Fatty Liver Disease: Causes, Risks, and Management Strategies

Yoon Hyun-sook's fatty liver is improving through medication, exercise, and dietary awareness, highlighting the importance of managing health holistically.

### Understanding Fatty Liver Disease: Causes, Risks, and Management Strategies
* 👩 Yoon Hyun-sook, diagnosed with fatty liver fifteen years ago, has seen improvement in her condition, with her fatty liver levels **decreasing from 60-90 to 30**, thanks to regular exercise and medication.
* 🩺 Despite her efforts, she struggles with abdominal obesity, which is linked to **hormonal changes post-menopause**, leading to **increased visceral fat** and a **higher risk of diabetes and other health issues**.
* 🍏 Interestingly, while she consumes a lot of fruit, which is often considered healthy, the **high fructose content** can **spike insulin levels**, contributing to **weight gain and fatty liver**.
* 📉 The rising prevalence of non-alcoholic fatty liver disease, particularly among women, has **increased by 3.6 times**, signaling a **growing health concern that should not be ignored**.
* 🏋 Mr. Oh Jung, a young man facing pre-diabetes, highlights how **insulin resistance can lead to excess glucose being converted into fat**, exacerbating fatty liver disease.
* ⚖ Managing portion sizes and understanding food quantities is crucial for addressing fatty liver and diabetes, as even **healthy foods can contribute to weight gain if consumed excessively**.
* 📊 Daily weight monitoring, as practiced by Professor Shin Hyun-pil, can provide **valuable insights into dietary effectiveness** and help **maintain healthy weight loss**.
* 🚨 Ultimately, fatty liver serves as a **warning sign for potential health complications**, emphasizing the importance of **diet, exercise, and regular health check-ups** to prevent progression to more severe liver conditions.

Yoon Hyun-sook, in her sixties, learned about her fatty liver fifteen years ago. Hello, Hyun-sook. How have you been? Yes, I have diabetes and I regularly visit the doctor to manage my fatty liver. That's why I’m taking medication. As you can see, there is some fat in the liver. The liver shows up as white on the scan, indicating that there is fatty liver present. Previously, her fatty liver was more severe, reaching up to 60 or 90, but last time it was 40, and now it is down to 30. Her fatty liver levels are gradually improving. As she exercises, her liver enzyme levels are decreasing. The yellow highlighted area indicates her hyperlipidemia. The LDL cholesterol level should be below 100, and it is currently at 78, which is manageable with the medication she is taking. The blue indicates visceral fat, while the green represents fat between the organs. However, this green fat is more than the visceral fat.

If the ratio is above 0.4, it's considered high. However, if it's 0.6, then I think, in fact, if we look at the waist circumference, the average waist circumference for women in South Korea is about 85 cm. This means that, even with the same waist circumference, there tends to be more fat distributed around the organs, which makes me think this could lead to diabetes, high blood pressure, and hyperlipidemia. Just looking at the waist circumference, it clearly indicates abdominal obesity. Gaining weight means that there is an excess of fat in the body, which refers to body fat. Body fat consists of subcutaneous fat and visceral fat in the abdomen. Abdominal fat, in particular, refers to an excessive amount of visceral fat. The food we consume is converted into glucose, which is used as an energy source. Any leftover glucose that is not used as energy gets converted into fat and stored. Initially, fat accumulates beneath the skin, in the subcutaneous layer, and any remaining fat then...

Visceral fat accumulates between the organs, causing inflammation. At this time, the remaining fat is stored in the liver, creating fatty liver disease. I originally didn't eat much rice. I don't really understand why fatty liver developed. Their father doesn't drink alcohol, doesn't eat snacks, and doesn't smoke. He wonders why so many health issues have arisen in his body. Yoon Hyun-sook doesn't enjoy eating meat and doesn't overeat either. What could be the reason for her fatty liver and the onset of abdominal obesity? When she goes to the market, she always stops by the fruit shop. Yoon Hyun-sook doesn't just choose one type of fruit. Even if she doesn't eat rice well, she makes sure to eat plenty of fruit. There are times when she feels full from fruit alone. Even when getting up at night to go to the bathroom, she grabs a piece of fruit from the table before heading back.

It seems that fruits, which are said to be good for the body, might actually be causing fatty liver and abdominal obesity. People often say they hardly eat rice, but they actually consume a little rice and mostly eat concentrated foods like rice cakes, bread, or other carbohydrates, along with a lot of fruits. Fruits high in fructose can suddenly raise insulin levels, and to quickly manage the spike in sugar, a large amount of insulin is released. After insulin is released, the sugar just consumed is hydrated, but as blood sugar drops again, they tend to eat something sweet. This leads to more insulin being released, and as they experience cravings, they eat more sweets. Thus, a vicious cycle begins, leading to obesity. Despite trying, weight loss is not easy, and the fatty liver issue is not being resolved. Yoon Hyun-sook's weight is not particularly high, yet...

