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By Adam Riordan, DO
Fatty liver disease, or FLD, is a widespread condition in which fat builds up in your liver, the largest organ inside the body. We differentiate between two main types of the disease. The most common, found in about 25 percent of people in the United States, is non-alcoholic fatty liver disease, or NAFLD. As the name indicates, it occurs in people who drink little to no alcohol but still have the resulting fat that deposits in the liver. In most cases, FLD will not cause serious problems or prevent your liver from working. When the fat percentage in the liver reaches about 5 to 10 percent of the weight of the liver, it can become more worrisome.
A few people, about five percent, also experience inflammation. This is called non-alcoholic steatohepatitis, or NASH, and may in some cases lead to liver injury, fibrosis, and ultimately cirrhosis – permanent scarring and hardening of the liver. Having cirrhosis can also increase the risk of getting liver cancer. In women over the age of 65, end-stage FLD is now the most common reason for a liver transplant, and it is expected to become the overall number one reason for liver transplants in the future. (Both NAFLD and NASH are different from alcoholic fatty liver disease, which occurs only in individuals who have alcohol as a risk factor.)
FLD is sometimes called “silent liver disease” because it usually has no symptoms, though inflammation in NASH may cause some fatigue or non-specific pain in the upper right side of your abdomen. The fat deposits are often found by chance during a regular checkup or imaging for other medical issues. Your doctor may also suspect FLD because you have other risk factors such as diabetes or obesity. In the case of NASH, inflammation can show up as abnormal values of certain markers in your blood work.
There is currently no medication for NAFLD or NASH. If you are diagnosed with either, much of the treatment – through weight loss, regular exercise, and managing related conditions – is in your hands, in coordination with your doctor.
Who is more likely to develop fatty liver disease?
People with obesity are more likely to have fat deposits in their liver. Where we carry our weight matters. We are finding that fat around the stomach and trunk means a much higher risk overall than fat deposits around other areas of the body. This is true even when someone is not clinically overweight.
FLD is most often diagnosed in middle-aged people, though children and young adults can also be affected. Hispanics appear to be most at risk, followed by non-Hispanic whites. It is less common in African Americans. The exact causes of FLD are unclear, but the disease has several known risk factors:
- Diabetes: Among people with type 2 diabetes, up to 75 percent may have NAFLD.
- Certain metabolic disorders, such as metabolic syndrome.
- Exposure to certain medications such as amiodarone, tamoxifen, steroids, and diltiazem.
- Obstructive sleep apnea.
- High blood pressure.
- High cholesterol.
How is fatty liver disease treated?
Weight loss is by far the most important treatment for FLD. We recommend losing three to five percent of body weight to lose some of the fat within the liver. This is best done slowly, one to two pounds a week, under the supervision of your primary care physician. The Mediterranean diet – with many fruits and vegetables, whole grains, legumes, healthy fats, and moderate amounts of fish, dairy, and poultry – may be helpful. Fad diets and losing weight too fast can increase the amount of fat in the liver and make it hard to keep the weight off. Alcohol should be avoided in NAFLD and MUST be avoided entirely in NASH. It is akin to “adding gas to the fire,” so to speak, and can accelerate damage leading to cirrhosis.
It is also important to treat other comorbidities by keeping type 2 diabetes under control and working on coronary-vascular risk factors such as high levels of cholesterol and triglycerides. Make sure to discuss with your doctor any medications, dietary supplements, and herbal remedies you may be using, and discontinue any that may be harmful to your liver.
The third main component is exercise. We recommend at least 150 minutes a week of vigorous movement. This should incorporate a mild to moderate resistance program with weightlifting as well, as this can improve insulin resistance.
While many drugs are being studied as possible treatments for FLD, there are currently no pharmacological options available. But with good nutrition, weight loss, and plenty of movement in your day, there is a lot that you can do on your own to control and reverse fat buildup in your liver.
Adam Riordan, DO, joined Gastroenterology Associates of Ithaca in 2018. He’s originally from the Southern Tier. He is board certified by the American Osteopathic Board of Internal Medicine in Gastroenterology and Internal Medicine. He can be reached at (607) 272-5011.
