What can you have on your liver? Fat!

Unnoticed, millions of Dutch people – even children – are accumulating more and more fat in the liver. The consequences don’t lie. Fortunately, you can also get this versatile ‘purification station’ clean again.

She thought she was being healthy by drinking fruit juices every day, but ended up with a specialist in the hospital. The conclusion from research: a fairly fatty liver. Thanks to the fructose in the fruit juices she drank every day. A glass of juice quickly contains a few pieces of fruit and therefore a lot of calories. Being overweight is a major cause of fatty liver disease, and calories from fruit juices can contribute to obesity.

Ger Koek, a specialist and researcher affiliated with Maastricht UMC+ and the University of Maastricht, has experienced it up close: apparently very healthy people get stomach aches or feel sick and tired because their liver can no longer perform its work properly.

Not just alcoholics

The fact that about half of the Dutch population is overweight has consequences for vital organs. In addition to the heart, lungs and kidneys, the liver – in the upper right part of the abdomen – is also included in this. The Maag Lever Darm Stichting maintains that 50 percent of the Dutch have an increased risk of fatty liver disease. More than 2.5 million people suffer from it to a greater or lesser extent and that number is only growing, according to the experts. Not a nice message.

“Your liver functions as a purification station in your body,” explains liver specialist Ger Koek. “It produces bile to digest fats and ensures that other organs are supplied with sugars, proteins and fats in a timely manner. The liver also neutralizes toxic substances in the body, such as alcohol. But once vervet, it becomes more difficult to perform those functions. And inflammation can develop that plays a role in serious conditions such as cardiovascular disease, type 2 diabetes and liver cancer.”

With liver disease, many people quickly think of alcoholics. Indeed, if you drink heavily, you’re almost certainly screwed. “About ninety percent of serious alcohol drinkers who consume at least five glasses a day develop fatty liver,” says Stijn Meijnikman, medical researcher at University Medical Centers (UMC) in Amsterdam. The organ becomes overloaded due to the breakdown of alcohol. The sugars from the alcohol are eventually converted into fat, also in the liver cells.

But the aforementioned 2.5 million Dutch people are not alcoholics: for the majority of them, the cause is the lopsided relationship between what they consume in terms of calories and what they burn. This variant is called non-alcoholic fatty liver disease. “The body takes in more sugars than it consumes over a long period of time and stores them in fat,” explains Meijnikman.

Insensitive fat cells

Such a thing does not happen from one day to the next. Only when the fat depots can no longer handle it and you do nothing about your weight gain, an imbalance arises. There is a greater chance that the fat cells will eventually become insensitive to insulin, the hormone that ensures that the broken down carbohydrates from a meal are transported to the cells as glucose. In insensitive fat cells, the absorption of substances is disrupted. If the liver has too long and too much work on its breakdown, there is a risk of chronic inflammation.

Chronic inflammation of the liver causes scarring, says Koek. “Compare it to a wound on your skin. That bit of red around it is a sign that it’s a bit inflamed. After the wound has healed, you will be left with a white scar. The same happens with an inflamed liver. Your healthy liver cells become surrounded by scar tissue, known as fibrosis. As a result, the capacity of the liver decreases. We call that cirrhosis of the liver, a major cause of liver cancer.”

Scar tissue

The tricky thing about fatty liver is that you don’t notice it at all at first, because this one and a half kilogram organ is flexible and has a large reserve capacity. Complaints that you can eventually feel are, for example, pain in the upper right abdomen, or being tired for no apparent reason.

“There are risk indicators,” says physician-researcher Stijn Meijnikman. “Nearly two-thirds of people with type 2 diabetes, for example, already have a severe form of scar tissue in the liver, according to a recent study. If you have a lot of belly fat or if you are a chronic alcohol user, there is a high risk that you have fatty liver disease. The more your body is out of balance, the greater the risk.”

It is still difficult to determine to what extent a liver is affected. The gold standard is the biopsy, in which tissue is removed for further examination. “But nobody wants some liver tissue to be aspirated,” says Meijnikman. “So first an ultrasound is made to examine the degree of fatty degeneration. This technique can be used to determine whether the liver is more than thirty percent fatty. An MRI also gives a definite answer.”

And in most cases you can still do what the patient who drank too many fruit juices in one day did: she rigorously adjusted her body by eating regular fruit. Within half a year she was fine again.