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  4. Fatty liver disease, non-alcoholic fatty liver, what to do?

Fatty liver disease, non-alcoholic fatty liver, what to do?

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Nearly 30% of French people are believed to have a fatty liver, meaning they suffer from non-alcoholic fatty liver disease, also called "fatty liver disease".

Often overlooked despite its alarming rise, it came to public attention in March 2017 when sports journalist Pierre Ménès revealed he had developed cirrhosis related to this condition.

A genuine disease of unhealthy eating habits, this condition can degenerate into cirrhosis if not addressed.

However, simple lifestyle changes can effectively and durably control its progression.

What is "fatty liver disease" or non-alcoholic fatty liver disease?

To better understand non-alcoholic steatohepatitis, let's first look at the role of the liver.

Understanding liver function

The liver, weighing an average of 1.5 kg, is located in the upper right part of the abdomen, protected by the last ribs.

It performs nearly 600 functions in the body.

The main functions are:

  • Production: It plays a central role in controlling blood sugar levels and is essential for the production of bile, proteins, fats, and certain hormones.
  • Detoxification: It acts as a filter for all molecules passing through the body (medications, alcohol, food, etc.).
  • Fat processing: It acts as a "processing center" for consumed fats: production, transformation, transport. The liver is not meant to store fats, but when healthy, some of its cells (up to 5%) contain a few "drops" of fat.

The liver is a crucial organ at the center of essential metabolic processes. And, due to its involvement in fat processing, it even plays a crucial role in the proper functioning of the cardiovascular system.

What is non-alcoholic fatty liver disease?

Non-alcoholic fatty liver disease is defined as a fatty overload of the liver, unrelated to alcohol consumption.

Naturally, sugar is converted into fats by the liver to be stored as reserves when needed. But when the intake of sugars and fats is too high, the liver produces and stores excess fat.

When the percentage of fat cells in the liver exceeds 5%, it is called "steatosis" (this term means "increased fat").

At this stage, the liver is generally larger than average and appears white on ultrasound (it is said to be "shiny"). In some people, this increase in fat will remain benign. But in others, without appropriate management, it can degenerate. It is at this early stage that action must be taken.

Understanding fatty liver disease

The causes

Fatty liver disease is a consequence of a too sedentary lifestyle combined with a diet too rich in fats and sugars.

It is often said to be a civilization-related disease because it is intimately linked to how we live today: lack of exercise, unhealthy eating habits, excessive consumption of refined sugars, etc.

It is important to note that this disease, unlike many liver conditions, is not caused by excessive alcohol consumption.

Risk factors

Some people are more exposed than others to fatty liver disease.

Indeed, some conditions are recognized as risk factors, particularly:

Overweight and obesity, meaning a body mass index (BMI) above 25 or 30.

Prediabetes and diabetes, which are disorders of sugar assimilation, utilization, and storage causing hyperglycemia.

Metabolic syndrome, which is the combination of several physiological and biochemical disorders indicating a metabolic disorder. A person is said to have metabolic syndrome when they have several of the following conditions:

  • Abdominal obesity (i.e., a waist circumference greater than 94 cm in men and 80 cm in women)
  • Prediabetes or type 2 diabetes
  • High blood pressure
  • High triglyceride levels (which are lipid molecules)
  • Low HDL cholesterol levels

Consequences

Fatty liver disease is what is called a progressive disease. Without management, it can evolve into more serious conditions, in stages.

NASH. At this stage, the fat accumulated in the liver becomes toxic and causes damage. The body then develops a defense mechanism called "inflammation." Cells suffer and swell.

Cirrhosis: If nothing is done to stop the progression of the disease, then the liver begins a process of scar tissue formation in the lesions. A tissue, like a scar, appears on the liver: it is "fibrosis." This scar tissue does not function as well as healthy tissue, and gradually, the liver loses its functions. Fibrosis is classified into 4 severity stages. In stages 1 to 3 (mild, moderate, advanced), the progression of fibrosis can still be slowed down or even stopped. At stage 4, this fibrosis extends to the entire liver. This is called cirrhosis. This gradually becomes irreversible.

Liver cancer. Following stage 4, the liver continues to degrade, leading to liver failure. Cirrhosis can then degenerate into liver cancer.

Note: In people with NASH, liver cancer can develop without necessarily going through the "cirrhosis" stage.

