Non-Alcoholic Fatty Liver Disease (NAFLD) – what everyone should know

Non-Alcoholic Fatty Liver Disease blog image

Recently, I’ve noticed I’m getting more and more enquiries from people who’ve been diagnosed with Non-Alcoholic Fatty Liver Disease (NAFLD) and are struggling to manage their symptoms. Unfortunately, when diagnosed, they get very little in the way of support from their GP to help them reverse this condition, yet it is reversible if caught early enough.  

NAFLD can be serious with long-term implications on overall health, so it’s crucial to understand what it is, what causes it and how it can be reversed. Let’s take a closer look.

A bit about your liver

Your liver does a lot for your health. As one of the body’s largest organs, it’s responsible for metabolic functions like converting nutrients from your diet so your body can use them and making sure toxic substances are flushed out before they cause any harm.

However, this workhorse of an organ is susceptible to a dangerous and often hard-to-diagnose condition called non-alcoholic fatty liver disease, or NAFLD.

According to the British Liver Trust, 63% of UK adults are now classed as obese and overweight, and it’s estimated that 1 in 3 has early-stage NAFLD. Experts predict that over the next decade, NAFLD will become the leading cause of end-stage liver disease and liver transplantation. 

When I read these stats, I was shocked.  I knew that we had a problem with obesity in the UK, but I didn’t realise just how serious it was and that NAFLD could cause end-stage liver disease.  Truly shocking when this can be prevented.

What is Non-Alcoholic Fatty Liver Disease?

Non-alcoholic fatty liver disease (NAFLD) is the term for conditions caused by a build-up of fat in the liver. A healthy liver should contain little or no fat. NAFLD is commonly seen in people who are overweight. Although similar to alcohol-related liver disease (ARLD), NAFLD is not associated with drinking too much alcohol.

Early-stage NAFLD does not usually cause any harm, but it can lead to serious liver damage, including cirrhosis, if it gets worse. Having high levels of fat in your liver is also associated with an increased risk of serious health problems, such as diabetes, high blood pressure and kidney disease. For example, if you already have diabetes, NAFLD increases your chance of developing heart problems.

If detected and managed at an early stage, it’s possible to reduce the amount of fat in your liver and stop NAFLD getting worse.

Stages of NAFLD

NAFLD develops in 4 main stages. Most people will only ever develop the first stage and probably not realise it.

In a small number of cases, it can progress and eventually lead to liver damage if not detected and managed.

The four stages of NAFLD are:

  1. Simple fatty liver (steatosis) – a largely harmless build-up of fat in the liver cells that may only be diagnosed during tests carried out for another reason
  2. Non-alcoholic steatohepatitis (NASH) – a more serious form of NAFLD, where the liver has become inflamed; this is estimated to affect up to 5% of the UK population.
  3. Fibrosis – where persistent inflammation causes scar tissue around the liver and nearby blood vessels, but the liver is still able to function normally
  4. Cirrhosis – the most severe stage, occurring after years of inflammation, where the liver shrinks and becomes scarred and lumpy; this damage is permanent and can lead to liver failure (where your liver stops working properly) and liver cancer

Stages 3 and 4 can take many years to develop, but if detected early can be prevented.

Risk factors for NAFLD

Obese woman - obesity can cause NAFLD
Obesity may cause NAFLD
  • High cholesterol
  • Metabolic syndrome (a combination of diabetes, high blood pressure and obesity)
  • Being over the age of 50
  • Smoking
  • Being obese or overweight – particularly if you have a lot of fat around your waist (an ‘apple’ body shape)
  • Type 2 diabetes
  • High blood pressure
  • Diet high in processed foods and sugar

Symptoms of NAFLD

As mentioned, symptoms of NAFLD in the early stages may not be noticed. Occasionally, people with NASH or fibrosis (more advanced stages of NAFLD) may experience:

  • a dull or aching pain in the top right area of the tummy (over the lower right side of the ribs)
  • extreme tiredness
  • unexplained weight loss
  • weakness

If cirrhosis develops, you can get more severe symptoms, such as:

  • yellowing of the skin and the whites of the eyes (jaundice)
  • swelling in the legs, ankles, feet or tummy (oedema)
  • itchy skin

Diagnosing NAFLD

NAFLD is often diagnosed after a liver function test produces an abnormal result and other liver conditions, such as hepatitis, are ruled out. Blood tests do not always detect NAFLD though. The condition may also be spotted during an ultrasound scan of your abdomen. Some people may also need a biopsy, where a small sample of liver tissue is taken for assessment.

Treating NAFLD

There’s currently no specific medication for NAFLD, but dietary interventions can certainly help. Treatment may be recommended for associated conditions (high blood pressure, diabetes and cholesterol) or complications.

