What is fatty liver?

With fatty liver (steatosis), fat is stored in the liver. The organ becomes larger. From this point of view, a fatty liver is also an enlarged liver. If it becomes inflamed at the same time, experts speak of fatty liver hepatitis or steatosis hepatitis.

Doctors differentiate between two types: Alcoholic fatty liver disease (AFL) is attributed by doctors to excessive alcohol consumption. In the non-alcoholic fatty liver (NAFL) , the liver fat is caused by strong overweight ( obesity ), diabetes , or certain medications. Fatty liver disease is very widespread in western industrialized countries. Around every third adult suffers from it - and the trend is rising. Every third overweight child already has an fatty liver.

There are three stages of fatty liver diseases:

• Grade 1: With grade 1 steatosis hepatitis or mild fatty liver, less than a third of the organ is fatty. Inflammation does not yet occur.
• Grade 2: Grade 2 steatosis hepatitis or moderate fatty liver indicates more than a third but less than two thirds of fat cells in the liver. In addition, the tissue becomes inflamed. Every second fatty liver patient is affected.
• Grade 3: With a grade 3 fatty liver or severe fatty liver (medical grade 3 steatosis hepatitis), more than two thirds of the liver are fatty.

Fatty liver per se is not yet dangerous for those affected, because fatty liver is reversible. In other words: the fatty liver can regenerate. If left untreated, however, the inflammation can scar the tissue in the further course of fatty liver hepatitis.

Then liver cirrhosis develops from the inflamed fatty liver. It begins with a progressive fibrosis, in which the connective tissue increases excessively, and represents the end stage of liver damage, in which the organ can no longer fulfill its metabolic and detoxification tasks in the body. Liver cell cancer can also develop from an inflamed liver.

In order to avoid these fatty liver consequences, it is important that those affected lead a healthy lifestyle. Above all, you need to avoid alcohol and ensure a balanced diet.

Fatty liver: causes

Fatty liver always develops when the organ has to process more toxins or fats than it can break down or store. Exactly how fatty liver develops depends on what type it is. In the case of alcoholic fatty liver , excessive alcohol consumption is the trigger. The liver is usually responsible for ridding the body of toxins and increasing the metabolism. If a person drinks too much beer, wine or liquor, the organ has to interrupt these tasks and instead take care of breaking down the alcohol. This creates substances such as acetaldehyde, which damage the liver. The organ then stores more fat - a fatty liver develops.

This is the maximum amount of alcohol you can drink in order not to damage your liver:

• Men are allowed to consume a maximum of 24 grams of alcohol per day . That is as much as 0.6 liters of beer or 0.3 liters of wine.
• Women must not exceed 12 grams of alcohol per day. That corresponds to 0.3 liters of beer or 0.15 liters of wine.
• In addition, both women and mens should have two alcohol-free days per week .

The trigger for non-alcoholic fatty liver , on the other hand, is usually the metabolic syndrome . Different diseases occur together: The affected are typically overweight, have high blood lipid levels and high blood pressure , and fatty liver and diabetes are also closely related.

The causes of these clinical pictures are usually an unhealthy diet and a lack of exercise. Patients often eat too much sugar and fat - for example in sweets, baked goods and ready meals. These foods overwhelm the liver and in the long run cause the organ to become fatty and inflamed. Excessive amounts of fruit can also damage the liver, as the organ processes the fructose it contains, i.e. the fruit sugar, like alcohol.

In addition, a non-alcoholic fatty liver can also occur more quickly from stress than from a more relaxed lifestyle. The stress hormone cortisol cause the body to produce less of the so-called Hes1 protein . This breaks down fat in the liver. The more stress, the less hes1 - and the more fat remains in the liver.

Also, if someone has to take certain medicines, these can make the liver more likely to become fatty as they can disrupt the functioning of the organ. For example, the drugs that can cause or promote fatty liver disease are cortisone, estrogen, amiodarone, diltiazem, valproate or tamoxifen. Further risk factors are older age (from 45 years), viral diseases such as hepatitis C and metabolic disorders . A malnutrition can lead to fatty liver. This can happen, for example, after an intestinal operation. In very rare cases pregnancy isthe cause. Doctors then speak of an acute pregnancy fat liver. It is very dangerous and can lead to death. Its causes are still unclear.

