatric surgery (which has been shown to reverse fatty liver hepatitis in up to 85% of patients within a year after surgery). But a less expensive, and less risky approach is by switching to a healthy plant-based diet. Several studies involving thousands of participants support the benefits of adopting a healthy, plant-based diet to prevent and address fatty liver. And the benefits are not just from the associated weight loss. A whole-food, plant-based diet is naturally low in calories, processed foods, and saturated fat and helps to reverse insulin resistance. This dietary pattern is also high in antioxidants, which the liver needs to balance the processes of oxidation. A WFPB diet is rich in vegetables, fruits, whole grains, legumes, mushrooms, herbs, spices, nuts and seeds. These foods, full of pre-biotic fiber, are critical to improving the damaged gut microbiome.
In addition to weight loss and what we eat, when we eat can help as well. A number of studies looking at periodic fasting, alternate day fasting, and time-restricted eating have shown benefits. Often, fasting studies also report a concomitant improvement in weight and insulin sensitivity.
Daily movement is the fourth area to focus on. Exercise reduces liver fat even without weight loss. A review of 30 studies showed that diet and exercise together reduced weight, insulin resistance, and fatty liver better than either alone. Let’s take advantage of our lovely Spring weather and lace up our sneakers!
In summary, fatty liver is a common condition that is caused by a combination of calorie excess, inflammatory foods, and a sedentary lifestyle. The good news is that we can take control of this disease with weight loss, eating a WFPB diet, incorporating intermittent fasting, and exercising. If you have fatty liver, I suggest working with someone trained in Lifestyle Medicine. Remember, with the right tools and motivation, our health is largely in our control.
For a more in-depth discussion on this topic, please see the Spring 2024 issue of Health Science magazine, a publication of the National Health Association. Please also see our recent discussion on this topic on our YouTube Channel, Lifestyle Telemedicine.
Sources
K Ray. NAFLD-the next global epidemic. Nat Rev Gastroenterol Hepatol. 2013 Nov;10(11):621.
Westfall, et al. Am Fam Physician. 2020;102(9):603-612
Wong RJ, Aguilar M, Cheung R, et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;148(3):547-555
Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-357.
Lassailly G, Caiazzo R, Buob D, et al. Bariatric surgery reduces features of nonalcoholic steatohepatitis in morbidly obese patients. Gastroenterology. 2015;149(2):379-388.
Mazidi M, Kengne AP. Higher adherence to plant-based diets are associated with lower likelihood of fatty liver. Clin Nutr. 2019;38(4):1672-1677. doi:10.1001/jamainternmed.2022.6444Akhtar
Ma, J. Et al. Gastroenterology 2018 Jul 155(1)107-117
Kahleova H, et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with Type 2 diabetes. Diabet Med. 2011 May;28(5):549-59. doi: 10.1111/j.1464-5491.2010.03209.x. PMID: 21480966; PMCID: PMC3427880.
Drinda S et al. Nutrients. 2019 Oct 30;11 (11):2001
Johani M et al. Sci Rep. 2019 Aug 2; 9(1) 11232
Kahleova H et al. Diabetologia. 2014; 57; 1552 – 60
Orci LA, Gariani K, Oldani G, et al. Exercise-based Interventions for Nonalcoholic Fatty Liver Disease: A Meta-analysis and Meta-regression. Clin Gastroenterol Hepatol. 2016;14(10):1398-411. [PMID:27155553]
Fernández T, Viñuela M, Vidal C, Barrera F. Lifestyle changes in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis. PLoS One. 2022 Feb 17;17(2):e0263931. doi: 10.1371/journal.pone.0263931. PMID: 35176096; PMCID: PMC8853532.
