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Thursday, October 26 2017

Nonalcoholic Fatty Liver Disease

It may surprise you that there is a mostly symptomless condition that 20-33% of all Americans have of their liver that ultimately could result in them needing a liver transplant.  I am referring to nonalcoholic fatty liver disease or NAFLD.  NAFLD is predicted to replace hepatitis C and alcohol abuse as the most frequent indication for liver transplantation in the next 10-15 years!  NAFLD is defined as deposition of fat in the liver cells with minimal or no alcohol intake.  It is linked to a group of progressive conditions closely associated with being overweight and obesity, insulin resistance, certain medications, and metabolic syndrome*.  NAFLD can eventually lead to nonalcoholic steatohepatitis or NASH and about 20% of those patients will go on to liver cirrhosis (irreversible result of fibrous scarring) with its accompanying risk of liver failure or liver cancer.  Overall, people with NAFLD stand a 12% risk of liver related death over ten yearsIn short it is a silent epidemic that few people talk about.


Symptoms, Causes and Diagnosis of NAFLD

Symptomatically a patient may have fatigue and pain in the upper right abdomen.  It is common that there is abdominal fat deposition.  Red palms, enlarged breasts in men, polycystic ovary syndrome in women, yellowing of the skin and eyes, sleep apnea, and diabetes or insulin resistance.


The commonly held idea that a fatty liver is due to the consumption of too much fat can be discredited by the fact that we have known since ancient Egypt what causes a fatty liver.  Foie Gras, (pronounced fwah grah) a culinary delicacy by some standards and a way of preserving meat, originated in Egypt and later used by the Greeks, and Romans, is the result of force feeding geese and ducks corn to fatten their livers.  Corn and other grains when consumed in excess have a greater association with the development of NAFLD than fats.  This comes as no surprise to many in the natural health community.  It is excess refined carbohydrates that are at the root of the other precipitating factors such as obesity and metabolic syndrome.  It has also been shown that certain medications are associated with NAFLD. Aspirin, Amiodarone (used for abnormal heart rhythm), Diltiazem (for high blood pressure and angina), Steroids, Methotrexate (cancer, psoriasis, rheumatoid arthritis),Tamoxifen (breast cancer), and Valproic Acid (antiepileptic) all have side effects of causing fatty liver.  Excess iron can also cause NAFLD. 


Another study showed that probiotics decreased NAFLD.  This shows that abnormal bacterial overgrowth or dysbiosis (bad life) in the gastrointestinal system can stress the liver.  The mechanism behind this is something called leaky gut syndrome where bacteria, yeast or viruses can migrate out of the gut and enter the circulatory system where it would need to be eventually removed from our body.  This could very well put undue stress on our liver. 


Blood tests for liver enzymes may or may not be elevated with NAFLD.  In years past, three liver enzymes were typically ordered on a routine blood exam. The ALT, AST, and GGT test.  In recent years the GGT isn’t always run by many doctors.  The GGT test is the most accurate test for early detection of this condition.  Other research showed there was a direct relationship between the elevated levels of CRP (C Reactive Protein) on blood testing with ultrasound confirmation of NAFLD.  The study showed the higher the CRP, the more serious the NAFLD.  It is also assumed that if someone has a blood hemoglobin A1C level of 5.9 or higher that there is a likelihood of NAFLD. 



Statin drugs have not shown any benefit for NAFLD.  In fact, they are associated with a rise in liver enzymes showing destruction of liver cells if taken too long.  The only medication to show some improvement with NAFLD was metformin, a blood sugar lowering drug.  From a natural perspective, some promising nutrients for helping NAFLD are vitamins A, D, and E.  Also, resveratrol from grape seeds, betaine from beets, green tea, N acetyl cysteine, glutathione, probiotics and milk thistle. It has been known for 20 years that removing choline from animals’ diet results in a fatty liver. Lecithin, choline and phosphatidylcholine (PC) are used interchangeably in scientific literature and lecithin contains both choline and phosphatidylcholine but PC has an added phosphorus group to choline. The consensus is that phosphatidylcholine is the preferred form as a supplement and helps NAFLD by improving the health of the cell wall and of the mitochondrial membrane to transport fat out of the cell.  Some recent studies suggest pyrroloquinoline quinone (PQQ) (an antioxidant in natto, kiwis, green peppers, spinach, carrots and cabbage) is also effective by improving mitochondrial function.



NAFLD is yet another example of the dangers of overconsumption of refined carbohydrates.  American children at ever increasing numbers are developing diabetes and other issues such as attention deficit problems due to the high consumption of sugars.  The worst of that group is HFCS (high fructose corn syrup) found in sweetened cereals and drinks.  Just this week it was announced that an all-time high of 40% of American adults are obese and almost 20% of American children are too.  Gary Taubes an award-winning journalist with several books on health and science has a new book out called The Case Against Sugar and he reports that 10% of all American children presently have NAFLD.  With the information and the statistics presented here and elsewhere it appears that NAFLD could be a 21st century epidemic by the time this generation reaches adulthood. 


*Metabolic Syndrome

Posted by: Dr. Goldstein AT 10:24 am   |  Permalink   |  0 Comments  |  Email

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