The liver is one of the most important organs in the body, serving vital metabolic functions and also playing a role in the production of blood components. In normal circumstances, the liver has a small amount of fat. However, if fat levels in your liver are more than 5-10% of the total weight of the organ, then you have a problem¹.  Fatty liver disease is a reversible illness, especially with an altered lifestyle. In the most typical cases of the condition, there are no symptoms and no permanent damage caused².  The disease is common, and about 10-20% of Americans are currently living with too much fat in their livers. Most cases are detected in people between 40 and 60 years of age. This is mainly due to the presence of risk factors such as obesity, type 2 diabetes and metabolic syndrome (including increased abdominal fat)³.

Causes of Fatty Liver Disease

The most common cause of Fatty Liver Disease is undeniably heavy drinking and alcoholism². Other causes of the condition include:

• Obesity
• Hyperlipidemia
• Diabetes
• Choline Deficiency
• Genetics
• Losing weight too quickly
• Drug side effects such as aspirin, steroids, tetracycline and tamoxifen

The types of Fatty Liver Disease

The basic mechanism underlying all types of fatty liver disease is the body creating too much fat or not being able to metabolize the fat as required. This leads to a buildup of fat in the liver, which predisposes one to develop the condition. The types of fatty liver disease include:

• Nonalcoholic Fatty Liver, which is increasingly common around the world, especially in Western nations. In the United States, it is the most common form of chronic liver disease, affecting an estimated 80 to 100 million people³.
• Alcoholic Fatty Liver
• Nonalcoholic steatohepatitis (NASH)
• Acute Fatty Liver of Pregnancy

Risk Factors for Fatty Liver Disease

You’re more likely to develop the condition if you’re obese. Insulin resistance also leads to a buildup of fat in the liver, which also leads to diabetes type 2. Other risk factors include:

• High cholesterol and triglyceride levels
• Malnutrition, especially choline deficiency
• Metabolic syndrome
• Pregnancy
• Excessive dosage of some over the counter drugs such as acetaminophen

Diagnosis of Fatty Liver Disease

For the doctor to diagnose you with fatty liver disease, a combination of history taking, physical examination, lab tests and imaging tests will be used to confirm the diagnosis of fatty liver.

In the history, the doctor will focus on some clues that may lead to fatty liver disease, such as lifestyle habits, a history of diabetes and obesity in the family and so on. Your liver will be inflamed and swollen during a physical exam. You may also exhibit signs of fatigue or loss of appetite that may be evident in a physical exam.

Some of the lab tests that the doctor may order include⁴:

• Fasting insulin and glucose levels for evaluating potential glucose intolerance
• Glutamyl transpeptidase (GGT) levels, which is related to alcoholism
• Alkaline phosphatase levels (ALP)
• Aminotransferase levels (AST and ALT)
• Viral serology tests for Hepatitis C- to exclude viral infection
• Iron levels and total iron-binding capacity
• Autoimmune markers such as antinuclear antibody (ANA)

Other tests will include a liver biopsy and an ultrasound of the liver

Treatment and Prognosis

Fatty liver disease is reversible, and significant medical intervention is not necessary to correct fatty liver⁵. However, natural solutions like diet and lifestyle changes are often necessary. Abstinence and a well-balanced diet are the standard therapy. While tracking prognosis of the condition, some blood tests may show cholesterol levels rising and triglyceride levels decreasing. This may be cause for worry for some patients, but this is a good thing, and it shows that the treatment is working.

More information on choline deficiency

Originally choline was discovered as an important nutrient because mice with a choline-deficient feed developed fatty liver. After looking for other known vitamins and minerals that could explain the issue, scientists eventually discovered that choline was the missing link. Another group of researchers found that choline reversed fatty liver in Type 1 Diabetic dogs.It may be advised to get between 500mg – 2g choline per day for people with fatty liver. 400-1,000mg per day is a good preventive for those wanting to maintain a healthy liver. Egg yolks are a great source of choline (about 110mg per egg and about 90% of that from the yolk). Liver and lecithin are also great sources of choline.

Treatment to do list

• Abstinence or moderation of alcohol intake, especially for those consuming excessive alcohol.

In cases of non-alcoholic fatty liver, the following needs to be done:

• Consuming 500-1,000mg choline per day (egg yolks, liver, non-GMO lecithin, and other dietary sources and/or quality supplements)
• Reducing the amount of ingested refined and processed carbohydrates (especially sugar and desserts)- this helps bring triglyceride levels down.
• Eliminating gluten and possibly all grains for a period of time until triglyceride levels are back to normal.
• Increasing healthy fats like Omega 3’s from cold water fatty fish or high-quality fish oil, and decreasing unhealthy fats.
• Reducing fructose (avoid high-fructose corn syrup and moderate fruit intake)
• Increase movement, especially walking and high interval training (HIIT)
• Mindfulness practices and stress-management techniques and can help balance cortisol levels and aid in returning to healthy weight.

 Reference Links

• https://www.webmd.com/hepatitis/fatty-liver-disease#1
• https://www.healthline.com/health/fatty-liver?m=0
• https://www.mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/home/ovc-20211638
• https://emedicine.medscape.com/article/175472-overview#a8
• https://emedicine.medscape.com/article/175472-overview#a12
• https://www.ncbi.nlm.nih.gov/pubmed/18329917/