Why has it come to the point of abdominal obesity? In our country, for those over 50, menopause leads to a deficiency in female hormones. When estrogen, the female hormone, becomes insufficient, cholesterol levels in the body rise, blood sugar levels increase, and significant obesity occurs. Visceral fat accumulates more as well, making middle-aged women much more vulnerable to obesity. Over the past five years, the number of patients with alcoholic fatty liver disease has shown a gradual decline. However, in contrast, the number of patients with non-alcoholic fatty liver disease has steadily increased each year. 

In particular, the number of female patients with fatty liver who do not consume alcohol has increased by a staggering 3.6 times. Women cannot be complacent about fatty liver disease. Please come to the office. A young man in his 20s, Mr. Oh Jung, is also significantly overweight. Since experiencing a traffic accident four years ago, he has been avoiding exercise due to discomfort in his body.

After that, my weight increased rapidly. As my weight gained, I had blood tests every 30 minutes to monitor my condition. Fortunately, I haven't developed diabetes yet, but I was already at the pre-diabetic stage. When I drank a sugar solution and had my blood drawn every 30 minutes, the most important factor was that my blood sugar should not exceed 140 after two hours. However, it was at 180, which indicates pre-diabetes. So, I am not diabetic yet, but I am at a crucial point where I could progress to diabetes. My insulin secretion is quite active, but there is insulin resistance in my body. Therefore, my insulin resistance markers are very high. The food we eat is converted into glucose through digestion. At this time, the hormone insulin is released. Our cells use blood sugar as an energy source. Insulin binds to receptors to help glucose enter the cells.

It creates energy sources by pushing in. At the same time, it regulates the blood sugar in the body. However, when insulin fails to function properly and a state of insulin resistance occurs, glucose cannot enter the cells, resulting in an overflow of glucose in the blood and a state of hyperglycemia. When there is an excess of blood sugar in our body, glucose that cannot be converted into energy accumulates as fat, ultimately leading to fatty liver disease. Additionally, fat accumulates in the blood vessels, causing inflammation, and oxidative stress in the blood vessels increases, which can lead to complications such as stroke or heart disease. Therefore, if there is fat in the liver, the liver is responsible for producing sugar or metabolizing it in the body through insulin. The liver is the most important organ, and if it is filled with fat, glucose metabolism will be disrupted. Furthermore, having fatty liver itself indicates that the hormone insulin in my body is not functioning properly. So, this is a sign.

Be careful, as fatty liver can lead to diabetes. The risk of developing diabetes in patients with fatty liver is 1.8 times higher. Ms. Oh Jung-sun is receiving education and is making efforts to prevent the progression to diabetes. One serving is 210 grams and 300 calories. For male diabetes patients, they can eat one serving, while women can have three-quarters of that. So, a half serving is what we typically consume. 

Now, let's look at this: one circle, two circles—what does that represent? One ping pong ball, two ping pong balls. Unfortunately, the amount of meat is one piece, two pieces, which corresponds to one ping pong ball, two ping pong balls. This is meat, specifically red meat, followed by fish—four servings of fish. Then, we have one plate, two plates of vegetables. Additionally, think of the amount of peanuts as the size of your thumb. 

To address fatty liver and diabetes, the first step is to reduce your meals. You can eat everything, but...

Understanding the concept of quantity is actually very important, which is why we make a lot of efforts to educate about it. It's okay to eat, but it’s important to eat in moderation. We continuously teach that it’s not about eating a lot, but rather managing the amount we consume. By controlling the quantity of food we eat, we can lose weight without starving ourselves. The key here is to eat sufficiently and evenly without exceeding the set limits. 

Additionally, some people tend to avoid protein intake out of fear of gaining weight, but it's crucial to include it in every meal to strengthen muscles. We also need to pay attention to carbohydrate intake. But why do we accumulate fat in our bodies even when we consume carbohydrates? Our bodies break down the carbohydrates we eat into sugars, which are then used as energy sources. Carbohydrates are made up of sugars, and depending on the structure of these sugars, they can be classified as monosaccharides, polysaccharides, or complex carbohydrates.

