American College of Nutrition Certified Nutrition Specialist | Author | Professor of Nutrition


NFLD – The Common Disease No One is Talking About

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Research shows 20-30% of American adults have Nonalcoholic Fatty Liver Disease (NFLD).  Yes, you read that correctly. One in four (maybe even 1 in 3) American adults has NFLD.

When 5% or more of your liver is full of fat you have NFLD.  Eating too much saturated fat (the kind that comes from animal products like meat, eggs and cheese), too much sugar, and too much cholesterol all contribute to NFLD. These fats and sugars accumulate in the liver, causing a lot of inflammation and impaired liver function.

What does our liver do?

Our liver stores fat, cholesterol, proteins and glucose. It makes amino acids and proteins, along with enzymes and neurotransmitters. It packages nutrients and sends them out into the bloodstream when they are needed. Many researchers call the liver our second brain, and for good reason.

Once nutrients are absorbed from a meal, they go to the liver for sorting, processing and storage. Our liver makes the proteins that escort nutrients like fat and cholesterol through the bloodstream, then bundles the proteins and fats together and releases them at the right time.

When we take medicine, or drink alcohol, or are exposed to chemicals in our environment, its our liver’s job to break them down into safe compounds that can be excreted. The liver is so important its one of the few organs that can regenerate itself, if its not too damaged.

Which is good news, because many of us will end up with fatty liver.

Nonalcoholic Fatty Liver Disease was practically unheard of until 1980.

In just the past 40 years it has become as common as diabetes. Obesity, diabetes, high cholesterol, high triglycerides, and high blood sugar all increase the risk of NFLD. Our liver takes in much of the fat, cholesterol and sugar in our meals, and when there is too much liver cells start to get full. The fat makes it hard for the cells to do their job, and the sugar causes inflammation and irritation in the cell.

This inflammation causes the cells to hold on to triglycerides (the main form of fat in our body) and blocks the pathway for these fats to be packaged and sent to the cells of the body for energy. So the liver keeps getting more and more full of fat, eventually making it hard for it to absorb any more. So the fat we eat stays in our bloodstream instead of being absorbed into cells. We all know too much fat in our blood is a bad thing.

Cholesterol also builds up in the liver cells, and with all of the inflammation going on it gets oxidized (attacked by free radicals). When cholesterol becomes oxidized, it can form into crystals, which are sharp and pointy. This causes more inflammation and damages liver cells.

White blood cells come in to try and help heal these cells, but they die when they absorb too much cholesterol and spill their contents in the surrounding tissue. Which results in more inflammation, which eventually can cause scarring of the liver tissue which can not be reversed.

How Do I Know if I Have NFLD?

If the blood tests you get each year show an elevation of liver enzymes with higher than normal triglycerides or blood sugar, you may have too much fat in your liver. Your doctor can then run more tests to see if you have NFLD. Catching NFLD early is important. The earlier its detected, the easier it is to reverse this process and heal.

Other signs and symptoms of NFLD are an enlarged liver that is tender to the touch, pain in the upper right abdomen, fatigue, and abdominal swelling. If you have high cholesterol, diabetes, insulin resistance, sleep apnea or obesity you are at a higher risk of NFLD.

Just one can of soda per day (12 ounces) increases our risk of NFLD by 300%. Yes, you read that correctly. We have a three-fold increase in our risk of developing NFLD by drinking just one soda per day. I think its because each 12 ounce serving of soda can have as many as 16 teaspoons of sugar. Rich desserts like ice cream and custard do the same thing.

Fried meats like fried chicken or chicken tenders dramatically increase our risk too, just like burgers and ribs. Eggs and cheese too, although these serving sizes tend to be smaller than meats.

The Good News

Diet and lifestyle changes are the best treatment for NFLD. A diet full of anti-inflammatory foods like fruits, vegetables, whole grains, beans, and nuts is essential. Exercise is essential too, to burn all of that extra fat coursing through our veins and in our liver.

In fact, with consistent diet and lifestyle improvements NFLD can reverse itself pretty quickly.

Once we stop eating the saturated fat and added sugars, the inflammation in our liver cells starts to calm down. Then those cells can start to burn the fat they have accumulated, and can clear it out into the bloodstream for other cells to use. This is all good, because we aren’t adding saturated fat to our bloodstream from our meals so our blood levels get down closer to normal.

Its like when we bring too much junk into our closets, and they become so stuffed you can’t get anything out, and then the junk starts spilling out into your hallways. Once you stop bringing in new junk, you can start clearing out the old junk. Then your closets can breathe and be functional again. Our livers are smarter than our closets, but you get the idea.

What Can I Do?

Foods like oatmeal, avocado and almonds are rich in compounds that reduce inflammation in the liver. Deeply colored fruits and vegetables like plums and peppers are great at reducing inflammation, so are herbs and spices. Avoid saturated fats and added sugars.

The Mediterranean Diet is pretty effective at reversing NFLD, even though its not a low-fat diet. Healthy fats like those in olive oil and nuts do not accumulate in the liver the same way saturated fats do, and actually seem to be protective of liver function.

Some medicine and herbal supplements can contribute to liver inflammation. Even common herbs like aloe, saw palmetto, and valerian, so please let your doctor know all of the supplements you are taking. Weight loss herbs and supplements can be very toxic to the liver, please do not take them.

Check with your physician before taking herbal remedies for NFLD. Milk Thistle is one herb that has shown some promise, along with vitamin E. Again, please check with your doctor or certified herbal medicine practitioner (not the person stocking shelves at Whole Foods or Sprouts) before you start taking these, as they can be harmful for some people.

Remember that herbal supplements do not replace a healthy diet and physical fitness.

Why is no one talking about it?

Many doctors finished medical school before NFLD was an identified condition, and certainly before it became this widespread. We used to think it was rare, but we now know that’s not the case. NFLD can lead to cirrhosis, when the liver becomes mostly scar tissue that can not regenerate itself. If caught early however, and lifestyle changes are made, NFLD can be reversed.

Ask your doctor if you are at risk of NFLD, or if you show the early signs of it. Elevated liver enzymes and triglycerides in your blood are usually the first signs. The sooner you deal with the issue, the better the outcome.

We all want to live long, healthy lives. A healthy liver is essential, so please take care of yours.

Send me an email ([email protected]) if you’d like help getting started. I will make it simple.


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