Fatty liver is striking early, but there are ways to beat it

Every third Indian has fatty liver, said Union minister Dr Jitendra Singh recently. If you’re quietly thinking that fatty liver disease, which causes the liver to swell with dangerous levels of fat, is not going to happen to you because you don’t drink, you’re wrong. Even a teenager can get it, and it can progress to a more severe condition called non-alcoholic steatohepatitis, or NASH, which is a leading cause of liver cancer, cirrhosis and liver transplants. But there’s a silver lining — it can be reversed in the early stages.Like 23-year-old Sunil Kumar did. “I had been struggling with obesity for years, but Grade 2 fatty liver was a wake-up call I never expected at my age,” says the Mumbai-based Kumar, who was 143 kg when diagnosed. A low-carb diet and intermittent fasting helped him shed significant weight and reverse his liver disease.STOP ITS PROGRESSA recent global study, involving over 40 researchers, revealed that the global prevalence of non-alcoholic fatty liver disease (NAFLD) is 30.2%. India has an even higher rate of 33%. It is more prevalent among Indian women (38%) compared to men (33%).Dr Sandeep Nayak, who practises in Bridgeport Hospital, USA and is principal investigator of the study, told TOI that a meta-analysis of 479 studies with over 70 million from 38 countries, shows NAFLD as a leading cause of chronic liver disease worldwide. medium nocaption113031477NAFLD happens due to various factors like excessive weight gain, high blood sugar levels, high cholesterol or elevated triglycerides, says Dr Debasis Datta, director of gastroenterology at Fortis Hospital, Kolkata. Dr V Mohan, diabetologist, says 50-75% of those with type 2 diabetes may have NAFLD, and around 90% of those with both diabetes and obesity are likely to have this condition. “NAFLD can progress to cirrhosis and even liver cancer in some people,” he says, adding that drugs like semaglutide are very effective in weight loss and have shown to reverse fatty liver.Managing diabetes effectively and taking medication to control cholesterol and triglyceride levels is crucial to control fatty liver disease in such patients, says Dr Prashant Kadam, consultant, liver transplant and HPB surgery at Fortis Hospital, Mulund. However, he says Grade 2 or Grade 3 fatty liver disease can almost be reversed through lifestyle and dietary changes — and studies show that weight loss of more than 3% of body weight can significantly reduce liver fat.THIN-FAT FACTORKey to Kumar’s weight-loss journey was Shashikant R Iyengar from Metabolic Health India, who says a diet of deep-fried food, sugary beverages (especially with high fructose corn syrup), fruit juices, refined carbs, etc, is to blame. “A sedentary lifestyle worsens the issue,” says the metabolic health coach.But it’s not just the obese who have fatty liver, says Iyengar. “We’re seeing a high incidence of ‘lean NAFLD’ or TOFI (Thin Outside, Fat Inside) syndrome whereby many young Indians with normal BMI are developing fatty liver,” he adds. Dr Chetan Kalal, liver specialist at Mumbai’s Nanavati Hospital, says there is a genetic link. “The PNPLA3 gene variant, which increases the risk of liver fat accumulation, is more prevalent in South Asian populations, including Indians,” he says. This, combined with lifestyle, is a recipe for fatty liver disease in young Indians.Devanand Prabhu, health coach and co-founder of Mind Muscle Project, says what was once an illness seen in people in their fifties is now common among people in their twenties and thirties. “I’ve even seen fatty liver cases among kids as young as 8,” he adds.JUNK THE JUNKPrabhu warns against seemingly innocent habits. “Can you imagine an Indian household without the 4 pm chai-biscuit ritual? These small indulgences, coupled with sugary drinks, are essentially liver bombs,” he says.Experts say prevention and reversal are important. Dr Sudeep Khanna, senior gastroenterologist at Indraprastha Apollo Hospitals, New Delhi, recounts how a 32-year-old vegetarian man from Gujarat reversed his Grade 3 fatty liver. “We switched him to a low-carb diet, cut down meal frequency, and started him on resistance training. In four months flat, he reversed his condition completely.” ShowQuotesFor Naresh Narayan Telange, a 43-year-old from Mumbai, the warning bells started to ring when he felt tired all the time. Telange was in the catering industry and would often eat deep-fried food. Routine blood tests showed abnormalities in his liver function, and an ultrasound confirmed Grade 2-3 fatty liver. Telange was advised exercise and dietary modifications, and managed to reduce 7 kg in six months. His liver function tests normalised and a repeat imaging showed his fatty liver had reduced to Grade 1. “Now, I carry my own tiffin to work. Today I had chapati, dal and gobi sabzi for lunch,” he says.HOLISTIC APPROACHOne of Dr Mohan’s patients with Grade 2-3 fatty liver and uncontrolled diabetes had a similar recovery process. “A spiritual guru, he integrated yoga and walking into his routine over the course of four months and significantly reduced his rice and carb intake. This led to weight loss, controlled diabetes and a clear ultrasound,” says Dr Mohan.Dr Vinit Shah, senior consultant of liver diseases at Ruby Hall Clinic, Pune, who reversed his own fatty liver condition, feels a holistic approach to treatment is crucial. “I worked on the most essential pillars — low-carb diet, fixed meal timings with dinner by 7 pm, avoiding junk food, strength and resistance training, sleep hygiene, and mind relaxation,” he says. Dr Shah dropped from 92kg to 74kg, and saw all his tests return to normal within a year.Additional reporting by Deepthi Sanjiv