03/02/2025
Scene: A casual dinner gathering at a café
Amit: So, I recently read something about how fatty liver is becoming a big issue. I thought only people who drink alcohol get liver problems?
Dr. Meera: That’s a common misconception. What you're thinking of is alcoholic liver disease. But the commonest problem today is what is called Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)—formerly known as non-alcoholic fatty liver disease (NAFLD). It happens when fat accumulates in the liver, not because of alcohol, but due to metabolic issues like obesity, insulin resistance, and poor diet.
Ravi: Wait, so just eating a bit of extra butter chicken can give me liver disease? That sounds extreme!
Dr. Raj: It’s not about one meal, but a long-term pattern of excess calories, especially from sugar, refined carbs, and unhealthy fats. The liver stores extra fat when the body’s metabolism is out of balance, and over time, this can lead to inflammation, scarring, and even cirrhosis.
Neha: That makes sense. Our bodies run on cycles—eating, activity, and rest. If one part is out of sync, everything gets affected.
Dr. Meera: Exactly! I can give you a simple way of thinking about how the body metabolism works .We can divide our body’s daily functions into three cycles:
Energy Cycle (Diet & Nutrition) – What we eat and how it fuels our metabolism.
Activity Cycle (Exercise & Movement) – How we burn calories and keep insulin in check.
Sleep Cycle (Rest & Recovery) – When the body repairs itself.
If any of these cycles are disturbed—say, too much junk food, too little exercise, or poor sleep—fatty liver can develop -not just fatty liver its a Metabolic syndrome thats unfurling especially when people enters middle age .
Amit: So how do you actually diagnose MASLD?
Dr. Ananya: Good question! Doctors use five key metabolic parameters from the AASLD 2023 MASLD Decision Tree:
Body Mass Index (BMI): If it's 25 kg/m² or more (lower for Asians), it’s a risk factor.
Waist Circumference: More than 94 cm in men, 80 cm in women.
Fasting Blood Sugar: 100 mg/dL (5.6 mmol/L) or higher.
Blood Pressure: 130/85 mmHg or more, or if you're on BP meds.
Lipid Profile: High triglycerides (>150 mg/dL) or low HDL cholesterol.
Neha: So if someone meets these criteria, they should be concerned?
Dr. Meera: Absolutely. MASLD increases the risk of heart disease, diabetes, kidney disease, and even muscle loss (sarcopenia). That’s why early intervention is crucial!
Energy Cycle: Fixing Diet for a Healthier Liver
Ravi: Okay, I admit I love my biryanis and sweets. But what’s the right diet to prevent or manage fatty liver?
Dr. Raj: The best approach is a diet low in sugar and bad fats, focusing on whole foods. Here’s what works best:
✔ Mediterranean Diet – Rich in veggies, whole grains, lean proteins, and healthy fats (like olive oil).�✔ Omega-3 Fatty Acids – Found in fish, walnuts, and flaxseeds; helps reduce liver fat.�✔ Coffee & Garlic – Both have protective effects on the liver.�✔ Fiber-Rich Foods – Helps control blood sugar and reduces fat accumulation in the liver.
Amit: So basically, avoid processed junk and eat real food?
Dr. Meera: Bingo! Also, reducing calories by 500-1000 kcal/day can help in gradual weight loss, which improves liver health.
Activity Cycle: The Role of Exercise
Neha: Diet is one thing, but what about movement? How much exercise is actually needed to reverse fatty liver?
Dr. Ananya: Exercise is one of the most effective tools for managing MASLD. Here’s the breakdown:
Aerobic Exercise: At least 150 minutes per week (walking, jogging, cycling) significantly reduces liver fat. If that’s tough, even 75 minutes of high-intensity workouts per week can help.
Strength Training: At least twice a week to build muscle and improve metabolism.
Consistency: Even 10-minute daily workouts make a difference.
Amit: I go to the gym, but I focus more on weights than cardio. Will that help?
Dr. Raj: Strength training is great for insulin sensitivity, but adding cardio helps burn liver fat. A mix of both is best.
Ravi: So, I don’t have to run a marathon, just move more?
Dr. Meera: Exactly. The goal is consistency, not intensity.
Sleep Cycle: The Forgotten Factor
Neha: People underestimate how important sleep is.
Dr. Ananya: That’s true. Poor sleep can worsen insulin resistance, disrupt liver function, and cause weight gain. Aim for 7-9 hours of quality sleep to allow the liver to repair and detoxify.
Amit: So if I eat well, exercise, but sleep only 5 hours a night, I’m still at risk?
Dr. Meera: Yes! All three cycles—diet, movement, and sleep—are interconnected.
The Bigger Picture: Why MASLD is More Than Just a Liver Issue
Ravi: So, what happens if MASLD is ignored?
Dr. Raj: Over time, it progresses to:
Liver Fibrosis & Cirrhosis – Permanent scarring, leading to liver failure.
Increased Risk of Heart Disease & Diabetes – Strong links between MASLD, high cholesterol, and heart attacks.
Muscle & Kidney Damage – Systemic effects that impact multiple organs.
Amit: That’s scary! Is there medication for it?
Dr. Meera: Research is ongoing. New drugs like GLP-1 receptor agonists (used for diabetes) and SGLT-2 inhibitors show promise. But lifestyle changes remain the first line of defence.
Neha: So exercise literally rewires our body’s metabolism?
Dr. Ananya: Yes! Exercise activates GLP-1, increases insulin sensitivity, and reduces inflammation. Researchers are even studying how exercise mimics drug-like effects.
Amit: Okay, I’m convinced. I’ll start tracking my waist size and triglycerides.
Ravi: I’ll cut down on sweets, but biryani stays! Maybe I’ll walk more.
Neha: This proves once again that health is a lifestyle, not a quick fix.
Dr. Meera: Absolutely! Small, sustainable changes in diet, activity, and sleep can reverse fatty liver and improve overall health.
Dr. Raj: MASLD isn’t just about the liver—it’s a whole-body disease that needs a whole-body approach.
Amit: Thanks, docs! I’ll treat my liver better from now on.