Premise
The following indications are for information purposes EXCLUSIVELY and are not intended to replace the opinion of professional figures such as doctor, nutritionist or dietician, whose intervention is necessary for the prescription and composition of CUSTOMIZED food therapies.
Hepatic steatosis
"Steatosis" means "abnormal increase in lipid concentration within a cell".
Note: although to a lesser extent, in liver steatosis there is also an increase in glycogen levels deposited in the liver.
Hepatic steatosis is not a serious pathological condition, but represents the reversible antechamber of diseases that can be shown to be far more severe.
Causes and Types
Liver steatosis can have two distinct nutritional causes that sometimes give rise to slightly different diagnoses and therapies:
- Alcohol abuse (see in-depth analysis: alcoholic steatosis)
- Overeating.
On the other hand, more often than not, degeneration occurs for multifactorial reasons, among which (in addition to the two already described) sedentariness also appears.
Liver steatosis is often accompanied by other comorbidities such as: obesity, Binge Eating Desorder (BED), overt alcoholism, dyslipidemia (hypertriglyceridemia, LDL and total hypercholesterolemia), hyperglycemia and type 2 diabetes mellitus.
There is a very serious form of hepatic steatosis that affects only pregnant women and is therefore called "gravidic hepatic steatosis".
Another even rarer form is caused by caloric and especially protein deficit (in the third world); in this case, the liver is not able to produce sufficient transport lipoproteins, therefore it accumulates fats internally.
It is possible that the percentage of glycogen in the liver cells is greater in alimentary hepatic steatosis, rather than in alcoholic steatosis.
Fat or Big?
Hepatic steatosis is also referred to as " fatty liver ", a definition much better known in ordinary language.
However, some confuse the word "big liver" with "fatty liver". This happens because, in most cases, the two circumstances coincide; in fact, in hepatic steatosis it is inevitable that the size of the organ will increase significantly.
Called "hepatomegaly" in medical language, the clinical sign of hepatic enlargement can also occur in other types of disease / condition, such as: pharmacological abuse or food supplements or nervine substances (caffeine and the like), use of doping, infectious diseases such as viral hepatitis or mononucleosis, tumors, haemochromatosis, congestive heart failure, generic bacterial infections, metabolic pathologies (eg glycogen storage disease II and IV), lymphomas, biliary disorders etc.
Symptoms, Complications, Care
Established hepatic steatosis is manifested by hepatomegaly, pain in the right hypochondriacal region, jaundice and splenomegaly.
WARNING! A frankly fat liver is an important, serious and alarming degeneration.
As anticipated, this is an objectively reversible condition, but not for this reason to be underestimated. It is absolutely essential that those who present risk factors - such as: obesity, metabolic pathologies, family history, alcoholism or alcohol abuse (> 2-3 portions a day), sedentariness and secondary factors (such as pharmacological or doping or substance abuse nervine) - pay attention to the painful symptoms which, many times, occur early with the sensation of soreness or swelling.
This is due to the distension of the Glissonian capsule (of Glisson), that is the membrane that surrounds the organ; this, very rich in nerve endings, if too stressed (from inside or outside) generates discomfort and / or pain. Some people confuse this feeling as an intestinal discomfort referred to the ascending portion of the colon (which is in the immediate vicinity); in doubt, it is absolutely advisable to consult the doctor who will perform a palpation and, if necessary, prescribe an abdominal ultrasound.
The complications of hepatic steatosis are mainly related to cell death, therefore to the clinical picture called cirrhosis. Cirrhosis, by definition, represents the "point of no return", ie the irreversibility threshold not to be exceeded. However, even in this circumstance there are various levels of severity and, in the mildest cases, it is possible to witness the inversion of the degenerative process.
NB . In a large part of severe cirrhotic conditions, cellular mutation can occur, and therefore the onset of a tumor.