Fatty liver: symptoms

At the beginning of the disease, those affected usually have no or only slight symptoms with fatty liver. Therefore, it is often not that easy, even for doctors, to recognize the disease immediately.

The fatty liver symptoms that typically appear in the initial stage are unspecific, which means that they cannot be clearly assigned to a disease.

Because the liver enlarges and stretches, those affected with fatty liver often have a slight feeling of pressure or fullness in the abdomen, or more precisely: in the right upper abdomen, where the liver is located .

Other early symptoms of fatty liver include fatigue and poor performance; Fatty liver symptoms such as diarrhea and flatulence are also possible. In the course of the disease, other fatty liver symptoms such as sweating or freezing may also be associated with liver fibrosis (more connective tissue is formed) or liver cirrhosis (scarring of the liver).

As soon as the fatty liver becomes infected and hepatitis develops, the symptoms worsen and there are a few more symptoms. At an advanced stage this means, for example, that ...

• ... the fatty liver causes severe pain in the upper abdomen.
• ... the person concerned feels sick and tired and has no appetite.
• ... the sick person vomits.
• ... the fatty liver symptoms become visible on the skin, it turns yellowish (jaundice).
• ... the affected person gets a fever and ...
• ... he is losing a lot of weight.

Fatty liver: therapy

Sufferers are often at a loss as to what to do with fatty liver disease. There are currently no approved drugs. The fatty liver treatment is therefore not successful without the help of the sick person. Because sometimes a fatty liver can be broken down by changing their lifestyle accordingly.

It is possible to cure alcoholic fatty liver in the early stages, for example, if the person concerned completely refrains from alcoholic beverages. Psychotherapy is useful for addicts . There they learn to break through the addiction. In the case of severe alcohol dependence , an inpatient stay is often necessary.

A non-alcoholic fatty liver can be detoxified,

• by avoiding alcohol,
• Aim for normal weight and
• Get treatment for previous illnesses such as diabetes and lipid metabolism disorders.
• In addition, those affected by fatty liver should deal with regular exercise,
• if necessary, discontinue medication such as cortisone, as they may promote fatty liver and
• make their diet liver-friendly.

People who are unsure about the composition of their diet should ask their doctor for advice on what to eat if they have fatty liver disease. There is no specific fatty liver diet. However, those affected with elevated liver values ​​can do a lot in terms of liver health through diet:

• Experts recommend a balanced, low-fat diet for fatty liver. This includes lots of fresh vegetables, whole grain products, lean fish and meats, as well as nuts and seeds.
• When cooking, patients should choose oils with a high proportion of unsaturated fatty acids - such as olive or rapeseed oil.
• Bitter vegetables such as Brussels sprouts, endive lettuce or chicory stimulate bile production. This supports the liver in its work.
• Processed foods with animal fats, sugar, flavor enhancers and preservatives should be completely eliminated from their menu. Dark chocolate in moderation is considered safe.
• If you don't want to do without milk and dairy products despite fatty liver , you should choose a low-fat variant - for example milk and natural yoghurt with 1.5 percent fat, low-fat quark or buttermilk.
• Onions and legumes such as peas, lentils and beans should only be on the menu occasionally. Patients often wonder why they shouldn't eat onions if they have fatty liver. The reason for this is that these foods put a lot of stress on the liver, and those affected often do not tolerate them and the legumes mentioned well.
• If you distribute small meals throughout the day, you prevent the liver from being overloaded.
• It helps if those affected drink enough. Two liters per day are a guideline. Water and unsweetened herbal teas are best. Coffee is also allowed in moderation for fatty liver.
• In some cases, the liver is already so badly damaged that the body can no longer supply itself with sufficient nutrients. Then it can be useful and necessary to compensate for a deficiency in magnesium , zinc , calcium , potassium and phosphate caused by fatty liver with dietary supplements. The doctor discusses with his patient individually which nutrients he needs to supply.

There are also some home remedies to reduce fatty liver disease . However, studies have not yet been able to scientifically prove their benefits.

• Milk thistle: The plant contains the substance silymarin, which is supposed to regenerate liver cells. Fatty liver patients can buy milk thistle as tea or tablets from pharmacies.
• Sage tea: The herbs are supposed to prevent fat from being stored.
• Artichoke: The vegetables contain the substances cynarin and cynaridin, which are supposed to support the regression of fatty liver. Affected people can eat artichokes whole, as juice or as tablets.