Hepatic Steatosis - Natural treatment, symptoms, causes
NASH (nonalcoholic steatohepatitis) is the most advanced stage of a silent liver disease that begins with the excessive accumulation of fat, in the form of droplets, within the liver tissue.
This is called hepatic steatosis or NAFLD (Non Alcoholic Fatty Liver Disease).
Photo Gustavo Fring in Pexels
In a second stage, the fat deposits lead to inflammation and damage to the liver tissue, indicating liver damage. This is called NASH for nonalcoholic steatohepatitis.
A global epidemic?
The number of cases of nonalcoholic steatohepatitis is constantly increasing in industrialized countries. In fact, some studies show that this pathology could increase by 63% between 2015 and 20301 in the United States.
As well as in Europe, and above all it could become the first cause of liver transplantation between 2020 and 20252. Studies from 20163 and 20194 estimate that 25% of the world population is affected by NAFLD, and 9% by NASH.
Non-alcoholic liver steatosis (NASH) seems to be becoming the most common chronic liver disease, affecting ¼ of the European population with a doubling of cases in the last 20 years.
The pathology affects obese people (80%) but also children and adolescents in 10 to 20% of the cases.
As for NASH, the inflammatory form of the disease, it affects 500,000 people in France, i.e. about 1% of the adult population.
What are the consequences of this disease?
The consequences of NASH are important because the inflammation generated by the accumulation of fat droplets can disrupt liver cells, creating lesions that will eventually heal by creating fibrous tissue.
This is called cirrhosis, which can occur in about 20% of cases after 20 years of evolution.
Cirrhosis can result in the appearance of liver cancer or hepatocarcinoma in 7% of cases.
In addition to these consequences on the liver, it can also multiply the risk of developing other pathologies, in particular cardiovascular pathologies such as myocardial infarction or stroke.
Risk factors for occurrence
Liver steatosis is more common in people with :
Overweight or obesity (BMI > 25): NAFLD increases are associated with increases in waist circumference and body mass index.
What is important to note is that while the prevalence of NAFLD is 3-10% in children, these figures can reach 40-70% of obese children.
A metabolic syndrome characterized by overweight, a large increase in waist circumference, high blood pressure, and biological signs such as high fasting blood sugar, increased triglycerides, or low levels of HDL ("good cholesterol").
Insulin resistance, i.e., the inefficiency of insulin that does not allow glucose to enter the cells,
Type 2 diabetes, which is very often associated with hepatic steatosis, with a close relationship between type 2 diabetes and the severity of NAFLD and the progression to nonalcoholic steatohepatitis,
A bad lifestyle with a diet too rich in sugars, sweetened drinks that provide a lot of fructose, too many calories too. We even talk about the "soda sickness". In addition, there is a lack of physical activity.
But there are also several genetic factors that are involved in its occurrence and severity6.
NASH (and NAFLD) is a silent evolving liver disease. People with fat deposits in the liver do not experience any particular symptoms.
However, there are some signs that may suggest a hepatic steatosis, such as fatigue or feeling of discomfort, but they are not very specific. Therefore, the diagnosis is usually late, when the liver damage is already significant, such as liver failure or liver carcinoma.
The role of diet in the development of this disease
In the last fifty years, there has been a real revolution in our diet, linked both to the growing urbanization of the population and to women's work, which has led to a diet that includes more and more industrialized products, to the detriment of fresh and homemade products.
During the 20th century, sugar consumption increased from 2 kg to 35 kg per person per year and, at the same time, pathologies such as the metabolic syndrome, obesity and type 2 diabetes have appeared. Sugar plays a very important role in their appearance.
Indeed, the industrialization of food has led to the arrival of preparations that are increasingly "convenient" for the consumer, faster and therefore loaded with many additives, to allow better preservation, better palatability or better appearance.
Sugar is capable of all this, enhancing the flavor, masking the acidity or bitterness, or preventing the oxidation of sausages and meats.
For a long time sugar was used in the form of sucrose from sugar beets or sugar cane, but for several years the food industry has developed a compound called glucose-fructose syrup, or isoglucose or high fructose corn syrup (HFCS).
