Fatty liver. Medication and effective treatment, diet

Fatty liver occurs in all age groups - in children and adults. This process can lead to serious complications - cirrhosis and carcinoma (cancer).

Treatment of the disease is carried out in a comprehensive manner and is aimed at eliminating the etiological factor and its consequences. There are a number of medications on the pharmaceutical market, the most effective of which are described in this article. In addition, it is necessary to adhere to a special diet aimed at reducing weight and body fat in the patient's body.

Basic principles of the treatment of fatty liver

Fatty liver (medication and effective treatment is determined depending on the cause of its occurrence) primarily develops due to:

• alcohol abuse;
• obesity;
• diabetes mellitus;
• infectious and systemic diseases;
• taking certain hepatotoxic drugs (hormonal, antibacterial and antifungal drugs, NSAIDs);
• metabolic disorders in the body.

Therefore, in order to restore the work of this organ, it is necessary at the first stage to eliminate the etiological factor due to which this condition arose. Often, obesity of the liver is combined with diseases of the gallbladder, pancreas and gallstone disease, in such cases, treatment is also carried out in a comprehensive manner.

The basic principles of therapy are as follows:

• elimination of indigestion syndromes;
• decrease in the level of lipid oxidation;
• decontamination of toxic substances;
• blocking inflammatory processes;
• slowing down the process of replacing normal, functional liver tissue with fibrotic.

Groups of medicines for treatment

There are more than 1000 drugs on the pharmaceutical market that are used to treat liver diseases.

The most significant in liver therapy are the following groups of funds:

• hepatoprotectors;
• choleretic drugs;
• detoxifying agents;
• preparations with a complex effect, on a plant basis.

Choleretic drugs

In most cases, drugs containing ursodeoxycholic acid (UDCA) are prescribed as choleretic agents.

It has several types of effects:

• a decrease in the concentration of toxic acids in bile;
• stimulation of the mechanism of cellular secretion in hepatocytes (liver cells);
• increasing the resistance of the outer walls of hepatocytes to damage by toxins;
• decrease in the production of proteins that stimulate the inflammatory process;
• slowing down the process of replacing normal liver tissue with fibrous;
• a decrease in the concentration of cholesterol in bile, which prevents the formation of stones and promotes their dissolution.

The drugs of choice for the complex treatment of liver and biliary tract diseases are listed in the table below.

Name	Daily dosage	Peculiarities	Average price, rub.
Ursosan	12-15 mg per 1 kg of body weight	Should not be taken with inflammation of the gallbladder, severe pathologies of the kidneys, liver, pancreas, in the presence of stones with a high calcium content in the gallbladder.	850 (50 capsules)
Ursofalk	up to 10 mg per 1 kg of body weight	880 (50 capsules)
Ursoliv	2-5 capsules depending on the patient's weight	1800 (50 capsules)
Choludexan	10-15 mg per 1 kg of body weight	600 (20 capsules)

Hepatoprotective agents

Fatty liver (medication and effective treatment involves the mandatory use of hepatoprotective drugs) is treated in 80% of hepatoprotectors. They have a selective effect on the liver: restoring normal metabolic processes in the liver, increasing the organ's resistance to toxins, stimulating recovery processes.

They can be roughly divided into several groups:

• means with essential phospholipids, which allow restoring and increasing the flexibility of the liver cell wall;
• alpha-lipoic acid (Thiogamma, Espa-Lipon, Berlition 300 and 600, Thioctacid), which has antioxidant, radioprotective and anticholesterol effects;
• herbal preparations containing glycosides, flavonoids, polyphenolic complexes (described below);
• metabolic stimulants (Heptral, Methionine, Riboxin, Mexidol);
• vitamin preparations that protect the liver from the effects of free radicals (vitamin E, C, sodium selenite);
• means that normalize the detoxifying ability of the liver (Hepa-Merz).

The most effective in this series are essential phospholipids.

The hepatoprotective process occurs according to the following mechanism:

1. The incorporation of molecules into the membranes of hepatocytes.
2. Reducing the supply of active oxygen to the liver cells.
3. Increasing the sensitivity of insulin receptors, lowering glucose levels.
4. Normalization of the metabolism of fats and proteins.
5. Reducing the loss of enzymes and other substances necessary for biological processes in the liver.
6. Slowing down the production of collagen and fibrotic phenomena.
7. Normalization of the composition of bile.
8. Reducing the activity of the inflammatory process and liver cell necrosis.

The characteristics of phospholipids are shown in the table below:

Name	Daily dosage	Peculiarities	Average price, rub.
Essentiale forte N	2 capsules 3 times a day	Contraindicated in case of intolerance to soy and legumes	1300 (90 pcs.)
Phosphogliv	Prescribed with caution for hypertension	600 (50 pcs.)
Essliver forte	Contains a complex of vitamins	400 (pcs.)

