The GI Files: Part 2 – Tackling fatty liver

by Jada-Virginia Surpin

You may have heard in our recent podcast Dr Patel, a consultant gastroenterologist at St George’s Hospital, discussing the problem of non-alcoholic fatty liver disease (NAFL) and non-alcoholic steatohepatitis (NASH). Despite continuing high rates of alcohol consumption, the data indicates that fatty liver disease (basically cirrhosis of the liver from eating the wrong diet) is continuing to increase with 1 in 5 people in the UK thought to be affected due to our ever-increasing consumption of poor quality processed fats and highly processed carbs. Today, we will take a look at why this is and how we can work to solve this.

NAFL is the build-up of excess fat in the liver. The risk factors are: obesity, type 2 diabetes, high blood pressure and metabolic syndrome. This is logical since the common denominator in all of these conditions is obesity; which is directly linked to poor dietary choices and the consumption of highly processed foods. Fatty liver disease has serious consequences, such as cirrhosis and kidney disease and can lead to an increased need for liver transplants and risk of mortality. In the past problems arse after years of inflammation. However due to increasingly poor lifestyle choices rates are climbing at alarming rates, particularly in younger people. The good news is if you act now, you can potentially reverse the disease.

The liver converts nutrients such as fat into substances that can be transported and used in our body. These are stored in the liver and sequestered for use elsewhere as needed. When fat is digested correctly in the small intestine, it is absorbed directly into the bloodstream in fatty packages called chylomicrons. However, when the liver contains an abundant supply of glycogen, it starts converting any excess glucose absorbed from the blood into fatty acids, for long-term storage as body fat. The fatty acids and cholesterol are once again gathered as fatty packages and delivered around the body through the bloodstream. Much of the fat ends up stored in fat tissues leading to a build-up of fat around our vital organs. However, over time, surplus fat produced and stored by the liver can sometimes lead the liver itself to accumulate fat, resulting in non-alcoholic fatty liver disease.

Although any surplus of fat can be damaging to the liver, good quality fats do not form harmful deposits. This is clearly demonstrated among the Massai tribe of Kenya, who consume a diet high in saturated fat due to their high intake of red meat and yet experience a low incidence of heart disease and high blood pressure. This has led to the discovery of industrial trans fatty acids (iTFA) and ruminant trans fatty acids (rTFA). ITFA is highly processed fat and rTFA is naturally occurring in meat and milk, two Massai staples. Although the Massai consume large amounts of saturated fat and rTFA, they see no adverse effects, demonstrating that the quality of fat is paramount in promoting good health.

In fact, all natural sources of fat contain varying compositions of both saturated and unsaturated fat. We should all be careful to eat these in the right amount and we shouldn’t be afraid to eat natural rTFA and saturated fat.

If this is done, naturally occurring fat can be used to effectively replace bad fats in the body. Over time, when good fats are digested, they are taken up in the bloodstream, which can even ensure that the rest of the fat contained in the body is of better quality, not only in the liver, and can help to combat overweight. Therefore, functional health specialists recommend that people with fatty deposits in their liver ensure that all fat intake is of good quality.

Coming from a large family, I speak from experience when I say that access to quality food does not mandate an extensive food budget, so don’t allow your budget to restrict you. Oily fish, coconut oil, olive oil, nuts and seeds are affordable if bought in the right places. BrandlessTM, for instance provide affordable, natural, largely eco-friendly products online, without the added price of branding. Here, organic, cold-pressed, unrefined coconut oil (although plastic- packaged) costs $3 for 300ml whereas other brands often capitalise on impressive health-related buzzwords, charging customers three times the reasonable price.

Below, I have compiled a list of fatty staples in my diet which are packed full of good fat and should provide guidance to the meal planners and budgeters among us. These foods contain omega 3 and 6, other types of unsaturated fat and saturated fat. Oily fish, nuts and seeds are high in omega 3 whereas red meat contains a greater proportion of omega 6 to omega 3.  Cod liver, flax seeds, chia seeds and olive oil are all notoriously high in omega 3.

I recommend coconut oil and red meat despite their large proportion of saturated fat, which is still needed for a balanced diet. Conversely, I particularly avoid commercially produced shortbread and cookies as these contain processed saturated fat and iTFAs, which are not at all needed for a balanced diet and produce harmful, even deadly long-term effects. If you suffer from NAFL, I would completely cut these things out of your diet, they are not worth the pain!

Plant-based sources of good fat Meat sources of good fat
Walnuts Mackerel
Chia seeds Cod and Cod liver
Flaxseeds Sardine
Coconut oil Salmon
Olive oil Tuna
Pumpkin seeds Beef
Sunflower seeds Duck

If you would like to follow the most evidence-based balanced diet, here is a link to the Alliance for Natural Health International’s Food4Health Guidelines.

Overall, overcoming a fatty liver is not the same as removing water-soluble substances.  The idea of using good fats is to replace inflammatory fatty deposits because good fats behave differently and don’t form harmful deposits. However, this is not to say that an overconsumption of good fats will help in treating fatty liver disease without other dietary and lifestyle changes!

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