Who Knew a Liver Could be Fat?

     There’s a silent liver disease gaining momentum and it’s riding on the heels of the obesity epidemic. I recently sat down with gastroenterologist Dr. Shahin Rahimian of Digestive Disorders Consultants to learn about nonalcoholic fatty liver disease (NAFLD) and a more serious condition called nonalcoholic steatohepatitis (NASH).

     Most of us know that drinking too much alcohol can harm the liver, causing scarring and inflammation known as cirrhosis. But did you know that carrying excess weight could be just as harmful to your liver as drinking too much alcohol? When fat accumulates in the liver—an organ that is not supposed to store fat—the liver’s health can be seriously affected, and possibly lead to liver failure or cancer.

Rising numbers
     A staggering 20-30% of Americans have fatty liver disease, and the number is increasing. NAFLD is now the most common cause of chronic liver disease in North America according to Dr. Rahimian—and NASH is one of the leading causes of cirrhosis. Most people are unaware that they have a fatty liver, but a continued lifestyle of unhealthy foods, large portions, and little exercise can set the stage for NASH.

Diagnosis
     When physicians see patients with a body mass index (BMI) of greater than 25, high blood pressure, high cholesterol, and persistent elevated liver enzymes, a red flag goes up. Nonalcoholic fatty liver disease is diagnosed based on blood test results or scans of the liver. Not all people with a fatty liver get the disease by being overweight and sedentary. Some medications and genetic factors can lead to NAFLD, although most patients who develop NAFLD are overweight or obese, according to Dr. Rahimian.

     While some people will always have NAFLD, others will develop NASH—a one-two punch, according to Dr. Rahimian. NASH is difficult to diagnose through blood tests and ultrasounds. Patients who have metabolic syndrome (high blood sugar, increased blood pressure, abnormal cholesterol levels, and excess fat around the waist) and a family history of liver disease are likely candidates for a liver biopsy—the only way to pinpoint NASH. Most people don’t have signs of NASH, although a dull ache in the upper right abdomen and fatigue can be symptoms.

Reversing fatty liver disease
     According to Dr. Rahimian, NASH is a man-made disease and largely preventable. People who gradually drop about 10% of their body weight can bring liver enzymes down and reverse NASH. He also stresses to follow a low carb/high fiber diet, avoid high fructose corn syrup, keep a food log, and get 150 minutes a week of heart-pumping exercise. Aside from lifestyle changes, there’s no cure for NASH, although several antidiabetic medications are in the pipeline. The irreversible or end-stage of the disease is cirrhosis and liver failure.

The take-away message
     Too many cheeseburgers and cocktails place stress on our livers—and this vital organ carries away waste, breaks down fat, clears our blood of toxins, and more. Nonalcoholic fatty liver disease is yet another reason to commit to a healthy lifestyle. Early in the game, you can change its course, but in the fourth quarter, you’re out of luck.

By: Anne Gill