Step 1: Detox and cleanse the liver
From a medical perspective, there is no accepted way to cleanse or detox the liver, Traditional doctors view liver cleanses and liver detoxes sold on the internet as scams or snake oil because nothing shows that these products work. In fact, some liver detox supplements may harm the liver. Green tea and turmeric can cause liver damage from hepatitis and coffee enemas can lead to infections or severe electrolyte deficiencies. The best way to cleanse or detox your liver is to eat healthy unprocessed foods like vegetables, fruits, and whole grains. To further reduce toxins in the liver, go organic as much as possible. Drink 2 liters of filtered water or lemon water every day to stay hydrated and help flush endocrine-disrupting environmental toxins stored in fat that are released with weight loss.
Step 2: Cut the calories
To heal a fatty liver, start by reducing calorie intake. Focus on lowering daily calories. I recommend foods that make you feel full, so your body craves fewer calories (vegetables, fruits, whole grains, nuts, seeds, seafood, lean poultry, low-fat dairy, and plant-based proteins). The exact combination of macros are not as important as the calories, so you can customize your ratio of carbohydrates, proteins, and fats to what works for you.
Step 3: Avoid foods that are bad for the liver
Avoid sugar, high fructose corn syrup, processed carbohydrates, starchy foods and saturated fat (red meat, fatty meat, butter, cheese, coconut oil). These foods cause inflammation and insulin resistance in the liver. Fructose is the most toxic of the sugars inducing hepatic insulin resistance. Extra sugar and saturated fat lead to creation of new liver fat known as de novo lipogenesis or DNL. A fatty liver can become inflamed, nonalcoholic steatohepatitis, NASH. Inflammation and liver injury does heal but leaves scar tissue known as fibrosis. Advanced fibrosis is known as cirrhosis, which can clog up the liver. When this happens, it is called decompensated cirrhosis which leads to end-stage liver disease, liver transplantation or death.
Step 4: Avoid gluten-free junk food
Avoid gluten free processed food. Gluten-free diets have been hyped as a cure all for thyroid disease but does not work for most people. The issue is not the gluten, it is the unhealthy carbohydrates that are usually in foods with gluten. It’s OK to go gluten-free but avoid gluten-free processed junk food like pasta, bread, and pizza. Processed gluten-free foods contain more sugar and worse carbs not to mention excessive amounts of arsenic and other heavy metals.
Step 5: Drink coffee
Coffee used to be a vice, now it is a virtue. I recommend that you drink at least 2 cups of coffee daily, which has been shown to improve liver health. The liver benefits of coffee come from brewed black coffee, not fancy expresso drinks. High calorie add-ins like cream and sugar will negate the beneficial effects of coffee, so keep it simple (regular black coffee is best). Don’t overdose on caffeine or drink it too late in the day when it could affect your sleep.
Step 6: Minimize alcohol
You should totally avoid alcohol but drinking too much or binge drinking can make a fatty liver much worse. Experts recommend no alcohol.
Step 7: See your doctor
The management of hepatic hypothyroidism starts with getting fat out of the liver. Weight loss with a diet plan is helpful for patients that need to lose a lot of weight and have had difficulty doing it on their own. Fast weight loss under medical supervision has been proven to work best because it is more motivating, compared to slow weight loss that can be frustrating.
Although there are no medications that have been officially approved to treat hepatic hypothyroidism, Resmetirom is entering the final states of testing. Resmetirom is a liver-directed, oral, thyroid hormone receptor-β agonist designed to improve liver health by increasing hepatic fat metabolism and reducing lipotoxicity. Essentially, the drug works by treating the root cause of hepatic hypothyroidism.
Other treatments for hepatic hypothyroidism include diabetes medications (such as GLP-1 medications tirzepatide - Mounjaro, semaglutide - Ozempic, Wegovy, Rybelsus or liraglutide-Saxenda, Victoza) can be very effective. Weight loss medications such as Qsymia or Contrave are effective. Even better results can be obtained by using a combination of medications.
