Non-Alcoholic Fatty Liver Disease: A Silent Epidemic

Non-alcoholic fatty liver disease strikes a startling one-third of Americans. Are you one of them?

non-alcoholic fatty liver disease

Researchers at Cincinnati Children’s Hospital Medical Center recently found that a protein called cdk4 occurs at higher levels in mouse models and human patients with fatty liver disease. Also, when they blocked the protein in mice, using drugs, it significantly reduced development of hepatic steatosis—the first stage of the disease.

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Nearly one-third of Americans have non-alcoholic fatty liver disease (NAFLD)—now the most common chronic disease of the liver.[1] Although rarely discussed in conventional medical offices and even less in the media, NAFLD is epidemic.

This stealthy condition can go undetected for years—with deadly consequences. Once advanced, NAFLD cannot be reversed. It is crucial to detect and treat NAFLD with lifestyle therapies and natural medicines as early as possible.

What Is NAFLD?

The liver carries out several necessary functions, including detoxifying harmful substances in the body, cleaning the blood, and making vital nutrients. In non-alcoholic fatty liver disease, fat deposits accumulate inside the liver. Early on, there are typically no signs or symptoms, although the accumulating fat is already starting to block the inflow of nutrients to liver cells, while simultaneously blocking the outflow of toxins.

The accumulation of fat and toxins inside the liver can cause liver inflammation and oxidative stress. If this happens, NAFLD is considered to have progressed from simple fatty liver disease to a more advanced stage of the disease called non-alcoholic fatty hepatitis or NASH.

The inflammation and damage caused by excessive free radical production associated with NASH can injure liver cells, causing scarring and, eventually, fibrosis, an advanced form of liver scarring known as cirrhosis. This further impairs the liver’s ability to efficiently detoxify and perform its vital functions. Eventually, cirrhosis can become so advanced and liver function so impaired that a liver transplant is needed to sustain life. Cirrhosis can also lead to liver cancer (hepatocellular carcinoma).

NAFLD Complications

Non-alcoholic fatty liver disease increases the risk of type 2 diabetes mellitus, cardiovascular diseases, and chronic kidney disease. It is strongly associated with a number of conditions that lead to these diseases, including obesity, insulin resistance, high blood pressure, and abnormal lipids (high total and LDL cholesterol, low HDL cholesterol, and/or high triglycerides).[2,3]

NAFLD increases the risk of overall death by 57 percent and most people with NAFLD die of cardiovascular disease rather than direct liver complications.[2,4]

How to Tell If You Have Non-Alcoholic Fatty Liver Disease

Since one-third of Americans have this serious condition and many doctors don’t even check for its presence, it is critical that you become aware of those factors that might suggest you have the disease yourself. Early detection is a key to a complete recovery.

Here are some factors that indicate increased risk of non-alcoholic fatty liver disease:

  • Are you overweight or obese?
  • Is your diet poor, with too much sugar and too many processed carbohydrates?
  • Do you regularly drink sugar-sweetened beverages?
  • Do you not eat fish regularly or take a fish oil supplement containing omega-3 fatty acids?
  • Do you experience fatigue and occasional nausea or stomach upset?
  • Do you occasionally experience vague pain in the right upper abdominal area?
  • Have you had a recent blood test that showed elevated liver enzymes?

If several of these indicators apply to you, waste no time in getting an appointment with your doctor and ask him to specifically test for NAFLD.

A doctor skilled with palpation, a method of diagnosis by manual examination and pressure, can distinguish a normal liver from an abnormal one by touch alone. Ultimately, an ultrasound test is required to diagnose NAFLD in the vast majority of patients, and your doctor may want to order that test immediately.

What Causes NAFLD?

In the past, fatty liver was seen in alcoholics with end-stage cirrhosis and liver disease. Now, however, it is common to see fatty liver in people who drink little or no alcohol because their livers are overburdened with unhealthy substances from diet or the environment. NAFLD is chiefly caused by poor dietary and lifestyle choices: eating too much of the wrong foods and not enough of the right foods and not exercising enough.

The Most Dangerous Foods

Eating any kind of food in excess of the body’s energy needs can lead to NAFLD. However, research indicates that some categories of foods may be worse than others for causing fatty liver.

Highly processed carbohydrate foods, particularly those containing added sugar, are the biggest dietary culprits. Sugar, whether common table sugar (sucrose) or fructose, is highly associated with NAFLD.[5]

Sugar-sweetened beverages (including those sweetened with high-fructose corn syrup) are particularly dangerous. People who drink one or more servings of sugar-sweetened beverages per day have a 61 percent greater risk of having fatty liver disease compared non consumers.[6] The tight association between regular consumption of sugar-sweetened beverages and fatty liver disease remains even after adjusting for body mass index, indicating that it’s the sugar responsible, not increases in body weight.

