Dr. Neil Julie

Hello again. this is Dr. Julie with a message for you about fatty diseases of the liver, its associations, causes, and significance. You may have heard or read about a few overlapping terms: fatty liver disease metabolic syndrome Nash or even insulin resistance. These are all associated terms but are not the same.

It all begins with too much fat (steatosis)— in this case involving your liver. More on the causes of this later.

Non-alcoholic fatty liver disease (abbreviated as NAFL or NAFLD) is the most common cause of liver dysfunction in the USA. As the name implies it arises from the presence of excess fat in your liver in the absence of moderate or excess alcohol use. NAFLD Is actually present in 20 to 30% of the US population and it is expected to become the leading cause of liver transplantation here in the next few years. There is a spectrum of NAFLD severity from the most common condition of simple fat in the liver to the more serious form of NASH which is fat accompanied by inflammation and fibrosis. It is therefore NASH that has the potential to progress over decades to cirrhosis and liver failure. However, this only occurs in 10 to 20% of patients with NAFLD.

It has become evident that fatty liver disease is the liver manifestation of the condition called metabolic syndrome. That’s a very common cluster of disorders which are high blood pressure, high blood sugar abnormal cholesterol levels, and excess body fat around the waist. Most often these patients are overweight with a BMI of greater than 30. If you have most of those then you probably have NAFLD too. Those conditions go hand-in-hand with difficulties with insulin resistance so many such patients have pre-diabetes or type two diabetes.

It is important for patients to find out if they have simple uncomplicated fatty liver or they have NASH Because with NASH comes inflammation and fibrosis which over time can potentially lead to cirrhosis and occasionally liver cancer (HCC). since fatty liver disease is subtle and silent it is most often detected incidentally on routine blood testing or an abdominal ultrasound. It then becomes important that we find out what is the correct diagnosis, rule out alternative causes of liver disease, and assess whether this incidental finding is of any clinical danger to the patient in their years and decades ahead.

The most basic diagnostic tests are liver chemistries and ultrasound of the liver. Once the abnormality is detected a more complicated and sophisticated battery of liver tests needs to be obtained and there are other steps that we gastroenterologists/hepatologists will take to establish the diagnosis and assess the severity of the condition. More on this and on treatment in the next blog in late February.

The Causes and the elimination of these causes of NAFLD show us the key to the origin of fatty liver disease and how we can reduce and eradicate it.

The combined causes that help lead to NAFLD include high calorie- high carbohydrate diet, the eating of junk food, excessive intake of high fructose corn syrup, and lack of regular exercise. Fructose is readily taken up by your liver and rapidly converted to liver fat whereas glucose is not.

So the ‘flipside then becomes treatment recommendations we make on how to reduce and eliminate NAFLD. It is best to change to a lower calorie high protein low carbohydrate diet that is rich in plants and vegetables. Avoid the dietary “bad-actors’ and begin a program of regular aerobic exercise. Since obesity is such an important factor it has been found that a diet leading to a 5% reduction in weight reduces liver fat and a loss of 7% significantly improved liver inflammation.

But please don’t ignore your liver. We are certainly all overwhelmed by the COVID-19 pandemic and the terrible impact it is having on our nation’s health. But there are other things that can be harmful to your long-term well-being and fatty liver disease is one of them. If you receive this diagnosis it would be advisable that you pay attention and seek the expert care of a physician.

More on the causes and treatments of fatty liver disease in two months. (to be continued)