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 😅

@velvetgeranium it’s not bollocks that he only presented data from 7 of the countries. It’s also not bollocks that the dietary guidelines launched after his study was published placed a limit is on total calories from fat and saturated fat, and recommended polyunsaturated fats to replace saturated fats.

The Mediterranean diet (as eaten by people on the Mediterranean at the time) was higher in fat than the limit suggested in the dietary guidelines, and relied heavily on olive oil, not seed oils. Seed oils are not the same as olive oil in their effect on metabolism, but the guidelines treated them as if they were.

I’ve no idea whether that was known at the time. In other words, I don’t assume that the people who eventually produced the guidelines knew that some elements of them would be harmful to health rather than supporting it, but went ahead anyway because of commercial interests.

UPF’s were a much smaller proportion of diet then, I’ve no idea whether there were any voices urging caution on them. There WAS a voice pointing the finger at sugar, a man called John Yudkin. Ancel Keys argued vociferously against Yudkins’ stance. Keys was convinced that fat, especially saturated fat, was the culprit in heart disease. That was the view which prevailed when the guidelines were developed.

I believe it would have been better had the emphasis been on reducing sugar consumption.

@PuzzledObserverbut olive oil IS higher in unsaturated fats not saturated fats so would match up with his hypothesis that heart health relies more on USF.

Except olive oil wasn’t what we got. We got sunflower oil and partially hydrogenated vegetable oil, aka trans fats, both of which are inflammatory and highly damaging.

I’ve seen papers and write ups suggesting that saturated fat, in the context of a diet low in processed carbs, does not raise risk of CVD. In fact, hasn’t the recommended limit on sat fat been dropped now?

Most vegetable oil is rapeseed now which is mostly PUFA.

Trans fats aren’t used a lot in the UK nowadays - where are you seeing partially hydrogenated oil?

Sunflower oil is 69% PUFA including Omega 6. And low in saturated fats.

And no the saturated fat limits haven’t been dropped they were recently changed from 11% of energy to 10% of energy.

@INeedNewShoes I'm wondering if you need another scan that diagnosed fatty liver disease if your ALT is 12.

I've been on methotrexate for years (for rheumatoid arthritis) and my ALT was last 45 - and that was after 3 months of being completely teetotal - not that I ever drank a lot of alcohol anyway. My BMI is around 22 and I do as much exercise as I can manage. I get what you mean about it feeling unfair - totally.

I haven't had a liver scan as haven't had any symptoms, but I am paying attention to my blood results and would like to get ALT down - but I get this might be difficult.

@HarvestMouseandGoldenCups

Most vegetable oil is rapeseed now which is mostly PUFA.

Sunflower oil is 69% PUFA including Omega 6. And low in saturated fats.

Yeah, you think that makes them good to eat. I don’t. PUFA’s very easily get oxidised - in the bottle, during cooking, or inside your body. The oxidative stress leads to inflammation and contributes significantly to insulin resistance.

There may be a problem with the ratio of omega 6 to 3, and vegetable oils don’t come out of that well. Though I just read something which suggested it is overwhelmingly the oxidation rather than the ratio which is the problem. Regardless - I avoid both problems by avoiding those oils as much as is practical.

Trans fats aren’t used a lot in the UK nowadays - where are you seeing partially hydrogenated oil?

I was referring to what happened historically based on the idea that sat fat is bad and unsaturated fat is good. Fortunately we discovered that trans fats are toxic, and they have largely been removed from the food supply. Although they are generated when vegetable oils are heated repeatedly - like when fries are cooked in vegetable oil rather than beef dripping.

And no the saturated fat limits haven’t been dropped they were recently changed from 11% of energy to 10% of energy.

Is that right? Maybe I’m mixing up with American guidelines, since a lot of the chatter in this subject comes from over there. Point is - I do not believe that saturated fat is the problem which it is claimed to be. So I don’t feel the need to follow the changes in guidelines which I think are not well founded.

What do you mean by oxidation in the body?

Oxidation is usually used to refer to the process by which food is turned into energy in the body. Without oxidation we would all die as we wouldn’t be able to make any ATP.

Do you mean the creation of free radicals in the body? Because they’re also somewhat necessary for our survival… they’re used in the immune system and are fixed with antioxidants.

I’m not entirely sure what your background is but you seem to read a lot on the subject but be lacking some of the basic biological knowledge required to understand it. Please forgive me if I’m wrong though because I’m not an expert either.

My DIL had this. Was fatty result. They said they'd retest in a few months. When they did it was normal. Apparently because she'd recently been ill with COVID the virus could have caused the first high reading.

So try not to worry. You might have had a virus recently.

@HarvestMouseandGoldenCups you’ve got me, I’m not a biochemist. I do have ADHD, which predisposes me to consume lots of information and not always retain all the details.

