Fatty Liver Disease: It's on the Rise and Dangerous, but Preventable
Hello, I am Julie Donaldson and I am a clinical nutritionist with functional medicine training. I specialize in restoring balance in complex, chronic and acute health conditions. I welcome you to peruse other articles that may be of interest to you in your health investigation!
“I had immediate results adhering to my nutrition plan (which now seems easy) and the benefits are profound including deep sleep, enhanced immunity, more joy and a balanced mind. With the recommended testing, I learned of my nutritional deficiencies and Julie advised me how to best address them.”
- JC, California
Fatty liver disease is fast becoming a common and dangerous condition, even in our children. It is a condition in which fats are stored in the liver and negatively impact its normal function. This has implications for your body’s ability to detoxify, process your nutrients and stabilize your blood sugar.
With fatty liver disease, accumulation of fatty acids from the blood serum is greater than fatty acid oxidation and export. The liver is a metabolic workhorse that performs a diverse array of biochemical functions necessary for whole-body metabolic homeostasis. The metabolic activities of the liver require a rich blood supply for delivery and export of substrates, hormones, and nutrients. In my practice, I refer to the liver as the ‘Maserati” of body organs - it is a very high performance machine that requires high-level nutrition and health to perform optimally. Its health becomes significantly compromised in the presence of fatty liver disease. A comprehensive approach is needed to accomplish holistic health, inclusive of your liver health.
Many people believe the condition can only be caused by excess alcohol intake, but what we will investigate here is the condition of Non Alcoholic Fatty Liver (NAFL) which is not directly correlated with alcohol use. Between 1980 and 2010, the Center for Health Statistics reports a rise in this condition worldwide of over 46%. In the years between 2007 and 2016, the rise in morbidity related to NAFL was 2.1%. Nonalcoholic fatty liver disease (NAFLD) is regarded as the hepatic (liver) manifestation of metabolic syndrome, ranging from simple hepatic steatosis to nonalcoholic steatohepatitis (NASH). NASH is the form of NAFLD in which a person has hepatitis (inflammation of the liver) and liver cell damage in addition to fat in the liver. NAFLD has become a major cause of chronic liver disease worldwide, and is treated as a public health priority. A recent meta-analysis showed that the global prevalence of NAFLD had reached as high as 25.2%, and this number is expected to be 33.5% in 2030. Prevalent NAFLD cases are forecasted to increase 21%, from 83.1 million (2015) to 100.9 million (2030), while prevalent NASH cases will increase 63% from 16.52 million to 27.00 million cases. Compared with people who develop NAFLD during adulthood, people who develop NAFLD during childhood are more likely to have NASH with related complications and/or liver disease as adults. Children with NASH may develop cirrhosis during childhood.
NAFL is associated with overall risk for mortality (from all causes) and is projected by some to be in the top 5 causes of death in the decades ahead, both in children and adults.
So, what is causing this dramatic shift and what can we do about it?
The Proverbial Ounce Of Prevention
Ultimately, when considering the risks of disease expression, we must back up to where things begin if we are to avoid the complicated web of symptoms and health challenges associated with a disease. The proverbial “An ounce of prevention is worth a pound of cure” is absolutely critical in the face of NAFL. Once the liver has become more than 5% fat, the challenge of reversing the damage and restoring the organ with healthy, functional tissue is much greater. At the center of increasing rates in NAFL expression is the spread of convenience foods throughout the world, including in poorer countries. Foods that are highly processed and low in nutrients are a major culprit. Everywhere in the world, staying focused on clean, nutritious, locally sourced foods is a public health concern that must be kept in the forefront.
So, what are the other major contributing factors for the disease development?
Obesity. While obesity is increasing in all ages of the population, it is particularly on the rise in children, which is a significant correlative factor with the rise in NAFL in children. Researchers estimate that close to 10 percent of U.S. children ages 2 to 19 have NAFLD, and 23% of those children will have NASH. At least 340 million adolescents worldwide between ages 5-19, and 40 million children under age 5 have been classified as overweight. The most profound increase has been in the 5-19 age group, where the global rate of overweight youth increased from 10.3% in 2000 to 18.4% in 2018. Study results released just this week from the CDC’s Division of Diabetic Translation offered some sobering realities - almost 1 in 5 teenagers in the U.S. has prediabetes. Young adults fared even worse -- 25% of those aged 19 to 34 have prediabetes. Current predictions are that nearly 1 in 2 people will be obese by the year 2030. t is likely that abnormalities in fatty acid metabolism, in conjunction with adipose tissue deposits, hepatic and systemic inflammation are key factors in the risk that forms between obesity and NAFL.
