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Fatty liver / steatosis hepatis
Fatty liver is an extremely common complaint in modern affluent societies. In the past, excessive consumption of alcohol was the main cause of fatty liver disease, but nowadays unhealthy nutrition and insufficient exercise are also important factors. But medication can also trigger fatty liver. Increasing fatty tissue in the liver is a warning for early liver diseases such as:
- Fatty liver hepatitis,
- Cirrhosis of the liver and
- Liver cancer.
Other diseases such as diabetes or a heart attack are favored by fatty liver.
According to the German Society of Digestive and Metabolic Diseases (DGVS), it is estimated that one in three to one in four adults in the United States and Europe could be affected by non-alcoholic fatty liver disease. In addition, there are fatty liver diseases due to increased alcohol consumption, which, according to the Gastro-Liga (German Society for the Control of Diseases of the Stomach, Intestine and Liver as well as Metabolism and Nutrition Disorders), accounts for a share of around 50 percent of the Identify overall cases. For many people there is also a lack of exercise due to work and leisure behavior.
The fatty liver is characterized by increased, basically reversible fat deposits in the liver cells (hepatocytes), whereby the organ as a whole becomes significantly larger and heavier. The definition can be made here via the proportion of liver cells that have increased fat deposits or via the proportion by weight of the stored fat in the total weight of the liver. If more than half of the liver cells are fatty, this is defined as fatty liver. The same applies if the percentage of fat in the total weight of the liver is increased to ten percent.
If there are accompanying inflammatory processes in the liver, experts talk about fatty liver inflammation (steatohepatitis). In addition, a distinction is made between alcoholic and non-alcoholic fatty liver diseases. This also applies to fatty liver inflammation, which is divided into alcoholic steatohepatitis (ASH) and non-alcoholic steatohepatitis (NASH).
In the case of moderately pronounced forms in particular, fatty liver causes no complaints for a long time. According to the Gastro-Liga, patients with pronounced fatty liver may experience unspecific complaints such as
- Feeling of fullness,
- Pressure pain in the liver region (liver pain),
- as well as a general physical and mental decline in performance.
There are often complaints when lying on the right side. According to the DGVS, the symptoms are often not associated with a disease of the liver, so the risk of progressive obesity threatens. In the further course, the fatty liver can develop into a fatty liver inflammation, whereby yellowing of the skin and eyeballs (jaundice), upper abdominal pain on the right side as well as nausea and vomiting are possible symptoms.
In the case of fatty liver disease, the secondary diseases are particularly dangerous. If dead glandular tissue of the liver is converted into connective tissue and scarred, there is a risk of incurable liver cirrhosis and the risk of liver cancer increases. Last but not least, the inflammatory processes can also damage the cardiovascular system, which significantly increases the risk of a stroke and a heart attack.
Causes of fatty liver
In particular, excessive alcohol consumption is a major trigger for the development of fatty liver, but other factors can also play a role, such as:
- an unhealthy diet,
- Lack of exercise,
- taking medication,
- Metabolic diseases
- and viral infections.
Most of the time, according to the Gastro-Liga, fatty liver is "an expression of excessive nutrition and / or excessive consumption of alcohol over a long period of time."
If more liver pollutants (e.g. alcohol, poisons or medication) are supplied than they can break down, the organ needs a very large proportion of the oxygen supplied and is ultimately no longer able to burn fat by oxidation or to generate energy use, explains the gastro league. The fat that is not broken down remains in the liver. This is the case for example with alcoholic fatty liver, but also with drug-related fatty liver diseases. According to the DGVS, the latter are a “health problem that has been generally underestimated to date.” For example, more than one percent of inpatients are affected by drug-toxic liver damage.
Liver cell obesity can also be triggered by an extremely high-calorie diet. The body simply receives more energy from the food than it consumes and the organism therefore begins to store fat as an energy store. Those affected develop overweight or obesity (obesity) and as a result of the disruption of the fat metabolism, fats accumulate in the liver cells, mostly in the form of so-called triglycerides. The changes in the liver are comparable to those in alcoholic fatty liver.
