The liver is the second largest organ in your body. It’s function is to process nutrients from items that are consumed and filters out substances unneeded by the body. Small amounts of fat in the liver are normal, but too much can result in serious health issues. A result of several factors, fatty liver disease (also known as hepatic steatosis), is fat build up in the liver beyond normal levels, which can cause damage, scarring, and even liver failure.
There are two main types of fatty liver disease- that associated with heavy alcohol consumption (AFLD- alcoholic fatty liver disease), and that which is not associated with alcohol consumption (NAFLD- non alcoholic fatty liver disease). The spectrum of both diseases ranges from stenosis (simple fatty liver, often categorized as benign), hepatitis, cirrhosis, and hepatocellular carcinoma (cancer that starts in the liver).
Alcoholic Fatty Liver Disease
Heavy alcohol consumption can wreak havoc on the human body; drinking heavily may lead to chronic health issues including heart disease, ulcers, excessive weight gain, liver damage such as alcoholic fatty liver disease (AFLD), and cirrhosis.
A healthy liver can process about one standard drink per hour; in the U.S. this is equivalent to:
- 12 ounces of beer, or one bottle at 5% alcohol.
- 8 ounces of malt liquor at 7% alcohol.
- 5 ounces of wine at 12% alcohol.
- 1.5 ounces of hard liquor, or one shot, at 40% alcohol.
As the liver breaks down alcohol, it can generate additional toxic substances in the body. Over time, with excessive alcohol consumption, the cumulative toxicity associated with alcohol can result in liver cell injury, inflammation, and a weakening of your body’s natural defenses. Studies have found that drinking even 1 ounce of alcohol a day can lead to fatty liver changes.
Symptoms of AFLD
AFLD is usually a silent disease with few or no symptoms. You may feel tired or have some aches in the upper right side of your abdomen if you do feel any symptoms. Jaundice (yellowing of the skin and whites of the eyes), irregular sleep, digestive problems, skin issues like itchiness, eczema, psoriasis, and even frequent heartburn and acid reflux can all be signs of AFLD. Alcohol abusers might notice significant decreases in their alcohol tolerance, becoming inebriated more quickly than usual. These symptoms, when experienced by an individual who heavily consumes alcohol, may point to AFLD, the earliest stage of alcohol-related liver disease. In the U.S., excessive alcohol consumption remains one of most common causes of both acute and chronic liver disease, and is the third leading preventable cause of death.
Addressing the underlying issues surrounding alcohol is primary in treating AFLD. The treatment for AFLD remains as it was 50 years ago: abstinence from alcohol, nutritional support and corticosteroids (or pentoxifylline as an alternative if steroids are contraindicated). Abstaining from drinking can lead to the reversal of AFLD, but many providers cite this as the most significant obstacle for patients. Those with severe alcohol addiction require substantial support through the process of withdrawal, adopting a nutritional program that address malnutrition often found in patients with AFLD, and long-term resources for maintaining sobriety. Smoking and obesity are also independent risk factor for the progression of AFLD, and so addressing both concerns are important in combating liver damage and preventing further development of the disease.
More severe or progressed forms of alcoholic liver disease include alcoholic hepatitis and cirrhosis. Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism; once liver damage has progressed to this level, it cannot be undone. In patients with cirrhosis, abstinence from alcohol has been found to prevent further damage and significantly increase life expectancy.
Nonalcoholic Fatty Liver Disease
Patients with non-alcoholic fatty liver disease (NAFLD) are usually obese, have insulin resistance and/or metabolic syndrome. According to researchers in the World Journal of Gastroenterology, NAFLD affects up to 25-30% of people in the United States and Europe. Various studies show that NAFLD may be the hepatic (meaning related to the liver) manifestation of metabolic syndrome.
NAFLD is linked to an increased risk of other diseases, including heart disease, diabetes and kidney disease. Over time, NAFL may lead to a more serious liver condition known as non-alcoholic steatohepatitis (NASH). NASH involves greater fat accumulation and inflammation that damages the liver cells. This can lead to fibrosis, or scar tissue, as liver cells are repeatedly injured and die off. Unfortunately, it is difficult to predict whether fatty liver will progress to NASH, which greatly increases the risk of cirrhosis and liver cancer.
Symptoms and Risk Factors of NAFLD
Some risk factors for NAFLD include:
- Obesity: Obesity involves low-grade inflammation that may promote liver fat storage. It’s estimated that 30–90% of obese adults have NAFLD, and it’s increasing in children due to the childhood obesity epidemic.
- Excess belly fat: Normal-weight people may develop fatty liver if they are “viscerally obese,” meaning they carry too much fat around the waist.
- Insulin resistance: Insulin resistance and high insulin levels have been shown to increase liver fat storage in people with type 2 diabetes and metabolic syndrome.
- High intake of refined carbs: Frequent intake of refined carbs promotes liver fat storage, especially when high amounts are consumed by overweight or insulin-resistant individuals.
- Sugary beverage consumption: Sugar-sweetened beverages like soda and energy drinks are high in fructose, which has been shown to drive liver fat accumulation in children and adults.
- Impaired gut health: Recent research suggests that having an imbalance in gut bacteria, problems with gut barrier function (“leaky gut”) or other gut health issues may contribute to NAFLD development. Read more about how a healthy gut is vital to your health here.
NAFLD causes no symptoms in most cases, with fatigue and slight pain or fullness in the right or center abdominal area being the most commonly experienced. Frequently, NAFLD comes to medical attention when tests done for other reasons point to a liver problem. Blood tests, imaging processes, and liver tissue examination (in the form of a biopsy) are all methods that can detect NAFLD.
Treatment of NAFLD
The first line of treatment is usually weight loss through a combination of a healthy diet and exercise. Losing weight addresses the conditions that contribute to NAFLD. For those who have cirrhosis due to NASH, liver transplantation may be an option.
Treatment surrounds a lifestyle modification including weight loss, a focus on changing nutritional habits, and incorporating regular exercise. Dietary modification plays a key role since a carbohydrate-rich diet, especially with high fructose, is the major cause of obesity, insulin resistance and NAFLD development. Sugar consumption should be kept below 10% of total caloric intake in a day and a fructose-rich diet should be avoided in such patients. Food rich in omega-3 fatty acid should be included and those rich in saturated fat and omega-6 fatty acid should be excluded from the diet.
Other therapies utilizing insulin sensitizers (thiazolidinediones) and antioxidants (vitamin E) also have been found to be useful, but their long-term safety and adverse effects have not been evaluated.
Lifestyle changes – weight loss, abstaining from alcohol, diet modifications and exercise are the best way to treat or at least stop the progression of fatty liver disease. Clearly these are daunting hurdles to overcome. That’s why it’s so important to get the guidance and support needed to maintain these long-term goals. You are not alone, call your provider to learn what options are available to help.