The treatment of hepatic steatosis takes place by means of: accurate dietary therapy, regular daily motor activity and, possibly, pharmacological treatment with: glutathione, urodesoxycholic acid, silymarin, thiopronin and phosphatidylcholine; methadoxine is recommended in alcoholism.
Specific Diet
The diet for hepatic steatosis is a diet useful to reduce, up to zero, the excess of energy substrates inside the liver cells.
The key aspects of the diet for hepatic steatosis are:
- Energy contribution limited to IPO-caloric; the adjective "limited" refers to both the percentage of caloric reduction and the time of treatment. On the contrary, if associated with obesity, the diet frankly becomes IPO-caloric slimming, to be continued for a sufficient time but not longer than 6 months. In the presence of metabolic pathologies, the diet must include the nutritional principles for specific care.
- Drastic reduction: of exogenous cholesterol, foods with high glycemic index (especially if refined or rich in refined sugars), saturated fats and food additives (some of which are more difficult to metabolize for the liver).
- Removal of the main elements of abuse, generally consisting of alcohol or excess / useless food. If the cause is food, especially junk food, it is absolutely essential to temporarily eliminate from the diet the products of which the subject nourishes abnormally or even compulsively (eg carbonated drinks, chips, hamburgers, sweets, sweet snacks etc).
- Increase nutrient levels and nutritional components with a "purifying" function; among these: fibers (above all soluble), antioxidant vitamins (A, C, E), vit B1 (often lacking in the alcoholic), other antioxidants (eg phenolic ones), lecithins and plant sterols (which reduce lipid absorption and improve its metabolism), cynarin and silymarin (molecules that improve liver activity). Contributing to this function are legumes, cereals, vegetables and fresh fruit.
- Increase overall physical activity level.
It is advisable to leave the liver with short periods of "rest", thus accentuating the time lapse between dinner and breakfast; 12-14 hour fasts may make it possible to progressively and rapidly improve hepatic steatosis and blood glucose, triglyceride and cholesterol levels.
Upper fasting periods should be avoided, as the liver could be stressed excessively to maintain glycemic levels through the process of neoglucogenesis.
Practical Tips
In practice, the diet for hepatic steatosis should be:
- Without alcohol, coffee, chocolate, black tea, energy drinks, cola and useless drugs
- Without junk foods like sweets, salty snacks, sweet drinks (packaged fruit juices, commercial teas, oranges, etc.), fast food (burgers, wraps, very stuffed sandwiches, fries, croquettes, etc.)
- Without discretionary sugar (the one added to the table in drinks or food)
- With at least 5 meals a day
- With whole or non-peeled cereals and legumes
- With lean food of animal origin
- With very few elaborate recipes, fat or containing refined ingredients
- With lots of seasonal vegetables, about 50% of which are raw
- With 2 portions of fresh seasonal fruit a day (better in summer or spring; otherwise, prefer oranges, grapefruit, apples, pears and kiwi; the most sugary must respect lower portions)
NB : If steatosis is generated by energy and protein malnutrition, make sure to reach at least 0.8-1.2 g of protein per kilogram of weight.
Supplements
Drugs for hepatic steatosis are the ones we talked about in the treatment chapter.
As for the supplements, instead, the products based on artichoke and milk thistle (1-2g / day of concentrated dry extract each), which are rich in cynarine and silymarin, are useful.
Furthermore, to guarantee the production of glutathione (liver enzyme) some choose to supplement the vitamin from which it derives, ie PP or niacin (one of about 1g / day).
All products rich in vitaminic or phenolic antioxidants can also be appreciated.
