In Germany, around 25 percent of the population suffer from fatty liver, warns a gastroenterologist in the Utopia interview. But the disease is difficult to detect, especially in the early stages. How to identify and properly prevent them.
Elke Roeb heads gastroenterology at the University Hospital of the Justus Liebig University in Giessen and is an expert in fatty liver disease. The disease is often associated with alcoholism – but Roeb explains in an interview with Utopia that other causes are much more common. In fact, according to the German Liver Foundation, fatty liver is already the most common liver disease in Germany, affecting millions of people. The expert gives tips on how to prevent properly.
Utopia: How many people in Germany suffer from fatty liver?
Elke Roeb: We are currently assuming that at least 25 percent of the population in Germany suffers from fatty liver – that is, one in four.
“Many fatty liver diseases are completely asymptomatic”
Utopia: How do I know if I’m affected?
Roeb: Many fatty liver diseases are completely asymptomatic, at least in the early stages. This is why it is called “silent inflammation”. In some cases, diffuse symptoms such as tiredness, a feeling of fullness or pain in the upper abdomen are reported. The disease only becomes visible when the liver values are measured. Some of these are routinely checked during a check-up by the general practitioner.
Utopia: Such check-ups are common from the age of 35. Are people under 35 also affected?
Roeb: Yes, children too. Every third overweight child develops a fatty liver. In this respect, the check-up at 35 comes too late. However, there is a certain risk awareness among paediatricians.
Consequences of fatty liver: From inflammation to liver cancer
Utopia: What are the consequences of untreated fatty liver disease?
Roeb: The fatty degeneration of the liver initially leads to inflammation that can become chronic. Then there is organ scarring, which is referred to as liver fibrosis or “hardening of the liver”. In a late stage of fibrosis – the so-called liver cirrhosis – the liver can only carry out its functions such as detoxification of the body to a limited extent. Several years or decades can pass before the liver reaches this final stage.
Utopia: Can you die from fatty liver?
Roeb: If it’s not treated and it develops fibrosis or cirrhosis, then yes. Serious complications can occur with fibrosis or cirrhosis, such as liver cancer, bleeding and hepatic coma.
Utopia: What is the most important cause of fatty liver disease in Germany?
Roeb: Lack of exercise, followed by poor nutrition. This is closely related to our way of life. Food is freely available, exercise is often no longer a big part of everyday life, but industrially processed food without fiber is. If we absorb more nutrients than we use, they are stored in the liver for emergencies. Over time, this leads to fatty liver.
“Men are generally more at risk than women”
Utopia: Apart from a lack of exercise and a poor diet, are there other causes for the development of a fatty liver?
Roeb: Yes, for example alcohol, dyslipidemia, drugs or certain medications. Genetic factors or drastic weight loss can also play a role. Obesity is a very common reaction of liver cells to toxins or damage, including malnutrition. But in relation to an unfavorable lifestyle, these causes are negligible. In 95 percent of cases, people suffer from fatty liver due to lack of exercise and poor diet.
Utopia: Fatty livers are primarily associated with alcohol. how come
Roeb: It has been known for more than 100 years that alcohol can cause fatty liver. We have only known for about 25 years that lack of exercise and obesity lead to fatty liver – the fact has not yet gotten around to many people. In addition, the clinical picture used to be much rarer. Our parents or grandparents may have had a fat child in their class, but now up to 10 percent of children are overweight. The prerequisites for fatty liver disease are increasing. Men are generally more at risk than women.
Utopia: Why are men more at risk than women?
Roeb: That has to do with the fact that men are more likely to develop abdominal fat for genetic reasons. This promotes fatty degeneration of the liver. Men also show more risk behavior when it comes to smoking and drinking.
Preventing fatty liver: Which foods to avoid
Utopia: How much exercise does it take to prevent fatty liver disease?
Roeb: The German Liver Foundation recommends 150 minutes of endurance exercise, ideally spread over 3-4 days a week. You can exercise, for example, by walking briskly, hiking, cycling or swimming. If you train for more than 30 minutes, the fat in the liver slowly breaks down.
Utopia: What foods should you avoid or eat in moderation to avoid fatty liver disease?
Roeb: Foods high in saturated fat. These are often found in animal products, for example in butter, meat, sausage or cheese, but also in vegetable sources such as coconut fat. In addition, highly concentrated fructose, artificial flavors, colors and preservatives, as they are contained in finished products.
Utopia: And how do you eat a liver-friendly diet?
Roeb: The basis of the diet should be fresh vegetables such as tomatoes, peppers, fennel and zucchini. Fruit, legumes, whole grains and potatoes are also good for the liver. You don’t have to avoid fat, but you should consume the right fats, i.e. polyunsaturated fatty acids. These are often found in plant sources such as nuts or seeds. Fish also contains unsaturated fatty acids and a lot of protein, which is also good for the liver.
Utopia: The German Liver Foundation has published a cookbook for liver-friendly nutrition. What recipes can you recommend?
Roeb: My favorite recipe is the Power Bowl. For this you need quinoa, red cabbage, tofu, apple, radishes and carrots. The food provides a lot of protein and fiber and is quick to prepare: simply boil the quinoa with water and salt, chop up the other ingredients and arrange everything in a bowl, for example with a yoghurt dressing. As a warm meal, I recommend a curry with spinach, sweet potatoes, chickpeas and rice, best seasoned with a little mint. In general, I would recommend cooking with as many fresh vegetables as possible, ideally combined with cereals or legumes as a filling side dish.
“One must not inhibit children’s urge to move”
Utopia: What would our society have to change to better contain fatty liver disease?
Roeb: Almost every child used to be in a sports club, and fatty liver diseases were also rarer back then. Today, sports clubs have to gradually close. I think that’s fatal. Children have a natural urge to move, which should be encouraged and not inhibited by tablets, cell phones or television. For children – and for all of us – exercise must be part of everyday life.
Day care centers and kindergartens should also inform children about the risks of too little exercise and an unhealthy diet – and show them with examples how things can be improved. If children are taught all this, there is a high chance that they will also eat healthier and exercise more as adults.
Utopia: And adults? What steps can we take to reduce our risk of fatty liver?
Roeb: Adults should cook more themselves and consciously buy healthy food instead of industrially processed food. And do endurance sports regularly and consume only little alcohol and no drugs or nicotine.
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