Aspirin May Help to Reduce Liver Fat

Researchers from Harvard recently showed that aspirin could help to treat people with fatty liver disease (Meeting of American Association for the Study of Liver Diseases, November 10, 2023). Eighty patients with non-alcoholic fatty liver disease (NAFLD) were randomly assigned to receive either low doses of aspirin (81 mg/day) or placebo for six months. Compared to the placebo group, the 40 patients who took aspirin had reduced amounts of fat in their livers and improved markers of liver inflammation and scarring. Among the aspirin group, only one dropped out of the study due to “heartburn,” and there were no reports of serious bleeding.

More than 80 million North Americans suffer from NAFLD. About 70 percent of patients with Type II diabetes and more than 90 percent of obese patients with diabetes suffer from NAFLD, and more than 20 percent of those patients already have permanent damage called cirrhosis, where healthy liver tissue is replaced by scar tissue. A person with NAFLD can go on to develop high blood pressure, high cholesterol and high triglycerides, which markedly increase risks for obesity, diabetes, heart attacks, strokes, and liver and kidney failure. Most people who have NAFLD do not know they have it until late in the disease when they develop abnormal liver function blood tests. By then, they are already likely to have permanent damage to their liver as well as significant blood vessel damage and heart problems.

How Does Aspirin Reduce Liver Fat?
Several studies show that aspirin is associated with a reduction in the amount of fat in the liver, scarring in the liver, liver cancer and liver-related death for patients with viral hepatitis (Biomed Res Int, 2020;2020:7806860). A fatty liver has many of the same risk factors as obesity and diabetes (J of Hepatology, 2008;49(4):600-607):
• eating too much food, especially foods that can raise blood sugar levels too high
• not exercising
• having high blood sugar, high cholesterol, high triglycerides and high blood pressure

We know that aspirin can lower blood sugar and the amount of insulin in the blood stream of diabetic patients (Cell Physiol Biochem, 2011 Dec; 28(5): 923-932). Aspirin stimulates insulin and glucagon secretion and increases glucose tolerance in both diabetics and non-diabetics (Diabetes, 1978 Dec;27(12):1196-1204). Scientific Explanation: Aspirin helps to reduce inflammation and liver cancer by blocking cycloxygenase-2, platelet-derived growth factor and harmful fat accumulation. Specifically, aspirin blocks cyclooxygenase 2, which converts arachidonic acid to prostaglandins that cause an overactive immunity called inflammation (J of Biological Chemistry, 1993;268(9):6610-6614).

Daily aspirin can reduce the risk of heart attacks and strokes in people with diabetes, but aspirin also increases risk of major bleeding (N Engl J Med, 2018;379:1529-39). Since aspirin can cause bleeding, most people who have bleeding disorders should avoid aspirin. So should most people with anemia or kidney disease. Currently, daily aspirin is not recommended for diabetics unless they have a history of heart disease and are at significant risk for suffering a heart attack (British J Of Clinical Pharmacology, Aug, 2020;86(8):1465-1475). Please read Daily Aspirin May Not Save Lives

Current Treatment for a Fatty Liver
People who store fat primarily in their belly are also most likely to store a large amount of fat in their liver. You can often identify who is likely to have a fatty liver and Type II diabetes just by looking at a person because people who have a big belly and small buttocks are at very high risk for being diabetic and suffering heart attacks (JAMA, 2017;317(6):626-634). A fatty liver can usually be treated in its early stages with an anti-inflammatory diet and exercise program, any program to lose weight, and even bariatric surgery when obesity is extreme. See Fatty Liver Disease Can Often Be Cured With Lifestyle Changes, Not With Drugs

At this time, there are no FDA-approved drugs to treat NAFLD, but some drugs such as pioglitazone or glucagon-like peptide-1 agonists may increase the benefits of lifestyle changes.

My Recommendations
Because of the potential to cause serious bleeding problems, most doctors would not recommend aspirin to treat a fatty liver unless a person is at very high risk for a heart attack or has already had a heart attack.

If you have a big belly, dramatic lifestyle changes can save your life. I believe that everyone should follow an anti-inflammatory lifestyle that helps to prevent excess fat from being deposited in the liver:
• Lose weight if overweight
• Eat lots of vegetables, fruits, beans, nuts and other seeds
• Avoid sugar-added foods and drinks (including fruit juices)
• Restrict refined carbohydrates – foods made with flour such as bakery products, pastas, and most dry breakfast cereals
• Avoid red meat and processed meats
• Avoid smoking and recreational drugs, and avoid or restrict alcohol
• Try to exercise every day