당이 에너지로 쓰이기 위해서는 탄수화물을 섭취한 후 소화 효소에 의해 당이 분해됩니다. 먼저, 빵에 있는 탄수화물의 경우, 결합되어 있는 당들이 소화 기관에서 나오는 효소에 의해 쉽게 분해되고 빠르게 화됩니다. 때문에 혈액에 많은 포도당을 내보내 혈당 수치를 올립니다. 탄산음료 또한 이와 비슷하게 작용합니다. 그러나 섬유소가 많은 음식은 조금 다릅니다. 탄수화물의 결합 구조가 소화 기관의 효소에 의해 쉽게 분해되지 않기 때문에 포도당이 혈액으로 나가는 것을 늦춰 당을 쉽게 올리지 않습니다. 이런 이유로 빵보다는 소화가 잘 되는 밥과 통곡물이 살을 덜 찌게 합니다. 지방간이 생기는데, 그게 꼭 지방이 많은 음식만 먹어서 생기는 것은 아닙니다. 탄수화물이 굉장히 많은 음식을 먹어도 지방간이 올 수 있습니다. 또 야채나 과일을 드실 때도 그냥...

It's better to chew them. Some people blend them into juice, but if we just chew them, the sugar level might rise by about 100. However, if you blend it into juice, the sugar level increases much more. So, when consuming vegetables or fruits, it's better to chew them and take them in a fiber-rich state rather than in juice form. 

It's easy to think that fatty liver is not a disease, but there comes a moment when it becomes dangerous. Today, Lee Seong-jin came back to the hospital after two weeks. His ascites have increased due to the progression of cirrhosis and complications. After we remove the ascites, we'll see if his shortness of breath improves. He has been experiencing shortness of breath and a bloated stomach, and his abdomen has been getting larger. At first, it can be managed well, but now...

You can't use it sufficiently; you can't use it, and as liver cirrhosis progresses, the best option ultimately is a liver transplant. However, the process of transplantation takes a long time. In the case of simple fatty liver, it is possible to return to a healthy liver, but it is difficult to reverse cirrhosis. Lee Seong-jin, who started experiencing ascites a year ago, is finding that the intervals between his hospital visits to drain the fluid are becoming shorter. The liver, hardened by cirrhosis, does not allow for good blood circulation. As its synthesis and detoxification functions decline, various complications arise. If the liver cannot produce enough albumin, fluid accumulates in the abdominal cavity, leading to ascites. When ascites builds up, it must be drained artificially. Additionally, as the liver hardens, the intrahepatic blood vessels become compressed under pressure, making it difficult for blood to flow into the liver.

The esophageal varices occur when blood vessels around the stomach and esophagus swell and burst. When these swollen vessels rupture, it can result in vomiting blood. Additionally, as liver function deteriorates, toxins such as ammonia cannot be properly detoxified, allowing them to flow into the bloodstream and reach the brain. This condition is referred to as hepatic encephalopathy, leading to unstable behavior and consciousness. 

As the liver becomes hardened, the blood vessels entering it also experience increased pressure, which can cause the surrounding vessels to expand. Furthermore, the hardened liver is less efficient in performing its original functions, such as metabolizing substances, regulating glucose, secreting bile, and producing proteins. Consequently, liver function declines, and this can also impact adjacent organs.

Having fatty liver generally indicates that insulin function is not operating smoothly. Additionally, it is often accompanied by conditions such as diabetes, high blood pressure, and high cholesterol. Due to the excess visceral fat, a significant amount of inflammatory substances are released from the abdominal fat, which can lead to increased cholesterol in the blood vessels, resulting in conditions like heart attacks, strokes, and atherosclerosis. This means that it can worsen vascular health. 

Who tends to accumulate more visceral fat, which is a cause of fatty liver? Here we have two individuals: Oh Jung-seon, a 20-year-old who is overweight, and Choi Tae-jun, a 70-year-old who is thin. We measured their visceral fat and subcutaneous fat levels. Oh Jung-seon has 24% visceral fat, while Choi Tae-jun has 90%. Why does Choi Tae-jun, who is managing his weight better, have more visceral fat than the overweight young person? The younger individual still has some level of...

Insulin functions smoothly, and because of that, in the early stages, you may have significantly more subcutaneous fat. Even if the waist circumference remains the same, as you age, visceral fat tends to increase. The reason for the rise in visceral fat compared to subcutaneous fat is that muscle mass decreases with age. As a result, the energy from the food you consume is not stored in muscles but accumulates as fat. Additionally, with reduced physical activity, the insufficient muscle cannot compensate, leading to the accumulation of visceral fat. This is why, as we age, it is essential to exercise and take care of our bodies. When we exercise diligently, we can utilize more glucose in the bloodstream with the same amount of insulin. This helps prevent the accumulation of fat in the body. As the amount of muscle increases, more glucose in the blood is used, which lowers blood sugar levels. Furthermore, the more muscle you have, the more calories you burn.

