You probably know that obesity can have an adverse effect on the heart, increasing the risk of heart disease, heart attacks and stroke. But what you may not know is that being seriously overweight can also lead to a serious liver condition called nonalcoholic fatty liver disease, or NAFLD, which occurs when fat builds up in the liver. Alarmingly, this condition is now the most common cause of chronic liver disease in the U.S., far surpassing alcohol-related liver disease. In addition, NAFLD is now one of the leading reasons for liver transplant in the U.S.
An estimated 20-30% of Americans have NAFLD, although most probably don’t know it because it progresses without symptoms. While the short-term effects are minimal, the potential long-term complications—gastrointestinal bleeding, anemia, encephalopathy (abnormal brain function), cirrhosis, liver cancer and liver failure—are the same serious health problems that often occur after decades of alcohol abuse.
Not just limited to adults, nonalcoholic fatty liver disease is also showing up in some of our pediatric patients at Westchester Health, most likely directly related to the obesity epidemic in the U.S. While the disease typically has no symptoms, some people experience pain in the upper right abdomen, fatigue and weight loss. Left untreated, NAFLD could cause permanent scarring of the liver and even liver failure.
How being overweight affects your liver
Due to genetics, lifestyle habits and other factors, people vary in the amount of weight gain their bodies can tolerate before they become resistant to insulin and start developing Type 2 diabetes. However, once people pass a certain threshold in terms of substantial weight paired with low activity level, the pancreas cannot produce enough insulin to keep the levels of blood sugar and blood fat (cholesterol) under normal control. This is when NAFLD appears to develop—when the liver (which regulates the amount of sugar and fat in the blood) becomes overwhelmed and starts storing excess fat in its own liver cells.
If too much of this stored fat builds up, or if certain genetic conditions are present, the fatty liver tissue can become inflamed, causing the liver cells to be damaged or destroyed. If the damage continues, NAFLD can lead to cirrhosis—permanent scarring of the liver—which progressively destroys the liver’s ability to function.
The good news: you can avoid (or lessen the effects of) NAFLD by changing your diet
Studies have now proven that a diet high in saturated fats can increase the risk of NAFLD. It is much more prevalent in western countries, including the United States, suggesting a strong correlation between a high fat diet and this disease. Switching to a low fat diet and maintaining a regular exercise program, with the goal of weight loss, has been shown to lessen the effects of NAFLD. Even weight loss of as little as 10 pounds has been shown to reduce liver fat, thereby reducing the risk of NAFLD.
Anyone who carries a lot of extra weight—especially around the belly—should be concerned about developing NAFLD. For my patients who are seriously overweight, I recommend testing for insulin resistance, Type 2 diabetes and high cholesterol. All of these conditions contribute not only to NAFLD but also to a host of other serious illnesses.
Although there is no medical treatment for NAFLD, most people can stabilize or even reverse the liver disease process by losing weight and choosing lifestyle habits that support, rather than harm, the liver. If you have been evaluated to be at risk of NAFLD, it would be a good idea to take the following steps to improve your health:
- Focus most of your diet (40-50%) on vegetables (not counting root vegetables like beets, potatoes and yams, which are high in carbohydrates).
- Limit (but don’t eliminate) carbohydrates. Your brain requires them, but most Americans consume them in much greater quantities than are needed. Carbohydrates should make up about 25% of your diet, or no more than a quarter of your plate. Think of carbs as dessert: if you decide to have French fries or mashed potatoes, that’s your dessert. Forego the ice cream, cookies, chips, juice, soda or whatever carb source you were planning on to finish your meal.
- Fill in the rest of your diet (25-35%) with lean, high-protein foods such as low-fat dairy, lean meat, fish, eggs, nuts and legumes.
- Commit to a program of regular exercise (walk, run, swim, bike, basketball, tennis, dance, join a gym), gradually working your way up to 30-60 minutes per session, 3-7 days a week. Talk to your doctor first to make sure you are physically able to exercise.
- Limit or eliminate alcohol which not only contributes to potential liver damage but also is another source of empty carbohydrates.
No medication, surgery or doctor can do more for the health of your liver than you can
Exercising your body and feeding it wisely are the two most important actions you can take to maintain a healthy liver. These changes will not only help you combat nonalcoholic fatty liver disease but will help you shed pounds, avoid diabetes and high cholesterol, and reduce your risk for heart disease, stroke and cancer.
Concerned about NAFLD? Please come see us.
If you think you are at risk for nonalcoholic fatty liver disease, please call (914) 232-1919 to make an appointment with one of our Westchester Health gastroenterology specialists for an accurate diagnosis. The sooner we determine if you have NAFLD (or are at risk of developing it) and start you on an intervention program, the healthier your liver will be and the better quality of life you will have. Whenever, wherever you need us, we’re here for you.