This document discusses fatty liver disease (NAFLD/MAFLD), which results from an accumulation of fat in the liver not caused by alcohol. Key points include: - Lifestyle changes like 5% weight loss through diet and exercise are the primary treatment approach. - Consuming too many carbohydrates and sugars can contribute to fat being made and stored in the liver. - Patients with other conditions like diabetes, hypertension, or obesity are at higher risk of fatty liver becoming more serious. - Supplements like omega-3s, vitamins, and minerals may help support liver health, but lifestyle interventions are fundamental for treatment.

1. “Diabetes Of The Liver”
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Fatty Liver

2. Dr. Natasha Iyer MBChB, ABAARM
Director,
Better Medical Centre, Calgary, Canada
www.better4life.ca
Dr. Shabnam Das Kar, MD, FMNM
www.drkarmd.com

3. Is It A “Drug-able” Or
A “Lifestyle-able” Problem?

4. WHAT IS FATTY
LIVER?
NAFLD (non-alcoholic fatty liver
disease) results from liver damage
due to the accumulation of fat
(triglycerides) and inflammation
within liver cells.
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5. NAFLD
Non-Alcoholic Fatty Liver Disease To Metabolic Associated Fatty Liver Disease.
Fatty Liver is a component of Metabolic Syndrome.
MAFLD

6. Where Does The Fat In The Liver Come From?
• Higher carbohydrate intake
• DNL : Fat made in the liver from glucose, fructose and amino acids

7. https://www.endocrineweb.com/conditions/type-2-diabetes/liver-disease-what-you-need-know-about-common-problem-diabetes

8. The most common cause of death in patients with
NAFLD is cardiovascular disease.
Chalasani, Naga, et al. "The diagnosis and management of nonalcoholic fatty liver disease:
practice guidance from the American Association for the Study of Liver
Diseases." Hepatology 67.1 (2018): 328-357.

9. How Will You Know If You Have
Fatty Liver?

10. Diagnosis
• Ultrasonography
• FIB-4 Index
• Fibroscan
• Confirmation is by liver biopsy

11. “Diabetes Of The Liver”
PCOS
Pregnancy
Diabetes
High Blood
Pressure
Belly
Fat/difficulty
losing weight
Fatty Liver
Abnormal
Lipids
Heart Disease Diabetes
BLOOD GLUCOSE LEVELS
TIME
TYPE 2 DIABETES CONTINUUM

12. TREATMENT
Lifestyle intervention is the fundamental and
the only treatment of NAFLD

13. Lifestyle Interventions
• Food. What , when and how many times
• Fructose, uric acid
• Prevention of Sitting Disease
• Supplements

14. Weight Loss
Patients losing ≥5% body weight stabilized or improved
fibrosis in 94% of the cases.
Chalasani, Naga, et al. "The diagnosis and management of nonalcoholic fatty liver disease:
practice guidance from the American Association for the Study of Liver
Diseases." Hepatology 67.1 (2018): 328-357.

15. Is It A “Drug-able” Or
A “Lifestyle-able” Problem?

16. Liraglutide Versus
Intensive Lifestyle Management
Parameters Liraglutide 3 mg/day Intensive Lifestyle Intervention
Weight loss = =
Fibrosis = =
Sustained weight loss No. There was weight regain when stopped Yes
Liver Fat Increased when stopped Remained at lower level
Khoo, Joan, et al. "Comparative effects of liraglutide 3 mg vs structured lifestyle modification on body weight, liver fat and liver function in obese patients
with non‐alcoholic fatty liver disease: a pilot randomized trial." Diabetes, Obesity and Metabolism 19.12 (2017): 1814-1817.

17. Mitochondrial Dysfunction and
NASH/NAFLD

18. NUTRIENTS REQUIRED FOR ENERGY PRODUCTION
Wesselink, E., et al. "Feeding mitochondria: Potential role of nutritional components to improve critical illness convalescence." Clinical Nutrition 38.3 (2019): 982-995.
Pizzorno, Joseph. "Mitochondria—fundamental to life and health." Integrative Medicine: A Clinician's Journal 13.2 (2014): 8.
1. Vitamins B1, B2,B5,B7, B12
2. Folate
3. Vitamin C
4. Vitamin E
5. CoQ10
6. Iron
7. Magnesium
8. Selenium
9. Taurine
10. Carnitine
11. Melatonin
12. Manganese
13. Zinc

19. Omega 3:
Dose , duration and blood levels matter
• Omacor 4 grams a day, which is 1840 mg of EPA and 1520 mg of DHA
a day.
• For 18 months
• Checked EPA DHA levels in Red Blood Cells
• For those individuals achieving a ≥2% absolute increase in DHA had
reduction in liver fat.
Scorletti, Eleonora, et al. "Effects of purified eicosapentaenoic and docosahexaenoic acids in nonalcoholic fatty
liver disease: results from the Welcome* study." Hepatology 60.4 (2014): 1211-1221.

20. Liver
“Clocks”
and Fatty
Liver
This Photo by Unknown Author is licensed under CC BY-SA
This Photo by Unknown Author is licensed under CC BY-NC

21. The High-Risk Fatty Liver Patient
• Type 2 Diabetes
• Hypertension
• Living with obesity

22. The Worst
Liquids For Fatty
Liver Are….
Sugar-sweetened beverages
(soft /cold drinks)
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23. What About Alcohol?

24. Our recommendations
1. Weight loss
2. Stop fructose
3. Low carb +TRE
4. Lower uric acid
5. Omega 3
6. Sitting risk
7. Xenobiotics
8. Circadian Rhythm
9. Vitamin D3
10. Vitamin C