When sugar is combined with excess intake of fats, particular trans-fats and fried foods, the risk of fatty liver may be amplified. In general, however, fats, including saturated fat, do not cause fatty liver if the diet does not exceed your body’s energy needs.[7] Likewise, the combination of sugar with certain nutrient deficiencies appears to amplify NAFLD.[8] Nutrient deficiencies are more common in people with fatty liver disease, making a high-fat, high-sugar diet particularly damaging.

Nutrient Deficiencies and Fatty Liver Disease

Even though people with NAFLD tend to consume too many calories, they have nutrient deficiencies that are directly associated with their liver disease and likely contribute to the progression of NAFLD. People with NAFLD take in too few antioxidant vitamins and minerals such as selenium, vitamin C, vitamin A, and vitamin E.[9-11] They also consume insufficient amounts of other vitamins and minerals including vitamin D, calcium, vitamin K, vitamin B6, and folate.

Furthermore, even though people with NAFLD often consume lots of fat, they consume too few mono- and polyunsaturated fatty acids, particularly the omega-3 fatty acids found in fish (EPA and DHA).[12-15]

Dietary Treatment of Non-Alcoholic Fatty Liver Disease

It is imperative that anyone with NASH permanently switch to eating a whole-foods, nutrient-dense diet that is low in sugars (even natural ones) and other highly processed carbohydrates, especially refined grains such as white flour.[16]

Absolutely no sugar-sweetened beverages should be consumed. Fruit juice and alcoholic beverage consumption should also be kept to a minimum. Foods containing flour, even whole-grain flour, should be eliminated or minimized. The focus should be on vegetables, nuts, seeds, fish, and leaner cuts of grass-fed meats, along with moderate amounts of whole grains, legumes, dairy, and fruit.

Learning to love fresh, whole foods prepared from scratch can be a challenge when our palates are so accustomed to processed foods that have been specifically designed to be highly palatable. But with time, patience, and persistence, the commitment to eating a less refined, more natural diet always pays off. You will start to crave healthier, fresher foods and they will be able to completely satisfy you.

Supplements for Treatment of NAFLD

Because of all the nutrient insufficiencies associated with non-alcoholic fatty liver disease, a high-potency, high-quality multivitamin is recommended for ongoing, daily intake. In addition, the following natural supplements are recommended:

  • Vitamin E. Vitamin E significantly improves liver function in patients with NAFLD/NASH. The results of five randomized controlled trials found that vitamin E significantly reduces circulating liver enzymes, a chemical marker of liver cell injury. Vitamin E supplementation lowers aspartate transaminase (AST) by -19.4 U/L, alanine aminotransferase (ALT) by -28.9 U/L, and alkaline phosphatase (ALP) by -10.4 U/L.[17] Vitamin E supplementation also significantly lowers the accumulation of fat in the liver (steatosis), inflammation, liver cell death, and fibrosis.[17]

These startling results are explained by vitamin E’s role as a powerful antioxidant. It is the major chain-breaking antioxidant in body tissue and is the body’s first line of defense against the oxidation of fats. As you learned, excess free radical production (oxidative stress) plays a key role in the initial development and progression of NAFLD, and people with the disease have depressed levels of vitamin E in their blood due to all the increased oxidation.[18,19]

Although the recommended dietary intake of vitamin E is only around 12 IU, the therapeutic dose needed to prevent the oxidation of fats and free radical damage in NAFLD and NASH is generally thought to be 800 IU per day. Choose a natural vitamin E supplement; synthetic vitamin E is not biochemically equivalent to the natural forms and is not as effective.

In addition, because natural vitamin E is actually a family of compounds, four tocopherols and four tocotrienols, choose a supplement that contains all of the natural forms of vitamin E as mixed tocopherols and tocotrienols. Research shows specific health benefits of the individual natural forms.[20] One recent study used only tocotrienols and found that 200mg mixed tocotrienols twice daily normalized the appearance of the liver after one year of treatment.[21]

  • EPA & DHA. Similar to vitamin E, EPA and DHA, the most important omega-3 fatty acids, fight the oxidant and inflammatory components of NAFLD, decreasing the toxic effects of excess fat accumulation in the liver.22 In addition to suppressing the production of new fat molecules in liver cells, omega-3 rich fish oil improves insulin sensitivity, reduces triglycerides, and stimulates liver tissue and skeletal muscle to use fat.