This type of drug must be taken for a long time, at least 3 months.

Amino Acid Medicines

Amino acids also have a complex effect on the liver:

• activation of biochemical reactions;
• participation in the formation of phospholipids (necessary for building the membranes of hepatic cells), the most important proteins, neurotransmitters that serve to transmit nerve impulses;
• regeneration (restoration) of organ tissues;
• antioxidant action, protection of cells from free radicals;
• detoxifying and biliary effect;
• improvement of blood biochemical parameters.

For drugs of this group, a long-term effect is characteristic that persists for 3 months after the end of treatment. They are also prescribed to patients undergoing therapy with hepatotoxic drugs and chronic liver diseases.

Name	Daily dosage	Peculiarities	Average price, rub.
Heptral (ademetionine)	10-25 mg per 1 kg of body weight	Contraindicated in genetic disorders of methionine and vitamin B12 metabolism, in manic and depressive disorders.	1700 (20 pcs.)
Methionine	0.5-1.5 g 3-4 times	Do not use in severe liver failure, viral hepatitis.	50 (50 pcs.)
Dibikor (taurine)	250-500 mg 2 times	It is used as a hepatoprotective agent for patients taking antifungal agents.	300 (60 pcs.)
Hepasol-Neo (amino acid complex)	1 ml per 1 kg of body weight, intravenously	It is used in stationary conditions for severe liver diseases, for the prevention of hepatic coma.	4000 (500 ml)

Detoxification products

With impaired liver function, the metabolic load on all organs increases. Sorbents are used to remove toxins from the body, which also prevent the development of toxic-allergic reactions, improve metabolic processes and stimulate gastrointestinal motility path. The most effective detoxifying agents used in hepatology are shown in the table below.

Name	Daily dosage	Peculiarities	Average price, rub.
Activated carbon	250-750 mg 3-4 times	The medicine is contraindicated in ulcerative lesions of the gastrointestinal tract.	20 (10 pcs.)
Polyphepan (lignin)	0.5-1 g per 1 kg of weight 3-4 times	Contraindicated for constipation, gastritis with low acidity.	150
Polysorb MP (colloidal silicon dioxide)	0.5 to 2 tbsp. l. depending on the patient's weight	Not prescribed for peptic ulcer disease, bleeding in the gastrointestinal tract, decreased intestinal tone.	250 (25 g)
Lactofiltrum (lactulose, lignin)	2-3 tablets 3 times	Cannot be used for gastrointestinal bleeding.	350 (30 pcs.)

Plant based preparations

Herbs containing the following biologically active substances have hepatoprotective properties:

• Silymarin, which is obtained mainly from milk thistle. This flavonoid protects the walls of hepatic cells from destruction, slows down oxidative processes, has immunomodulatory and antiviral properties, and reduces the activity of inflammation.
• Keoside, hyperoside, quertecin, isolated from the Far Eastern lily of the valley and multifilament buckwheat. The complex of these flavonoids has a choleretic, antispasmodic, hepatoprotective effect.
• Polyphenolic complexes, contained in sea buckthorn oil, sandy immortelle flowers, pumpkin seeds, artichoke leaves.
• Flavonol Aglycones (Flacumin)obtained from the leaves of the scumpia bush. They promote bile secretion, reduce spasms, and have a protective effect on liver cells.

Fatty liver cannot be quickly eliminated. Therefore, treatment with these medications should last for several weeks. The most common and effective herbal preparations are listed in the table below.

Name	Daily dosage	Main components	Average price, rub.
Hofitol (oral solution, tablets)	2-3 tablets, 3 times	Aqueous extract of fresh leaves of field artichoke	450 (60 tablets)
Tykveol (capsules, oil)	1 tsp. l. 3-4 times	Pumpkin seed oil	350 (50 pcs.)
LIV-52 (tablets)	2-3 tablets 2-3 times	A complex of powders and herbal extracts: caper roots, chicory seeds, black nightshade, terminalia ajurna bark, western cassia seeds, yarrow herb, Gali tamarix and others.	450 (100 pcs.)
Silibor	1-2 tablets 3 times	Silymarin	370 (20 tablets)
Silymarin	1-3 capsules	800 (50 capsules)
Carsil	1-4 pills 3 times	Milk thistle fruit extract	380 (80 pcs.)
Hepabene	1-6 capsules 3 times	Milk thistle and fume extract	460 (30 pcs.)

The following can be used as plant antioxidants:

• soy;
• crushed bran obtained from the hulls of rice grains;
• garlic extract;
• water extract of carrots;
• sunflower seeds.