Type 2 diabetes and insulin resistance. Elevated circulating free fatty acid levels result in increased delivery of free fatty acids to the liver. This is, in part, related to diminished suppression of adipose tissue lipolysis by insulin. The synthesis of excess triglyceride in the liver is driven by this supply of fatty acids and the accumulation of excess liver fat is further exacerbated by impaired hepatic fatty acid oxidation secondary to insulin resistance. When glucose levels are elevated in the context of pre-diabetes or overt diabetes, this provides further substrate for triglyceride synthesis. There may not only be an increased risk for NAFLD secondary to diabetes, but there also is evidence suggesting that NAFLD conversely may be a risk factor for the development of Type 2 diabetes.
Metabolic syndrome In addition to the association with disordered glucose metabolism, most patients with NAFLD have other clinical characteristics that qualify them for the diagnosis of metabolic syndrome. A common operative definition of metabolic syndrome is the presence of any three of the five abnormalities: abdominal obesity (increased waist size or waist/hip ratio), impaired glucose tolerance or overt diabetes, elevated triglycerides, low high-density lipoprotein cholesterol, and elevated blood pressure.
Imbalanced nutrition relative to the individual’s needs. This is referred to as “fuel overload”. Fuel overload is the excess consumption and storage of any nutrient (protein, carbohydrate or fat), resulting in elevated triglycerides. It has been previously assumed that only excess fat (especially trans fats and saturated fats) are to blame for elevations in triglycerides. However, we now understand that any nutrient excess (relative to the person’s metabolism and nutrient requirements) is problematic.
Heavy metal toxicity. Researchers have defined correlations between the severity of fatty liver disease and concentrations of soil-based heavy metals (arsenic, mercury, cadmium, chromium, copper, nickel, lead and zinc). I investigate heavy metal burdens in all of my clients, as we are all exposed and at risk in our current world. Exposures do vary alongside wide variations in soil content of heavy metals (this was the focus of the cited research). With heavy metal exposure, the fatty liver risk is actually highest for men with lean body mass. This factor creates a separation from other metabolic stresses and their relationship to weight and body mass in the face of NAFL.
As we can see by studying these risk factors, most everything is preventable, and it all begins with proper nutrition and intelligent monitoring/testing. Individualized nutrition is the first and most important step in any program I design for a client, whether young or old. Without this proper foundational support, no healing can occur and no lifestyle of good health and disease prevention can occur.
How Is NAFL Diagnosed?
The only surefire diagnosis of NAFL is a liver biopsy. Naturally, few of us want to go to that extent to know where we stand (although it is advised in serious situations where the likelihood of the disease is high). Ultrasound is sometimes used to investigate the liver for NAFL, but it cannot be considered a rule-out test if there is less than 30% adhesion in the liver.
In a blood test, there may be some indicators of subclinical NAFL. These can be elevations in the liver enzymes ALT and GGT, as well as fasting glucose over 90. When liver cells die (as they do daily), they spill their contents - when ALT Is elevated, it is an indication that there is poor processing of these contents and adjacent cells are being harmed. Elevations in GGT indicate damage to the liver, including fibrosis and necrosis. GGT enzymes are transport molecules that help move other molecules and enzymes throughout the body. They play a vital role in metabolizing toxins.
Symptoms, of course, are not diagnostic, but can provide information on the possibility of NAFL. The most common symptoms are gas and bloating, as well as poor biliary excretion/bile production.
You may calculate your risk (not diagnostic, risk only) for NAFL with this index. It is a mathematical formula which utilizes your Body Mass Index (BMI), waist circumference, GGT and triglyceride levels (blood testing is required for the latter two).
