Most people who aren’t medical professionals probably know that excessive alcohol consumption can damage the liver. And it’s likely that most non-health care professionals are familiar with the connection between conditions like heart disease and diabetes and obesity. But many people may not be aware of how obesity is associated with a condition that can cause severe liver damage in people who drink little or no alcohol, says Dr. Arthur McCullough, a hepatologist who specializes in fatty liver disease at the Cleveland Clinic.
Nonalcoholic fatty liver disease affects about a third of adults and 10 percent of kids in the U.S., and it’s one of the most common causes of liver disease in the U.S. NAFLD is a spectrum of disorders, according to the Mayo Clinic: simple fatty liver and nonalcoholic steatohepatitis, or NASH. While the former typically doesn’t cause serious health problems, NASH is the fourth most common reason for a liver transplant in the U.S. and predisposes people to primary liver cancer (which occurs even without cirrhosis), says Dr. Sumit Kapoor, a gastroenterologist at OhioHealthDoctors Hospital in Columbus, Ohio. What’s more, the incidence of NASH is quickly growing: Researchers estimate NASH will become the most common indication for liver transplantation between 2020 and 2025, says Pascaline Clerc, the U.S. campaign manager for the NASH Education Program.
Here are five strategies to avoid or mitigate the effects of NAFLD:
— Maintain a healthy weight.
— If you smoke, stop.
— Drink black coffee.
Simple Fatty Liver
Simple fatty liver is also known as NAFL, or nonalcoholic fatty liver. It’s a typically benign type of NAFLD in which you have fat in your liver but little or no inflammation or liver cell damage, according to the NIDDK. Simple fatty liver doesn’t typically progress to cause liver damage or complications. The inciting factor that would cause progression of disease or liver damage is not clearly understood, Kapoor says.
NASH is a form of NAFLD in which you have inflammation of the liver — hepatitis — and liver cell damage, in addition to fat in your liver, according to the NIDDK. Inflammation and liver cell damage can cause scarring of the liver. NASH can lead to cirrhosis or liver cancer. It’s not fully understood why some people with simple fatty liver progress to NASH and others don’t.
Symptoms of NAFLD
The vast majority of people with NAFLD will experience few or no symptoms other than fatigue and mild abdominal pain, typically on their right side, McCullough says. “This is a silent disease and typically there are no symptoms until it is advanced (it can lead to cirrhosis),” Kapoor says.
Symptoms of NASH
NASH can lead to cirrhosis of the liver, which in turn can cause these symptoms as the condition progresses, according to Cedars-Sinai, a nonprofit academic health care organization serving the Los Angeles community:
— Bleeding easily.
— Bruising easily.
— Itchy skin.
— Yellow discoloration in the skin and eyes (jaundice).
— Fluid accumulation in your abdomen.
— Loss of appetite.
— Swelling in your legs.
— Sleep apnea.
— Gastric reflux.
NAFLD Risk Factors
According to the NIDDK, you’re more likely to develop NAFLD, whether it’s simple fatty liver or NASH, if you:
— Are overweight or obese.
— Have insulin resistance, which puts you at risk of Type 2 diabetes.
— Have abnormal levels of fats in your blood.
— Have metabolic syndrome, which is linked to being overweight or obese.
— Have Type 2 diabetes.
Consuming a Western diet rife with fatty foods, high amounts of fat and sugar and highly-processed offerings increases your risk of NAFLD, says Dr. Jaideep Behari, an associate professor at the University of Pittsburgh School of Medicine.
NASH Risk Factors
People with NAFLD are more likely to have NASH if they have one or more of the following conditions, according to the NIDDK:
— Obesity, especially with a larger waist size.
— High levels of triglycerides or abnormal levels of cholesterol in their blood.
— Type 2 diabetes.
— Metabolic syndrome, which could include high blood pressure, high blood sugar, excess body fat around the waist or abnormal triglyceride or cholesterol levels.
Complications of NAFLD
Most people with NAFLD have simple fatty liver, and therefore don’t develop liver-related complications, though they may develop heart complications, says Dr. Tarek Hassanein, director of Southern California Liver Centers. He’s based in San Diego.
Complications of NASH
NASH is associated with serious and potentially fatal liver complications like cirrhosis and liver cancer, Hassanein says. It’s also associated with cardiovascular disease. Heart disease is the leading cause of death in NAFLD patients, according to the NASH Education Program. If you have NASH, your risks of dying of liver-related causes also increases.
How Is NAFLD Diagnosed?
Since there aren’t typically any symptoms associated with NAFLD, it’s often spotted during routine blood testing when the liver enzymes are elevated, Behari says. However, these liver enzyme tests can be normal in up to 60 percent of individuals affected by the disease, Clerc says. A follow-up ultrasound of the abdomen would show whether the liver is fatty, Behari says. Some physicians diagnose NAFLD when their patients undergo an ultrasound, an MRI test or a CT for an unrelated reason.
How Is NASH Diagnosed?
A liver biopsy is the current “gold standard” when it comes to diagnosing NASH. However, liver biopsies are costly surgeries and present a minor risk of bleeding and pain to the patient. “Although this invasive test could be performed by hepatologists, the number of these specialists who have both the expertise and comfort to execute, order or interpret a liver biopsy is very low as compared to the number of suspected NASH patients,” according to the NASH Education Program. Other imaging methods, like an ultrasound or an MRE (magnetic resonance enterography, a special type of MRI that can also estimate the severity of liver scarring), can also be used to diagnose NASH. A biopsy is the only way to accurately identify the stage of the disease in patients, Clerc says. Nonetheless, noninvasive tests like an ultrasound or MRE are recommended by the current guidelines of the American Association for the Study of Liver Diseases, Clerc says.
How to Prevent and Treat NAFLD and NASH
There are no medications approved by the Food and Drug Administration to treat NAFLD or NASH, McCullough says. A natural form of vitamin E has been shown to improve NAFLD in some patients. Ask your doctor whether a dietary supplement might be helpful to you. Overall, weight loss is the most important strategy to prevent and treat NAFLD and NASH, he advises. A weight loss program should include an eating regimen to lose pounds and an exercise program that includes at least 150 minutes weekly of aerobic activity and strength exercises two or more days a week, he says. The Mediterranean diet and the Keto regimen are among the approaches that can be effective. “Even a modest weight loss of 5 to 10 percent can decrease the amount of fat and inflammation in the liver,” he says. Signs of reversal of the early stages of scarring can be seen in patients who lose 10 percent of their weight, Clerc says.
Drinking three to four cups of black caffeinated coffee, preferably without cream or sugar, is another good strategy for warding off NAFLD or NASH, he says. Also, if you smoke, stop.
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