If you develop severe cirrhosis, and your liver stops working properly, you may need to be put on the waiting list for a liver transplant.

A functional nutrition approach to NAFLD

Most people think of NAFLD as being caused by a diet that is too high in fat. However, if you think about foie gras, the French delicacy made from duck or goose liver, it is made by force-feeding the animals a combination of sugar with corn and starch, intentionally creating a fatty liver.

Sugar - excess sugar causes a fatty liver

The true criminal is not fat, but sugar. A large proportion of the population has a diet that’s too high in sugar and refined carbohydrates, which can lead to developing a fatty liver.  

Research shows that carbohydrates (and not fat) produce more fat in your abdomen and liver. Sugar switches on fat production in your liver, creating an internal process called lipogenesis, which is your body’s normal response to sugar. Fructose, the most detrimental sugar that heads directly to your liver, ramps up lipogenesis. This is why sugar, especially fructose, is linked with an increased risk of NAFLD.

Today, it is not uncommon to see 12-year-old children with fatty livers because fizzy sugary drinks and processed foods have been part of their everyday diet for years and they now need liver transplants. Children are also exposed to many more antibiotics these days, which can lead to a leaky gut. Leaky gut can mean that toxins from gut bacteria can make their way from the gut into the liver.

The link between gut health and NAFLD

Bacterial infections such as small intestinal bacterial overgrowth (SIBO) and candida can create the perfect storm for NAFLD to develop. These types of pathogens can produce ethanol as a by-product. If there is intestinal permeability present, aka leaky gut, then microbial products from the gut as well as ethanol can be transferred via the portal vein to the liver.  This can increase free radical damage to the liver and eventually lead to NAFLD.

There is a condition known as ‘Auto-Brewery Syndrome’ which is also known as Gut Fermentation Syndrome or Endogenous Ethanol Fermentation. This happens when bacteria in your gut turns sugary and starchy foods into alcohol. This has been seen in patients with SIBO, causing them to exhibit signs and symptoms of alcohol intoxication without consuming any alcohol. This endogenous production of ethanol can cause damage to your liver.

Top tips for managing NAFLD naturally

Plus sized women exercising
Daily exercise improves insulin resistance and reduces a fatty liver
  • Eliminate all high-fructose corn syrup (HFCS)Read labels carefully as this ingredient can even be found in ‘healthy’ foods like salad dressings. To put things into perspective, one serving of commercially made tomato sauce can have more fructose than a serving of Oreos. So, cooking from scratch is always preferable so that you can control the amount of sugar going into your body.
  • Eliminate white, processed flours which are found in processed baked goods. They increase your blood sugar levels, stressing your liver and resulting in high triglycerides, which promotes a fatty liver.
  • Add healthy fats to your diet. Incorporate anti-inflammatory, liver-healing foods like low-sugar fruit, vegetables, nuts, seeds, lean animal protein like chicken and fish and good, healthy fats like olive oil, macadamia nut oil, avocados, coconut oil, grass-fed butter and fish oil. A great way to combat sugar damage is to eat plenty of these healthy fats.
  • Improve your metabolism through exercise. Daily exercise improves insulin resistance and reduces fatty liver. Start out with something simple like walking for 30 minutes. More seasoned exercisers might incorporate high-intensity interval training and weightlifting.
  • Supplement where necessary. It’s well documented that milk thistle helps to reduce inflammation in the liver.  For liver support, take one of our Milk Thistle tablets daily with food.
  • I also use nutrients like lipoic acid and N-acetyl-cysteine, which make powerful antioxidants to heal and rejuvenate your liver while increasing the powerful antioxidant glutathione. Other liver-healing nutrients include B vitamins and magnesium. Please check with your practitioner before starting any supplements, especially if you are on any medications.
  • Eat liver-supporting foods. Include plenty of foods from the cruciferous family – like broccoli, cauliflower, and Brussels sprouts, as well as leafy veggies like kale, collards, cabbage, rocket, and watercress. Garlic and onions are amazing sulphur-rich foods that help to support the liver too.  
  • Probiotics. Beneficial strains of live bacteria can decrease levels of ethanol and endotoxins in the liver and result in lowering pro-inflammatory cytokines.
Click on the image to buy my Just For Tummies Live Bacteria capsules
  • Support your gut lining. If you suspect you have leaky gut or NAFLD then supporting the health of your gut lining is extremely important as this can stop LPS toxins and ethanol from entering the liver. It would be a good idea to work with a Nutritional Therapist to help put a protocol together for you for this.
  • Rule out underlying issues. Rule out SIBO or other gut infections as a cause of NAFLD. As mentioned, pathogenic bacteria and yeast produce ethanol, which can affect the liver and lead to NAFLD. If you would like more information on functional gut testing and SIBO testing, you can find an article I have written about this here.