The sweetness of this product is much greater than that of glucose.
In addition, it has a liquid texture that facilitates its use by the industry. Finally, it is very cheap, which allows its use in many food products.
Unlike glucose, which requires the action of insulin to be metabolized and used by the body, fructose, a fruit sugar (and therefore HFCS) is taken directly by the liver.
Its action in the body is therefore different from that of glucose.
In fact, fructose is transformed at the level of the hepatocytes into triphosphate, sugars that, when produced in large quantities, participate in the production of intrahepatic triglycerides, that is, of fat within the liver.
In 2019, an experiment conducted on mice showed that a diet rich in fat and fructose for ten weeks triggered signs of insulin resistance and hyperglycemia in the animals, in addition to a 40 to 60% weight gain.
The researchers also found that these mice showed a significant accumulation of fat in the liver and a failure of the mitochondria, small energy centers in the cells.
An effect that had not been seen in mice fed a diet high in fat and glucose7.
Therefore, the researchers concluded that a diet high in fat and fructose was responsible for the accumulation of fat in the liver, hence liver steatosis.
Finally, another study8 was conducted for six weeks with monkeys.
The monkeys were separated into two groups and given exactly the same diet in terms of both calories and composition.
With the exception that in the first group the diet was enriched with 24% fructose while in the control group the fructose was around 0.5%.
After 6 weeks, the high fructose diet group had a liver that showed inflammatory lesions and fat deposits. In addition, there was an increase in the intestinal permeability of these monkeys.
However, fructose or HFCS is increasingly used in industrialized products, pastries, but especially in soft drinks and fruit juices.
This is particularly true in the case of the United States, but Europe, of course, is not immune to this phenomenon, as a study published in 2015 shows9 . Therefore, it is not surprising that there is a growing prevalence.
How to diagnose this liver disease?
It is particularly stealthy and remains totally silent for a long time.
Most of the time it is discovered during an ultrasound of the liver adapted to the detection of hepatic steatosis called "Fibroscan".
But it can also be found during an MRI without the latter being able to distinguish between a DISEASE and an NASH.
Liver biopsy is undoubtedly the most accurate test for making this distinction, but it is a particularly invasive test and not without danger.
Finally, there are biological tests such as liver transaminases or gamma-GT.
Furthermore, the abnormalities of these liver enzymes are not specific to NASH, revealing rather a liver dysfunction that can be of various nature.
Finally, an index of hepatic steatosis called FLI has been developed for the Fatty Liver Index which takes into account the BMI (Body Mass Index), waist circumference, serum triglycerides and the range of GT.
If the FLI is less than 30, the presence of fat in the liver is excluded. Above 60, the presence of fat in the liver is 99% likely10.
What is the natural treatment for hepatic steatosis?
Hepatic Steatosis: what is the natural treatment?
Conventional medicine does not really offer pharmacological treatments, even though several molecules are being studied, such as Elafibranor, which is in a phase II trial, or Victoza, which is used in the treatment of type 2 diabetes but does not currently have a marketing authorisation under NASH.
In the stage of liver cirrhosis, transplantation is the only alternative.
Thus, in the United States, non-alcoholic steatohepatitis has become the leading cause of liver transplantation, from 1.2% in 2001, 9.7% in 2009 and over 20% in 2013, a jump of 170% between 2001 and 2013.
However, there are certain natural approaches that can slow down the development of this disease: what natural treatment should be preferred in the case of hepatic steatosis?
Change the diet
The first thing to do is to stop any industrial food containing fructose or glucose-fructose (or HFCS) as :
- Sodas, juice,
- Ice cream,
- A little yogurt, creamy desserts,
- Cookies, cakes
- Meat from the delicatessen store,
- Breakfast cereals...
Of course, the list is not exhaustive, so do not hesitate to read the list of ingredients on the package and look for terms such as "glucose-fructose syrup", "isoglucose", "invert sugar", "corn syrup" or HFCS.
The second element to consider is the glycemic index of the food.
In fact, the increase in the number of cases of NAFLD and NASH is correlated with the appearance of the metabolic syndrome and type diabetes because it seems that, while foods with a high glycemic index are the cause of type 2 diabetes and the metabolic syndrome, fructose and especially isoglucose aggravate insulin resistance (the mechanism that leads to type 2 diabetes).
