**The Foundation of Fatty Liver Prevention and Treatment: In-depth Analysis of Seventeen Common Misconceptions and Sixteen Lifestyle Taboos**

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One misconception: Fatty liver is painless and doesn't cause any symptoms, so it's not considered a disease; at most, it's just a sign of sub-health.

Myth 2: Fatty liver is incurable. Simple fatty liver is an early manifestation of various hepatotoxic injuries. If the cause is removed and the primary disease controlled in time, the fat deposits in the liver can completely disappear within a few months. Therefore, early diagnosis and treatment of fatty liver should be emphasized. The reason some fatty liver patients fail to recover may be due to delayed treatment, inappropriate treatment methods, or insufficient treatment duration. Alcoholic fatty liver can improve with early cessation of alcohol consumption, drug-induced fatty liver with timely medication changes, and malnutrition-related fatty liver with protein supplementation. Even if fatty liver develops into steatohepatitis and liver fibrosis, the liver lesions can still be reversed with active treatment. However, non-pharmacological treatments need to be implemented lifelong; otherwise, fatty liver will recur even if cured.

Myth 3: Treatment of fatty liver mainly relies on medication. In the comprehensive treatment of fatty liver, medication is only an adjunct measure, primarily used for patients with fatty liver disease accompanied by elevated transaminase levels; it is a short-term, intensive approach. Not everyone with fatty liver needs to take lipid-lowering drugs, and improper use of these drugs can sometimes not only fail to alleviate fatty liver but also worsen liver damage. A fatty liver has decreased tolerance to lipid-lowering drugs, and improper use can easily lead to hepatotoxicity.

Myth 4: Fatty liver with elevated transaminase levels means you can't be very active. Epidemiological surveys show that fatty liver in obese individuals with elevated transaminase levels is closely related to a Westernized diet and a sedentary lifestyle. In fact, while controlling your diet, engaging in at least 150 minutes of moderate-intensity aerobic exercise per week is the most effective treatment.

Myth 5: The more fruit, the better for obese patients with fatty liver. Fresh fruit is rich in water, vitamins, fiber, and minerals, and regular consumption is undoubtedly beneficial to health. However, the health benefits of fruit are not a case of the more the better. Fruit contains a certain amount of sugar, and long-term excessive consumption can lead to elevated blood sugar and blood lipids, and even induce obesity, so it is not advisable to eat too much. Therefore, obese patients, diabetics, hyperlipidemia patients, and fatty liver patients should not eat too much fruit. The correct way to eat fruit is to choose fruits with low sugar content, such as apples and pears, and not to eat too much; if necessary, replace fruit with vegetables such as radishes, cucumbers, and tomatoes; try to eat fruit before meals or when hungry between meals to reduce the amount of food consumed at main meals.

Myth Six: Fatty liver is hereditary. As we know, fatty liver is mainly caused by fatty degeneration of the liver due to various factors such as obesity, diabetes, and dyslipidemia. These diseases tend to cluster in families and have a certain hereditary tendency, medically known as polygenic hereditary diseases. However, if parents are obese, have diabetes, or have dyslipidemia, their children will not necessarily develop these diseases. Genetic factors only play a role based on unhealthy lifestyles and unscientific living habits. Therefore, fatty liver itself is not hereditary. In the familial clustering of fatty liver, acquired environmental factors such as unhealthy lifestyles and unscientific dietary habits are likely more important.

Myth 7: You won't get fatty liver if you're not overweight. Fatty liver is not a disease in itself. Besides obesity, hyperlipidemia, and overnutrition, it can also be caused by alcoholism, type II diabetes, chronic hepatitis, essential amino acid deficiency, and adverse drug reactions. Therefore, not only overweight people can get fatty liver, but thin people can too. Many Chinese people have "big bellies and thin legs," meaning their weight may not be excessive, but their abdominal fat, or visceral fat, is already excessive. These people are considered to have abdominal obesity and are just as prone to fatty liver as severely obese individuals. It's worth noting that rapid or drastic weight loss, or large fluctuations in weight over a period of time, can also easily induce fatty liver. Losing more than 5 kilograms per month can lead to abnormal liver function and increase the risk of gallstones.

