More than 80 million North Americans suffer from a fatty liver and many do not know that they have it because most people with a fatty liver have normal liver function blood tests in the early stages of the disease. The American Association of Clinical Endocrinology, supported by the American Association for the Study of Liver Diseases, has issued guidelines for diagnosing and treating a fatty liver (Endocrine Practice, May 1, 2022;28(5):528-562).
You can have excess fat in your liver for a few years with no symptoms. However, if you do not get rid of the excess liver fat, it will markedly increase your chances of being obese and/or diabetic, and put you at significant risk for suffering a heart attack, certain cancers and dementia. Having a fatty liver may be the most common cause of liver failure and need for a liver transplant (Clin Gastroenterol Hepatol, 2019;17:748–55).
How a Fatty Liver Causes Diabetes
Storing fat in your belly is a stronger risk factor for diabetes than just being overweight, and is arguably the most common cause of Type II diabetes in North America today (BMC Public Health, November 18, 2019). Most cases of Type II diabetes are caused by inability to respond to insulin because of excess fat in the liver (J Clin Invest, May 19, 2020). Having excess fat in your liver also puts you at high risk for strokes, heart attacks, liver failure, and some cancers. More than 50 percent of people with excess fat in their liver are already diabetic or pre-diabetic (J of Family Med and Prim Care, Dec, 2022;11(12):7640-7643), and 11-20 percent of people with excess fat in their liver will suffer from liver failure within 10–15 years (Clin Gastroenterol Hepatol, 2015;13:643–540).
Signs of a Fatty Liver
You are at very high risk for a fatty liver if:
• You have a big belly and small buttocks. Men are at increased risk for having a fatty liver and being diabetic if their waist circumference is greater than 38.7 inches, and women if it is greater than 36 inches. Measuring a person’s waist circumference is a simple and efficient way to see if people who are not overweight are still at increased risk for diabetes (Arch Med Sci Civil Dis, July 22, 2019;4:e64–e71).
• You can pinch more than 2.5 inches of skin and fat next to your belly button.
• A sonogram demonstrates a fatty liver.
• Your blood sugar one hour after eating a meal is greater than 145 mg/dL. You are probably already diabetic, even if your fasting blood sugar is normal (under 100 mg/dL).
10-20 percent of North American adults have a fatty liver, and 2-5 percent already have liver damage from the excess fat. All diabetics should be checked for a fatty liver; 73 percent of diabetics and 95 percent of obese diabetics have a fatty liver (Gut, 2016;65:1359–68), and 52% of insulin resistant diabetics will develop a fatty liver within three years (Hematology, 2020;72:1230–41).
Diagnosis and Treatment of Fatty Liver
Risk factors for a fatty liver include being overweight, having high blood triglycerides, having high blood pressure, having high LDL cholesterol, and being diabetic. Early on, fatty liver disease causes no symptoms. As your liver damage increases, you will become tired and weak. Early on, your liver function tests will be normal, but if you do not make lifestyle changes to treat the fatty liver, your liver will be severely damaged and your liver tests will become abnormal.
No medication is available today to reverse the fat buildup in your liver. Researchers are studying some new diabetes medications to treat fatty liver. Current treatment (Gut, Sept 7, 2022;71(10):2123-2134) includes:
• Medications to lower high cholesterol, high triglycerides and high blood pressure if you need them
• Control of diabetes with lifestyle changes and taking diabetes medications if you need them
• Lose weight if overweight
• Avoid alcohol
• Follow a plant-based diet with vegetables, fruits, whole grains, beans, nuts and other seeds. Severely restrict foods with added sugar, all sugared drinks, mammal meat, processed meats, and fried foods
• If you have a large belly, limit all refined carbohydrates such as those found in foods made from flour, including bakery products, pastas, and most dry breakfast cereals
• Start and maintain a regular exercise program. Both exercise and calorie restriction reduce liver fat in overweight and obese adults, but only exercise has a dose-dependent effect in reducing liver fat and reducing belly fat (Br J Spots Med, Jan 20, 2023). A review of 105 studies shows that a regular exercise program lowers fasting blood sugar and HBA1c (which measures the amount of sugar stuck on hemoglobin) in both diabetics and non-diabetics, and that each additional 100 minutes per week of physical activity was associated with a mean average decrease of 2.75 mg/dL of fasting blood sugar (Acta Diabetol, (2017) 54:983). Strength training lowers high blood sugar levels and liver fat, even before weight loss occurs (Journal of Endocrinology, Apr 2019;241(1):59–70). Try to move about or exercise before or after you eat. Contracting muscles remove sugar from your bloodstream without needing insulin
• Keep blood levels of hydroxy vitamin D above 30 nmol/L