Fatty liver despite decent diet and healthy bmi

[INeedNewShoes]

I'm just wondering if anyone else is in the same boat.

Ultrasound scan showed fatty liver. I've read the NHS advice and I already naturally follow most of it re fruit and veg, wholegrains, lean meat and fish. All meals I eat are cooked from scratch. I eat no UPFs. I drink very little alcohol. Daily drinks are coffee and water.

Where I could be going wrong is that I eat full fat dairy and I probably roast/fry foods more than is ideal. I also enjoy eating cake and biscuits. Having said that, my BMI is 23 and I've actually been concerned that I've been losing weight for no apparent reason lately.

I generally walk 3 miles a day, spend very little time sitting and also go on bike rides and do Pilates. When I read the info on fatty liver I feel like I don't fit, yet here I am.

I'm not sure how concerned to be and I'm most definitely feeling a bit indignant about it 😅

Can I ask why you had a scan originally? What symptoms you had that led to a scan being ordered?

Upper abdominal discomfort. I'm on immunosuppressants so I was a little worried it could be pancreas related but that looked fine. I think the discomfort might be stress related as it went for a couple of weeks then returned during a stressful few days.

Biologics?

Not recently but I did have a year of Infliximab/Remsima for UC which didn't agree with me

Do you or did you take supplements, such as curcumin for example?

No - only vitamin D sporadically

do they not think it's due to the UC?...IIRC it's not that uncommon.

What did the GP suggest? You don’t seem to process fats well. What next steps did they recommend?

Human bodies are all different. It maybe that you are just predisposed to fatty liver. Definitely try to limit your oils and spreads (including in biscuits and cakes etc) and I’d swap to semi skimmed milk.

Annoying! I recently had my cholesterol levels go sky high which I’ve never had before and all that has changed is I’ve LOST 13kg and was taking Omega 369 capsules 😂

The next available appointment with my GP is in six weeks' time which is a long time to mull this over for...

Ah thanks. I will ask my IBD nurse about it.

Well that's most definitely not fair!

I will definitely try to use less oil when cooking and reduce nice baking a little mmn

I was on immune suppression for a year and it wrecked my liver

I’m going to send you a dm op as I’ve had similar situation but feels a bit weird discussing it on a public forum.

Fatty liver does not come from dietary fat. It comes from over-consumption of carbohydrates, especially fructose. Gram for gram, fructose is twice as likely as glucose to turn into liver fat. Frequency of consumption is also a factor.

No cells in the body can use alcohol for energy - it has to be metabolised by the liver and got rid of that way. And if you present the liver with too much too often, it gets turned into fat. Exactly the same is true of fructose.

Excess glucose, whether from sugar or starches, will also turn into fat in the liver. Just at a higher level of intake compared to fructose.

Cut carbohydrate consumption, especially sugar. Fruit is not a total no-no, but ideally limit it to the low carb ones such as berries, and no more than once a day. Do not snack. Consider reducing to two meals a day rather than three, aka intermittent fasting. A longer fast from time to time will also be effective at reducing liver fat.

I was going to ask how your gut is, as I've heard that IBD can be linked to fatty liver. But you've already mentioned you do have IBD, so that could be why? That would also fit with the weight loss you've mentioned. I'd talk to your gastroenterologist for the best advice.

My DH had the same thing in his mid-20's. Same thing with diet etc. and he didnt drink (despite age related assumptions). A bit of a fondness for pizza but that was it. Think it's as much genetic as anything else.

Did it get any better or worse over time?

Good oils, such as extra virgin olive oil, are beneficial for fatty liver.

Thanks. I use extra virgin olive oil for salad dressing but standard olive oil for cooking. I'll switch over to using the good stuff for more. I've probably used a bit too much butter in cooking as well.

immunosuppressants, particularly corticosteroids, calcineurin inhibitors (CNIs like tacrolimus/cyclosporine), and mTOR inhibitors (like sirolimus), can cause or worsen fatty liver (NAFLD/MASLD) by promoting insulin resistance, high triglycerides, weight gain, and metabolic syndrome
. These drugs create metabolic disturbances that lead to fat accumulation in the liver, both in transplant patients and potentially in others, with some drugs like sirolimus being particularly linked to lipid issues.
How Different Immunosuppressants Contribute to Fatty Liver:

• Corticosteroids (e.g., Prednisone):Increase glucose production and decrease glucose absorption, leading to insulin resistance and weight gain.
• Calcineurin Inhibitors (CNIs - Tacrolimus, Cyclosporine): Also promote hyperglycemia (high blood sugar), hypertension (high blood pressure), and dyslipidemia (abnormal lipids).
• mTOR Inhibitors (Sirolimus, Everolimus): Directly increase triglyceride production and worsen insulin resistance.
• Methotrexate: Long-term use is associated with fatty liver and fibrosis, though often without early symptoms.
• Mycophenolate Mofetil: Generally considered to have fewer metabolic side effects compared to other agents.

Why It Happens: These medications disrupt normal metabolism, increasing factors that drive NAFLD, such as insulin resistance, high blood sugar, high cholesterol, and high triglycerides, often leading to a broader metabolic syndrome. Management: Doctors manage this risk by:

• Tailoring immunosuppression to minimize problematic drugs.
• Early withdrawal or reduction of corticosteroids.
• Monitoring metabolic factors closely.
• Encouraging lifestyle changes (diet, exercise).

Is that same as NAFLD?

If yes, what stage are you at?
How old are you, OP?
What is your BP like?
Do you get at least 150 mins of aerobic exercise every week?
Diet choices may not be your only strategy to address this?

Hi -

All I know at this stage is my ultrasound report says fatty liver with increased reflectivity.

I'm 43. BP tends to be healthy.

I'm not sure about the aerobic exercise. I do a good hours' walking at a moderate pace every day with some jogging and some fast walking but probably not 150mins of proper heart rate raising movement.

@INeedNewShoesI think it’s fairly well established scientifically that butter isn’t good for you. Best to use only occasionally.