by Doc Mok

Did you know that even your liver can be fat?  That’s right, the obesity epidemic can pour over into our internal organs.  Fat on the outside, fat on the inside, both bad for your health.  As a GI Doc, I see many a person suffering from fatty liver disease and the number one intervention is…LIFESTYLE.  This week at Maximal Being, we help you lose fat in your liver using simple lifestyle changes.

The Role of Your Liver in Fat Loss

Apart from the obvious job of the liver, to filter toxins such as alcohol, the liver performs many other functions.  The liver filters your blood, counterbalancing nutrients and regulating the storage of much of your micronutrition (like iron).

Your liver can also convert your nutrients into vital products.  Some examples include albumin (shuttles medications, and other compounds around the body), clotting factors.  Red blood cells and platelet also partially mature in the liver.  The liver also helps you break down fat in the diet, by making bile.  Bile is stored in the gallbladder and released by the bile tubes. 

Excess carbohydrates, fat, and proteins can all be converted in the liver to meet the demands of various other bodily needs.  If you eat an excess of carbohydrates, the liver stores this in the form of fat or in the form of glycogen.  If you need energy, the liver can also shuttle fat within itself into the form of carbohydrates, fats or proteins.  Pretty amazing huh!

The Liver Gets Mad When It Can’t Lose Fat

Though very good at balancing your nutrients, the liver can only do so much.  Excess calories, especially in the form of simple carbohydrates, can overwhelm your liver’s delicate regulation and the liver gets mad!  By mad, I mean it releases inflammatory cells.

When inflammatory cells are released in the liver, liver cells can become damaged.  Damaging the liver leads to the release of what we term as transaminases.  If you are looking for such values on your liver testing, these are the AST (SGOT) and ALT (SGPT).  These values are quite different than the liver’s functional ability.  Measures of liver function include the clotting time (INR), platelet count, bilirubin, and albumin, for the reasons stated above (function).  Changes in these values, in the context of liver disease, can indicate that the liver is not functioning properly.

This inability to function is often because your healthy liver cells have been replaced with scar tissue.  Scarring in the liver can be at a low level or advanced leading to cirrhosis.  As an aside, it is a common misconception for people to think that cirrhosis is ONLY from alcohol.  The truth is, that cirrhosis can be caused by 100s of different conditions and really just means scar tissue in the liver, which ultimately interferes with the liver function.

Why Lose Fat in the Liver?

The reason to avoid cirrhosis of the liver is because cirrhosis has MANY serious conditions associated with it.  Due to scar tissue, the blood cannot filter through the liver, leading to a back-up of blood.  This backup can cause swelling of vessels inside the abdomen (varices), which can rupture and BLEED LIKE STINK. 

Also related to the poor filtration, toxins can build-up in the body causing confusion (hepatic encephalopathy).  Other than toxins, fluid can also backup and weep off of the liver causing fluid within the belly cavity.  A buildup of fluid, termed ascites, can make people look pregnant and can become infected (spontaneous bacterial peritonitis).   As if that wasn’t enough, your risk of liver cancer also goes up exponentially when you have scar tissue, so watching for this cancer is certainly important.  Not to mention all of the above clotting, blood cell and energy storage functions go NUTS!  Now that I have scared you, let’s review the underlying principles behind improving fat loss in your liver and preventing these conditions. 

The Principles Behind Liver Fat Loss

Generally speaking, the underlying mechanisms for fat within the liver has to do with excess calories, namely in the form of simple carbohydrates.  As you know from our articles on Insulin Resistance (here), The Ketogenic Diet (HERE), and Intermittent Fasting (HERE), too many carbohydrates over time, leads to many spikes in insulin.  When the body received many insulin spike, the response to these spikes blunts over time, leading to insulin resistance.  An end result, your body stores fat around your middle and in the liver. 

The key to mitigating this storage process is to improve the insulin resistance via the cause, what you put in your mouth.  Yes, medications can be used to modulate insulin resistance.  If you want to learn more about this, I recommend discussing this with your physician.  Otherwise, let’s delve into things YOU CAN DO RIGHT NOW!

Stop or Cut Back on Alcohol to Lose That Fatty Liver

As discussed above, one of the liver’s main jobs is to detoxify your body.  When you overwhelm it with alcohol, it cannot efficiently break alcohol down.  Also, all of the extra alcohol units cannot be used as energy, so your body will store it in the form of fat globules.  This is termed alcohol-induced liver disease.  Add on inflammation and you have steatohepatitis or ASH. 