Myth 8: Some patients with fatty liver disease are dismissive, believing it's not a real disease and that treatment is unnecessary. Most patients with fatty liver disease do not experience any noticeable symptoms, and some even develop fatty hepatitis or early-stage cirrhosis without showing obvious symptoms. However, the belief that fatty liver is a benign disease and doesn't require treatment because there are no symptoms is extremely dangerous. The liver is the body's largest "cleaner," detoxifying the body of toxins, waste products, ingested harmful substances, and drugs. If fat accumulates in the liver over a long period, it not only damages the liver but also severely affects the body's nutrient metabolism and detoxification functions. If left untreated, it can lead to liver fibrosis, cirrhosis, and even liver cancer, seriously threatening life. Fatty liver disease is closely linked to diabetes and coronary heart disease, and patients with fatty liver face numerous chronic disease threats. Epidemiological surveys have found that obese patients, those with diabetes, and those with hyperlipidemia have a higher prevalence and more severe cases of fatty liver. Many patients with fatty liver have normal weight, blood lipids, blood sugar, and blood pressure at the time of diagnosis. However, further follow-up studies have found that these patients rapidly develop hyperlipidemia, diabetes, and arteriosclerosis and related complications within several years of the diagnosis. Therefore, while treating fatty liver, patients should also strengthen the treatment of systemic diseases, such as lowering blood pressure, blood sugar, and blood lipids.

Myth #9: You have to be a vegetarian if you have fatty liver.

Myth #10: Fatty liver requires weight loss. Weight loss is only beneficial for obese individuals with fatty liver; there's no weight loss to be gained for those without. Some statistics show that obese patients with fatty liver and abnormal liver function experienced a 9% weight loss after 12 weeks of weight loss treatment, and 74% of them had their liver function return to normal. However, weight loss should be a gradual process. Rapid weight loss in a short period can potentially cause liver cell necrosis, impaired liver function, and even induce liver fibrosis. Using rapid weight loss to treat fatty liver will only cause greater harm.

Myth 11: Liver disease patients should not restrict their diet; a balanced diet is most important. Dietary therapy for fatty liver used to differ from today's. In the past, the intake of fat and protein was restricted, especially fat, which was considered extremely harmful to the liver and should be strictly limited. However, now, people are less sensitive to fat intake and generally follow a high-protein, high-calorie, and high-vitamin diet. Fatty liver patients already have poor liver function; if they also lack nutrition, fatty liver becomes very difficult to eradicate. The clinical symptoms of fatty liver are nonspecific. Most patients may be asymptomatic, while some may experience fatigue, discomfort such as distension and pain in the liver area, or other symptoms associated with metabolic syndrome. Therefore, the presence or absence, severity, and normality or abnormality of liver function are not directly proportional to the degree of inflammation and fibrosis in liver histology, nor are they significantly correlated with the progression of other accompanying metabolic syndromes. Therefore, one should never judge the severity of fatty liver based on the presence or absence of clinical symptoms or normal liver function, lest the condition be delayed. Some patients, even after entering the stage of fatty hepatitis, still insist on not using medication. Some patients experience worsening of hepatic steatosis or even abnormal liver function after using Western lipid-lowering drugs, leaving them at a loss. Some blindly believe in advertising claims and take medications indiscriminately; others hope for a quick fix and cannot consistently change their unhealthy lifestyles. Coupled with increasingly abundant diets, many find it difficult to resist temptation, leading to a worsening of their condition. They then pin their hopes on some kind of miracle drug or other means for rapid results. In reality, there are no shortcuts to treating this disease; comprehensive and persistent treatment is essential.

