One in 4 adults in the West suffers from an accumulation of fat in the liver due to an unhealthy diet. Liver doctor Maridi Aerts and nutritionist Amandine De Paepe give tips that help you get rid of that Burgundian liver.
When you think of liver disease, you usually associate it with alcohol. Yet the most common liver disease in the general population is not due to it. ‘Non-alcoholic fatty liver disease is becoming more common in the West,’ says gastroenterology and liver specialist Maridi Aerts (UZ Brussel).
Today, 20 to 30 percent of the Western population suffers from this disease, which can eventually lead to non-alcoholic steatohepatitis or NASH. This is a form of chronic liver inflammation that can progress to cirrhosis of the liver. We are already seeing an increasing trend of patients developing cirrhosis due to underlying fatty liver disease. Cirrhosis used to be caused exclusively by alcohol consumption and hepatitis.’
Silent worker
As the name “non-alcoholic fatty liver disease” (non-alcoholic fatty liver disease or NAFLD), alcohol is not the culprit, neither is viral hepatitis nor hereditary liver disease. A fatty liver is a disease of civilization due to a modern lifestyle that is disastrous for the giant gland. Ultra-processed food and soft drinks, constant snacking, medicines, stress, air pollution, endocrine disruptors: they all have an effect on the liver. But genetic factors also play a role. For example, NAFLD can even occur in children.
‘Risk factors are mainly abdominal obesity, more specifically belly fat’, Aerts clarifies. ‘There is a connection with the metabolic syndrome. This is a metabolic disease characterized by high sugar levels, high blood pressure, high cholesterol and abdominal obesity. People with diabetes, overweight, elevated cholesterol levels or elevated blood pressure have a higher risk profile for fatty liver disease.’
Surprisingly, you can also have fatty liver if you are fit and lean. That is the phenomenon of the ‘skinny fats’. Scientists do not yet know exactly why, but it could be related to an excess of ultra-processed food.
The liver is a wonderful organ, but has one major drawback: it is a hard but very silent worker, which gives few signals in the event of a problem. The liver has no pain nerves and patients do not experience any symptoms until most of the damage has already been done.
‘For the diagnosis we mainly depend on medical imaging. This is usually an ultrasound scan of the liver,’ says Aerts. ‘We can also combine an ultrasound with an elastography (determining the elasticity of the liver tissue using sound waves, editor’s note). This way we can also put a “value” on the fattening. Another possibility is a fibroscan, an ultrasound examination that uses pressure waves. This also gives you those values, but you do not do any imaging of the liver. All our patients with type 2 diabetes receive liver imaging because they are a high-risk group for developing NAFLD.’
Alarm signals of an overloaded liver
‘Non-alcoholic fatty liver disease will be the disease of the future,’ emphasizes food scientist and biomedical scientist Amandine De Paepe. In her book There’s more to your liver than you think does she take the word ‘foie gras’ in the mouth because ‘we also stuff ourselves’.
According to De Paepe, we do not have to wait for an ultrasound to know whether the liver is overloaded. At an early stage, the liver can indicate that it can no longer perform its functions properly. This can manifest itself in energy shortage, brain fogdifficulty losing weight, vitamin deficiency, poor sleep and acne, but also hormonal imbalance and fertility problems in women.
‘Unfortunately, a burdened liver is not discussed enough by the GP,’ says De Paepe. ‘However, the liver is more than a detox machine for alcohol. She is a real multitasker. It regulates our body’s energy and vitamin balance, produces protein substances for the production of hormones, such as the survival hormone insulin, and plays a role in the immune system. These functions are of vital importance and are therefore always given priority. Filtering harmful substances from the blood, such as alcohol, comes last. For example, that is why you sometimes wake up at night after drinking alcohol. Only then does the liver begin the detoxification process.’
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Good news: the liver can recover
There is no cure for fatty liver disease. The good news is that, unlike cirrhosis of the liver, your liver can repair itself. That is perhaps the organ’s best feature: its ability to regenerate. Cut off two-thirds of a liver and it will be back to its original size in a few weeks. Who one foie gras has in his or her body, can therefore still turn the tide by living healthier.
‘We need to pay more attention to limiting overweight and especially to the importance of more exercise,’ says Aerts. ‘Unfortunately, it is not easy to motivate patients. It is not self-evident to encourage people to stop drinking alcohol. Talking about weight loss and more exercise is even more difficult. Sometimes we even have to ask them to adjust all those aspects of their lifestyle at once because non-alcoholic and alcoholic fatty liver disease often occur together. So a typical patient is someone who adheres to the Burgundian lifestyle.’
