Liver health probably isn’t the top concern for most people with diabetes. After all, it’s not one of the organs most commonly associated with diabetes complications — in contrast to widespread concerns about diabetic kidney disease, eye disease and foot complications.
But your liver plays a key role in many processes in your body that are relevant to diabetes. It’s your body’s main “storage tank” for glucose, releasing glucose into the bloodstream when it’s needed and taking in glucose when it’s not — processes that may be impaired in people with diabetes. Your liver also plays a central role in converting both fructose and protein into glucose that your body can use as energy.
One of the most common causes of liver damage is nonalcoholic fatty liver disease (NAFLD), in which the liver tissue becomes fatty and abnormal — potentially leading to structural changes like advanced fibrosis and cirrhosis that can irreversibly affect liver function. A new statement from a group of medical societies underscores how widespread undiagnosed fatty liver disease is in people with diabetes. At the same time, a study hints at a dietary strategy that may help limit the risk of this condition.
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Statement urges action to diagnose and treat fatty liver disease
The risk of fatty liver disease in people with diabetes is the subject of a pending joint statement from the Endocrine Society, the American Association of Clinical Endocrinologists, the American Gastroenterological Association and other groups. As noted in a Medscape article on the statement, these groups’ upcoming “Call to Action” highlights the fact that that while fatty liver disease is very common in people with type 2 diabetes, they often aren’t screened or treated adequately for the condition.
In fact, two studies showed that steatosis — fatty changes to the liver — was present in 70% to 74% of people with type 2 diabetes. Advanced fibrosis was seen in 6% to 15% of people with type 2, and previously unrecognized cirrhosis — even more advanced liver damage — was seen in 3% to 8%. Despite these alarming rates of disease and damage, many endocrinologists don’t order tests to detect fatty liver disease in people with diabetes — probably because they simply aren’t aware of the higher risk people with diabetes face, the statement notes.
Luckily, though, a separate recent study points the way to a dietary strategy that may help people with diabetes avoid fatty liver disease.
Mediterranean diet with more greens, less red meat
The study, published in the journal Gut, looked at the effects of following a “green” Mediterranean diet — similar to a standard Mediterranean diet, but with even less red and processed meat and more green plants and polyphenols — beneficial components found in many plant foods. A standard Mediterranean diet tends to emphasize vegetables and fruits, whole grains, olive oil, beans and other legumes, seafood and other lean sources of protein, and moderate alcohol intake centered on red wine.
A group of 295 participants with abdominal obesity and abnormal blood lipid (cholesterol and triglyceride) levels was randomly assigned to follow one of three diets — one based on general health guidelines, a standard Mediterranean diet, and a “green” Mediterranean diet. All three groups took part in physical activity as part of the study. The average age of participants was 51, and 88% were men. Their average body-mass index (BMI, a measure of weight that takes height into account) was 31.3, which falls in the “obese” category. Most importantly for this study, 62% had fatty liver disease, with an average of 10.2% liver fat.
Both Mediterranean diet groups consumed 28 grams of walnuts each day, while the “green” Mediterranean group also drank three to four cups of green tea each day along with 100 grams of Mankai, an aquatic plant, as part of a daily “green shake.”
After 18 months, there were dramatic differences in outcomes related to fatty liver disease. The rate dropped from 62% to 54.8% in the general healthy diet group, to 47.9% in the standard Mediterranean diet group, and to 31.5% in the “green” Mediterranean group. While both Mediterranean diet groups experienced a similar level of moderate weight loss, the “green” group lost an average of 38.9% of their liver fat, while the standard group lost only 19.6% of their liver fat. The general healthy diet group lost an average of 12.2% of their liver fat.
These results show that to reduce the rate and impact of fatty liver disease, a “green” Mediterranean diet that includes Mankai, green tea and walnuts — and that heavily limits red and processed meat — may be a promising nutritional strategy.
Want to learn more about liver health? Read “Undiagnosed Liver Disease Found to Be Common in Type 2 Diabetes,” “Don’t Call My Liver Fat!” and “Healing Leaky Livers.”