Myth #12: The treatment of fatty liver is a long-term, systematic, and individualized process. How fatty liver patients should eat, what they should eat, how much they should eat, how they should exercise, what type of exercise to use, how to control the amount of exercise, and whether medication is needed-all of this must be done under the guidance of a doctor, not simply as a personal choice. Insufficient weight loss will not achieve the treatment goal; excessive weight loss is not only difficult to maintain but can also lead to many complications, resulting in more harm than good. After consultation, fatty liver patients should receive three prescriptions-a medication prescription, an exercise prescription, and a nutritional prescription. For the liver, fatty liver is a chronic liver disease. For the whole body, fatty liver is a risk factor for cardiovascular disease in patients with type 2 diabetes, and the incidence of cardiovascular and cerebrovascular events is higher than in the general population. Therefore, fatty liver patients should be monitored and followed up long-term, and reasonable comprehensive treatment measures should be taken to minimize the harm of the disease to the body. Clinical practice shows that only by addressing all three aspects simultaneously can significant therapeutic effects be achieved. Neglecting any one aspect will result in "half the effort for twice the result."

Myth #13: Quitting alcohol and smoking. Studies on the relationship between alcohol consumption and liver damage show that drinking 160g of alcohol daily will cause serious liver damage in the long run. However, drinking less than 80g of alcohol daily will not cause liver damage, while the effects of drinking more than 80g but less than 160g depend on individual constitution and diet. Therefore, many patients with fatty liver control their alcohol consumption. However, they continue to smoke, believing that smoking has little effect on the liver, which is a big mistake. The greater the amount of nicotine accumulated in the body, the greater the toxicity. The nicotine in one cigarette can kill two mice; the nicotine in 40 cigarettes can be a lethal dose for an average-weight adult. As a detoxification organ, the liver's detoxification function is already reduced after developing fatty liver, and the accumulation of large amounts of nicotine in the body further aggravates the damage to the liver. In addition, patients with fatty liver often have poor microcirculation in the liver, with stagnation. Nicotine can damage the circulatory system, causing vasoconstriction and increasing blood viscosity, leading to microcirculatory disorders. Simultaneously, the large amounts of carbon monoxide inhaled while smoking hinder the binding of hemoglobin with oxygen, causing tissue hypoxia. Therefore, heavy smoking in hepatitis B patients can exacerbate hepatic microcirculatory disorders, leading to insufficient blood and oxygen supply to the liver, further worsening liver damage and exacerbating the condition.

Myth #14: A normal ultrasound report completely rules out fatty liver. Ultrasound examinations can only detect moderate to severe cases of fatty liver. The accuracy rate of ultrasound in diagnosing fatty liver is generally 60%–70%. Fatty liver that ultrasound can detect is generally moderate fatty liver with more than 33% steatosis. In other words, mild fatty liver with less than 33% steatosis is easily missed.

Myth #15: Fatty liver in children isn't a big deal. Children with fatty liver have a higher chance of developing liver inflammation and fibrosis. If fatty liver in children isn't treated promptly, the risk of developing diabetes and hypertension later in life increases significantly. Because children are in a period of rapid growth and development, it's very difficult to strike a balance in weight loss-ensuring effectiveness without hindering their growth and development.

Myth #16: Fatty liver and steatohepatitis are the same thing. Fatty liver, also known as intrahepatic steatosis, refers to the accumulation of fat in liver cells caused by various factors. Steatohepatitis refers to hepatitis secondary to macrovesicular hepatocyte steatosis, and can be divided into two main categories based on etiology: alcoholic hepatitis and non-alcoholic steatohepatitis.

Myth #17: Drinking tea after meals can remove greasiness and is beneficial for treating fatty liver. Tea contains a large amount of tannic acid, which can combine with protein to form astringent tannic acid proteins, slowing down intestinal peristalsis, easily causing constipation, and increasing the toxic and carcinogenic effects of substances on the liver, thus easily leading to fatty liver.