Moreover, and since the liver is at the center of multiple metabolic processes, the chronic inflammation created by the disease has detrimental effects on the proper functioning of the cardiovascular system. Thus, the first danger for patients is cardiovascular: occurrence of a disease or an event (heart attack, stroke…)

Finally, fatty liver disease also increases the risk of developing diabetes or worsening existing diabetes.

Symptoms

Since the liver is a rather discreet organ, fatty liver disease is a silent disease. Generally, patients do not feel any symptoms, and it is discovered incidentally during examinations.

However, a few clues may raise suspicions:

  • Moderate pain
  • Discomfort in the upper right part of the abdomen
  • Fatigue
  • Only at a more advanced stage do the first symptoms appear, but they are nonspecific and may be related to other conditions:

  • Loss of appetite
  • Swelling of the legs
  • Confusion and speech disorders
  • Yellowing of the eyes or skin
  • Digestive bleeding
  • Accumulation of fluid in the abdomen.
  • Non-alcoholic fatty liver disease, what to do?
  • Faced with fatty liver disease, it is urgent to change one's lifestyle to limit the progression of the disease.

There is currently no drug treatment, but it is possible to act durably and effectively by following simple recommendations.

This is an essential effort that involves weight loss, adopting a suitable diet, physical exercise, and the use of appropriate dietary supplements.

The role of diet

Since fatty liver disease is a nutrition-related disease, it is essential to act at the dietary level. The main lines of advice given for type 2 diabetes or metabolic syndrome will be found:

  • Adopt a low-calorie, yet balanced diet that will allow you to lose weight sustainably and control insulin resistance.
  • Prioritize low-calorie density foods such as fruits and vegetables, which also provide fiber and antioxidants.
  • Limit your carbohydrate intake. The reduction in calories should come mainly from carbohydrates rather than fats.
  • Avoid simple sugars (sweets, pastries, etc.) except those found in fruits. Do not sweeten your yogurt, fruits, or hot drinks. Be vigilant with food labels. Many industrial products, such as breakfast cereals, contain added sugar in often significant quantities.
  • Choose foods with a low glycemic index (GI): whole and semi-whole grains, legumes; sweet potatoes… Pay attention to the cooking method: al dente pasta will have a lower glycemic index than well-cooked pasta. Avoid fast-cooking starches and false friends, such as rice cakes.
  • Consume monounsaturated fatty acids, especially omega-3s (fatty and semi-fatty fish, canola and flaxseed oil, nuts, etc.)
  • Reserve alcohol for festive occasions and avoid sodas and other sugary drinks. Make sure to drink 1.5 to 2 liters of water per day.

Physical Activity

Physical activity allows for better weight control, as well as blood sugar control for diabetics, and reduces cardiovascular risk. It also provides significant emotional support when embarking on changing dietary habits, which can often be stressful.

Be as active as possible. Walk, garden, engage in moderate physical activities (swimming, slow jogging, yoga), and if your condition allows, more intense activities (tennis, cycling, fast running...).

Enjoy yourself and engage in activities that suit you while remaining cautious. If you're restarting exercise, talk to your doctor so they can support you in starting this transition calmly and safely.

Dietary Supplements

Regulating organs and addressing deficiencies can help limit the progression of fatty liver disease and prevent it from developing into more serious conditions.

Artichoke

Consumed in the form of fresh plant suspension (SIPF), artichoke:

  • Supports liver activity thanks to its purifying and choleretic properties, meaning it stimulates bile secretion.
  • Plays a protective role in the liver.
  • Helps prevent liver cancer. Its polyphenols are thought to induce apoptosis (programmed cell death) in liver cancer cells.
  • Helps lower blood sugar. Leaf extract has been shown to have a hypoglycemic effect, with studies demonstrating a significant decrease in blood sugar in people with type 2 diabetes using this extract.

Vitamin E

It has been shown that people with metabolic syndrome, often associated with non-alcoholic fatty liver disease, have an increased need for vitamin E, 30 to 50% higher than healthy individuals.

Furthermore, studies have shown that vitamin E helps reduce inflammation and fibrosis in individuals with fatty liver disease. Another study revealed that vitamin E tends to protect the liver in people with non-alcoholic fatty liver disease.

Zinc and Copper Picolinate

Zinc regulates blood sugar by stimulating insulin synthesis. Additionally, in combination with magnesium, it has been shown to lower high blood pressure often seen in people with metabolic syndrome.

As for copper picolinate, it also helps control blood sugar, improves sugar assimilation, and helps reduce cholesterol and triglyceride levels. It contributes to reducing fat mass and increasing muscle mass.

Omega-3 Fatty Acids

Omega-3s help reduce liver fat. While consuming canola and flaxseed oil generally covers recommended alpha-linolenic acid intake, the long-chain omega-3s EPA and DHA needs are rarely met through diet, especially as high triglyceride levels tend to increase these needs.

Therefore, omega-3 supplementation is often necessary to reach the recommended daily intake of 1 to 3 grams.

Probiotics

It is now known that the gut microbiota plays a crucial role in our body's functioning, particularly in metabolism (energy metabolism, insulin sensitivity, carbohydrate processing, bile acid metabolism, etc.).

Moreover, gut microbiota imbalances induce low-grade inflammation and can lead to insulin resistance.

Studies have shown that probiotic supplementation, by restoring gut microbiota balance, can reduce fatty liver and combat inflammation.

To restore gut flora balance, start with at least one month of L-glutamine, an amino acid that helps strengthen intestinal mucosa integrity, and reduces inflammation, with probiotics. Then regularly engage in maintenance courses for 20 to 30 days.

Fatty liver disease, initially silent but compounded with visible risk factors, requires active management from the patient themselves. While dietary supplements can help limit disease progression, true lifestyle modifications are essential.

Sources:
(1) Maryem Ben Salem& Hanen Affes & Kamilia Ksouda & Raouia Dhouibi & Zouheir Sahnoun & Serria Hammami  & Khaled Mounir Zeghal. Pharmacological Studies of Artichoke Leaf Extract and Their Health Benefits. Plant Foods Hum Nutr (2015) 70:441–453 DOI 10.1007/s11130-015-0503-8
(2)Miccadei S, Di Venere D, Cardinali A, Romano F, Durazzo A, Foddai MS, Fraioli R, Mobarhan S, Maiani G. Antioxidative and apoptotic properties of polyphenolic extracts from edible part of artichoke (Cynara scolymus L.) on cultured rat hepatocytes and on human hepatoma cells. Nutr Cancer. 2008;60(2):276-83
(3)Maret G Traber, Eunice Mah, Scott W Leonard, Gerd Bobe, Richard S Bruno. Metabolic syndrome increases dietary α-tocopherol requirements as assessed using urinary and plasma vitamin E catabolites: a double-blind, crossover clinical trial. The American Journal of Clinical Nutrition, 2017; ajcn138495 DOI: 10.3945/ajcn.116.138495
(4)K Sato et al. Vitamin E has a beneficial effect on nonalcoholic fatty liver disease: A meta-analysis of randomized controlled trials. Nutr J 2015; Jul–Aug Vol31:923–30.
(5)Magosso E, Ansari MA, Gopalan Y, Shuaib IL, Wong JW, Khan NA, Abu Bakar MR, Ng BH, Yuen KH. Tocotrienols for normalisation of hepatic echogenic response in nonalcoholic fatty liver: a randomised placebo-controlled clinical trial. Nutr J 2013 Dec 27;12(1):166.
(6)Diabetes Care, octobre 2005, vol. 28, n° 10, p. 2.458-2.464
(7)Martin, J., Wang, Z. Q., Zhang, X. H., Wachtel, D., Volaufova, J., Matthews, D. E., & Cefalu, W. T. (2006). Chromium picolinate supplementation attenuates body weight gain and increases insulin sensitivity in subjects with type 2 diabetes. Diabetes care, 29(8), 1826-1832.
(8)Parker HM, Johnson NA, Burdon CA, Cohn JS, O’Connor HT, George J. Omega-3 supplementation and non-alcoholic fatty liver disease: a systematic review and meta-analysis. J Hepatol 2012 Apr;56(4):944-51.
(9)He X, Ji G, Jia W, Li H. Gut Microbiota and Nonalcoholic Fatty Liver Disease: Insights on Mechanism and Application of Metabolomics. Int J Mol Sci 2016 Mar 15;17(3).
(10)Tian Y, Wang H, Yuan F, Li N, Huang Q, He L, Wang L, Liu Z. Perilla Oil Has Similar Protective Effects of Fish Oil on High-Fat Diet-Induced Nonalcoholic Fatty Liver Disease and Gut Dysbiosis. Biomed Res Int. 2016;2016:9462571
(11)Ilan, Y. (2012). Leaky gut and the liver: a role for bacterial translocation in nonalcoholic steatohepatitis. World journal of gastroenterology: WJG, 18(21), 2609.
(12)

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