Nutrient Processing And Overload
There is no shortage of bad nutritional advice in our world of technology and information overload. This, unfortunately, is also contributing to poor nutrient balance and fuel overload. Many fad diets such as Keto and plant-based diets are encouraging one-size-fits-all approaches for absolutely everyone, and it’s dangerous. We are all biochemically unique, and we require what we require individually. If a person needs a low carbohydrate diet and is consuming a plant-based carb-heavy diet, they will have fuel overload based upon their metabolic function. If a person needs a high carbohydrate diet and is consuming a Keto diet, they also will have fuel overload. (It is important to note, given the particular popularity of Keto diets that hepatocytes cannot use ketones. If there is stress on the liver and possible development of NAFL, this can be especially detrimental.)
As fuel overload occurs (again, on individual terms), excess triglycerides will accumulate. Triglycerides crowd out glycogen which is a very important source of blood sugar stored in the liver and muscles. Glycogenolysis is the process by which glycogen is broken down into glucose to provide immediate energy and to maintain blood glucose levels during fasting. Glycogenolysis occurs primarily in the liver and is stimulated by the hormones glucagon and epinephrine (adrenaline). When blood glucose levels fall, as during fasting and post-digestion, there is an increase in glucagon secretion from the pancreas. Glycogen is an emergency blood sugar source when food is not available and allows the stabilization of blood sugar (a most important homeostatic mechanism) without the stimulation of the glucose-insulin response.
At True Nature, a reliable, individualized assessment of nutrient processing patterns is used in the beginning of our healing programs. It is Metabolic Typing ®. Without this format, one is stabbing in the dark to understand what types of foods and in what ratios foods are best for optimal metabolic function. We are looking at the dominant system running your metabolic functions and how to fine-tune that system with a plan that works for you. This is key to all healing, as MT helps to stabilize homeostatic mechanisms that are foundational for all body functions - blood sugar regulation, blood pressure, pH balance, electrolyte balance, and temperature. It is also key to preventing fuel overload (again, remember ANY nutrient in excess can cause this).
What’s A Banana Got To Do With It?
Specifically, what’s a green banana got to do with it? Green bananas are a fabulous source of resistant starch. Resistant starch (vs. standard starches) is metabolized in the large intestine rather than the small intestine and helps to provide greater quantities of butyric acid as it interacts with healthy bacteria in the gut. Butyric acid improves colon health and through fermentation in the gut aids in the production of adenosine triphosphate (ATP) - your body’s main source of energy in the mitochondria. On the contrary, most other carbohydrates result in production of palmitic acid, a fat that has a high level of association with cardiovascular disease. Excesses of this fat are stored in the liver and can be problematic in the development of NAFL. Resistant starch provides a healthy solution. Another excellent form of resistant starch is from boiled and cooled potatoes. Repetitions of the boiling and cooling increase the amount of resistant starch.
Other Supportive Therapies In Subclinical NAFL
As we’ve discussed, preventing a subclinical case of NAFL from reaching full-blown disease is the first order of business. With a higher risk index and/or symptomatology of NAFL, we want to consider the use of some other therapies in addition to individualized nutrition. These include but may not be limited to:
Bile acid and vitamin E combinations
Reishi mushroom extract
phosphatidyl choline
precursors to glutathione such as NAC and ALA
Milk thistle has been touted as a primary support for NAFL, and this is likely true in its ability to reduce cell death. Some information, however, indicates that milk thistle may not be as supportive as once thought, at least in people whose bodies are under high amounts of stress. The benefits of milk thistle appear to be mutlifactorial, including the stimulation of hormesis which happens via stressful input. Under variable sets of circumstances, it seems to be less effective.
All types of exercise including cardio, intermittent intensity and resistance training have been shown to support healing in NAFL. Daily cardio activity in moderate amounts with other forms of exercise added periodically appears to have the most benefit. As we know, exercise improves the balances of most homeostatic mechanisms and mitochondrial function as well, if done appropriately for the individual and his or her condition.
A proper approach for anyone with any condition requires individual investigation and protocol development. You are unique, your body and biochemistry are unique, and the True Nature approach respects and operates with these truths. Personalized nutrition, testing and therapeutic protocols are key to your success. Contact me today for more information, Julie@truenaturehealthconsulting.com. We provide holistic telehealth services.