Non-alcoholic fatty liver disease is the silent killer linked to too much fast food, soda and fat — and you might not know you have it
A friend of my older brother recently complained loudly, to any and all who would listen, after his doctor sent an email that said something to the effect of "quit drinking or your liver will be shot." Funny thing, though: Everyone who knows this guy can vouch that he rarely touches even a drop of alcohol. So it was no surprise to hear that he fired back a scathing response to his doctor.
Seems the back and forth email volleys all started when routine blood tests for my brother's friend showed elevated levels of two liver enzymes, alanine amontransferase (ALT), and aspartate animontransferase (AST).
Since excess alcohol can be the culprit behind rising liver enzymes, it's the first thing many doctors focus on. A steady diet of Bloody Mary, whiskey or beer puts stress on a liver and causes it to become fatty. Eventually, continued damage can lead to cirrhosis and liver failure.
Yet researchers are finding that a steady diet of fast food, sugary soft drinks and artery-clogging saturated fat can elevate liver enzymes and damage the liver, too.
And while this non-alcoholic fatty liver disease (NAFLD) can be caused by any number of different ailments, scientists suggest that obesity, unhealthy diets and sedentary lifestyles are probably behind the high prevalence of the disease. Estimates from the American Liver Foundation suggest that more than 20 percent of the population has NAFLD.
An extreme example of this diet-liver damage connection is seen in the 2004 documentary Super Size Me. In a self-inflicted experiment, director Morgan Spurlock spends one month eating every meal at McDonald's and not exercising. No surprise, he gains 24 pounds, hikes his cholesterol level 65 points and damages his liver. "My liver basically turned to fat," Spurlock told CBS News. "It was so filled with fat the doctors said it was like paté; it was reaching a toxic level, putting me at risk of having non-alcoholic type of hepatitis, hardening of the liver, cirrhosis."
A 2008 Swedish study with healthy young adults mirrors Spurlock's findings. Scientists asked volunteers to dine on two fast-food meals per day (with the goal of doubling their normal caloric intake) and to curtail exercise for four weeks. The result: Levels of the liver enzyme ALT shot up quickly, signaling problems. "Our study clearly shows that in the evaluation of subjects with elevated ALT the medical history should include not only questions about alcohol intake but also explore whether recent excessive food intake has occurred," write these researchers in the journal Gut.
You may be walking around with a fatty liver and not know it. In most cases, the disease shows no symptoms. So routine blood tests and medical check-ups are a good idea, particularly if you're a middle-aged woman (40 to 60 years old) — women are more likely than men to develop NAFLD. Serious problems can kick in when untreated NAFLD progresses to what's called non-alcoholic steatohepatitis (NASH). Once NASH develops it causes the liver to swell and may cause scarring (cirrhosis) over time. In fact, according to the American Liver Foundation, NASH is one of the leading causes of cirrhosis in adults in the United States.
At present, there are no proven medical treatments for NAFLD. But preliminary reports suggest positive lifestyle changes could prevent and even reverse liver damage. Experts lay out a two-step process:
1. Lose a few pounds if you're overweight or obese — even a small amount, say 5 or 10 percent of your current weight. For a 250-pound man that would be as little as 13 to 25 pounds.
2. Clean up your eating habits. A 2011 report in the World Journal of Gastroenterology outlines the diet rehab process this way:
- Minimize fast food meals.
- Reduce saturated fat and trans fat.
- Increase omega-3 fatty acids from fatty fish, like salmon and sardines.
- Reduce sugar, including soft drinks and fruit juices.
- Increase fiber intake.
As for my brother's friend, there's no word yet on whether he and his doctor are back on speaking terms. Yet, to look at him, this friend seems like a potential case of NAFLD. He's at least 50 or 60 pounds overweight and sports a big belly. He doesn't exercise at all. And he loves to eat out, including fast food. It's hoped his doctor (or a new one!) can do further tests — an ultrasound can confirm the diagnosis — and then outline a course of treatment.
