Preventing fatty liver with the right nutrition

Tackling a fatty liver with the right nutrition? The liver is our most important metabolic organ and it is essential for detoxifying both the body’s own substances and substances that come from outside. But what happens when this vital organ “turns fatty”, when what is known as a fatty liver develops.

What should we actually picture when we hear the word fatty liver? These are the questions we would like to answer in this article. And even more than that: what can we do to avoid the whole thing? Can we eat our way to a healthy liver? Small teaser: yes 😉 And we will tell you how!

Before we go deeper into the subject of fatty liver, let us first look at the basics. What do we need our liver for? What makes it so special that we should give it this much attention in the first place? One thing we can reveal straight away: the tasks of the liver are extremely varied and above all vital.

Our liver is the organ when it comes to energy metabolism. It evens out fluctuations in the supply of nutrients and in this way keeps the internal environment constant. The stabilisation of blood sugar levels is particularly important. The liver can take up large amounts of glucose, store it in the form of glycogen and release it back into the blood when needed. The liver is also the most important organ for metabolising fructose. But it also influences the metabolism of other groups of nutrients. That only makes sense when you consider that it receives the nutrients directly from the gut.

Besides its functions in the metabolism of energy and toxins, the liver is also an important production site. It produces, for example, almost all plasma proteins, that is, the proteins that “float around” in our blood and take on various tasks. Transport proteins, for instance, ensure the efficient transport of many substances in the blood. These include transferrin, which is responsible for transporting iron, and C-reactive protein CRP, which is an important inflammation marker. Albumin is the most important transport protein in terms of quantity and is also responsible for holding water back inside the vessels. If there is a deficiency, many substances cannot be transported and water can no longer be held back. That is why people with liver disease often suffer from oedema and ascites, water in the abdomen. The proteins of blood clotting are also formed in the liver, for example the clotting factors and antithrombin, which prevents the development of thromboses. People with liver disease are consequently more prone to bleeding because of a lack of these substances. The fat-transporting proteins VLDL and LDL (“low densitiy lipoprotein”) are produced in the liver as well.

Another important substance that is produced in the liver is cholesterol. About 90% of cholesterol biosynthesis takes place in the liver, which corresponds to roughly one gram per day. Among other things, cholesterol is the starting material for our sex hormones and for the bile acids. And while we are on the subject: bile fluid is also produced by the liver. Bile plays an important role in digestion and excretion. In this way fats and substances that are no longer needed, such as heavy metals and some medicines, can be excreted. Some hormones and creatine are produced in the liver as well.

A further task of the liver is the storage of certain substances. Vitamins A and B12 and folic acid in particular are stored in the liver. The liver is also known as a store for iron and copper and, of course, for glucose. Thanks to certain immune cells, the so-called Kupffer cells, the liver is also able to break down bacteria and other pests.

If the liver loses its function, for example because of an advanced fatty liver, it can no longer carry out all the tasks just described. No other organ can take over its tasks, which is why in severe liver disease a liver transplant is the only option. That is why we should pay close attention to our liver health and give it the best possible conditions so that it can do its work!

The liver is a true all-rounder in our body. But like every organ it is also susceptible to disease, and one of the most common conditions is fatty liver.

From a liver fat content of more than 5 to 10% of the liver weight onwards we speak of steatosis of the liver, that is, fatty liver disease. If more than 5% of the liver cells are affected by the fat accumulation, this is initially called liver cell steatosis; if more than 50% of the liver cells are affected, a fatty liver is present.

Two main forms of fatty liver are distinguished: the alcoholic fatty liver, which is largely caused by increased alcohol consumption, and the non-alcoholic fatty liver (NAFLD: “nonalcoholic fatty liver disease”), which arises mainly through lifestyle factors. Mixed forms are also possible. We will look at the exact causes of how the liver can become fatty in more detail in the next point.

Within non-alcoholic fatty liver disease two further forms can be distinguished:

With the alcoholic fatty liver the cause is already in the name: alcohol. More precisely, years of chronic alcohol consumption. When alcohol is broken down in the liver, acetyl-CoA is produced, a substrate of our metabolism that can be metabolised when alcohol consumption is moderate. With long-term alcohol consumption, however, acetyl-CoA leads to increased production of fatty acids and triacylglycerides, the storage form of fatty acids. In addition, alcohol prevents the release of lipoproteins, which transport the fat out of the liver. In combination with the increased production this leads to more fat being deposited in the liver. First liver cell steatosis develops and then a fatty liver. By giving up alcohol, however, the fatty liver is completely reversible again.