Fat metabolism can also become unbalanced in diabetes patients in such a way that more fat deposits are formed in the liver and there is a risk of fatty cells becoming fatty. Overall, people with a so-called metabolic syndrome are particularly at risk, which is characterized by the combination of obesity, diabetes, disorders of the cholesterol metabolism and high blood pressure.
The same applies to malnutrition, in which too little protein is supplied to the body. As a result, fat burning is inhibited and more fats remain in the liver. Overall, disorders of the fat metabolism or the cholesterol metabolism are relatively often triggers of non-alcoholic fatty liver diseases. In this context, scientists at the Ludwig Maximilians University in Munich were able to demonstrate at the end of 2014 that the defect in a particular ion channel in the liver significantly increases the susceptibility to non-alcoholic fatty liver disease.
Lack of exercise
Too little exercise, in connection with the causes mentioned above, is now considered to be one of the main causes of fatty liver. Signs of fatty liver disease can already be observed in adolescents, which are caused by a combination of lack of exercise and improper nutrition.
A fatty liver can also develop during pregnancy. This so-called pregnancy fatty liver affects one in every 7,000 to one in 16,000 pregnant women, according to the "Deutsches Ärzteblatt" and is largely due to a "defect in mitochondrial beta-oxidation of fatty acids and the hormone-related increase in free fatty acids during pregnancy". Pregnancy fatty liver can lead to serious complications in the course of pregnancy and represents a very serious threat to the mother and the unborn child.
Diagnosis of fatty liver
Relatively reliable indications of the presence of fatty liver often result from the patient's medical history. A detailed medical history, which also discusses any existing alcohol problems, diet and any previous illnesses, is therefore a good start in diagnostics. The enlargement of the liver can usually also be determined when the abdomen is palpated. If the subsequent blood test shows changed or increased liver values, this can indicate inflammatory processes such as fatty liver inflammation. The blood test also serves to rule out other liver diseases.
Modern imaging methods such as sonography (ultrasound examination), magnetic resonance imaging (MRI) or computer tomography (CT) are used to determine the liver size and to determine possible changes in the shape of the organ. In order to confirm the diagnosis, a tissue sample or a liver biopsy (puncture of the liver) is still required in case of doubt. "A small tissue sample is taken from the liver under local anesthesia with a long, thin hollow needle and examined microscopically in the laboratory," reports the Gastro-Liga. The biopsy can also be used to determine whether there is inflammation of the fatty liver, cirrhosis of the liver or even cancer.
The treatment of fatty liver should always be based on its causes, whereby extensive changes in the lifestyle of the patients are usually required. Since alcohol is associated with additional stress on the liver, it is imperative not only to avoid this in the case of alcoholic fatty liver diseases. Furthermore, it is advisable to reduce existing excess weight - especially in the case of non-alcoholic hepatic steatosis. "Losing weight and adapting your lifestyle reduce the fat and damage to the liver," says the statement in the guidelines of the German Society for Nutritional Medicine (DGEM) on clinical nutrition in gastroenterology - liver.
The experts also recommend eating overweight or obese fatty liver patients according to the applicable obesity guidelines. According to the DGEM, a very low-calorie diet lowers body weight and effectively and safely improves non-alcoholic fatty liver diseases within twelve weeks. Exercise is also given a special role in reducing body weight and normalizing fat metabolism.
It is important for a diet that is designed to break down fatty liver that it takes place slowly, since too rapid a breakdown of fat cells releases the toxins they contain, which in turn leads to an increased burden on the liver.
In addition to normalizing body weight, it is advisable to check blood sugar levels, particularly in diabetics. Excessive blood sugar should be avoided and the medication adjusted if necessary.
If the existing fat metabolism disorders do not go away as part of the dietary changes, they can be treated with medication, if necessary, to avoid further fatty tissue in the liver. However, medication can also cause fatty liver disease. Stopping the medication is strongly recommended here, but sometimes not possible, as otherwise there is a risk of more serious health consequences from the illness against which the medication was originally used.
