Fatty Liver 101: What You Need To Know.
Have you been told that you have fatty liver? Fatty liver used to be called NAFLD (Non-Alcoholic Fatty Liver Disease) however recently, they have changed the name to MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease). NASH which was non-alcoholic steatohepatitis, inflammation of the liver due to fatty infiltration, is now called MASH (Metabolic Dysfunction-Associated Steatohepatitis). The name changes, MASLD and MASH, are to better reflect that non-alcoholic fatty liver is a liver manifestation of metabolic syndrome and is associated with cardiometabolic changes and insulin resistance [1]. Alcoholic fatty liver is still referred to ALD, alcoholic-associated liver disease.
Cases of fatty liver have risen dramatically across the globe due to poor lifestyle and dietary choices and now we are seeing our children and teenagers being diagnosed with it. The good news is that if it is caught in its early stages, fatty liver can be reversible before the liver becomes chronically inflamed and cirrhotic. Once your liver is fatty, it doesn’t function as well which lends itself to high cholesterol levels. If it isn’t addressed in time, the liver can become inflamed, develop cirrhosis which is permanent liver damage, and eventually a risk of liver failure. Take care of your liver because you need it to detox all the chemicals around you and your hormones and keep your skin looking good.
Lifestyle Factors That Contribute to Fatty Liver:
1) A lack of exercise. Prolonged sitting such as at home watching TV, at the office on the computer, and in the car going places leads to an inability to burn fat in the liver enabling more to accumulate.
2) Stress and poor sleep – Poor sleep and increased stress increases your cortisol levels which disrupts your blood sugar regulation and insulin regulation leading to increased fat storage.
3) Irregular eating patterns – This can be eating late at night, particularly eating lots of starch or sugars later at night and not burning the sugar which then gets deposited in the liver as fat. It also is eating constantly or grazing without giving your gut a rest period of at least 3-4 hours in between meals to allow insulin levels to drop and stay down. When you are continuously adding any form of starchy carbohydrate, sugar, or protein into your mouth, you are causing a release of insulin and continuous insulin release will lead to higher levels.
Dietary Factors Contributing to Fatty Liver:
1) Excess sugar and refined carbs – These include chocolates, candies, sweets, sodas, white flour items like white bread, pastries, cakes, pastas, white rice, and processed foods. Sodas may have sugars inside that you may not even know of. Diet sodas are no exception because they contain artificial sweeteners which means they may be 0 kcal or 0g of sugar on the nutrition label but the sucralose, aspartame or acesulfame-K will “mess” with your insulin regulation and can lead into fatty liver.
2) Low protein and high carb diet – This means your diet has little protein and is higher in grains (starch breaks down to glucose) which makes it harder for your liver to metabolize fat. This type of diet is really common in vegetarians as one would tend to eat more rice, pasta and carbs to fill satiated since they don’t eat meat. Being vegetarian is great but you still need to make sure you are eating your protein and doing it right!
3) Processed foods, condiments, and fast foods – Most of these contain so many preservatives, sugars and high fructose corn syrup that affect insulin regulation and contribute to fatty liver.
Fat has very little to do with fatty liver, particularly consuming healthy fats. Yet, most family doctors will tell you cut down on fat when they tell you that you have fatty liver.
How do you know if you have MASLD (Fatty Liver)?
The best diagnostic tool for fatty liver is an ultrasound, however, it can also be diagnosed through blood test markers and a review of your health history and lifestyle.
Check your blood tests for:
High triglycerides: Triglycerides can be found on your lipid panel and even though it is a lipid marker, it is associated with a diet high in carbohydrates. High triglycerides are one of the parameters for metabolic syndrome and also MASLD. When you eat a lot of carbs/glucose, the glucose that your cells don’t take in stays in the blood until it makes its way to the liver and is stored as fat in the form of triglycerides. Want to reduce your triglycerides? Reduce on your carbohydrate intake!
ALT and GGT: These are liver function tests more specific to the liver, particularly when the GGT is high AND the ALT is above an optimal level. The cut-off for ALT should optimally be <20U/L but not super low (1-5 is too low). Whenever I see an ALT higher than 25, this indicates the liver is stressed and not functioning as well.
Fasting insulin: Optimal range for this marker after an 8 hour fast is <50. If it is higher, it means either your liver is not clearing insulin because it is taxed or you are producing too much and your cells will eventually become insulin resistant. This leads to glucose building in the blood (diabetes) and then glucose stored in the liver as triglycerides (fatty liver). Fasting insulin can be a great marker for metabolic health but unfortunately, you have to speak with a naturopathic doctor to get the test done as many family doctors (MDs) are reluctant.
Fasting glucose and HbA1c: These can provide insight if you are moving towards fatty liver and are great markers for metabolic health and metabolic syndrome and where your risk level lies.
CRP: Inflammation somewhere in the digestive tract which could happen if fatty liver is prolonged.
What Can You Do To Try and Reverse or Prevent Fatty Liver?
Reduce your refined sugar and processed foods consumption.
Cut down on starches like breads, pastas, and rice and try to opt for whole-grain options when you do consume starches so they have fibre.
Have more protein and non-starchy vegetables on your plate with only a ¼ plate of starchy carbohydrates (rice, pasta, bread, potatoes, squashes).
Stop drinking soda (pop) including no more diet sodas.
Stop shopping in the middle of the grocery store and spend more time in the perimeter where the whole foods are. This will reduce your processed food intake.
Get moving – at least 30 minutes of physical activity every day should be your goal whether it is a walk, the gym, freestyle dancing at home, or an organized class.
Lift weights as we know that weight-bearing exercise and lifting weights can help improve insulin sensitivity.
Work on improving your sleep quality.
Managing your stress to regulate your cortisol since high cortisol will increase blood glucose and insulin levels.
Try to avoid grazing in between meals as much as possible and have at least 3-4 hours in between your meals or even intermittent fasting with 14-16 hour continuous fasting window and corresponding 8-10 hour eating window.
It is possible to improve your blood markers so they come back into optimal range and stay there! You do the work, you get the results and reduce your risk for other metabolic-associated diseases as you get older. Of course, there are supplements to help you kickstart improving your blood markers while the lifestyle changes take a bit to grasp and add to your daily routine. Supplements and other treatments like acupuncture can also be added to a treatment plan to help with improving sleep quality and stress management. Looking for guidance on how to prevent or manage your fatty liver? Book a discovery call with our naturopathic doctor to learn how she can help you.
Reference:
[1] Rinella, M. E., & Sookoian, S. (2024). From NAFLD to MASLD: updated naming and diagnosis criteria for fatty liver disease. Journal of lipid research, 65(1), 100485. https://doi.org/10.1016/j.jlr.2023.100485
