5 Things You Need To Know About Fatty Liver Disease
This article is about a medical condition that is very common and yet, widely ignored – Fatty liver Disease.
The global estimate1 (Araújo et al., 2018) of the prevalence of fatty liver is greater than 25%. It means that 1 in 4 people in the world suffer from this condition. It is considered as the most common liver disease in the world.
In US, this statistic is between 20-40%. That is almost 2 out of 5 people.
However, there is very less awareness of what this condition actually is or the risks of ignoring it. Truth is that even the medical community is still just learning about this.
So without further ado, let’s get to it.
What is Fatty Liver?
Non-Alcoholic Fatty Liver Disease (NAFLD) is a medical condition in which there is build-up of extra fat in the liver. It is to be noted that this is the type that is not related to alcohol use. It is more of a lifestyle disease.
There are 2 types of NAFLD:
- Non-Alcoholic Fatty Liver (NAFL) – also known as just “Fatty liver”
- Non-alcoholic steatohepatitis (NASH)
Non-Alcoholic Fatty Liver (NAFL)
It is defined as the presence of fat accumulation in the liver after excluding other causes of liver disease, excessive alcohol consumption and other conditions that may lead to fatty liver.
NAFLD is characterized by ≥ 5% of hepatic (or liver) fat accumulation in the absence of any secondary causes and is a diagnosis of exclusion. In simple terms, it means that the condition of having high fat in the liver can only be confirmed as NAFLD after eliminating all the other possibilities that may lead to this condition.
Simple fatty liver does not cause any sickness related to liver. And for most people, it is just a case of simple fatty liver. This is why most people diagnosed with this are living a normal life.
Non-Alcoholic Steatohepatitis (NASH)
Those with the latter kind – Non- alcoholic steatohepatitis (NASH) – have inflammation and injury to their liver cells. NASH increases the risk of being affected by major diseases like fibrosis (scarring) of the liver, cirrhosis, and liver cancer.
How to Identify If You Have Fatty Liver?
Many times, this is an inadvertent discovery which occurs as part of diagnosing some other health problem. For example, if a routine check-up showed elevated liver enzymes, your practitioner may tag it as NAFLD.
Among the non-invasive diagnostic methods, abdominal imaging is a common method used to diagnose fatty liver. CT scan, MRI (Magnetic Resonance Imaging), MRS (Magnetic Resonance Spectroscopy) etc. are similar diagnostic methods used to detect NAFLD. Hepatic Stiffness measurement using MRE (Magnetic Resonance Elastography) is another technique with a good accuracy rate.
It is important to distinguish between NAFL and NASH as the latter can progress quickly into end-stage liver diseases. Imaging techniques are not fully equipped to make this kind of analysis, especially in obese people.
The gold standard for this is a liver biopsy. But since this is a painful and costly option, this is only used as a last resort in diagnostics. It is after eliminating all other factors and correlating other test data like metabolic factors that doctors suggest this option.
More efficient non-invasive biomarkers are under research. Hopefully, there will soon be such options to easily distinguish the progress and threat of NAFLD in a non-invasive manner.
How Dangerous Is Fatty Liver?
NAFL is mostly known to have a benign path whereas NASH is a premonition of the rapid approach of potentially deadly liver diseases.
However, if completely ignored and in the absence of any corrective measures, there is a probability for NAFL to progress to NASH and then to end-stage liver diseases like fibrosis (scarring) of the liver, cirrhosis, and liver cancer.
But focusing on just the liver may cause you to miss the potential impact on your heart. According to experts, the greatest risk of anyone with NAFLD is cardiovascular disease. Hence, when read together with other metabolic factors, it may also be used to assess your risk of cardiovascular diseases.
What Causes Fatty Liver?
To begin with, this is still under study. From the available researches, NAFLD may be caused by a combinatorial effect of genetic, clinical, environmental or demographic factors.
