Nonalcoholic fatty liver disease and obesity: Are you at risk?

A woman in her mid-forties goes to see her primary care physician for routine fasting lab work and to discuss weight loss. It had been several years since she has had any sort of physical due to a lack of insurance.

When her results returned, they showed an elevation in her liver enzymes without obvious cause as she did not regularly use medications, drink alcohol, or have a history of drug use. An abdominal ultrasound was ordered and it reported "several areas of fatty infiltrate consistent with fatty liver disease".

Nonalcoholic fatty liver disease (NAFLD) is a condition where an excessive accumulation of fats (such as triglycerides) build up in the liver cells known as hepatocytes.

It is most commonly caused by obesity, type 2 diabetes, elevated cholesterol/triglycerides, and/or elevated insulin. However, certain medications can cause it, such as methotrexate, corticosteroids, tamoxifen, and amiodarone.

NAFLD typically does not have any symptoms but in some cases a sufferer may experience pain in the upper right area of their abdomen.

A more serious result is the development of cirrhosis, resulting in fibrosis and scar tissue. This can render the liver cells inefficient over time to the point that a liver transplant may be required.
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Treatment of NAFLD is varied but most often incorporates weight loss strategies, cessation of alcohol and/or medications that may be worsening the situation, diabetes control, and liver protection.

Changing lifestyle habits to lower triglycerides include the elimination (or extreme moderation) of foods containing fructose and sugar, simple carbohydrates, and adding in a good quality omega-3 fatty acid at a therapeutic level of 2000-3000mg per day.

Significantly increasing fiber may help bind up excess cholesterol while balancing insulin and glucose levels.

The commonly accepted recommendation for fiber intake is 25-30 grams per day. This can come from fiber powders, ground flax seeds, beans and lentils, whole grains such as brown rice or quinoa, and of course eating plenty of vegetables.

Consider supplements such as choline to help with liver function and protection, inositol to also improve liver function and support detoxification, and alpha lipoic acid to protect the liver and slow lipid accumulation within the cells.

Medications may include those to stabilize diabetes or improve elevated insulin levels.

Talk with your health care provider about the best options for improving NFLD.