Managing Non-Alcoholic Fatty Liver Disease

Liver is one of the most important organs of the body and the largest. The functions of liver include changing food into energy (metabolizing), helping your body use medications, removing alcohol and other toxins from the body, and production of bile that aids in digestion.

There are two types of Non-Alcoholic Fatty Liver Disease (NAFLD), which happens when the liver stores too much fat and it is not related to heavy alcohol use. NASH is Nonalcoholic Steatohepatitis, a form of NAFLD where fat in the liver causes inflammation called hepatitis and liver cell damage.

In time NAFLD can lead to fibrosis or scarring or permanent scarring (called cirrhosis) of the liver and liver cancer.

Symptoms of NAFLD

Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis are thought to be silent diseases, with generally no symptoms.

Possible symptoms in some patients could be:

• Pain or heaviness in right upper quadrant of abdomen (beneath the right rib)
• Tiredness
• Generalized weakness

Once a patient develops cirrhosis then he may have:

• Swelling of belly or legs
• Blood in vomitings
• Mental confusion

Causes

Causes of NAFLD or NASH are still not clear and are being studied. Some risk factors include:

• Being overweight or obesity with a BMI over 30
• Insulin resistance (when the insulin the body produces doesn't lower blood sugar levels)
• High cholesterol levels
• High triglyceride levels
• Certain medications like steroids, antiepileptic medications, antiarrhythmic medicines

Getting Tested for NAFLD

Your doctor will take history of your medication intake, do physical examination and order certain tests to diagnose NAFLD which may include:

• AST and ALT (these are liver enzymes)
• Ultrasound of abdomen
• CT Scan
• Fibroscan (Here sound waves are used to measure liver stiffness)

Liver biopsy is the best way to look at liver tissue for damage but is invasive and usually done rarely nowadays.

Treatment of NAFLD

• Weight loss: Your doctor may recommend weight loss for management of both NAFLD and NASH. Weight loss may help in decreasing the liver fat, swelling, and even liver scarring. Doctors generally recommend a weight loss of 7% over a period of time. This is achieved with decrease in calorie consumption, smaller portion size, and daily exercise.
• Nutrition: Your doctor may suggest you to a nutritionist or a knowledgeable dietician. They will suggest eating less saturated fats and trans fats, and more mono- and polyunsaturated fats. Monounsaturated fats are found in olive oil, peanut and canola oils. Polyunsaturated fats include safflower oil, omega-3 fatty acids found in salmon fish oil, walnuts, and flax seeds. Eating more foods with low glycemic index like fruits, vegetables and whole grains, and cutting down on foods with high glycemic index like white bread, white rice, and potatoes.
• Medicines: Currently there are no drugs that are approved for treatment of NAFLD or NASH, but a lot of research is ongoing to find newer medications.
• Surgery: Those with a BMI over 40 or 35 with comorbidities like diabetes or sleep apnea who are unable to lose weight might be offered bariatric surgery.