The food you eat can have a significant impact on your liver
If your liver is healthy a well-balanced diet can reduce your risk of developing some types of liver disease in the future.
If you have liver disease eating a good, balanced diet is essential to maintain strength and a healthy weight. You might also need to change the food you eat depending on:
If you have already been given dietary advice you should not make changes without first talking to your consultant or dietitian.
If you have a liver condition, there are some special considerations you may need to make in your diet to stay nutritionally well andto help to manage your condition. Some of these are specific to certain liver diseases, others relate to how advanced your liver disease is.
If you are experiencing symptoms such as loss of appetite, nausea, low energy levels, fluid retention in the legs or accumulation of fluid in the abdomen (ascites), you will need to follow a more specialised diet. These, and other problems associated with advanced liver disease, require specialist dietary advice from a registered dietitian.
It is important that you talk to your doctor as well as reading this information. Your consultant will be able to refer you to a registered dietitian. If you have already been given dietary advice you should not make changes without first talking to your consultant or dietitian.
You need food to power your body, giving it energy and the material it needs to grow and repair itself. When you eat food, it is broken down in your stomach and intestine (gut) and three main nutrients are extracted:
- carbohydrates
- fat
- protein
These nutrients are then absorbed into the bloodstream and carried to your liver. Here they are either stored, or changed in such a way that your body can use them at once.
At the same time your liver is also working to detoxify substances which may harm your body such as alcohol, other drugs and some of your body’s waste products. If you have a liver problem, then your liver may not be able to do these jobs as efficiently as it should.
A healthy, balanced diet is a way of thinking about everything you eat and drink. The overall picture of your diet is more important than any one small detail. The aim is to generally eat and drink healthily most of the time. You can adapt it to suit you, for example if you are vegetarian.
For most people, a well-balanced diet is one that is low in fat, sugar and salt, and high in fibre, vegetables and fruit. Your diet should also contain enough protein and a wide range of vitamins and minerals.
It is important to remember that your body’s nutritional needs may vary depending on the type and severity of your condition. Particularly, if you are unwell and losing weight you may need to vary your diet from the recommendations below. Please refer to the ‘Coping with eating difficulties’ section for more advice in those circumstances.
Read more here: A Well Balanced Diet
Some liver diseases are linked to build up of fat in the liver. This leads to a condition called non-alcohol related fatty liver disease (NAFLD). If fatty deposits build up over a long time they can damage the liver and stop it working properly. People are more likely to develop NAFLD if they have an unhealthy diet or they live with overweight or obesity.
Obesity can also speed the damage associated with other conditions such as alcoholic liver disease and can decrease the effectiveness of treatments for hepatitis C .
It is important to maintain a healthy weight. To do this you need to balance the amount of food you eat with the energy you need. If you eat more than you use, your weight will increase. If you eat fewer calories than your body uses you will lose weight. There are two ways to shift the balance of calories and lose weight. Eat a healthy, balanced diet. And be more physically active.
Losing weight can seem hard. Take it one step at a time and keep going. People often find it is easier to make small changes one at a time. Give yourself time to get used to your change and then make another one.
Read moreIf you have cirrhosis you may be advised to consume more energy (calories) and protein than a healthy person of the same weight and age.
If you haven’t seen a dietitian or you have specific questions about your diet, ask you doctor to refer you.
Learn moreSome people find eating a well-balanced diet difficult, especially if they have been seriously ill. Two common reasons for this are:
- loss of appetite
- feeling sick (nausea).
However, it is important to eat as well as possible. Follow the link below for some tips.
Read moreThere is a great deal of information available on diet on the internet with many people offering dietary advice.
If you have liver disease, it is important to seek advice from your doctor and ask to be referred to a dietitian before taking any complementary medicines or dietary supplements.
