Fatty liver is also called Non-alcoholic Fatty liver Disease (NAFLD). It has become the most common chronic disease in the USA, affecting one in three people (in the UK the figure is 20-30% of adults and worryingly 20% of all children). It is closely linked with obesity and also with metabolic syndrome (see separate leaflet).

           It is normally diagnosed with a liver scan. Blood tests typically show raised liver enzymes. It is generally benign but in one in six cases can go on to a more serious condition called non-alcoholic steatohepatitis (NASH) where inflammation, scarring and fibrosis are found in the liver. About 5-10% of patient with NASH develop cirrhosis.

          Two studies shed an interesting light on this. In a Swedish study, a group of volunteers deliberately ate two fast food meals daily and had their liver enzymes monitored. At the onset their blood tests were normal. After one week 75% had abnormal liver enzymes suggesting they were developing liver damage after one week.

           In a second study, the SUCRE controlled trial, a group aged between 9 and 19 years old were investigated. They found 25 out of the 42 already had signs of fatty liver. They were put on two diets of equal calories, one with sugar and one without. Those on the sugar-free diet reduced their liver fat by 29% over the 10 days, their fasting insulin went down 10% and triglycerides were halved whereas those taking sugar did not.

         This result was ground-breaking. It demonstrated conclusively that it was not calories but sugar that was responsible for fatty liver (and diabetes). 

         What strikes me about these studies is how quickly the liver can be harmed by junk food and how quickly in can reverse when on a healthy diet.

          The best diet for NAFDL is one with little or none of the foods which convert into sugar, such as refined carbohydrates (white flour, most bread, white rice, cooked potatoes and processed foods) but even more important a diet with no sugar (or to be more specific no fructose – 50% of sugar is fructose). High-fructose corn syrup, which is present in almost all processed food, contains more fructose than sugar (55%). Sugar and high-fructose corn syrup are the major drivers for this disease. One study found 80% of people with NAFL were taking high fructose corn syrup and 30% were taking it daily.

         Unlike other sugars, such as glucose, fructose can only be broken down in the liver, and once the liver is overloaded with fructose it starts to malfunction.

       A more detailed version of the dietary changes for fatty liver can be found on the leaflet for metabolic syndrome leaflet. The first and essential step is stopping sugar and high-fructose corn syrup. The second step is reducing refined carbohydrates and diet drinks. Eating plenty of fruit and vegetables whilst reducing meat and dairy, avoiding snacking, having a long gap between the last food in the day and first in the morning (ideally over 12 hours) and exercising more can also help.

         Toxicity may be a further factor in fatty liver. On study showed that rats exposed to the weed killer, glyphosphate (Roundup), at a dose which was a staggering 5000 times below than safety limit developed fatty liver. Many of our crops, especially wheat are contaminated with traces of glyphosphate.