Liver doctors across the country agree that the number of people with fatty liver has been on the rise. For people as young as 20 to the elderly, poor dietary choices, lack of sleep, unhealthy and sedentary lifestyles, and eating of ultra-processed food are possible factors that are causing people to develop potentially dangerous liver disease.
Dr Cyriac Abby Philips — popularly known as TheLiverDoc on Twitter — a much sought-after liver surgeon, hepatologist and scientist from Kerala, took to Twitter recently to post 10 key points to address fatty liver.
What is fatty liver?
Speaking to South First, Dr Kaiser Raja, consultant in liver diseases at the Dubai branch of King’s College Hospital London, explains that fat deposition in the normal liver is termed as fatty liver.
The doctor, who also consults at Karnataka’s Aster Hospital, explains, “If there is no inflammation associated with this condition, then it can be ignored. However, if this deposition leads to swelling in a fatty liver, then it is non-alcoholic steatohepatitis (NASH). If this is not treated it can convert into cirrhosis of the liver.”
However, fatty liver can be reversed through certain lifestyle changes and by inculcating healthy habits, explains Dr Abby Philips (Aka TheLiverDoc).
Dr Sonal Asthana, Lead Consultant for Hepatobiliary and Transplant Surgery at Aster CMI Hospital, told South First that in the Indian population, the prevalence is estimated to be around 9-31 percent.
The 10 key points by TheLiverDoc to address fatty liver
Exercises to reverse fatty liver
Quoting a study, the doctor said that there are three types of exercise that have benefits on fatty liver — aerobic exercise, resistance training, and high-intensity interval training. He suggested that any of these could be included in one’s daily routine.
So many asking about NAFLD.
Here is a sweet, and detailed long form tweet on it.https://t.co/Zgu3JzXXIA
— TheLiverDoc (@theliverdr) March 26, 2023
Diet for fatty liver patients
As diet plays a major role in fatty liver, the doctor clarifies that it is not the carbohydrates or the fats, but the calories. Low-calorie dietary interventions are most effective.
According to Dr Philips, other than low-calorie deficits, a Mediterranean diet without alcohol has proven to help. He suggests a calorie intake of 1,000 to 1,500 calories/day with deficits of 500-750 calories.
Afternoon nap is bad for fatty liver
With studies proving that people are not getting enough sleep, which also leads to fatty liver, the liver doctor insists that one must get adequate sleep of at least six hours and avoid daytime napping of more than 60 minutes.
“Poor sleep, non-restorative sleep, and daytime napping >60 mins are all independently associated with new onset or worsening fatty liver. Pamper your liver by getting some good sleep in your routine,” he tweets.
Drinking coffee reduces fatty liver
Interestingly, while caffeine should be limited for a majority of health conditions, TheLiverDoc says that there are limited studies to show that a minimum of three cups a day (before late evening) of black coffee — no sugar, no milk — can help in reduction of fatty liver disease.
He says, “Much to the offence and annoyance of tea connoisseurs, coffee intake has been shown to reduce fatty liver disease independent of other dietary modifications (limited evidence vs no evidence). Ideally, it is black coffee, no sugar, no milk, a minimum of 3 cups a day, complete intake before late evening & never into the night. This dose will not affect your blood pressure, in fact may reduce it.”
It’s a no to alcohol!
Can a person with fatty liver drink alcohol? An emphatic “no”, says TheLiverDoc. He says that the most common cause of fatty liver is possibly alcohol use.
The safest level of alcohol in preventing fatty liver is ZERO, he tweets. Stop alcohol use and switch to non-alcoholic, alcohol-like low calorie beverages instead.
Stay away from these two foods
Sugar-sweetened beverages and fructose-containing processed foods. The TheLiverDoc says that those with fatty liver must stay away from these two.
Reason: it can increase liver fat immensely and has been linked to fatty liver in both children and adults.
What about artificial sweeteners?
The doctor clarifies that artificial sweeteners are safer to use over natural sugars, even though preclinical studies have shown increased liver fat in animal models due to action on gut bacteria.
“Stevia is supposedly the safest bet among artificial sweeteners. In case of diabetes/obesity, speak with your specialist before you use them,” he explains.
Medicines that work for fatty liver disease
Dr Philips says that there are NO approved drugs for the treatment of fatty liver disease.
Explaining further, he says that the recommended drugs include vitamin E and pioglitazone.
“NO OTHER DRUGS ARE USEFUL. These are not used life long, but only until other associated risk factors are well-controlled. Drug therapy should be initiated in only those with CONFIRMED NASH (ideally biopsy proven or Fibroscan/Shearwave),” Dr Philip explains.
Rational approach to fatty liver
TheLiverDoc says that fatty liver disease is a misnomer. It is really not a disease, but an association.
He urges that the treatments should be aimed at controlling causes of fatty liver disease (alcohol use, diabetes, obesity, hypothyroidism, sleep disorder, sedentary life etc.) rather than the liver itself.
What does NOT work in reducing fatty liver?
Being a doctor who takes on alternate medicines and insists on the need to believe science and data, TheLiverDoc lists some of the foods and exercises that do NOT work in reducing fatty liver.
He says, “Ursodeoxycholic acid, milk thistle, green tea, omega-3 supplements, detox products, yoga (because it is not aerobic), fruitarian diets, crash diets, turmeric/cinnamon supplements, shifting to honey or coconut sugars, herbal formulations, multiherbal products, any product with ‘liver detox’ written on it & any product or advertisement with ‘reverse fatty liver’ written on it.”