The thought of being diagnosed with a disease is terrifying — there’s a sense of permanency to it. While this is true with many conditions, it’s luckily not the case with fatty liver disease. The Stark team had the chance to chat with Dr. Ibrahim Hanouneh, leading hepatologist and author of Skinny Liver: A Proven Program to Prevent and Reverse the New Silent Epidemic-Fatty Liver Disease. Here’s what you should know about the diagnosis and treatment of fatty liver disease.
What is Fatty Liver?
Simply put, fatty liver is the accumulation of fat in the liver. Dr. Hanouneh says, “when we take a picture of the liver, you’ll see a lot of fat there. There are two common causes of fatty liver: alcohol or fat.” You have likely heard the age old saying that “you are what you eat”, so therefore people believe they will gain adipose tissue (body fat) if they eat fat (the macronutrient)— but that’s not necessarily true. Its actually excessive sugar that causes you to gain adipose tissue. While fatty liver disease is the accumulation of fat in the liver, it is caused by carbohydrates or sugar.
He continues, “Excessive alcohol intake can certainly cause fatty liver and eventually scarring of the liver, psoriasis, and possibly liver cancer. Similarly, fat can do the same thing. When you talk about liver disease, the first thing that comes to a liver doctor’s mind is alcohol. But, most people don't know that fat is as dangerous as alcohol on the liver — by far the most common cause of liver disease in the country is fatty liver.”
The process looks like this: fat in the liver eventually turns into inflammation, which leads to scarring of the liver, which could lead to liver psoriasis or liver cancer. When it comes to liver disease, Dr. Hanouneh says that fatty liver is potentially the beginning of the end.
Identifying Fatty Liver Disease
25% of Americans are at risk for fatty liver disease — but many remain undiagnosed. Since it’s such a common disease, it’s difficult to provide a mass screening. Dr. Hanouneh says he tends to scan patients with high-risk characteristics like type 2 diabetes, central obesity (fat around the belly button), hypertension, or a family history of fatty liver.
You could get a blood test from your general practitioner, but unfortunately, these aren’t very accurate tests. It’s not uncommon for people with fatty liver to receive normal results from a blood test. Dr. Hanouneh uses an ultrasound technique called the fibroscan — this test accurately measures how much fat is in the liver.
Getting tested for fatty liver disease is incredibly important if you’re in an at-risk group. It’s important to note that age isn’t necessarily a risk factor! For example, a twenty-five-year-old with obesity and a family history of fatty liver would require screening, while a sixty-five-year-old lean man with no history of fatty liver wouldn’t.
Dr. Hanouneh says, “At an earlier stage, fatty liver is reversible with weight loss. It turns out that if you lose 5-7% of your weight, your fatty liver will go away. It's a little more difficult for fatty liver to get reversed once you have scarring or psoriasis. It’s not impossible, you may still reverse fatty liver at a later stage, but it’ll be much more difficult.”
Here’s the good news: there’s still hope if you get diagnosed with fatty liver disease. You should aim to get a screening before you develop scarring or psoriasis.
Preventing or Reversing Fatty Liver Disease
Fatty liver disease is directly correlated to your alcohol intake, excess sugar, and the amount of exercise you incorporate into your routine. There’s a common misconception that you won’t have a fatty liver if you don’t drink alcohol — but you can get a fatty liver just by having a high carbohydrate or sugar intake.
To prevent or reverse fatty liver disease, you need to make serious lifestyle changes. Dr. Hanouneh recommends following a low-carb diet and exercise program that primarily consists of strenuous activity. Light exercise doesn’t burn fat in the liver. You should try strength or interval training to get your heart rate up — even if it’s just for a short time! Lifestyle changes are the difference between a healthy liver and a fatty liver.