It is therefore necessary to have a diet that gives priority to vegetables, whole grains, legumes and, above all, to avoid all foods with a high glycemic index, i.e. above 70.
Similarly, it is necessary to exclude from the diet refined products such as pastries, cakes and pastries, or even industrially prepared foods that very often contain sugar.
In addition, one could opt for a Mediterranean diet, for example.
It is also possible to increase coffee consumption and drink 2 to 3 cups a day. A recent study showed that heavy coffee drinkers with NAFLD had less liver fibrosis than those who consumed less12.
Taking food supplements, a natural treatment, also helps to combat hepatic steatosis.
As explained above, hepatic steatosis or fatty liver disease is accompanied by an inflammation of the liver to which mitochondrial insufficiency is added, that is, a malfunctioning of the power plants within the cells themselves.
This dysfunction is very often due to a lack of micronutrients, either B vitamins or alpha-lipoic acid, which has also been shown to be effective in reducing insulin resistance.
It is also important to think about magnesium, which improves insulin resistance by making the cell's insulin receptor much more sensitive.
Magnesium is found in foods such as whole and semi-whole grains, legumes, and oil seeds.
However, ultraprocessed and ultrafine products are largely lacking in magnesium. It is therefore possible to propose a magnesium supplement in the form of bisglycinate or glycerophosphate at about 400 mg/day.
Omega 3 supplements may also be considered. In fact, a study has shown that sufficient intake of omega-3 polyunsaturated fatty acids improves hepatic steatosis in both adults and children with a daily dose of EPA+DHA for adults of about 2 grams per day.
Antioxidants can be added to combat oxidative stress caused by inflammation. For this purpose, it is recommended to consume foods richer in polyphenols such as green vegetables or carrots (carotenoids), tomatoes (lycopene), spices such as turmeric or ginger, etc.
Phytotherapy, another natural treatment, can also be considered to combat hepatic steatosis.
Many plants have an action on the liver with different actions that can be cholagogic, ie stimulating the contraction of the gallbladder, choleretic increasing the production of bile or regenerative.
Among all these plants with hepatic tropism, the Marian thistle (Sylibummarianum) in particular will be preserved for its hepatoprotective and regenerative properties.
Among its components, lasilimarin, anti-inflammatory and antioxidant, is able to reduce the level of TNF-α (inflammation marker) and increase the level of glutathione, which is a very important antioxidant in the liver.
The development of hepatic steatosis (LS) is closely linked to our way of life, namely an excessive consumption of food, refined, processed, too rich in sugar and fructose, accompanied by a sedentary lifestyle with little physical exercise related to urbanization and modernization of our environment.
Thus, the introduction of sports activities can have a positive impact on steatosis and liver fibrosis, but only if this activity is intense and vigorous compared to an activity of moderate intensity, as this study shows.
In addition, this physical activity will have an impact on insulin resistance and on the cardiovascular system, thus reducing the risk of developing type 2 diabetes or cardiovascular pathologies such as heart attacks or strokes.
NAFLD and NASH are true pathologies of our way of life, of our environment that should make us think about our diet.
If awareness is not raised quickly, a pandemic could emerge, with an increase in cirrhosis and liver or hepatocellular cancer, especially in young people.
In fact, almost 10% of children are affected by hepatic steatosis, of which almost half are overweight or obese. However, obesity in children is steadily increasing and has increased tenfold in the last forty years. Therefore, it is a real public health problem that we face collectively, given the hepatic and cardiovascular consequences of this pathology.
Frequently Asked Questions
What is hepatic steatosis?
Hepatic steatosis is a condition characterized by an excessive accumulation of fat in the liver. This fatty liver disease can then lead to liver tissue damage.
Hepatic Steatosis: what natural treatment is best?
- Taking dietary supplements: vitamin B, alpha-lipoic acid, magnesium or omega-3 supplements - Phytotherapy
Milk thistle and its hepatoprotective properties
What are the other recommendations?
- Adopting a healthy and balanced diet -
Practicing a sport activity
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