Diet example
Adult man, overweight, who lives alone and works as a doorkeeper. Dedicated to alcohol only in the evening, it often eats out and does not practice any sport outside the football with friends (once a week).
| Sex | Male |
| Age | 40 years |
| Stature | 178.0cm |
| Wrist circumference | 17, 2cm |
| Constitution | Normal |
| Stature / wrist | 10.3 |
| Morphological type | normolineo |
| Weight | 88.0Kg |
| Body mass index | 27.8 |
| Rating | Overweight |
| Desirable physiological body mass index | 21.7 |
| Desirable physiological weight kg | 68.9 |
| Basal kcal metabolism | 1676, 6kcal |
| Coefficient of physical activity level | 1.41 (light without desirable motor activity) |
| Energy expenditure | 2363, 9kcal |
| Diet | HYPOCALORIC, at 70% of the NORMOCALORICA | 1650Kcal (approximate) | ||
| Lipids | 25% | 45, 8g | 412, 5kcal | |
| proteins | > 0.75 and not more than 20% | 67g (average value) | 268Kcal (average value) | |
| carbohydrates | 58.8% | 258, 5g | 969, 5kcal | |
| Breakfast | 15% | 248kcal | ||
| Snack 1 | 10% | 165kcal | ||
| Lunch | 35% | 577kcal | ||
| Snack 2 | 10% | 165kcal | ||
| Dinner | 30% | 495kcal | ||
EXAMPLE DIET DAY 1
| Breakfast | ||||
| Soy milk, enriched in calcium | 300ml | 1 cup | ||
| Oats in flakes | 40g | 8 tablespoons | ||
| Snack 1 | ||||
| Apple, with peel | 200g | 1 apple | ||
| Rice flakes without salt | 16g | 2 biscuits | ||
| Lunch | ||||
| Pasta with tomato sauce | ||||
| Semolina pasta, whole wheat | 80g | |||
| Tomato puree | 100g | |||
| Grain | 10g | 2 teaspoons | ||
| Cardi | 200g | |||
| Whole grain bread | 30g | 1 slice | ||
| Extra virgin olive oil | 15g | 3 teaspoons | ||
| Snack 2 | ||||
| oranges | 300g | 1 orange | ||
| Natural, low-fat yogurt | 120g | 1 jar | ||
| Rice flakes without salt | 8g | 1 cake | ||
| Dinner | ||||
| Lessi beans | ||||
| Borlotti beans, dried | 40g | |||
| Polo breast with Piastra and Stewed Artichokes | ||||
| Chicken breast | 150g | |||
| Artichokes | 200g | |||
| Wheat bread | 30g | 1 slice | ||
| Extra virgin olive oil | 15g | 3 teaspoons | ||
| DAY 1 nutritional translation | ||
| Nourishing or nutritional component | Quantity | |
| Power | 1633, 2kcal | |
| Food water | 1410, 4g | |
| Protein | 90, 4g | |
| Total energy lipids | 44, 5g | |
| Saturated fats, total | 9, 7g | |
| Total monounsaturated fatty acids | 25, 8g | |
| Total polyunsaturated fatty acids | 9, 0g | |
| Cholesterol | 149.5mg | |
| Carbohydrates | 232, 3g | |
| Simple sugars, total | 75, 5g | |
| Alcohol, ethanol | 00:00 | |
| fibers | 45, 2g | |
| Sodium | 1590, 4mg | |
| Potassium | 4672, 6mg | |
| Football | 939, 7mg | |
| Iron | 17, 2mg | |
| Phosphorus | 1560, 8mg | |
| Zinc | 12, 7mg | |
| Thiamine or vit. B1 | 2, 20mg | |
| Riboflavin or vit. B2 | 2, 53mg | |
| Niacin or vit. B3 or vit. PP | 36, 82mg | |
| Pyridoxine or vit. B6 | 3, 87mg | |
| Folate, total | 20, 3μg | |
| Ascorbic acid or vit. C | 209, 3mg | |
| Vitamin D | 0.00IU | |
| Retinol equivalent activities or vit. TO | 351, 5RAE | |
| α-tocopherol or vit. IS | 16, 0mg | |
As can be seen in the nutritional translation of day 1, the share of ethyl alcohol is reduced to 0 and the fiber intake is more than significant; the latter, of almost 10g over the average intake for a healthy adult, act as modulators of the absorption for carbohydrates.
