New research suggests an association between fatty liver and IBS. One study identified that patients with fatty liver had a 13 % increased risk of developing IBS. Another study revealed that patients with IBS were 3 times more likely to have fatty liver. Both IBS and non-alcoholic fatty liver are among the top gastrointestinal and liver issues in the general population.
IBS and fatty liver share risk factors, including changes in the microbiome, leaky gut, immunity, SIBO, and bile acid metabolism. Research is still unclear as to whether IBS can cause fatty liver or vice versa, but they definitely impact each other as the body is interconnected.
Regardless anyone with fatty liver and IBS symptoms such as abdominal pain associated with defecation, altered bowel movements, and bloating should be investigated for IBS. Anyone with IBS and abnormal liver function tests should explore the possibility of fatty liver.
Non-alcoholic fatty liver is characterized by the accumulation of 5 % or more fat in the liver. The prevalence of liver conditions is widespread and, unfortunately, becoming more common.
Symptoms of NAFLD include metabolic syndrome, insulin resistance, obesity, and diabetes mellitus, and now research demonstrates an association between fatty liver and IBS. Excessive fat accumulation in the liver can lead to more severe conditions such as high blood sugar, liver failure, and liver cancer.
This research is fascinating and of utmost importance as a common set of symptoms I see simultaneously among clients I have worked with is difficulty losing weight and signs of a sluggish liver and gallbladder with symptoms of SIBO and IBS.
Anyone with excess fat in the abdomen or struggles with weight loss should consider a liver problem at the root of their issue, especially alongside IBS symptoms. The liver is crucial for maintaining overall health, normal blood glucose levels, and optimal gut health.
The liver and the gallbladder are the primary organs involved in digestion. Everyone often talks about gut health, the fodmap diet, and probiotics without understanding the implications and correlation between fatty liver and IBS. A healthy liver is essential for optimal gut health and the prevention of SIBO and IBS symptoms as the liver produces bile which is antimicrobial and prevents small intestinal bacterial overgrowth.
A primary problem I see for people suffering from IBS symptoms who follow a restricted low fodmap diet for far too long in an attempt to reduce and control their IBS symptoms is that they unknowingly cause further damage to the liver and microbiome in the gut. This is especially true for people eating a high-fat diet, including high amounts of saturated fats that increase the risk of developing fatty liver while altering the microbiome.
Diet for IBS and fatty liver
One study revealed that a high intake of red meat and full-fat dairy products, which are high in saturated fats, was associated with an increased risk of developing non-alcoholic fatty liver.
The consumption of both fruits and vegetables reduced the possibility of developing fatty liver.
Isoflavones in legumes have been shown to reduce fat accumulation in the liver with anti-inflammatory effects that help prevent the development of fatty liver.
Red meat is low fodmap and frequently eaten by those on a low fodmap diet. However, this may not be beneficial in large amounts for someone with fatty liver or possibly undiagnosed fatty liver due to the saturated fats that have a positive association with increasing the risk of developing fatty liver.
Cheese is also high in saturated fats and can be enjoyed on the fodmap diet. But if you have a fatty liver reducing your cheese intake and thus saturated fat intake can help to prevent the worsening of fatty liver.
Fish is a fantastic alternative to red meat, which is low fodmap and an excellent source of omega three fats which have been shown to reduce fat accumulation in the liver.
Eggs are another great source of protein for individuals on the fodmap diet for IBS and fatty liver, as no correlation between the consumption of eggs and fatty liver was found in a meta-analysis. The nutrient choline is crucial for preventing the development of fatty liver, and eggs are one of the best sources of choline.
No correlation between nuts and seeds was found to be associated with fatty liver, and these nutrient-dense whole foods are a fantastic addition to low fodmap salads or a great snack on the go.
Both fruits and vegetables were associated with a decreased risk of developing fatty liver. They are also essential for building a diverse microbiome. For this reason, it is crucial to include a wide variety of low-fodmap fruits and low-fodmap vegetables for people needing to follow both a fatty liver and IBS diet.
Individuals often avoid legumes on the low fodmap diet to the fermentable carbohydrates found in these foods. While these foods can be problematic for those with IBS, they are still beneficial for fatty liver and building a healthy and diverse microbiome in the long run.
Don’t be afraid of all legumes for the rest of your life if you are currently diagnosed with IBS. Often taking digestive enzymes with these foods is the extra support the body needs to efficiently break down these foods and reduce digestive symptoms. Pre-soaking and cooking your beans is highly beneficial in reducing enzyme inhibitors and thus making them much easier to digest.
High fructose corn syrup worsens IBS symptoms and contributes to fatty liver. Those with fatty liver and IBS should avoid it as it is highly processed and not beneficial. High fructose corn syrup is in many processed foods, including juices, sauces, and condiments, so eat whole foods as much as possible to avoid the foods high fructose corn syrup is hidden in.