Learn more
A British Liver Trust report (published June 2016) ‘Coffee and the liver – the potential health benefits’ confirms coffee is good for liver health. It is the first time that the entire body of current research and evidence has been reviewed and compiled into a single report.
The report provides evidence that:
- Regularly drinking moderate amounts of coffee may prevent liver cancer – the World Health Organisation has recently confirmed this reduced risk after reviewing more than 1,000 studies in humans
- Coffee also lowers the risk of other liver conditions including fibrosis (scar tissue that builds up within the liver) and cirrhosis
- Drinking coffee can slow the progression of liver disease in some patients
- Beneficial effects have been found however the coffee is prepared – filtered, instant and espresso
People with alcohol-related liver disease should stop drinking alcohol for life.
If your liver disease is not alcohol-related, and you are concerned about whether you can drink alcohol, discuss it with your doctor. If your doctor says you can drink alcohol, stick to government guidelines and drink no more than 14 units a week, with 2-3 consecutive alcohol-free days each week. However, the lower your alcohol intake the better.
Remember that alcohol is a significant source of calories. For example, a 330ml can of 5% beer contains around 129 calories and a 175ml glass of wine (12%) has about 158 calories (for comparison, a Cadbury Mini Roll contains 115 calories and a 330ml can of Coca-Cola contains 139 calories). These are ‘empty calories’ and can cause unhealthy weight gain.
Alcohol can worsen the liver damage caused by chronic viral hepatitis, obesity-related liver disease and haemochromatosis. It can also increase the risk of bone disease and may interfere with a number of commonly prescribed medications.
What is a ‘fad’ diet and are they safe?
Fad diets are usually weight loss diets that promise you can lose weight quickly. These diets usually involve crash dieting; calorie intakes may be drastically reduced or certain food groups such as carbohydrates removed almost entirely. These diets tend to provide a short-term fix but are difficult and potentially dangerous to maintain in the longer term. They are generally not recommended for people with liver disease.
I have read about diets which ‘detox’ your liver – should I try one?
There are diets that recommend certain foods to help your liver ‘detox’ or promote ‘liver cleansing’. However, you cannot physically detox your liver. There is no evidence that toxins build up in the liver and some of these diets can be dangerous for people with liver disease.
Should I take dietary supplements?
Dietary supplements are not an alternative to eating a well-balanced diet. Your body needs a wide range of vitamins and minerals to be able to function correctly, and the best way to ensure an adequate supply of these is to eat a variety of foods. You should always consult your doctor or dietitian before considering taking supplements. If you are prescribed supplements, you should always take them.
Can I take complementary and alternative medicines?
A great deal of information is available online and in the media about complementary and alternative treatments for liver disease. It is important to seek advice from your doctor before considering use of these products. Many are based on herbal preparations which may themselves cause liver damage in susceptible people, so at present healthcare professionals do not believe that they have a place in the management of people with liver disease. More research is needed on the use of such therapies.
As the majority of these products are not classified as medicines they are not licensed. This means that their production is not controlled and there is no requirement for them to undergo rigorous testing for quality or effectiveness.
It is possible that these often-expensive products may either have no effect or even be harmful.
Does milk thistle help the symptoms of liver disease?
Milk thistle is an over-the-counter supplement which is advertised as a natural treatment for jaundice, hepatitis, cirrhosis and gallbladder disease. The active ingredient of milk thistle is silymarin, which is believed to have antioxidant properties.
The evidence that milk thistle is an effective treatment for liver disease is conflicting, with no strong evidence to support its use. In addition, it could result in low blood sugar levels.
It might also interfere with the actions of drugs such as diazepam (sedative), warfarin (anticoagulant) and metronidazole (antibiotic). Of particular concern is the fact that taking milk thistle can increase the blood concentration of simeprevir, a drug used to treat hepatitis C, and might change the way the body processes sirolimus, an immunosuppressant used following liver transplantation. Do not use milk thistle without discussing it with your doctor.