Only the protein intake, due to the principle of the practicability of the portions and the coverage of other nutritional quotas, is to be considered slightly in excess.
EXAMPLE DIET DAY 2
| Breakfast | ||||
| Soy milk, enriched in calcium | 300ml | 1 cup | ||
| Corn flakes | 40g | 8 tablespoons | ||
| Snack 1 | ||||
| Pear, with peel | 200g | 1 pear | ||
| Rice flakes without salt | 16g | 2 biscuits | ||
| Lunch | ||||
| Zucchini Risotto | ||||
| Rice, whole grain | 80g | |||
| Zucchini | 100g | |||
| Grain | 10g | 2 teaspoons | ||
| Red cabbage | 200g | |||
| Whole grain bread | 30g | 1 slice | ||
| Extra virgin olive oil | 15g | 3 teaspoons | ||
| Snack 2 | ||||
| Kiwi | 200g | 2 kiwis | ||
| Natural, low-fat yogurt | 120g | 1 jar | ||
| Rice flakes without salt | 8g | 1 cake | ||
| Dinner | ||||
| Ceci Lessi | ||||
| Chickpeas, dried | 40g | |||
| Sea Bass Fillet and Steamed Carrots | ||||
| Sea bass, fillets | 150g | |||
| carrots | 200g | |||
| Wheat bread | 30g | 1 slice | ||
| Extra virgin olive oil | 15g | 3 teaspoons | ||
EXAMPLE DIET DAY 3
| Breakfast | ||||
| Soy milk, enriched in calcium | 300ml | 1 cup | ||
| Oats | 40g | 8 tablespoons | ||
| Snack 1 | ||||
| clementines | 150g | 1 mandarancio | ||
| Rice flakes without salt | 16g | 2 biscuits | ||
| Lunch | ||||
| Minestrone (with potatoes) and barley | ||||
| Whole barley | 50g | |||
| Frozen vegetables (with potatoes) | 300g | |||
| Grain | 10g | 2 teaspoons | ||
| Whole grain bread | 30g | 1 slice | ||
| Extra virgin olive oil | 15g | 3 teaspoons | ||
| Snack 2 | ||||
| Pomegranate, peeled | 100g | 1 pomegranate | ||
| Natural, low-fat yogurt | 120g | 1 jar | ||
| Rice flakes without salt | 8g | 1 cake | ||
| Dinner | ||||
| Lentils Lesse | ||||
| Lentils, dried | 40g | |||
| Egg Omelette, Egg Whites and Spinach | ||||
| Whole egg | 50g | 1 chicken egg | ||
| Egg whites | 350g | |||
| spinach | 200g | |||
| Wheat bread | 30g | 1 slice | ||
| Extra virgin olive oil | 15g | 3 teaspoons | ||
EXAMPLE DIET DAY 4
| Breakfast | ||||
| Soy milk, enriched in calcium | 300ml | 1 cup | ||
| All brain and Muesli | 40g | 8 tablespoons | ||
| Snack 1 | ||||
| Grapes | 100g | |||
| Rice flakes without salt | 16g | 2 biscuits | ||
| Lunch | ||||
| Potato, rocket and parsley salad | ||||
| Potatoes | 450g | |||
| Rocket salad | 100g | |||
| Parsley (fresh) | QB | |||
| Whole grain bread | 30g | 1 slice | ||
| Extra virgin olive oil | 15g | 3 teaspoons | ||
| Snack 2 | ||||
| Winter melon | 300g | 3 slices | ||
| Natural, low-fat yogurt | 120g | 1 jar | ||
| Rice flakes without salt | 8g | 1 cake | ||
| Dinner | ||||
| Peas Read | ||||
| Peas, buckets | 40g | |||
| Lean Milk Flakes with Fennel | ||||
| Light Milk Flakes | 150g | 1 jar | ||
| flakes | 200g | |||