ASH and non-alcohol related steatohepatitis (NASH) can both be improved with avoidance of reduction in alcohol use.  Even in low amount and within the daily recommended number of alcoholic beverages (2/day for a woman and 3/day for a man), damage to the liver can be seen.  For more, on the effects of alcohol on your liver, check out our articles on alcohol science (HERE) and why cutting back may benefit your wellness (HERE).  The benefit to stopping or cut back are not just for your liver, but MUCH MORE. 

Lose Fat in the Liver with Nutrition Changes

As we discussed above, energy balance is a large player in the fatty liver disease state.  Excess calories can be stored in the liver, and the best way to do so is in the form of fat globules, as they house more calories per unit.  Therefore, using a calorie restriction protocol, has shown benefit in people with non-alcohol-induced fatty liver disease (NAFLD).

Regarding macronutrition, many have theorized the role of low fat and low carbohydrate interventions on fatty livers.  One study looked, specifically at sugar, intake, showing improvements in clinical outcomes using this approach.  In my opinion, this is likely due to the role insulin sensitivity rather than energy balance.   

Next regarding fat intake, a study funded by the American Diabetes Association (ADA), demonstrated a more damaging effect of saturated fat on the liver when compared to simple sugars.  Despite, this, it appears our old tried and true Mediterranean diet, which does involve the ingestion of more monounsaturated and polyunsaturated fats, appears to work for fatty liver disease.  However, understanding the biochemical basis of the ketogenic diet and intermittent fasting, one would surmise that these strategies would be beneficial.  The results are yet to be concluded. 

Other than fats, the protein appears to carry some benefit for those with NAFLD.  Using similar diet, the total amount of protein does improve inflammation in people with fatty liver disease.  Though the source of protein can, be debated, the total amount appears to carry some beneficial effects on the liver.  

Supplements and Coffee for Losing Liver Fat

After establishing the role of various macronutrients in NAFLD, the next step involves outlining additional supplementation that could reverse or prevent such changes.  Of these interventions, vitamin D is the most established.  Not only does low vitamin D, lead to more fatty liver disease, but vitamin D supplementation can improve it. 

Coffee = Good for your Liver

Other such vitamins have been evaluated, the majority of which prove more harm than good.  The exception to this is vitamin E, which is a long-established therapy for NASH and NAFLD.  Glutamine, non-acetyl cysteine, and various herbals have been described, but lack conclusive data.  On the other hand, grounded in scientific data, are the beneficial effects of coffee.

It appears that the benefit of coffee within the liver involves unique compounds and not just caffeine.   The positive effect of coffee on the liver appears when 2-3 cups daily are consumed but does not increase much with more.  With several apparent studies performed looking at various populations, the message is conclusive, coffee = good for your liver.  

Exercise Can Help You Lose Fat in Your Liver, but Also Your Belly

As opposed to the effects of coffee, which is not dose-dependent, exercise absolutely improves fatty liver disease in a dose-dependent fashion.  In fact, a systematic review (group of studies looked at together) demonstrated that this benefit reduced fat in the liver 20-30%, which was completely independent of body fat loss.  This means, just from the exercise alone and not the fat loss as a result.

Whether is be aerobic exercise, high-intensity interval training (HIIT), moderate intensity walking or weightlifting, the veracity, and consistency appears to determine long-term success.  Specifically, the intensity improved the cardiac (heart) risk factors the most, but the ability to keep up with any exercise is most important.  

What about the weights?!  Well, weightlifting, does increase your ability to burn oxygen and depending on the intensity may have long-lasting benefits.  Furthermore, weight training increasing your VO2 max appears to continue burning fat for days after the action has been performed.  Overall, leading to a 10-15% improvement in fat within the liver.  Honestly, as long as you are doing the action, it helps.  As long as you can do it over time, great. 

Doc Mok’s Take on Losing Fatty Liver Disease

Fatty liver disease is a complex grouping of conditions both related to alcohol and metabolic syndrome.  Though not always cause for concern, consider NAFLD a warning sign for future inflammation, cirrhosis, and possibly cancer.  Act before this disease progresses by lowering the glycemic index of your carbs (vegetables), lowering saturated fats, caloric, and processed foods.  Increasing your protein intake and adding vitamin D, along with 2-3 cups of coffee can most certainly help.  Move more and if possible, add intensity, but make Longevity and SUSTAINABILITY your focus. 

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