Insulin resistance plays an important role in the development of non-alcoholic fatty liver. Because of the raised blood concentration of insulin as a result of insulin resistance, more free fatty acids are released from the fatty tissue. These then reach the liver, where they accumulate and result in a fatty liver. Through complex interactions between liver cells, Kupffer cells, fat tissue cells, inflammatory mediators and free radicals, NASH ultimately develops, that is, the inflammatory form of fatty liver. The oxidation of free fatty acids produces reactive by-products. The chronic inflammation contributes to damage to the liver cells and in the long term promotes the development of liver fibrosis and cirrhosis.

But how can it come to this in the first place?

One of the most important causes that can bring about a fatty liver is a chronically positive energy balance. This arises when you take in more energy from food than you use up, for example with a hypercaloric diet and little physical activity. In the long term this leads to fats being deposited in tissues such as the liver and the pancreas. This can occur both in overweight people and in 7 to 16% of people of normal weight.

Carbohydrates also play an important role in the development of fatty liver. Studies show that the production of fat from carbohydrates makes an important contribution to the development of non-alcoholic fatty liver. The decisive factor here is insulin sensitivity, that is, the degree to which our body cells respond to insulin. With lower sensitivity the body forms about 4 to 5 times more liver fat, even on an energy-adjusted diet, than with higher insulin sensitivity, or indeed with insulin resistance as it occurs in type 2 diabetes mellitus. But insulin-sensitive people also respond to a very high carbohydrate intake with a massive increase in fat synthesis.

Among the carbohydrates, fruit sugar, that is, fructose, is of particular importance when it comes to non-alcoholic fatty liver. Fruit sugar is first converted into glucose in the liver and then used. Through the consumption of juices, soft drinks and so on, the liver is exposed to a great deal of fructose all at once. It then has to convert a great deal of fructose into glucose in one go, which quite simply overwhelms it. Fat is produced. And so a high consumption of fruit sugar can lead to a fatty liver developing within a short time. Fructose occurs in the form of sucrose, a double sugar made of fructose and glucose, in ordinary table sugar. This is used in numerous drinks. Supposedly healthy smoothies also contain a great deal of fructose, which is why smoothies made from fructose-rich fruit are not recommended. We will tell you how to create a healthy and tasty smoothie instead right at the end of the article. And of course the pure fruits also contain masses of fruit sugar. But do not worry, you do not have to give up fruit completely, because a normal intake of fructose does not automatically lead to a fatty liver. Only when fructose is consumed excessively can problems arise. At the end of the article you will also find a few do’s and don’ts for foods that do your liver good 😉.

Besides these diet-related causes there are also other factors that can lead to the development of a fatty liver. These include chronic inflammatory bowel disease or an infection with the hepatitis C virus. Certain cancer medicines can result in a fatty liver as well. A differential diagnosis can establish the cause of the fatty liver.

Starting from the fatty liver, further secondary conditions can also arise. If it is not already present, it is a risk factor for type I diabetes, cardiovascular disease and kidney disease. Disorders of fat metabolism also often develop as a consequence of a fatty liver, because the liver tries to release its fat into the blood in the form of VLDL. Among other things, this raises the risk of heart attacks. Through deposits in the vessels, the development of atherosclerosis is also promoted as a direct consequence of the fatty liver.

People with a non-alcoholic fatty liver often have thin legs and hardly any fat on the thighs and buttocks, but a lot of belly, because the inside of the abdomen has become fatty. They show non-specific symptoms such as a general feeling of being unwell or headaches. Nevertheless the fatty liver can develop into a serious threat to health. If it develops into liver cirrhosis, those affected show symptoms connected with the loss of liver function. This includes jaundice, which shows itself in a yellow discolouration of the skin, the mucous membranes and the sclerae, the white parts of the eye.

There are various examination techniques for diagnosing a fatty liver.

Since there are no approved medicines for treating a fatty liver, only the accompanying conditions are treated with medication. But we want to tackle the problem at the root. Keyword: nutrition.

For liver function to be restored, it is important to get back below the individual threshold of fat accumulation that led to the loss of liver function. So there are no fixed targets and normal values, as long as the fat mass is reduced again.