As consumption increases, it helps to burn off fat effectively. This is not only beneficial for weight control but also significantly aids in improving fatty liver. Therefore, it is recommended to limit weight loss to about 1 kg per week and to approach it gradually. In cases of severe fatty liver, a reduction of about 10% is advised initially. Typically, if we consider a common weight of around 70 kg, it is suggested to aim for a weight loss of about 2 to 3 kg in the first month. However, if there is a substantial weight loss, it is necessary to consult a doctor. If we take 70 kg as a reference, a weight loss of around 7 kg in the first three months would be considered a very appropriate rate of loss. Professor Shin Hyun-pil, who has been consistently maintaining his weight loss, emphasizes that aside from exercise and dietary therapy, there is one more special effort in his diet. Since March of last year, he has been tracking his weight without missing a single day.

I am recording this. Why do I measure my weight every day? The habit of measuring and recording my weight daily allows me to understand whether my diet from the previous day was effective or not. By looking at my weight over the week, I can tell if I gained weight because of what I ate, or if my weight didn’t drop as expected. This way, I can identify what might be wrong with my food choices. So, don’t think too grandly about it; by reducing my meal portions and adjusting my diet while measuring my weight daily, I can accurately know if I am heading in the right direction. Fatty liver disease often associates with bad friends like diabetes, high blood pressure, and high cholesterol, threatening our health. It’s a warning sign: will it lead to cirrhosis, or will it stop here? Right now, fatty liver is sending a signal. When the yellow light turns on...

In addition to fatty liver, it is important to check for other potential issues. People with fatty liver often have other conditions such as high blood pressure, cholesterol, and blood sugar levels. It can be a good opportunity to confirm whether these factors are being managed. Therefore, fatty liver can be seen as a yellow signal. It would be great if there were a medication that could completely eliminate the fat in the liver with just one pill, but such a medication does not exist. Ultimately, the way to eliminate fatty liver is through diet and exercise. It's essential to engage in regular exercise and work on losing weight, as managing obesity and returning to a normal weight are the most important treatments.

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Yoon Hyun-sook's Journey with Fatty Liver

Yoon Hyun-sook, in her sixties, has been managing her fatty liver and diabetes for fifteen years, with her liver fat levels gradually improving.

Despite a healthy lifestyle and a fruit-rich diet, she struggles with abdominal obesity and excess visceral fat, which can lead to various health issues.

Her LDL cholesterol is at a manageable level, and she is focused on reducing her liver enzyme levels through exercise and medication.

The Impact of Fruit and Hormonal Changes on Obesity

Fruits high in fructose can lead to insulin spikes and cravings, creating a vicious cycle that contributes to obesity.

Middle-aged women, particularly those over 50, are more vulnerable to abdominal obesity due to a deficiency in female hormones like estrogen.

The number of non-alcoholic fatty liver disease patients, especially women, has been steadily increasing, highlighting the need for awareness and intervention.

The Impact of Insulin Resistance and Fatty Liver on Health

Insulin resistance leads to high blood sugar levels, causing glucose to accumulate as fat and potentially resulting in fatty liver disease.

Fatty liver disrupts glucose metabolism and is a sign of improper insulin function, increasing the risk of developing diabetes.

Managing meal portions and including protein in every meal are key strategies for preventing fatty liver and diabetes.

The Impact of Carbohydrates on Blood Sugar and Fatty Liver

Carbohydrates are broken down into sugar by digestive enzymes, with quick-acting sources like bread and soda raising blood sugar levels rapidly.

Foods high in fiber, on the other hand, slow down the release of glucose into the bloodstream.

Fatty liver can result from a high carbohydrate intake, and while simple fatty liver can be reversed, cirrhosis is more difficult to treat, often leading to the need for a liver transplant.

The Impact of Liver Dysfunction and Visceral Fat

Esophageal varices occur when blood vessels around the stomach and esophagus swell and burst, leading to vomiting blood and hepatic encephalopathy.

A hardened liver increases pressure on blood vessels, causing them to expand and declining its ability to perform essential functions.

Visceral fat accumulation, more pronounced with age, is linked to insulin dysfunction and can lead to increased cholesterol and vascular health issues, making exercise crucial for managing weight and preventing fat accumulation.

Effective Strategies for Managing Fatty Liver

Increasing consumption can help burn off fat and improve fatty liver, with a recommended weight loss of 1 kg per week.

Tracking weight daily can provide insight into the effectiveness of diet and exercise, while fatty liver often indicates other health issues like high blood pressure and cholesterol.

Ultimately, the key to eliminating fatty liver is through diet, exercise, and managing obesity.