Non-Alcoholic Fatty Liver Disease (NAFLD)

Non-alcoholic fatty liver disease (NAFLD) is the accumulation of fat in the liver caused by over-consumption and the inability to process fats effectively.  It involves the deposition of excess free fatty acids within liver cells known as hepatocytes.

It is the liver manifestation of metabolic syndrome and is usually associated with obesity, insulin resistance and/or type 2 diabetes. It may eventually progress to inflammation, fibrosis and cirrhosis of the liver and is an independent risk factor for coronary artery disease.

NAFLD is the most common cause of liver dysfunction in Australia, US and UK in both adults and children, but is mostly seen in the fourth or fifth decade of life.

Causes / Risk Factors of Non-Alcoholic Fatty Liver Disease

• Obesity and insulin resistance
• Poor diet (high in sugar and fat)
• High blood triglycerides or cholesterol
• Metabolic syndrome
• Type 2 diabetes
• Hypothyroidism
• Polycystic ovarian syndrome
• Smoking

Signs & symptoms of Non-Alcoholic Fatty Liver Disease

• Often asymptomatic
• Fatigue and malaise
• Depression
• Dull right upper quadrant pain and discomfort

Differential Diagnosis

• Non-alcoholic steatosis
• Alcoholic liver disease
• Hepatitis C
• Wilson’s disease
• Cardiovascular disease
• Gallbladder disease
• Irritable bowel syndrome

Investigations

• Liver Function Test’s: usually shows elevated liver enzymes (especially GGT)
• Viral serology: to exclude viral hepatitis and other viral diseases
• Blood lipids: elevated triglycerides in > 50% of patients
• Ferritin: elevated in 20-50% of patients
• Liver scans (ultrasound, CT, MRI)
• Advanced Stool Testing
• Methylation prolife & genetic testing
• SIBO breath test

TREATMENT STRATEGY FOR NON_ALCOHOLIC FATTY LIVER DISEAESE

• Identify / reduce risk factors
• Ensure gut function and methylation are optimised
• Regulate blood lipids
• Regulate blood glucose
• Reduce weight
• Reduce hepatic inflammation and oxidative stress
• Protect liver and prevent fibrosis
• Support liver and digestive function

Diet plan guidelines for Non-Alcoholic Fatty Liver Disease

• Low carbohydrate diet, especially sugars and refined carbohydrates: excess sugar is converted to fat and stimulates insulin response
• Eliminate high-fructose corn syrup (HFCS): found in soft drinks and other sweetened foods, promotes the storage of fats and stimulates triglyceride synthesis
• Reduce intake of commercially produced saturated fats and trans fats
• Avoid foods that place a burden on the liver e.g. alcohol, processed foods, food additives
• High antioxidant and anti-inflammatory food intake: turmeric, green tea, berries, fresh fruit and vegetables, oily fish, etc
• Ensure sufficient protein: prevents and reverses fatty liver
• Weight loss diet: low carbohydrate, energy-restricted diet

Supplements that support Non-Alcoholic Fatty Liver Disease

• Omega-3 fatty acids: anti-inflammatory, improves lipid profile and reduces hepatic fat content
• Vitamin E: shown in studies to reduce lipid peroxidation in NAFLD, and prevent and reduce fibrosis
• Vitamin A: prevents and reduces fibrosis
• L-carnitine, alpha-lipoic acid, coenzyme Q10: help stimulate mitochondrial function which is affected by accumulation of lipids in hepatocytes; may also help with the fatigue associated with NAFLD
• N-acetyl cysteine: supports glutathione production, essential in protecting liver and reducing inflammatory enzymes
• Lipotrophic factors: promote the flow of fat and bile to and from the liver, as well as improving liver function and fat metabolism e.g. B-vitamins, methionine, cysteine, glycine
• Probiotics, prebiotics and fibre: restore intestinal flora balance and function to GIT. In particular, L. bulgaricus and B.longum reduce hepatic inflammation in NAFLD patients.  Comprehensive gut testing is recommended to patients with NAFLD

Herbal medicine treatment for Non-Alcoholic Fatty Liver

• Antioxidants to liver: St Mary’s thistle, turmeric, schisandra
• Anti-inflammatory: turmeric, baical skullcap. Licorice, grapeseed extract
• Liver protective: St Mary’s thistle, bupleurum, turmeric, andrographis, dan shen, globe artichoke, phyllanthus, rosemary, schisandra, terminalia
• Liver restorative: St Mary’s thistle, globe artichoke
• Gall bladder stimulants: barberry, blue flag, fringe tree, gentian, globe artichoke, greater celandine, yellow dock, dandelion, golden seal, milk thistle, turmeric

Lifestyle considerations to improve Non-Alcoholic Fatty Liver

• Regular vigorous exercise: reduces adipose tissue (including liver fat), enhances insulin sensitivity, increases muscle mass and mitochondrial energy production
• Hydrotherapy, saunas: thought to increase filtration through the liver by encouraging blood circulation

FUNCTIONAL MEDICINE TREATMENT OF NON ALCOHOLIC FATTY LIVER DISEASE

Non Alcoholic Fatty Liver Disease is a widespread condition in patients that eat a heavily processed western diet.  Elevated blood markers for the liver are the initial laboratory test results that indicate the onset of the disease. 

There are a number of systemic factors that greatly contribute to the function of the liver and processing of fat and toxins.  These include a compromised gall bladder, impaired digestive function, bacterial overgrowth of the gut and poor methylation function.

A functional medicine approach requires the assessment of the gut and digestive system along with methylation status of the body.

Digestive function is required to ensure patients are able to break down foods effectively and support the processing and absorption of fats and other nutrients. 

The methylation process is vitally important in NAFLD as detoxification pathways with not operate correctly with impaired methylation, this results in sluggish bile flow, the accumulation of toxins and heavy metals and the inability to process fats properly.

At our Perth clinic of Advanced Functional Medicine we have experience with  non-alcoholic fatty liver disease and a range of other liver and obesity related conditions.

If you or a family member are require assistance with NAFLD or another liver condition we would love to hear from you.  What treatment have you undertaken to return your liver markers to normal?  What were the levels of your liver function test?  Please write a comment below.

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