Fatty liver disease is an increasingly common condition that affects as many as one in three adults in the US, and one in five adults in the UK. Although some cases are linked with alcohol intake, most cases are associated with an unhealthy diet and carrying excess weight. It’s estimated that between 70% and 90% of people who are obese, or who have diabetes, have non-alcoholic fatty liver disease, although many cases remain undiagnosed. If not recognised and addressed, fatty liver disease can progress to cause liver inflammation and scarring.
What is non-alcoholic fatty liver disease?
Non-alcoholic fatty liver disease occurs when excess fats build up in liver cells. This leads to inflammation and can progress to fibrosis, cirrhosis, liver failure and even liver cancer if not recognised and treated.
The good news is that your liver is quite forgiving – even when a surgeon removes 75% of a liver lobe, it usually tries to grow back. As a result, in the early stages, NAFLD is reversible with appropriate diet and lifestyle changes. Once the liver becomes inflamed, however (a condition known as non-alcoholic steatohepatitis, or NASH), levels of liver enzymes start to soar.
Blood levels of two enzymes in particular, ALT (alanine transaminase) and AST (aspartate transaminase) are measured to assess the extent of liver damage, as they are released into the circulation when liver cells rupture. ALT and AST are good markers for the extent of liver cell damage and, once these enzymes are significantly elevated, it becomes less easy for the liver to recover.
Advanced (NASH) is notoriously difficult to treat, and is the underlying reason for between 15% and 20% of liver transplants. But exciting new research suggests that globe artichoke extracts (Cynara scolymus) can help liver cells to recover, and potentially reverse fatty liver disease. Artichoke extracts can even reduce elevated enzyme levels in people with NASH.
What causes NAFLD and NASH?
The liver has numerous important functions, among which are the processing of dietary fats to make cholesterol and triglycerides, and the conversion of glucose to glycogen (a starchy emergency fuel) and to more triglyceride fats for longer term energy storage.
Because a fatty liver is stuffed full of fat, it is easy to assume that NAFLD is linked to eating too much dietary fat. But, in fact, the usual cause is eating too much carbohydrate – especially excess sugar.
When liver cells are hard-pushed from processing lots of carbohydrates (or alcohol) they start to accumulate fat. The fatty changes that occur are identical to those involved in the production of pâté de fois gras when geese and ducks are force-fed carbohydrate (in the form of grain) in Perigord, France. Your liver enlarges and takes on a mottled, yellow appearance.
How do artichoke extracts help?
Globe artichoke extracts have a large volume of research to support their benefits on liver and digestive health. They are also effective at reducing cholesterol and triglyeride levels (which you can read about on my globe artichoke page). Now, researchers have found that globe artichoke extracts also have protective effects on the liver even when liver inflammation is present, and can reverse damage so that ALT and AST enzyme levels start to fall.
In a gold-standard, randomised, double-blind, placebo-controlled trial, researchers asked 60 people with non-alcoholic fatty liver plus inflammation (NASH) to take either globe artichoke extract (as 6 tablets per day providing 2700 mg) or placebo for two months. Both groups were also asked to exercise regularly (20 minutes walking, 5 days a week) and to lose weight.
Both groups lost a similar amount of weight during the 2 months study – an average of 4.7kg each. In those taking the globe artichoke extracts, however, levels of triglycerides and total cholesterol also reduced significantly:
- Total cholesterol went from 206mg/dl (5.3mmol/l) down to 182mg/dl (4.7 mmol/l)
- Triglycerides went from 193mg/dl (2.18 mmol/l) down to 154 mg/dl (1.7mmol/l)
In the placebo group, cholesterol and triglyceride levels hardly changed at all.
The most exciting finding, though, was that the elevated levels of liver enzymes came right down (in fact, they virtually halved) in those taking the globe artichoke extracts. In the treated group:
- ALT (alanine transaminase) fell from an average of 81.77 mg/dl down to 38.40 mg/dl.
- AST (aspartate transaminase) reduced from an average of 45.53mg/dl down to 24.60 mg/dl.
In comparison, the enzyme levels in those taking placebo only improved slightly as a result of their weight loss (ALT from 74.13 to 64.07 mg/dl; AST from 44.5 to 39.60 mg/dl).
From Ranboo V et al, 2016. International Journal of Hepatology
Given that globe artichoke is a remarkably safe herb, used for thousands of years to aid digestion and provide liver support, it’s worth considering if you are overweight, have diabetes, or regularly drink alcohol.
NB If you have diagnosed liver disease or gallstones do not take supplements except under the advice and supervision of your own doctor.
Self-help for fatty liver disease
Other ways to help protect the liver from fatty changes include:
- Cutting back on your intake of carbohydrates – especially sugar
- Eating plenty of fruit and vegetables – at least 5-a-day – for their antioxidants, including protective polyphenols.
- Obtaining healthy fats (from olive, rapeseed, nut and fish oils)which do not have a major impact on the amount of cholesterol manufactured in the liver, and which have anti-inflammatory effects.
- Avoiding excess alcohol. As alcohol is poisonous, liver cells drop their normal house-keeping metabolic reactions and work overtime until the alcohol is converted to less toxic substances. Because liver enzymes are diverted from their normal tasks to metabolise alcohol, liver cells start to accumulate unprocessed globules of fat and become abnormally swollen. Even a single episode of binge drinking can change liver cell metabolism and worsen fatty degeneration.
- Taking milk thistle seed extracts which boost levels of a liver antioxidant, glutathione, which protects liver cells from toxic damage. Milk thistle (which is related to globe artichoke) has been shown to stimulate liver cell regeneration and reduce the formation of scar tissue.
- Taking a probiotic supplement, as beneficial bacteria (eg Lactobacilli, Bifidobacteria) digest dietary fibre to produce short-chain fatty acids, such as propionate, which have an anti-inflammatory effect on the liver.
- Drinking coffee – caffeine stimulates the metabolism of lipids stored in liver cells and decreases fatty liver associated with a high-fat diet. Researchers from Duke University have found that consuming the equivalent caffeine intake of four cups of coffee or tea may help to prevent and slow the progression of NAFLD.
- Ensuring a good intake of magnesium and B vitamins, which are needed for optimum liver function.