Patients who come to the emergency department with abdominal pain often have an ultrasound as part of their diagnostic tests – especially if the pain is localized in the upper right abdomen. This is done to evaluate emergency causes of pain, especially if the source is related to the liver or gallbladder.
With increasing frequency over the years, I have seen ultrasound results showing ‘fatty liver’ in patients. In the absence of chronic alcohol use, nonalcoholic fatty liver disease (NAFLD) affects between 80 and 100 million Americans. This adds up to about a third of adults. Despite its name, a third of people with fatty liver disease are not obese.
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Where do those fatty deposits come from?
NAFLD is actually a group of liver diseases that includes fatty liver, which occurs when there is an excess of fat deposits in the liver. When fatty liver is accompanied by inflammation and progressive fibrosis, this is referred to as nonalcoholic steatohepatitis (NASH). If NASH is allowed to progress, it can lead to cirrhosis, which is permanent scarring that leads to liver failure.
So where do the fatty deposits in our livers come from in the first place? Chronic alcohol consumption or a diet rich in “bad” saturated/trans fats and simple dietary sugar contribute to fatty acid deposits in the liver. Although the exact cause remains elusive, NAFLD is the result of a complex interaction of multiple metabolic diseases including:
- High triglycerides
- high blood pressure
No wonder then that fatty liver is an independent risk factor for heart disease. This was a major contributing factor to the American Heart Association’s recent writing of a position paper on NAFLD.
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Fatty liver: silent but dangerous
Most people with nonalcoholic fatty liver disease likely will not have symptoms. Those with fatty liver may experience nonspecific symptoms such as intermittent or persistent pain in the upper right abdomen (where the liver is located) and tiredness or chronic fatigue.
Patients with more advanced disease such as nonalcoholic steatohepatitis or cirrhosis may have swelling of the hands or legs, an increase in the circumference of the abdomen, or yellowing of the skin or eyes known as jaundice.
Diagnosis of fatty liver disease
Most patients discover they have symptomatic fatty liver after treatment for abdominal pain or through their primary care physician. I hesitate to say “I’ve been diagnosed with fatty liver” because as mentioned earlier, fatty liver is part of a group of liver diseases caused by multifactors. The treatment, as I will discuss below, involves addressing the multiple metabolic imbalances that contribute to fatty deposits.
In the emergency department, an ultrasound of the patient’s abdomen indicates “fatty liver”. Liver function tests may be elevated and indicate a certain level of inflammation.
Fatty Liver Treatment: Treating Multiple Causes
The liver is a vital organ that performs a variety of critical tasks including converting food into energy and removing toxins from the body. Fortunately, fatty liver is reversible and can be treated with a range of non-pharmacological interventions.
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First and foremost, losing weight is an essential component of a fatty liver treatment plan. Remember that both strength training and cardio exercises can reduce fat. Aim to exercise at least 30 minutes a day on most days of the week. However, rapid weight loss is dangerous and can worsen nonalcoholic fatty liver disease. If you are obese, aim to lose 7-10% of your body weight over the course of one year. A simple rule of thumb is your ideal target body weight – your height in centimeters minus 100 kilograms. So for example, if you are 182cm (6ft) tall, your ideal body weight to photograph would be 82kg (181lbs).
In general, note that there is no particular diet style that is better when it comes to reducing fatty liver disease. The focus should be low in carbohydrates. Interestingly, the treatment focuses on replacing simple sugars like table sugar, sucrose, and fructose with low-glycemic fruits just as much as replacing “bad” saturated/unsaturated fats with trans fats. This is because simple sugars are the main cause of many of the metabolic imbalances mentioned above that contribute to fat deposition.
Additional guidelines to follow in developing a fatty acid diet plan:
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However, if the fatty liver develops into more advanced inflammation or cirrhosis, see your primary care physician and referral to a gastroenterologist. There are currently no US Food and Drug Administration (FDA) approved medications for nonalcoholic fatty liver.
Michael Daignault, MD, a board-certified emergency physician in Los Angeles. He studied global health at Georgetown University and received his medical degree from Ben-Gurion University. He completed his residency training in emergency medicine at Lincoln Medical Center in the South Bronx. He is also a former US Peace Corps volunteer. You can find him on Instagram @ dr.daignault