People who don’t consume enough fish and other sources of omega-3 fats in their diets are prone to NAFLD.23,24 In one recent study, taking a fish oil concentrated in EPA and DHA per day significantly decreased liver fat in patients with NAFLD.[25] The fish oil product used in the study contained approximately 465mg of EPA and 375mg of DHA per 1-gram capsule and subjects took a total of four capsules (4g) per day.

Many other studies have tested both lower and higher doses of EPA and DHA and all show beneficial results for people with NAFLD.[26] Omega-3 supplementation can significantly decrease liver cell damage and triglycerides levels, and improve the appearance and blood flow of the subjects’ livers on ultrasound. The exact dose of EPA and DHA needed to optimally affect NAFLD outcomes, however, is not known.[27]

Try to eat oily fish, like salmon, at least twice per week, and take 1g to 4g of supplemental omega-3s daily. Watch for worsening glucose levels or LDL cholesterol levels on high doses of fish oil and decrease your dose if you experience either of these side effects.[28]

  • Milk thistle extract. Milk thistle extract has a long history of medicinal use for liver disorders and for good reason—the active compounds in milk thistle, a group of flavonoid compounds called silymarin, are exceptional antioxidants and anti-inflammatories with an affinity for the liver. Of all the silymarin compounds, silybin is the most potent. Silybin substantially boosts the liver’s resistance to toxic insults, protecting the liver by conserving glutathione, the liver’s most important self-made antioxidant.

On its own, silybin has poor bioavailability, but the addition of phoshphatidylcholine improves absorption.[29] This combination, known as silybin phytosome, may be superior to regular milk thistle extract (standardized for silybin) for treating NAFLD. Furthermore, taking silybin phytosome along with vitamin E may offer even greater effectiveness.

The combination of silybin, phospholipids such as phostphatidylcholine, and vitamin E has been studied and found to be very effective for improving liver structure and function in patients with NAFLD. The three compounds appear to work synergistically to protect liver cells from damage. The combination significantly improves liver function and structure and decreases insulin resistance in patients with non-alcoholic fatty liver disease.[30] A formula containing 376mg silybin, 776mg phosphatidylcholine, and 360mg vitamin E reduces liver fat accumulation and liver scarring and improves insulin resistance.[31,32]

You can now find silybin phytosome through a number of supplement manufacturers. Take 360mg per day.

What to Try First

Non-alcoholic fatty liver disease is a serious condition that affects one out of every three Americans and often goes undiagnosed until it’s too late. Therefore, it is imperative that you are alert to certain factors that indicate you or your loved one may have the disease. Early diagnosis and treatment with the natural protocols described here can often reverse this deadly condition.

Cooperation and close monitoring by a physician is recommended because the liver metabolizes many nutrients and drugs and could become

overwhelmed if the right dosages and combinations of quality supplements are not used.

The natural medicines and dietary strategies outlined here, however, should be safe for the majority of patients with NAFLD but without other serious health conditions.

The most important natural treatment for fatty liver disease is dietary therapy.

  • Eliminating added sugars and refined grains from your diet is the number one priority.
  • Increasing whole, fresh foods and increasing your intake of vegetables, nuts, seeds, fish, and fresh, lean, grass-fed meats is second.

For supplements:

  • Take a good multivitamin along with 1 to 4 grams of fish oil per day.
  • If your liver function has not improved within three months, add in extra natural vitamin E as mixed tocopherols and tocotrienols to achieve the dosages suggested above, along with 360mg of silybin phytosome.

These treatments are the most evidence-based natural strategies for fatty liver disease. Following this treatment plan will help to return your liver to a healthy state. Taking care of your liver is a crucial piece of optimal health and wellness.

This article was originally published in 2016. It is regularly updated.

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Originally published in February 2016 and updated.

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Jami Cooley, RN, CNWC

Jami Cooley is a Certified Nutrition and Wellness Consultant as well as a Registered Nurse, but her interest in integrative medicine grew out of her experience in conventional medicine. Cooley … Read More

View all posts by Jami Cooley, RN, CNWC

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  • I like that you mention how you need to find a skilled doctor that knows how to specifically test for non-alcoholic fatty liver disease. In order to find one, you could get recommendations from your regular physician or from people you know. It might also be a good idea to research online to find doctors that specialize in liver diseases so they know how to test for the condition and can then start figuring out what treatment and care would be best.

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