In specialized stores you can also find effective multicomponent teas for liver restoration: "Carpathian", Ayurvedic, Indian and Chinese teas used in folk medicine.

Anti-inflammatory drugs

Traditional anti-inflammatory drugs used for other diseases (infectious fever, arthritis and arthrosis, headache, muscle pain), are not used for liver diseases, since they have a toxic effect on this organ action.

To reduce the activity of the inflammatory process, the drugs listed above, based on phospholipids and plant components, are used.

Weight loss pills

Fatty liver (medication and effective treatment described in the article for informational purposes) depends on the body mass index. One of the important components of complex therapy is the fight against excess weight. It has been reliably established that 60-95% of obese patients develop fatty liver disease, even if there are no other risk factors, such as alcohol abuse.

An insignificant increase in body weight can also lead to a disruption in the distribution of fats in the tissues of the human body and disruption of their normal metabolism. Reducing the amount of body fat reduces the severity of negative processes in the liver.

In addition to changing diet and exercise, your doctor may recommend taking pharmacological medications for weight loss. For some patients, surgical treatments may be used if indicated. The main drugs for obesity are listed in the table below.

Name	Daily dosage	Peculiarities	Average price, rub.
Orlistat (Xenical) 60 or 120 mg capsules	60 mg 3 times	Violates the breakdown of fats in the gastrointestinal tract, which leads to a decrease in their absorption into the body. The drug itself does not penetrate the walls of the gastrointestinal tract. It cannot be used for stagnant bile.	700 (60 pcs.)
Reduxin or Goldline plus (Sibutramine)	Up to 15 mg	Acts on serotonin and adrenaline receptors, inducing a feeling of fullness. It is contraindicated for organic causes of obesity, with a history of ischemic heart disease, myocardial infarction, chronic heart disease. insufficiency, tachycardia, arrhythmias, stroke, hypertension, glaucoma, thyroid and prostate diseases, severe liver pathologies and kidneys.	1400 for Goldline and 2700 for Reduksin
Turboslim (bromelain, dietary supplement)	2 capsules	Contraindicated in cardiovascular diseases.	860

Biguanides

As medical statistics show, obesity of the liver develops in 80% of cases in patients with type 2 diabetes mellitus, and in 24% in patients with type 1 diabetes mellitus. The regression of this process is facilitated by an increase in the sensitivity of body tissues to insulin.

This can be achieved with pharmaceuticals from the metformin biguanide group. In some patients, there is also a decrease in fibrotic changes in the liver. Positive dynamics is confirmed by ECHO-KG.

Unlike other medicines, biguanides do not lower blood glucose levels. Therefore, when they are taken, hypoglycemia cannot occur. These drugs help to improve the absorption of sugar in the tissue, while slowing down this process in the gastrointestinal tract. The most effective drugs from the biguanide series are shown in the table below.

Name	Daily dosage	Peculiarities	Average price, rub.
Metformin (tablets)	500-850 mg, divided into 3 doses	Does not change the amount of insulin in the blood, reduces the level of triglycerides (lipids). It is contraindicated in severe kidney disease, respiratory and heart failure, myocardial infarction, alcoholism, while taking X-ray contrast agents.	180 (60 pcs.)
Silubin retard (Buformin, dragee)	100 mg	Should not be taken for insulin-dependent diabetes	55 (60 pcs.)
Siofor (tablets)	500-850 mg	Not prescribed for severe liver and kidney disease, low-calorie diet.	300 (60 pcs.)

Statins

Statins are drugs that are used to lower cholesterol levels in order to reduce the risk of developing cardiovascular diseases and their complications (stroke, heart attack, thrombosis). They are not used as monotherapy for obesity in the liver, only in complex treatment.

These drugs should be combined with a cholesterol-free diet. The most modern and effective drugs in this group and their characteristics are shown in the table below.

Name of tablets	Daily dosage	Peculiarities	Average price, rub.
Rosuvastatin	10-20 mg	It is not used for severe liver and kidney diseases, progressive muscle damage, while taking immunosuppressants.	400 (30 pcs.)
Atorvastatin	10-80 mg	Not prescribed for severe liver damage; can cause muscle tissue diseases while being treated with immunosuppressants, antibiotics and antifungal agents, nicotinic acid.	200 (30 pcs. 20 mg each)
Simvastatin	5-40 mg	It is contraindicated in active pathological processes in the liver.	90 (30 pcs. 20 mg each)

Glucocorticoids

Glucocorticoids are prescribed for severe inflammation and fibrosis in the liver. These drugs are hormonal, so their use should be strictly prescribed by a doctor and for medical reasons. Metabolic disorders can occur as side effects.