| Wheat bread | 30g | 1 slice | ||
| Extra virgin olive oil | 15g | 3 teaspoons | ||
EXAMPLE DIET DAY 5
| Breakfast | ||||
| Soy milk, enriched in calcium | 300ml | 1 cup | ||
| Oats in flakes | 40g | 8 tablespoons | ||
| Snack 1 | ||||
| Apple, with peel | 200g | 1 apple | ||
| Rice flakes without salt | 16g | 2 biscuits | ||
| Lunch | ||||
| Eggplant Pasta | ||||
| Semolina pasta, whole wheat | 80g | |||
| Eggplant | 100g | |||
| Grain | 10g | 2 teaspoons | ||
| Cardi | 200g | |||
| Whole grain bread | 30g | 1 slice | ||
| Extra virgin olive oil | 15g | 3 teaspoons | ||
| Snack 2 | ||||
| oranges | 300g | 1 orange | ||
| Natural, low-fat yogurt | 120g | 1 jar | ||
| Rice flakes without salt | 8g | 1 cake | ||
| Dinner | ||||
| Lessi beans | ||||
| Borlotti beans, dried | 40g | |||
| Grilled Veal Steak and Stewed Artichokes | ||||
| Calf, "walnut" cut | 150g | |||
| Artichokes | 200g | |||
| Wheat bread | 30g | 1 slice | ||
| Extra virgin olive oil | 15g | 3 teaspoons | ||
EXAMPLE DIET DAY 6
| Breakfast | ||||
| Soy milk, enriched in calcium | 300ml | 1 cup | ||
| Corn flakes | 40g | 8 tablespoons | ||
| Snack 1 | ||||
| Pear, with peel | 200g | 1 pear | ||
| Rice flakes without salt | 16g | 2 biscuits | ||
| Lunch | ||||
| Pumpkin Risotto | ||||
| Rice, whole grain | 80g | |||
| Pumpkin | 100g | |||
| Grain | 10g | 2 teaspoons | ||
| broccoli | 200g | |||
| Whole grain bread | 30g | 1 slice | ||
| Extra virgin olive oil | 15g | 3 teaspoons | ||
| Snack 2 | ||||
| Kiwi | 200g | 2 kiwis | ||
| Natural, low-fat yogurt | 120g | 1 jar | ||
| Rice flakes without salt | 8g | 1 cake | ||
| Dinner | ||||
| Ceci Lessi | ||||
| Chickpeas, dried | 40g | |||
| Sea Bream Fillet and Steam Biete | ||||
| Sea bream, fillets | 150g | |||
| Biete | 200g | |||
| Wheat bread | 30g | 1 slice | ||
| Extra virgin olive oil | 15g | 3 teaspoons | ||
EXAMPLE DIET DAY 7
| Breakfast | ||||
| Soy milk, enriched in calcium | 300ml | 1 cup | ||
| Oats | 40g | 8 tablespoons | ||
| Snack 1 | ||||
| clementines | 150g | 1 mandarancio | ||
| Rice flakes without salt | 16g | 2 biscuits | ||
| Lunch | ||||
| Potato puree with spelled | ||||
| Potatoes | 300g | |||
| farro | 30g | |||
| Grain | 10g | 2 teaspoons | ||
| Whole grain bread | 30g | 1 slice | ||
| Extra virgin olive oil | 15g | 3 teaspoons | ||
| Snack 2 | ||||
| Pomegranate, peeled | 100g | 1 pomegranate | ||
| Natural, low-fat yogurt | 120g | 1 jar | ||
| Rice flakes without salt | 8g | 1 cake | ||
| Dinner | ||||
| Lentils Lesse | ||||
| Lentils, dried | 40g | |||
| Egg omelette, egg whites and chicory | ||||
| Whole egg | 50g | 1 chicken egg | ||
| Egg whites | 350g | |||
| Chicory | 200g | |||
| Wheat bread | 30g | 1 slice | ||
| Extra virgin olive oil | 15g | 3 teaspoons | ||