De Paepe emphasizes that this exuberant lifestyle is best exchanged for a healthy and more sustainable way of life that relieves the liver. She especially underlines the importance of insulin, the hormone that regulates the metabolism of glucose (a form of sugar) in the body. That mechanism is very important for the body but sputters in these modern times.
Also the popular French biochemist Jessie Unweared writes in her international bestseller Glucoserevolutie about the Disadvantages of having too much glucose in your system. Her Instagram account Glucose Goddess has almost 2 million followers.
‘The glucose revolution is more than a health hype,’ says De Paepe. ‘There is a clear link between sugar peaks and an overloaded liver. Because we often eat so much and also consume too much sugar and carbohydrates, the body eventually becomes insensitive to insulin, and therefore to the sugar in the blood. This causes an energy shortage, more sugar cravings and a constant feeling of hunger. You then eat and drink more, so that you again consume sugar. The liver converts those sugars into fats, becomes fattened and the whole process starts again.’
In her book, De Paepe gives tips (see box below) to limit glucose peaks as much as possible. Can help: avoid snacks, eat more vegetables (600 grams per day), opt for a savory instead of a sugary breakfast and ban ready-made meals, which contain a lot of hidden sugars. Intermittent fasting and more exercise also have a positive impact on insulin levels and liver function.
Detox the liver?
Extra vitamins and minerals also play an important role, says De Paepe. ‘In an ideal world, a healthy diet and lifestyle should suffice, but we simply live in a world with stress, pollution, lack of sleep and ultra-processed food. As a result, we do not get enough vitamins and minerals. In the blood analysis in my practice, we very often see deficiencies in vitamin D, B12, folic acid, magnesium and omega-3. Especially if you follow a vegan lifestyle, you should supplement with supplements. But know what you’re doing. Wrong cocktail of vitamins can have just the opposite effect and put a strain on the liver, for example.’
Liver doctor Maridi Aerts also warns against supplements and herbs that can be harmful to the liver and cause toxic hepatitis (liver inflammation). According to her, detoxifying your liver yourself with a so-called detox cure is completely pointless. ‘Unfortunately, there are no magic products that ‘repair’ the liver. Juices, shakes or cleansing pills are especially expensive and not efficient in the long term. An interesting detox cure, for example, is a project such as Tournée Minérale, where you do not drink alcohol for a month. You could do the same with sugar or saturated fats, but preferably much longer than a month. You will notice that it gives you more energy and you feel healthier. You don’t have to cut anything completely from your diet. The ultimate tip for a healthy liver is quite simple: healthy, unprocessed food, no alcohol, not too many saturated fats, not too much sugar.’
5 tips from Amandine De Paepe for a stable blood sugar level
Don’t drink fruit, eat it. ‘Fruit juices seem healthy, but they are a wolf in a sheep’s coat. On the other hand, if you eat whole pieces of fruit, the fiber helps to control the spikes in blood sugar levels because the fiber structures bind the sugars and the insulin receptors no longer recognize them. Another tip for a stable blood sugar level: always combine fruit with a protein source (such as skyr) or add a teaspoon of cinnamon when you eat fruit. That also helps to stabilize your blood sugar level.’
Start every meal with vegetables. ‘Take an example from the Italians with their antipasti or from your grandmother who starts the meal with a vegetable soup. Research shows that the insulin and blood sugar levels of people who first eat vegetables, then meat and finally carbohydrates are generally lower and more stable. The fibers in the vegetables ensure that the glucose is less quickly released into the blood, so that the blood sugar peaks less after a meal.’
Let potatoes and rice cool down first. ‘During cooling, the starch becomes resistant, so that it begins to resemble an indigestible fibre. And that’s good, because the more difficult the carbohydrates are to digest, the less the blood sugar level will rise, because glucose is released less quickly.’
Drink a glass of lukewarm water with a tablespoon of vinegar before meals (or use it in your dressings): ‘Acetic acid temporarily inactivates the alpha-amylase, the enzyme that breaks down starch into smaller molecules. As a result, sugar and starch are converted into glucose more slowly.’
Exercise after eating. ‘The glucose peak is smaller when the muscles use up the excess glucose from the blood. ‘
Amandine De Paepe, There’s more to your liver than you think, Borgerhoff & Lamberigts207 sheets, 24.99 euros.