The source for my comment about PUFA’s oxidising with in the body is a book called Dark Calories by Cate Shanahan, more specifically a section about the work of a German chemist called Gerhard Spiteller. He died in 2017 having published nearly a hundred articles on the link between polyunsaturated fats and the diseases which are linked to oxidation reaction and the formation of free radicals.

He demonstrated that the same reaction which occurs within the deep fat fryer can, in certain circumstances, occur within cell membranes in a chain reaction which produces huge oxidative stress and, yes, free radicals. And the thing about those, AIUI, is that up to a point they can be managed by the body. You say they are useful - I had not seen that before. But in excessive quantities they overwhelm the body’s ability to fix them with antioxidants, as you put it. That’s when they become problematic.

The message seems to be that the more PUFA you eat, the more antioxidants you need to deal with them. If your diet is rich in fruit and vegetables and you happen to use sunflower oil for cooking, and only heat it once, you might be fine. However, the typical processed food diet is high in PUFA but low in antioxidants.

There is also some interesting and scary stuff in that book about how the composition of human body fat has changed. It tracks the proportions of fatty acids in the diet. Between 1959 and 2008, the percentage of PUFAs in human body fat increased from (an average of) 9.1% to 21.5%, mirroring the increase in PUFA’s in the diet. You are what you eat, literally.

That makes more sense thank you for clarifying and I will take a look at that book. The idea that a UPF diet vs a whole foods diet would be differently able to fix varying levels of free radicals holds weight absolutely - most antioxidants come from fruit and vegetables, Vitamin E and C are powerful ones that can donate ions to stop free radicals (also known as Reactive Oxygen Species) from causing damage. So the more antioxidants you absorb the less damage free radicals can do.

But yes free radicals do also have their own role in the body as does inflammation. Both are necessary for normal function.

Hopefully my experience helps.
About 7-8 years ago I got diagnosed with fatty liver. I was scanned ever two years to keep and eye on it. Liver doctor told me to cut down on juices and anything with fructose. He also said that coffee helps - at the time I didn’t like coffee. I was also obese.
In the last year I have started drinking iced coffee and also overhauled diet and exercise. I have lost 13 kilos and am now overweight rather than obese and I drink 1 iced coffee a day. I eat much less sweets/chocolate/biscuits/cake. Exercise is walking
I had another liver scan 2 weeks ago and the fatty liver is 99% gone.
He could hardly see anything. I am sure it’s the weight loss and improved diet.
He also said it takes at least 6 months for the liver to show a difference.
Hope this helps

Liver doctor told me to cut down on juices and anything with fructose.

There we go - inference being, an actual liver doctor is pointing the finger at sugar (more specifically, fructose) as being a major factor in developing fatty liver.

Did he say anything about fat in your diet, @Ritaskitchen ? Amount and type of fat?

I had some worrying very high liver results, and it was similarly caused by having had flu the previous week - apparently some respiratory viruses can affect these blood markers. Once they retested a few months later the markers were all within normal range.

@HarvestMouseandGoldenCups

But yes free radicals do also have their own role in the body as does inflammation. Both are necessary for normal function.

True of most things, really. There’s a healthy range… and if you are either above or below that range, there are consequences. I give you: Blood pressure, fasting insulin, heart rate, electrolyte levels, blood glucose.

No he didn’t.
I would say the amount if fat in my diet has reduced in the last year as I am not eating as much cake/chocolate etc.

You seem to have swallowed a whole load of diet-bro theory. Keys was promoting the Mediterranean diet in the 50s and 60s - a diet high in olive oil, but low in saturated fats compared to the levels of animal products and animal fats in the standard western diet of that time.

What the diet industry did is irrelevant. Low-fat diets were big in the 70s. It's not Keys' fault.

UPF’s were a much smaller proportion of diet then

Yes, I remember.

All that stuff about seed oils is very trendy.

I’m not a scientist. I’m an individual whose life and health have been turned around by adopting a low carb and (necessarily) high fat diet. So I’ll continue to follow that, and to share information about it. Including - which is what this thread is about - that it is NOT dietary fat which causes fatty liver, its carbs, especially sugar.

I was diagnosed with "marked fatty liver" following a scan after I presented to the GP for continuous nausea. She doesn't think that caused the nausea (which has since abated) but she ran a load of blood tests and I have high lipids and high ferretin (I've had high ferretin for years, they don't know why).

I do have some sort of IBS.

GP advice - cut down carbs and fat, do more exercise.

She's going to check again in six months.

I also feel like I have a pretty good diet. I was about two stone overweight, now one stone overweight....and hopefully reducing still. I'm 57. I do some exercise, not loads.

But it is annoying when I love vegetables and cook nearly all meals from scratch.

I did read that 40% of adults have fatty liver, so I wondered if being aware of it matters that much!