As such means, mainly 2 types of drugs are used:

• Prednisolone. In addition to anti-inflammatory action, the drug has antiallergic, immunosuppressive and antiproliferative effect (prevents pathological cell division and tissue proliferation). The agent is administered intramuscularly or intravenously. The dosage ranges from 5 mg to 100 mg per day and is determined individually. With caution, it is used for recent infectious diseases, after vaccination, with ulcerative lesions of the gastrointestinal tract.
• Dexametozone. Has a similar effect as for the previous drug. The dosage for severe diseases is 10-15 mg per day. Contraindications are the same as for Prednisolone.

Diet to help with obesity

Fatty liver (medication and effective treatment helps to eliminate most of the symptoms) also requires adherence to a special diet. Despite the fact that overweight contributes to the development of pathological processes, weight loss should be moderate - no more than 2 kg per month. Too drastic weight loss can lead to aggravation of the disease.

The general principles of the diet are as follows:

• It is necessary to increase the protein content in food and reduce the amount of fat. To normalize blood glucose levels, you should also limit the use of "fast", easily digestible carbohydrates.
• It is recommended to increase the amount of plant fiber up to 40 g per day to improve intestinal motility and create a feeling of fullness. To do this, you can introduce wheat bran, flaxseed into the diet (in the absence of contraindications from the gastrointestinal tract).
• The diet should be hypocaloric (reduced in calories). The proportion of vegetable fats should be increased by 10-15%.
• You need to eat regularly, without creating long intervals between meals. Fasting is contraindicated. Food should be taken at about the same time, in fractional portions, 4-5 times a day.
• Food must be fortified. If necessary, you can use complex vitamin preparations.
• Dishes should be cooked in an easily digestible form; steaming and boiled foods are preferable.
• The last meal should be no later than 6 pm.

Allowed Products

The diet should contain such foods and dishes as:

• boiled lean meat and fish (in a piece or in the form of cutlets);
• buckwheat and oatmeal (milk or water);
• vegetable oils (linseed, pumpkin, soy);
• vegetarian soups, weak broths;
• curd and cereal casseroles;
• low-fat dairy products;
• boiled vegetables;
• egg omelet (as a protein source).

Cottage cheese, buckwheat, oatmeal, dairy products are especially useful for this disease, since they have a hepatoprotective effect. You also need to take into account individual intolerance to the above types of food.

Prohibited foods

The following types of foods must be excluded from the diet:

• fatty meat and fish;
• alcoholic drinks;
• food that irritates the gastrointestinal mucosa and creates a load on the liver - fried, spicy, salty, spicy dishes, canned food, smoked meats, legumes; coarse food - stringy meat, nuts, coarse fiber; chips;
• cheeses with a fat content of more than 45%;
• butter, margarine, mayonnaise;
• dairy products with a fat content above 3.2%;
• fresh bread and yeast pastries (instead of them, the use of dried bread is allowed);
• vegetables with a high content of organic acids and essential oils - radish, radish, bell pepper, onion, garlic, spinach, sorrel; these products are especially harmful for cholelithiasis;
• concentrated juices (it is best to dilute them with water in a ratio of 1: 2);
• sweets (chocolate, candies, jam, marshmallows), instead of them you can use dried fruits;
• coffee, cocoa, strong tea and carbonated drinks.

Sample menu for 3 days

A sample menu using approved foods is shown in the table below.

Breakfast	Dinner	Afternoon snack	Dinner
1 day
buckwheat porridge with milk; boiled chicken; weak tea with stevia-based sweetener; bread.	fresh cucumber and tomato salad; vegetable soup; boiled turkey with potatoes; fresh fruit compote; bread.	Apple; fat-free cottage cheese.	low-fat beef steamed cutlet; boiled cauliflower; tea is weak; bread. for the night - low-fat kefir
2nd day
oatmeal in milk; low-fat yogurt; dried fruits compote; wheat loaves.	vegetarian borsch; meatballs; boiled vegetables; sweetened tea; low-fat cheese; bread.	pear; cottage cheese casserole.	vegetable stew with zucchini; steamed hake; baked apples; sweetened tea; bread.
Day 3
steam omelet from eggs in milk; boiled chicken drumstick; fruit salad; sweetened tea; whole grain crispbreads.	milk soup with noodles; lean boiled beef; buckwheat stewed with carrots and onions; curdled milk.	vegetable caviar; dried bread; yogurt.	boiled shrimp the vinaigrette; vegetable juice (diluted with water).

Obesity of the liver with metabolic disorders is a reversible process, since this organ has a high ability to regenerate. The medical and effective treatment described above must be agreed with the doctor.

Some of the drugs mentioned in the article are not compatible, for example, preparations based on spotted milk thistle and lipoic acid. It is also necessary to consider concomitant diseases and the potential danger of side effects.

Fatty liver videos

Malysheva on fatty liver disease: