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Fatty liver is one of the most common causes of abnormal liver function in adults in industrialized countries and, increasingly, in children and adolescents. The disease may progress to more serious conditions such as cirrhosis (scarring of the liver) and even hepatocellular carcinoma (a form of liver cancer).

The main causes of fatty liver can be summarized by two major factors: obesity and insulin resistance. Obesity contributes to fat accumulation in the liver cells because these adipose cells release excessive amounts of free fatty acids into the bloodstream beyond what the muscles can use. These high concentrations of fatty acids bind to albumin, which moves directly to the heart. Still, when this excess concentration inhibits its ability to function normally, the bound fatty acid moves towards other organs, including the liver, where it accumulates.

Insulin resistance is the most common metabolic abnormality associated with fatty liver disease. It occurs when insulin (the hormone responsible for reducing blood sugar) cannot adequately regulate blood sugars. Due to this, glucose continues to circulate in the body; tissues like muscle and fat take up excess glucose for energy or store it as fat which eventually results in fatty liver disease. Once this condition has developed, weight loss alone will not resolve this problem unless there is also a reduction in insulin resistance. Increased fatty acid concentration will continue to contribute to more fat production even if less is released into the circulation. Medications such as fibrates (cholesterol-lowering medications) help with fatty liver by increasing the breakdown of fatty acids and decreasing triglycerides (the fat in the bloodstream).

From the information stated earlier, it is clear that fatty liver disease strongly correlates to obesity and insulin resistance. This means that your lifestyle and diet should be adjusted accordingly: exercise regularly and maintain a healthy weight; avoid alcohol consumption; eat nutritious food rich in dietary fibers, omega-3s (for example, fish), antioxidants (fruits and vegetables), and other nutrients such as magnesium which helps to regulate glucose. Often, good nutrition alone may be enough to prevent or reverse fatty liver disease caused by these two major factors.

If you are overweight but have no fatty liver disease symptoms, you do not start treatment yet unless recommended by your physician. If you are overweight and have fatty liver disease, then it is suggested that you lose some weight (5-10%) through one of the methods mentioned above.

If your fatty liver disease is mild and you do not have any symptoms, lifestyle changes alone may be enough to improve or even resolve your condition.

If your fatty liver disease is moderate or severe, i.e., if you have jaundice with elevated ALT enzymes in the bloodstream (>300 units/liter) or if your blood albumin level is low, then medications are needed along with lifestyle changes. Medications include vitamin E, fibrates, or statins for most patients who need treatment; sometimes, antibiotics are given for a secondary infection.

In some cases, fatty liver disease may lead to more serious cirrhosis and hepatocellular carcinoma. In these cases, medications are required, and lifestyle changes, including weight loss through exercise and a healthy diet, can reverse the fatty liver condition. Fortunately, most patients respond very well to the combination of medication and lifestyle changes with complete resolution of their fatty liver without long-term complications, even if they have been suffering from this condition for many years.

If lifestyle changes do not help you with your fatty liver, then it is recommended that you take medication under the supervision of your physician or gastroenterologist; in addition to reducing blood sugar levels, statins (cholesterol-lowering medications) also help with fatty liver by suppressing the production of fat in the liver.

Medication does not always have to be taken for life, but it is recommended that you consult your physician to discuss this matter so you can come up with a plan that fits your specific situation.

Compared to the rare serious complications associated with fatty liver disease, taking medication should truly be seen as a blessing since it can prevent other conditions that are even worse without any long-term side effects if taken under physician supervision. However, you should look at the good side of medications and their potential side effects, including muscle aches and pains, increased glucose levels (for diabetics), headache, and upset stomach, which often go away over time. Your physician should keep a close watch on your liver enzymes and cholesterol levels so that you do not have any major problems while taking these medications.

An essential aspect of fatty liver disease is family history. If a family member has this condition, it is recommended to be tested to prevent further liver damage before symptoms begin. This is especially true when there are other risk factors present such as diabetes or obesity.

In most cases, fatty liver is a reversible condition requiring surgery but rather simple lifestyle changes and medication with limited side effects.

If you want more information regarding fatty liver, please see your doctor or gastroenterologist to determine the cause of your conditions, recommend a treatment plan and monitor your progress.

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