Pregnancy fatty liver
Pregnancy fatty liver usually sets in in the last third of pregnancy and in view of the acute course, intensive medical treatment is often necessary. According to the "Deutschen Ärzteblatt", for example, the administration of glucocorticoids is provided to improve the liver situation. If there is no improvement, the immediate initiation of childbirth remains the last option. After birth, the pregnancy fatty liver usually disappears completely.
Naturopathy for fatty liver diseases
Nutritional therapy also plays an important role in the treatment of non-alcoholic fatty liver in naturopathy. These include, for example:
- Therapeutic fasting,
- Detoxify liver,
- Change of diet,
- Leech therapy.
With so-called therapeutic fasting, there is a special option here to tackle the fatty tissue of the liver, but you have to be careful. It is imperative to avoid additional strains on the liver, such as those caused by abrupt changes in eating habits.
Detoxify the liver naturally
In naturopathic fatty liver therapy, methods for detoxifying the liver are also often used. They are supposed to relieve the liver and promote the breakdown of fat deposits. In connection with the normalization of fat metabolism, various medicinal plants such as
- Evening primrose, but also
- and beetroot
a liver detoxifying effect.
Various medicinal herbal teas also support detoxification of the liver such as
- Milk thistle,
- Boldo and
- a ginger tea.
A little lemon as an addition to food and drinks also helps the liver to heal, since it helps the organ to burn the accumulated fat. Lemon water before breakfast provides an extra boost of vitamin C. Put the freshly squeezed juice of half a lemon in a glass of warm water and drink the mixture in the morning on an empty stomach.
Furthermore, naturopathic therapy - in addition to changing the diet - offers various options to support the patient in reducing existing obesity. Here, for example, from the area of traditional Chinese medicine (TCM), acupressure should be mentioned, but homeopathy also knows various means that help you lose weight. Fucus vesiculosus, for example, reduces appetite and increases fat burning. Helianthus tuberosus is especially recommended for obese diabetics to help them lose weight.
To offer further options for the treatment of fatty liver or to support the treatment
- hydrotherapy (water applications),
- orthomolecular medicine, but also
- diverting procedures such as leech therapy.
Altogether, numerous naturopathic treatment approaches are available for the therapy of fatty liver, whereby the selection of suitable methods should be based on the causes of the fatty liver disease and the severity.
A healthy lifestyle with enough exercise, as little alcohol consumption as possible and the avoidance of substances harmful to the liver as well as a protein-rich and low-fat diet with low carbohydrates can usually prevent the development of fatty liver quite efficiently. Obesity is to be assessed as a clear risk factor and therefore a normal body weight must be observed. Diabetics should also keep an eye on the optimal setting of their blood sugar in order to avoid fatty cells in the liver. (fp, ok)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Geogr. Fabian Peters, Barbara Schindewolf-Lensch
- German Liver Foundation: Inflammation of fatty liver (steatohepatitis) - most common liver disease in Germany (accessed: July 29, 2019), deutsche-leberstiftung.de
- Deutsche Leberhilfe e.V .: Liver diseases fatty liver (NASH / ASH) (accessed: July 29, 2019), leberhilfe.org
- Merck and Co., Inc .: Fatty liver (steatosis) (accessed: July 29, 2019), msdmanuals.com
- Herold, Gerd: Internal Medicine 2019, self-published, 2018
- Weiß, Johannes / Rau, Monika / Geier, Andreas: Non-alcoholic fatty liver disease epidemiology, course, diagnostics and therapy, Dtsch Arztebl Int, 2014, aerzteblatt.de
- German Society for Gastroenterology, Digestive and Metabolic Diseases e.V. (DGVS): S2k guideline for non-alcoholic fatty liver diseases (status February 2015), detailed guideline view
- Mayo Clinic: Nonalcoholic fatty liver disease (accessed: July 29, 2019), mayoclinic.org
- National Health Service UK: Overview - Alcohol-related liver disease (accessed: 07/29/2019), nhs.uk
- Harvard Health Publishing: Fatty liver disease: What it is and what to do about it (accessed: July 29, 2019), health.harvard.edu
- Cleveland Clinic: Alcoholic Liver Disease (accessed: July 29, 2019), clevelandclinicmeded.com
ICD codes for this disease: K70, K76ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.