My GP says I have fatty liver disease. I always thought you could only get that if you drank too much alcohol. But I don’t really drink that much, so I’m a bit surprised by this. My GP now wants me to eat healthier and lose weight. I assumed I was already eating reasonably healthily but apparently I’m wrong. How come I have fatty liver disease and, more importantly, how do I fix this?
Rens, 51
What is fatty liver disease?
Fatty liver disease is often associated with excessive alcohol consumption. This is known as alcoholic fatty liver disease (AFLD). But even if you do not drink any alcohol at all, you can still develop fatty liver disease.
Fatty liver disease that is not caused by excessive alcohol consumption is called non-alcoholic fatty liver disease (NAFLD). NAFLD is actually a collective term for all non-alcoholic liver diseases. Fatty liver disease (steatosis) is the initial stage, inflammation of the liver (non-alcoholic steatohepatitis or NASH) is the final stage. This inflammation of the liver can also lead to cirrhosis and liver cancer.
The liver plays an important role in fat metabolism. If something goes wrong with fat metabolism, the liver can start storing more and more fat in the liver cells. This fatty liver disease is therefore a build-up of fat in the liver.
If you would do nothing about it, your liver will become increasingly fatty. One in five people who have a fatty liver for a long period of time develop an inflammation of the liver (hepatitis). This inflammation can cause scarring (liver fibrosis) and ultimately lead to cirrhosis. Cirrhosis is serious damage to the liver that can eventually lead to liver failure. This can be life-threatening. A liver transplant is then the only treatment option.
Do not underestimate non-alcoholic fatty liver disease: it is very common, estimated to affect one in four people. It is also one of the fastest growing serious diseases.
How do you get it?
Non-alcoholic fatty liver disease is a lifestyle disease. It is common in Western countries and is caused by a very unhealthy lifestyle and lack of physical activity. The body’s fat metabolism is disturbed and fat accumulates in the abdominal organs, including the liver. The liver’s own metabolism also changes, so that more fat ends up in the liver cells themselves.
The liver is not meant to store fat at all, but to perform other important tasks that keep you healthy:
- production of bile fluid
- storage of vitamins and minerals
- production of important nutrients
- neutralising toxic substances and medications
- regulation of energy metabolism
If your liver is increasingly used to store fat, these functions can be seriously compromised.
So fatty liver disease is very serious?
Absolutely: if your liver function fails partially or completely due to inflammation and cirrhosis (scar tissue on the liver), fatty liver disease can be deadly. If your liver function fails too much to function, your only option is a liver transplant. And don’t forget that you have a higher risk of developing liver cancer.
And it is caused is by an unhealthy lifestyle?
Fatty liver disease occurs due to an imbalance in the intake of fats and carbohydrates from your diet. But it’s the carbohydrate intake in particular that does the damage. If your diet consists of food with excessive amounts of carbohydrates, and especially at too many times of the day, more and more of the hormone insulin has to be released to regulate blood sugar.
Insulin ensures that blood sugar is transported to the various cells in your body and ‘opens’ these cells. The blood sugar can then be taken up by the cells and used as energy. The surplus is stored in fat, muscle and the liver. If you consume too many carbohydrates, the cells become less and less sensitive to insulin, which means that it is no longer possible to regulate the blood sugar in the blood properly. You become insulin resistant. Insulin is also a hormone that stimulates fat storage even more and this includes fat storage in your liver.
Who is more likely to develop NAFLD?
As described above, insulin resistance is the main cause of fatty liver disease. And the chance that you are insulin resistant is very high if you have a diet of too many carbohydrates and unhealthy fats. But there are also other risk factors:
- type 2 diabetes
- being overweight and obesity
- metabolic syndrome
- TOFI; this stands for ‘thin on the outside, fat on the inside’, in other words, slim on the outside but with fat accumulated around the organs
- excessive alcohol consumption
How do I know I have fatty liver disease?
Fatty liver disease can go unnoticed for a long time. Sometimes you may experience (mild) pain in the upper right part of your abdomen and fatigue. Very occasionally you may experience jaundice. Jaundice is the yellowing of the whites of the eyes and the skin.
In 1 out of 5 people with the condition, an inflammation of the liver (hepatitis) developes. This can cause various complaints. Think of chronic fatigue, a general feeling of sickness and sometimes itching of the skin. Nausea and pain in the joints may also occur.
Your doctor may suspect that fatty liver disease is present on the basis of symptoms. A blood test is then carried out to check whether liver values have increased. However, it is usually discovered by accident. During an ultrasound scan of the upper abdomen for example. Or by detection of abnormal blood values during an examination for completely different complaints.
OK, so I have been diagnosed, what can I do?
Since the main cause of NAFLD is the disregulation of the hormone insulin you need to begin by restoring this. You do this by eating far fewer carbohydrates. Your blood sugar levels will begin to normalise and insulin will once again be able to play its proper role. Your liver will stop storing fat reserves and will eventually release the existing fat reserves. This way, you can make your liver become healthy again and do what it is supposed to do.
This ketogenic approach almost always produces immediate results. Liver values can drop within a few days and within a few months the fatty liver has also decreased enormously. After one year, about 60 percent of patients who follow a ketogenic lifestyle have a healthy liver again.
It is of course important to continue the ketogenic lifestyle, even if you no longer have a fatty liver. If you return to the diet that caused non-alcoholic fatty liver disease in the first place, there is a very good chance you wil develop it all over again.
Have you been diagnosed with NAFLD? The keto lifestyle is the best approach to help reverse your diagnosis. Do you need help getting started? Book a 30-minute consultation so we can discuss which keto coaching option is best for your specific situation and needs.
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