Fatty liver-an epidemic for mid-life Americans

OK, most of us have to admit that we’ve put on a little bit of the fluffy stuff over the years.  Unfortunately, for every portion of those exterior pinchable pounds, we pack an equivalent ratio of fat into and around our interior organs.  One example of this would be the pressure on the gut from intra-abdominal fat that causes excess acid reflux and heartburn.  This is the reason stomach acid reducing drugs are among the most prescribed in this country each year.  Our liver also suffers from this excess fat effect, but more from the internal infiltration of fat into the liver, rather than from its external pressure.  NAFLD, or non-alcoholic fatty liver disease is the result of this fat infiltration into the working cells of the liver, and is estimated to have an incidence in the US of 25-30% of the adult population. It is rapidly becoming the most common liver disease worldwide.  About 10% of these individuals will go on to have the more concerning NASH, or non-alcoholic steatohepatitis hepatitis, which can eventually progress to liver cirrhosis and liver cancer.

How do I know if I’m at risk?

The diagnosis of NAFLD in population studies is usually obtained by an ultrasound, which typically underestimates the presence of a fatty liver problem.  Much of the time a fatty liver is an incidental finding while imaging for other reasons.  And while liver function tests in NAFLD can be elevated, most people with a fatty liver have normal liver tests. That having been said, if you are overweight and have elevated liver tests, you probably have NAFLD.

The two things most predictive of a fatty liver are a high Body Mass index2 and elevated triglyceride levels.3  These correlate with the finding of NAFLD in 80-90% of obese adults (BMI over 30) and up to 90% in patients with high triglycerides (>150).

You also carry increased risk of complications if you have one of the metabolic comorbidities associated with NAFLD 1, including:

-type 2 diabetes 23%

-hypertension 39%

-metabolic syndrome (AKA insulin resistance) 43%

Why is it important to know if I’m at risk?

While the potential for a fatty liver to progress to cirrhosis and liver cancer is low if you do not have Hepatitis B or C and don’t have an alcohol overuse problem; the reduced ability of the fatty liver to detoxify chemicals, hormones and prescription drugs is a real concern.  Such individuals may be more prone to lipid problems, diabetes, weight gain, hypertension, heart disease, strokes and drug side effects.  As mentioned above, the two most useful indicators for fatty liver are:

Elevated triglycerides on a fasting test (usually 150 is the cutoff at most labs)

Elevated Body Mass Index (>30)  Calculate your BMI at http://www.mayoclinic.org/diseases-conditions/obesity/in-depth/bmi-calculator/itt-20084938

What can I do to prevent or manage a fatty liver?

The best way to safely wring fat out of your liver is to lose fat weight overall.  Gee doc, I’m so surprised to hear that…  Well, skinny people rarely have a fatty liver.  So, this usually means addressing the problems that got us to overweight in the first place by:

-lowering the glycemic index of carbs by picking whole food and less refined and processed food choices.

-engaging in moderate but regular exercise to lower insulin resistance and improve your 24/7 fitness and muscle metabolic activity.

-reducing or eliminating alcoholic beverages

-considering the use of liver repair nutrients, such as:

-berberine, which inhibits the accumulation of lipids inside liver cells and enhances insulin activity, usually at 500 mg twice daily.

-alpha lipoic acid 200 mg once or twice a day.

-silymarin (from milk thistle) 200-300 mg/day

-detoxifying the organic chemicals we have accumulated through decades of Western industrial contamination. Exercise helps with this, as does the regular use of a sauna.

Having a fatty liver is rarely a fatal disorder.  But it is an indicator that your lifestyle if heading down the wrong path and that you are at risk for metabolic syndrome complications like diabetes, heart disease and stroke. It also suggests that you are not able to detoxify adequately.  It’s never too late to do the right thing, so if your liver is getting fluffy, start taking positive action today.

Resource links:

1  “Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes.”  Younossi Z, et. al. Hepatology. 2016 Jul;64(1):73-84. doi: 10.1002/hep.28431. Epub 2016 Feb 22.   https://www.ncbi.nlm.nih.gov/pubmed/26707365

2 Use The National Heart, Lung and Blood Institute’s BMI calculator at https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

3  “The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population.”  Giorgio B et.al.  BMC Gastroenterology20066:33 https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-6-33

4 “Berberine improves lipid dysregulation in obesity by controlling central and peripheral AMPK activity.”  Kim WS et. al. Am J Physiol Endocrinol Metab. 2009 Apr;296(4):E812-9. doi: 10.1152/ajpendo.90710.2008. Epub 2009 Jan 27.  https://www.ncbi.nlm.nih.gov/pubmed/19176354?dopt=Abstract


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