Some established risk factors are:
- Obesity
- Metabolic syndrome
- Type-2 Diabetes
- Hypertriglyceridemia – High levels of fat triglycerides in blood
Some suspected factors include:
- Poor quality of sleep and sleep deprivation
- Hypothyroidism – low levels of thyroid hormone
- Rapid weight loss
- Excess fructose (fruit sugar) consumption
- Polycystic Ovarian syndrome
- Hypopituitarism – low levels of pituitary hormones (this is a rare disorder)
- Hypogonadism – failure of gonads – testes in men and ovaries in women – to function properly
- Total parenteral nutrition (TPN) – supplying all the nutritional needs of the body by bypassing the digestive system and dripping nutrient solution directly into a vein
- Genetic predisposition – the presence of PNPLA3 and TM6SF2
The aforementioned are the risk factors of NAFLD overall. Below are certain risk factors for NASH progression:
- Obesity
- Diabetes mellitus
- Older age
- Hypertension
- Low platelet count
- Higher AST/ALT ratio3 (Wikipedia) – A normal range is approximately 0.8
- High ALT or AST4 (Wikipedia) – AST normal range is 7-56 IU/L, ALT normal range is 0-35 IU/L
- Non-African-American ethnicity
Treatment Options for Fatty Liver
The good news is that NAFL is readily reversible if lifestyle modifications are made in time. The below steps may help you reverse NAFL:
01
Stop Drinking Alcohol
This is actually very common knowledge and it is easier said than done. i.e. while this may be “non-alcoholic” fatty liver disease, alcohol consumption can still hurt you. So if you have NAFL and want to make your liver healthy, this is mostly non-negotiable.
To be frank, there are opinions that only too much of it will cause a problem. But the measurement of “too much” is a controversial topic. Hence, experts2 (Armand, Harvard Health Publishing, 2019) suggest avoiding alcohol consumption as much as you can.
02
Lose Weight
Gradual weight reduction is THE most effective treatment for NAFLD. There should be an emphasis on the “gradual” part as rapid weight loss may accentuate the condition. A loss of 5% body weight can improve the results of your next liver test. A 7-10% reduction may even reverse some of the inflammation and damage from fibrosis.
03
Perform More Aerobic Exercises
Aerobic exercises are intense and consume more energy. Independent to that obtained from weight loss, this may provide an additional reduction in inflammation and liver damage depending on its intensity. But if you are someone who cannot perform aerobic exercises due to other reasons, resistance training is also effective.
A 2017 review5 (Hashida et al, 2017) that compared the efficacy of aerobic vs. resistance exercises in the treatment of NAFLD found that both gave comparable benefits. The difference was that resistance exercises required lower energy consumption and could be performed by those who cannot tolerate aerobic exercises.
04
Go on A Healthy Diet
Some diets like the Mediterranean diet, Time-restricted fasting may be helpful in treating NAFLD.
The American Liver Foundation suggests that for a healthy liver, we should stay away from and say NO to the below food items7 (American Liver Foundation):
- Raw or undercooked shellfish
- High-fat diet
- High-calorie food
- Sweetened products
- Salty food
- Fried items
- Fast food
Say YES to the below liver-friendly food items:
- High-fibre diet like oatmeal
- Green tea – It has anti-inflammatory, anti-oxidative and anti-fat accumulating properties that can help fight against NAFLD.
- Coffee – 2 cups of coffee a day might help
- Blueberries
- Grapes etc.
According to a 2016 study6 (Golabi et al, 2016), diet along with exercise was a more effective control mechanism than exercise alone.
05
Check Your Medications
Some medications/herbs/supplements that you take may be causing your NAFLD. You can check this in the LiverTox database8 (LiverTox). If you find something, consult your doctor for advice.
Bottom line is that if you have NAFLD, you should not ignore it. According to sources, there is no effective medication available for NAFLD. While there are some experimental drugs in the pipeline, they are yet to be available in the market.
So make the necessary lifestyle changes and do everything in your power to ensure that you stay healthy and happy.