Non Alcoholic Fatty Liver Disease (NAFLD): The Emerging Health Threat

Non Alcoholic Fatty Liver Disease (NAFLD): The Emerging Health Threat

As we get fatter, our livers are getting fatter too.

Physicians are now seeing an escalating epidemic of liver disease in their patients.  This health threat that used to almost exclusively be seen in heavy drinkers is rising proportionately with the obesity crisis.  We know many disease states are associated with obesity, including heart disease, type 2 diabetes, some cancers and stroke, but what is not often discussed is how obesity affects the liver.

According to the American Liver Foundation, approximately 25 percent of Americans are estimated to have Non Alcoholic Fatty Liver Disease (NAFLD), a condition where fat accumulates in the liver. Risk factors for NAFLD are related to conditions directly associated with obesity: insulin resistance, abnormal levels of fats in the blood and type 2 diabetes. The scariest part: If you have it, you probably don’t know it. NAFLD does not usually produce red flag symptoms that present with cardiovascular disease- there is often nothing to indicate that the liver is in trouble. The liver is a resilient, hardy organ and may be harboring NAFLD for many years before the disease is noticeable. This makes the condition difficult to recognize, much less treat.

Fatty liver was not always considered life threatening, but today it is known to progress to advanced liver disease, including nonalcoholic steatohepatitis (NASH), the more severe form of NAFLD.  NASH causes the liver to swell with fat, and the damage is very similar to that observed in heavy drinkers.  In those with NASH, the culprit is not alcohol. NASH is yet another manifestation of an unhealthy diet and obesity.

Non-alcoholic fatty liver disease describes a sequence of four stages including simple fatty liver, non-alcoholic steatohepatitis, fibrosis and cirrhosis. During the first three stages, fat accumulates in the liver. This build up of fat causes inflammation and scarring, leading to fibrosis. Over time, this scarring can progress to cirrhosis, which causes irreversible damage to the liver.  Shockingly, in just a couple of decades NASH is predicted to soon surpass hepatitis C and alcoholic liver disease (ALD) to become the number one disease on the liver transplant list. Research shows that liver transplants for NASH patients have increased by five times over the last ten years.

Although the pharmaceutical industry is sprinting to be first to find a treatment, there are currently no approved medicines on the market to treat NASH.  People with NASH are obese, or have a metabolic profile consistent with obesity, despite a normal BMI.  Therefore, weight loss is one of the only ways to reverse or slow down progression of the disease.  Weight loss lessens inflammation in the body and reduces all body fat- including fat stored in the liver. Studies show that losing as little as 10 percent of one’s weight through lifestyle modification can resolve or improve most cases of NASH. However, the greatest improvements were found in people who lost over 10 percent of their body weight.

Many patients with NAFLD show signs of insulin resistance and metabolic syndrome, a constellation of factors including high triglycerides, low HDL-cholesterol, large waist circumference and high blood pressure.  Studies indicate that the sugar consumption typical in high carbohydrate diets increases insulin resistance and also promotes liver inflammation. In fact, there is evidence indicating that low-carbohydrate diets could be more effective in treating NAFLD than traditional reduced calorie regimens.

To address the burgeoning epidemic of NAFLD, physicians can offer their patients comprehensive weight management solutions to help improve and prevent all health conditions related to obesity, including liver disease. Weight loss with a low-carbohydrate (or for some patients, a ketogenic) protocol that promotes sustainable weight loss can significantly impact liver health, improving or reversing NAFLD before it progresses to NASH – or worse.

The rise of NAFLD makes addressing the obesity epidemic even more of an urgent priority. It doesn’t suffice to say this health threat is looming on the horizon. Unfortunately, it has arrived.

To join the ranks of healthcare providers fighting obesity, tweet @DrsFightObesity or use #DoctorsFightingObesity to keep the conversation going.

David Jeremy Davidson, MD is a board-certified internist and cardiologist at NorthShore University HealthSystem in Evanston, Illinois. He is board certified in Internal Medicine, Cardiology and Lipidology. Dr. Davidson is a Diplomate of the National Lipid Association and a Fellow of the American College of Cardiology. He is Director of NorthShore’s medical weight loss clinic, where he offers a structured multifaceted weight management solution for overweight and obesity. Dr. Davidson is also a member of the Ideal Protein Cardiology Advisory Board.