Lifestyle restrictions for patients with fatty liver:

One of the taboos: People with fatty liver should avoid spicy and stimulating foods such as onions, garlic, ginger, chili peppers, black pepper, curry, and alcohol. They should also limit their intake of foods high in nitrogenous extracts, such as meat broth, chicken broth, and fish broth. Additionally, foods high in fat and carbohydrates should be avoided.

Second taboo: Patients with fatty liver should not eat animal offal. Animal offal is a high-cholesterol food.

Thirdly, people with fatty liver should avoid eating squid and sardines, as these are both high in cholesterol.

Fourth taboo: Patients with fatty liver should not eat fatty pork. Fatty pork is a food rich in animal fat.

Fifthly, patients with fatty liver should avoid eating egg yolks and crab roe. Egg yolks and crab roe are also high in cholesterol.

Sixth taboo: Patients with fatty liver should not eat brain marrow. Brain marrow is also a high-cholesterol food.

Seventh taboo: Patients with fatty liver should not eat too much garlic.

Eighth taboo: Patients with fatty liver should not eat foods high in fat and carbohydrates.

The ninth taboo: Patients with fatty liver should not drink alcohol. Most alcohol is detoxified, broken down, and metabolized in the liver after entering the body. Long-term or excessive drinking is a direct cause of alcoholic fatty liver.

Tenth taboo: Patients with fatty liver should not eat too much fried food. Excessive oil intake will increase the accumulation of fat in the liver, thereby aggravating the degree of liver fattyization. It is recommended to choose steaming, boiling, stewing, braising, poaching, and cold dishes, and avoid frying.

Taboo number eleven: Patients with fatty liver should avoid foods high in sugar. Excessive intake of high-sugar foods will exceed the liver's metabolic burden and worsen the condition.

Taboo number 12: Patients with fatty liver should not drink carbonated beverages.

Taboo number thirteen: Patients with fatty liver should not drink tea immediately after eating meat.

Taboo number fourteen: Patients with fatty liver should not read or watch television for extended periods. Eye and mental fatigue, like any physical fatigue you experience, can negatively impact liver recovery. Those who read or work for more than an hour should look at distant objects for 5-10 minutes as a break.

Taboo number fifteen: Patients with fatty liver should not consume cold drinks. Consuming large amounts of cold drinks in summer can irritate the gastrointestinal tract, cause vasoconstriction, and raise blood pressure.

Taboo number sixteen: Patients with fatty liver should not consume milk. Because of abnormal liver function, the lactose in milk is difficult to absorb in the body.

For most patients with fatty liver, the first step should be to identify the possible causes and contributing factors. A scientific and reasonable dietary plan plays an important role in the effective prevention and treatment of fatty liver caused by obesity, post-hepatitis fatty liver, hyperlipidemia-related fatty liver, and alcoholic liver disease. Nutritional therapy is the most basic treatment measure for patients with fatty liver. The principles of nutritional therapy are to control total energy and carbohydrate intake, increase the quality and quantity of protein, provide an appropriate amount of fat, control cholesterol intake, and supplement sufficient vitamins, trace elements, and dietary fiber. Simultaneously, it is essential to abstain from alcohol and change unhealthy eating habits.

Control energy intake. The energy supply for patients with fatty liver should not be too high. Hospitals typically use Body Mass Index (BMI) as the diagnostic standard (BMI = weight/height²). A BMI between 18.5 and 22.9 kg/m² is considered normal weight, greater than 23 is overweight, and greater than 25 is obese. The energy supply for patients with fatty liver should not be too high. For hepatitis patients in the recovery period who engage in light activity, 30-35 kcal per kilogram of body weight per day can be provided to prevent weight gain and the induction of fatty liver. For obese or overweight individuals, 20-25 kcal per kilogram of body weight can be provided to control or reduce weight, striving to reach an ideal or suitable weight. As the patient's weight decreases, the infiltration of fat in the liver significantly reduces, and liver function also improves accordingly.