Fatty liver disease is often ignored or minimized, but this is a big, big mistake. Everyone has a little bit of fat in their liver. However, once someone has enough fat in their liver to account for 5-10% of the organ’s total weight, they have fatty liver disease. There is fatty liver disease caused by a high intake of alcohol, but that’s not the kind that I want to focus on. I want to talk about nonalcoholic fatty liver disease (NAFLD), which is growing more and more common in the United States and is associated with diabetes, insulin resistance among people who don’t have diabetes, dyslipidemia, and obesity. Other causes of NAFLD can include certain medications, viral hepatitis, autoimmune or inherited liver disease, rapid weight loss, and malnutrition.
If you’re wondering how insulin resistance and diabetes cause NAFLD, remember that insulin is a hormone released by the pancreas to usher sugar into your body’s cells so that it’s not just having a party in your bloodstream (you obviously don’t want too much glucose hanging out in your blood). For some people, their body’s cells stop responding to insulin, and though the insulin continues to knock on the doors of the cells to get the sugar out of the blood and into the cells, the cells just don’t answer the door anymore. The pancreas responds by cranking out even more insulin (maybe more will work!). The liver becomes bombarded by insulin, which allows more fat into the liver cells and decreases the amount of fat processed and released from the liver cells. Now the liver cells are just holding onto all of that fat.
At one time, NAFLD was kind of brushed off as something that shouldn’t cause too much worry. Now it’s known that the more severe form of NAFLD is non-alcoholic steatohepatitis (NASH), which causes the liver to swell and become damaged. Up to 25% of people with NASH have cirrhosis, which is the loss of liver cells and the irreversible scarring of the liver that develops as a complication of liver disease. Cirrhosis is often fatal without a liver transplant.
Keep that in mind when you consider that NAFLD is sharply increasing among American children. In fact, 10% of all children and more than 15% of adolescents may have NAFLD. However, 38% of obese children have NAFLD. In a retrospective study of 66 children with NAFLD who were followed for 20 years, 4 developed type 2 diabetes, 2 underwent liver transplantation, and 2 died of cirrhosis. Pediatric NASH is more common in children with Hispanic or Asian backgrounds and is more common in males than females. Because children have so much life to live, they are at high risk for needing a liver transplant later in life, because liver disease is a progressive disease. About 2 in 100 people with simple fatty liver progress to cirrhosis over 15-20 years and about 12 in 100 people with NASH progress to cirrhosis over about eight years.
The fatty liver itself is only part of the problem. A fatty liver seems to pump out inflammatory compounds that promote heart disease, damage the arteries, and make the blood more likely to clot (increasing the risk of stroke).
Researchers have also seen that there seems to be a strong association between liver cancer and both obesity and NAFLD. Over the last 20 years, doctors have seen an increase in the number of patients with an end-stage liver disease requiring a transplant and a rise in the incidence of liver cancer. Once you have NAFLD, it can’t be cured, but you can help to prevent liver damage or reverse it if you catch it early enough.
What are the best ways to avoid NAFLD or the progression of it, whether you’re a child or an adult?
- Limit added sugars and refined carbohydrates (white bread, pasta, white rice, cookies, pastries, pancakes and waffles, crackers, etc.)
- Limit fried foods
- Limit processed meats and red meats (remember that pork is red meat even though it is marketed as “the other white meat”)
- Avoid sugary drinks such as sodas and fruit drinks
- Limit alcohol if you have NAFLD and avoid it entirely if you have NASH
- Move more and minimize time spent sitting as much as possible
- Eat a minimum of five servings of fruits and vegetables a day
- Bring down your cholesterol and other blood lipid levels via medication and lifestyle modification
- Losing just 5% of body weight has been associated with significant improvement; weight loss must be very gradual – remember that rapid weight loss is a cause of NAFLD
- Talk to your doctor about vitamin E supplements, an antioxidant that might help to treat NASH
- Eat anti-inflammatory foods including olive oil, nuts, fatty fish like salmon and tuna, and the vegetables and fruits mentioned above
- Some doctors may recommend medications traditionally used to treat diabetes, even if you don’t have diabetes
- Follow your doctor’s advice for managing your high blood pressure and/or diabetes
- Stop smoking if necessary