In first place in nutritional therapy comes the treatment of the components of metabolic syndrome. Since insulin resistance in particular plays a decisive role in the development of non-alcoholic fatty liver, it is important to get this disorder of carbohydrate metabolism back under control. That works best when you turn the carbohydrates down and give preference to foods with a low glycaemic index. Fructose in particular puts a special strain on the liver and should therefore be consumed in moderation! Studies have shown that even without a reduction in calories, a ketogenic diet can clear the fat from the liver again within a few weeks, and that even though more fat is eaten. Through the improvement in insulin resistance the cardiovascular risk profile also improves, which means many further risk factors are improved.

Studies have also shown that a reduction in weight leads to an improvement in the fatty liver. A weight reduction of about 0.5 to 1 kg per week is recommended. Here too it has been shown that a carbohydrate-reduced diet with an emphasis on fat and protein can achieve significantly greater weight loss than fat-reduced diets. Studies have shown that, independently of weight reduction, a low-carb diet brings about a significantly greater reduction in liver fat than a low-fat diet. A Mediterranean diet, in which vegetables, olive oil, seafood and fresh preparation are to the fore, is also well suited to treating a fatty liver. Omega-3 fatty acids help to clear the fat from the liver and make it fully functional again.

Of course physical activity plays a role too. Regular activity increases energy consumption and improves the ability of the muscles to use components of food to generate energy. This produces positive metabolic effects. In combination with improved insulin sensitivity, less substrate is available to the liver, which reduces fat formation in the liver. By lowering specific blood parameters, increased physical activity can lead to an improvement in glucose and fat metabolism.

That was a lot at once, so here again are the most important points of liver-healthy nutrition at a glance:

Or you can listen to the interview as an audio version in our podcast “Eat better, not less”.

We have now looked in detail at the fact that nutrition plays an important role both in preventing and in treating a fatty liver. But why is that actually the case? Which nutrients are responsible for these effects? We will look at that more closely in what follows.

Getting started with a low-carbohydrate diet can be a real challenge at first, but with a few practical tips you can fit it into your everyday life more easily.

Before you stand in despair in front of the supermarket shelves without knowing what you are allowed to eat and what not, it makes sense to inform yourself a little beforehand. The Logi pyramid from section X can help with that. On our blog you will also find an overview of how many carbohydrates there are in various types of fruit and vegetables and which ones you can best use. Did you know, for example, that berries in particular are especially low in carbohydrates? And so that you know exactly where you stand, here are a few do’s and don’ts about the most important food categories to take with you:

Before you go shopping, think about what you would like to cook over the next few days. Also build up a few stores of foods that keep, so that you always have a good option at home. It does not always have to be a complicated, elaborate dish. We will show you how you can conjure up tasty low-carbohydrate dishes quickly and easily. You will find suitable recipes further down and of course on our blog.

Plenty of vegetables on your plate creates plenty of volume in your stomach and therefore a high level of satiety. That way you stay full for longer and the risk of food cravings drops.

Who does not know the feeling: you come home from a long day at work and really have no desire at all to stand in the kitchen for ages. It is easy to be tempted to stop at the nearest fast food restaurant or quickly shove some convenience product into the oven. Our tip: cook ahead! Simply prepare a little more of a dish and freeze it. That way you always have something tasty and healthy at home that is ready in no time at all.

You simply cannot do without your bread in the morning? Then why not try lower carb substitute products or simply bake it yourself. Rice is just part of the deal for you? No problem! You can make a rice substitute from cauliflower in no time. The same goes for pasta: simply cut courgettes into thin strips with a spiraliser and you have tasty vegetable noodles.

Be clear about why you are doing all this. If you already have a fatty liver, you can reverse it with the power of nutrition alone. With that you can lower your risk of further conditions such as cardiovascular disease or a heart attack. And even without an existing fatty liver you can counteract the whole thing preventively, so that it does not come to that in the first place! You improve your quality of life enormously in the process. Keep reminding yourself of that whenever you are struggling with yourself. It is in your hands to live the best possible life!

All beginnings are difficult. And sometimes, even after a long period of motivation, you can suddenly fall into a hole. Whatever happens, our community is there for you and will catch you. In our Facebook group you will find support, tips and tricks that help you find your motivation again.

As promised, here now is the recipe for a smoothie that you can sip with a clear conscience, armed with all this background knowledge. But we would not be Foodpunk if we only had this one recipe that does your liver good. So here comes a whole list of tasty, liver-healthy recipes that you really should try. And do you know what? Those are nowhere near all of them! On our blog you will find many more of them.