5 Liver-Saving Strategies for the New Year

Dharani Guttikonda, MD; Nancy S. Reau, MD

Disclosures

December 23, 2019

The holiday season can be notoriously hard on the liver, as diets are abandoned and alcoholic beverages are downed in higher numbers. They also provide an ideal moment to remind ourselves that both alcoholic and nonalcoholic fatty liver disease (NAFLD), the most common liver diseases in the industrialized world,[1] can be prevented by adopting healthy lifestyle interventions. Here are five approaches to help patients modify their risk factors this new year.

1. Cut way down on calories, strategically.

Caloric restriction can reduce insulin resistance, weight, hepatic fat, and cardiovascular risk factors, regardless of carbohydrate content.[2,3]

Although we may have overindulged during the holiday season, different strategies to achieve caloric restriction can help to get us back on track, including such fasting regimens as time-restricted eating (meals consumed within a limited number of hours), alternate-day fasting, and the 5:2 eating pattern (unrestricted eating for 5 days, followed by 2 days of restricted intake).

Intermittent fasting may not be safe for all patients, especially those with diabetes or cirrhosis, in whom fasting increases the risk for sarcopenia. Clinicians should guide patients and remind them to use caution in their weight loss efforts, as recent studies suggest that moderate to large weight loss increases the risk for mortality in patients aged 45-74 years.[4]

2. Exercise your way to a healthier liver.

Increasing physical activity has consistently been shown to reduce the concentration of liver fat and elevation of aspartate aminotransferase and alanine aminotransferase levels, as well as improve insulin sensitivity.[1,5]

After implementation of an exercise program, both invasive and noninvasive measurements have shown a decrease in intrahepatic fat.[6] Exercise alone, without additional dietary modifications, also results in improved hepatic steatosis.[7]

Exercise has many other associated health benefits. Regardless of how it is achieved, weight loss of at least 7% can lead to remission of NAFLD in obese and nonobese patients.[8] And the type of exercise may not matter, because both aerobic and resistance training have been shown to reduce liver fat.[7]

3. Celebrate dry January (or sober September).

The concept of "dry January"—or abstinence from alcohol during the first month of the new year—has grown in popularity. Evidence suggests that it is a trend that patients would benefit from adopting.

Mehta and colleagues[9] found that 1 month of abstinence resulted in significantly improved insulin resistance, blood pressure, weight, lipid profile, and liver function tests, compared with a control group who continued consuming alcohol. At 6 months, a significant reduction of alcohol consumption persisted in the abstinence group. The investigators found that abstinence even resulted in decreased expression of vascular endothelial growth factor and epidermal growth factor, key molecules in the development of cancer.

These results suggest even short-term abstinence from alcohol can have significant effects on both liver health and overall health, especially because alcohol use and insulin resistance are major causes of steatohepatitis. This effect may lead to more health awareness, given the subsequent decrease in alcohol consumption even months later.[9,10,11]

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