Many people with IBS notice that healthy foods such as fruits and vegetables worsen their symptoms. As a result, people may adopt an unhealthy diet that leads to weight gain and the progression of non-alcoholic fatty liver disease.
The long-term effects of the low fodmap diet and fatty liver still need to be studied as there is insufficient data. For this reason, I never recommend a high fat low fodmap diet long term as fiber in fruits, vegetables, and legumes are crucial in diversifying the microbiome with beneficial bacteria and preventing the development of fatty liver.
The microbiome, fatty liver, and IBS
Dysregulation of the microbiome in the gut is a component of developing both non-alcoholic fatty liver and IBS.
A leaky gut and the abundance of bacteria that produce the inflammatory lipopolysaccharide endotoxin cause liver inflammation as LPS is transported from the gut to the liver. Activated charcoal is great for absorbing LPS endotoxins.
People with hepatic steatosis have an altered microbiome and dysbiosis with low levels of bifidobacteria, which has beneficial effects on the gut. Berberine has been shown to promote the growth of beneficial bifidobacteria while reducing harmful bacteria associated with SIBO and IBS. Not to mention berberine is a fantastic supplement for fatty liver and an antimicrobial for IBS.
Immune system activation in fatty liver and IBS
Chronic inflammation is a critical driver in the progression of NAFLD, and in IBS, similar chronic inflammation occurs in the gut. When the immune system is constantly activated due to fighting foreign invaders (i.e., bacteria & viruses), chronic inflammation can lead to liver inflammation and even liver fibrosis.
Interestingly, rifaximin, an antibiotic used to treat SIBO, has also been shown to reduce insulin resistance, inflammation, and NAFLD scores. Once again, there is a commonality between an antibiotic that is beneficial for fatty liver and SIBO, which is associated with IBS.
Altered bile acid metabolism
Bile acid malabsorption has been associated with an increased NAFLD score, and bile acid malabsorption is a cause of chronic diarrhea. Up to a third of people with IBS-D were shown to have bile salt malabsorption when investigated.
When bile acids are not properly reabsorbed in your intestines, they can trigger your colon to secrete extra water leading to diarrhea and watery stools.
As you can see, fatty liver and IBS share several commonalities and risk factors correlated with the development of each disease. The possibility of fatty liver and IBS existing simultaneously should be considered and investigated thoroughly. Many people may be unaware that they have a fatty liver alongside their IBS symptoms.
I believe the two are intimately connected, as supporting my liver was the key to my success in getting rid of my SIBO symptoms. While there is evidence that people with IBS are more likely to develop non-alcoholic fatty with various mechanisms that possibly contribute to both, there is still limited data, and more research is needed.
Diet Tips and Supplements to Support the Liver
In the meantime, I highly recommend you learn how to support your liver and prevent fatty liver. Diets high in saturated fatty acids have been shown to induce a greater increase in liver fat and insulin resistance compared to diets enriched with monounsaturated or polyunsaturated fatty acids. The type of fat matters when it comes to preventing and reversing fatty liver.
Sunflower lecithin is an oil rich in polyunsaturated omega-6 fats high in phosphatidylcholine, a critical nutrient for preventing fatty liver. Phosphatidylcholine was also the magic nutrient that helped me to knock down the last of my SIBO.
Sunflower lecithin has beneficial effects for both fatty liver and IBS! How’s that for another supplement that benefits two highly prevalent conditions among the population? I wonder why more people aren’t talking about this. This nutrient is especially important for anyone with a PEMT gene mutation and thus an increased risk for developing fatty liver and IBS.
Another phenomenal supplement for fatty liver and IBS is berberine, one of the top antimicrobials used for IBS and SIBO. Berberine also has profound effects on liver health and has been shown to alleviate non-alcoholic fatty liver in mice which was induced by a high-fat diet. Berberine also regulates fat metabolism and inhibits the formation of new fat accumulation in the liver.
In all the studies I have read, a high-fat diet is used to induce fatty liver, yet compounds found in the plant kingdom prevent the accumulation of fat in the liver, such as blueberries.
Fruits, vegetables, and legumes are crucial foods to maintain a healthy liver and a primary reason why I am not a big fan of the low-fodmap diet (especially a high-fat, low-fodmap diet). If you have IBS symptoms and fatty liver that you need to get under control, be sure to include lots of low fodmap fruits and vegetables in your diet as fruits and vegetables are among the best foods to cleanse your liver!
Temporarily avoiding high fodmap foods can reduce the severity of IBS symptoms but also be sure to support the liver by making lifestyle changes such as reducing alcohol consumption, high fructose corn syrup, and eating a healthy diet low in saturated fats to help prevent the buildup of fat in the liver.