How to manage fatty liver disease through lifestyle modifications

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July 28 has been set aside annually to commemorate World Hepatitis Day by the World Health Organisation.

This year’s theme is ‘Hepatitis-Free Future.’ Being a hepatitis advocate, my role is to enlighten the public about hepatitis, ways to protect and maintain the liver in a healthy state.

In the next two editions of this piece, I will be dwelling on conditions of the liver which are prevalent in our nation. Today’s piece is on Non Alcoholic fatty Liver disease (NAFLD).

The main medical umbrella term NAFLD refers to a fatty liver that is not related to alcohol use. NAFLD is further divided into two groups: Non-alcoholic fatty liver (NAFL), otherwise known as simple fatty liver, or Non-alcoholic steatohepatitis (NASH). NASH causes inflammation and injury to their liver cells while NAFL does not.

Non-alcoholic fatty liver disease is the common cause of liver disease and is estimated to affect up to a quarter of adults in the world. It is defined by excess fat accumulating in the liver and usually occurs in people with obesity, high blood sugars (diabetes), abnormal cholesterol or triglyceride levels, or high blood pressure.

Symptoms: It usually doesn’t cause any symptoms and is often first detected by accident when an imaging study such as an abdominal ultrasound, CT scan, or MRI is requested for another reason.


Excess liver fat triggers chronic liver inflammation. This condition is called non-alcoholic steatohepatitis. As with other liver diseases, such as viral hepatitis or alcohol-related liver disease, chronic inflammation can cause ongoing damage, which leads to liver scarring known as fibrosis. Severe fibrosis is called cirrhosis regardless of the cause. People with cirrhosis are at risk for liver failure and liver cancer, and may need liver transplantation.

Diagnosing fatty liver

The key to preventing complications of NASH is to catch it early and treat it before the liver has sustained significant damage. Early diagnosis is tricky; usually, people have no symptoms from their liver disease. The most accurate way to diagnose NASH is by liver biopsy.

Blood tests and imaging tests can be used to determine who might be at low risk for NASH to avoid unnecessary liver biopsies. A useful, non-invasive test for some people is liver elastography called Fibroscan, a special kind of ultrasound that estimates how much scarring there is in the liver.


For people who are overweight or have obesity, the best treatment for NASH is weight loss. Studies showed that losing 10 per cent of one’s body weight can reduce liver fat, resolve inflammation, and potentially improve scarring. Weight loss by behavioral programs, medications, or weight-loss surgery can successfully treat NASH.

Diet and exercise are the first line of treatment. At least 150 minutes of heart-pumping activity (exercise) per week is recommended.

Dietary advice- vegetables and whole foods, such as the Mediterranean diet are good options. Some studies suggest that the Mediterranean diet may also decrease the fat in the liver. This nutrition plan emphasizes fruits, vegetables, whole grains, legumes, nuts, replacing butter with olive or canola oil, limiting red meat, and eating more fish and lean poultry.

Coffee intake- Studies showed that patients with NAFLD who drank coffee (about two cups every day) had a decreased risk in fibrosis. However, they are to watch the downsides of regular caffeine intake.

For certain people without diabetes, vitamin E can help treat NASH, this should be made in consultation with the doctor. For those with diabetes, certain medications that improve blood sugar, such as the thiazolidinedione drug may also have beneficial effects on the liver

Individuals with NASH must also protect the liver from any other causes of liver inflammation. This means abstaining from alcohol and making sure they are vaccinated against hepatitis A and hepatitis B viruses.

In conclusion, even though it can be difficult to make these lifestyle changes and lose weight, the benefit is immense for those with fatty liver.

Medical advice for keeping the liver healthy

If you have been diagnosed with fatty liver disease, it is important to keep your liver as healthy as possible and avoid anything that can damage your liver. Here are some important things you should do.

— Don’t drink too much alcohol. It is probably best to avoid alcohol completely.

— Make sure that none of your medications, herbs, and supplements are harmful to the liver.

— Get vaccinated to protect against liver viruses hepatitis A and B.

— Control other health conditions that might also affect your liver.

— Get regular screening tests for liver cancer if you already have cirrhosis.

— Take dietary green leaves and balanced diets.

The good news is that the most effective treatment so far for fatty liver disease does not involve medications, but rather lifestyle changes. The bad news is that these are typically hard to achieve and maintain for many people.

More details to come later.

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