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Fix your Non-Alcoholic Fatty Liver

Non-Alcoholic Fatty Liver Disease (NAFLD) is a disease of the liver not related to alcohol consumption, but rather from our diet and lifestyle that results in fatty deposits in the liver. It is now often referred to as Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD). How to fix Non-Alcoholic Fatty Liver Disease? Changing your diet to reflect a Mediterranean Diet can be a real life saver.


What is Non-Alcoholic Fatty Liver Disease?

Liver disease is the spectrum of liver damage ranging from Non-Alcoholic Fatty Liver Disease (NAFLD), to Non-Alcoholic SteatoHepatitis (NASH), to Cirrhosis and Hepatocellular Cancer (HCC or Liver Cancer.) NASH is the more aggressive form of NAFLD, is irreversible, and as a consequence places the person at significant risk of death from liver failure.


Non-Alcoholic Fatty Liver Disease (NAFLD) is present in approximately 30% of the world's population. It coexists with the majority of people who are obese and have Type-2 Diabetes (T2DM) and is characterised by increased triglyceride and increased insulin levels. It is the manifestation of Metabolic Syndrome in the liver.


Difference between NAFLD and NASH and HCC

  • NAFLD - there is fat accumulation in the liver cells plus insulin resistance in NAFLD. Importantly, this is a reversible condition.

  • NASH - where there is further oxidative stress, endotoxins and inflammatory cells infiltrating the liver. From this point on it is an irreversible condition.

  • HCC - 'ballooning' of the liver in the presence or absence of fibrosis. This is an irreversible condition.

  • Cirrhosis is a complication of NAFLD and NASH from the liver trying to prevent inflammation, where scarring (fibrosis) occurs. Fibrosis occupies more space in the liver, hence why you can 'see' an inflamed liver underneath peoples clothing.

Statistics:

  • 30% of NAFLD progresses to NASH

  • 20% of NASH progresses to Cirrhosis

Graphic showing Normal liver progressing to cirrhosis via NAFLD and NASH
Reversible and irreversible paths in Liver Disease

How does Non-Alcoholic Fatty Liver Disease Develop?

There are several mechanisms believed to be behind the formation of NAFLD. These include:


Fatty Acid Metabolism Imbalance

Excess fat consumption and excess food consumption in general leads to excess fatty acids and glucose, causes insulin resistance. This causes fatty deposits in liver cells. It is important to note that fatty deposits do not just come from fat consumption. Excess fat consumption can also cause potential issues with oxalate formation (kidney stones and painful arthritis-like symptoms).


Endotoxin Behaviour

Certain bacteria in our gut microbiome (Gram negative bacteria with endotoxins in their cell walls), trigger our innate immune system, resulting in the release of pro-inflammatory cytokines (IL-6, IL-1, TNF-a) which is not desirable. How do we get these gram negative bacteria in the first place? Dietary choices we make like meals high in red meat, saturated fat, processed foods etc and low in dietary fibre.


If we combine this with a leaky gut (intestinal permeability) which occurs in settings where there may be nutritional or environmental issues, or diabetes for example, then the endotoxins are able to cross directly into our blood circulation via the portal vein, which has direct access to the liver. So this means inflammatory substances go straight to the liver, which is not desirable.


Often there is bacterial overgrowth in our gut microbiome that is pro-inflammatory from dietary choices, setting us up for inflammation in the liver. This is one reason why we test the gut microbiome to test what sort of microbiota you have hanging out.


Oxidative Stress

Pro-inflammation from the gram negative bacteria results in oxidative stress, which means the production of reactive oxygen species (ROS) which is again not desirable. The products of this lipid peroxidation go on to alter our mitochondrial DNA, and trigger NFkB (project manager of inflammation) that upregulates TNFa that leads to even more pro-infallamtory changes and even further mitochondrial reactive oxygen species (ROS). Think - bushfire!


It is known that the microbiota that live in the distal colon (last part of the colon), absorb short chain fatty acids (SCFA) from fibre - which is a good thing. In the absence of a diet high in dietary fibre, the distal colon will absorb protein which results in harmful products like ammonia, branched chain fatty acids (BCAA), hydrogen sulphide, phenols etc.


If we absorb SCFA then we get the positive effects of insulin secretion, feeling satiated, and stimulate anti-inflamatory processes - a great thing! However if we absorb the harmful effects of protein in a heavy meat, low vegetables and fruits diet, then we get harmful inflammation of the liver, and fat accumulation in the liver a.k.a the beginnings of NAFLD.


Dietary changes to include more fibre need to happen to prevent this from progressing further down the spectrum of liver disease. Remember that at this atge it is reversible, but if ignored it will be irreversible, and on a negative final trajectory for your life.


Prebiotic fibre can assist greatly, as can ensuring you have lots of vegetables and fibre to 'outweigh' the heavy protein diet. Increasing fibre provides a mix of prebiotic fibres to prevent obesity, NAFLD and T2DM. Supplementing with prebiotic fibre is crucial at this point.


Graphic showing whole foods as healthy, while lean red meat as potential source of inflammation and high far dairy as inflammatory
How eating can predict if you are going to develop NAFLD based on gut microbiome inhabitants

Symptoms of NAFLD

  • Often there are no signs and symptoms at all, but can include:

  • Fatigue

  • Malaise

  • Pain in upper right rib area

Conditions associated with NAFLD include obesity, insulin resistance, obstructive sleep apnoea, hypothyroidism, hypertension, polycystic ovarian syndrome (PCOS from Insulin Resistance)


Symptoms of NASH

  • Itchy skin

  • Ascites

  • Shortness of Breath

  • Swelling of legs

  • Spider veins beneath skin

  • Enlarged spleen

  • Red palms

  • Yellowing of skin and eyes

Complications can include swollen veins in oesophagus (oesophageal varices that can result in deathly bleeding), sleepiness, slurred speech, Liver cancer and finally Liver failure


How to Fix Non-Alcoholic Fatty Liver Disease?

  • Dietary choices designed to follow a Mediterranean Diet

  • Increase fibre for prebiotic effects

  • Minimise protein from red meat

  • Eats walnuts, chia seeds and oily fish for omega-3 (anti-inflammatory)

  • Eat seeds for antioxidant effect from Vitamin E

  • Consume unsaturated fats (olive oil, avocados, nut butters)

  • Eat green, leafy vegetables to prevent fat build up

  • Lower blood lipids (Bergamot, Aged Garlic)

  • Lower blood sugar dysregulation (Berberine)


Supplements to consider

As shown by the graphics below, there are suitable supplements to incorporate into your diet that should be discussed with a qualified practitioner before use. For example, globe artichoke may cause problems if you have gallstones which are often found with NAFLD.



Graphic showing NAFLD and how supplementation can intervene the pathophysiology
Supplements as well as Interventions, Testing, Diet, Lifestyle for NAFLD

Actions of supplements shown on the progressive spectrum of NAFLD and how they intervene is shown in the graphic below.

Graphic showing the 4 stages of NAFLD progression with interventional supplements and how they act
The 4 stages of NAFLD progression with supplement interventions that can be life saving
Pathology results

Pathology results can give amazing insight into liver conditions.

  • Markers to watch for fatty food consumption or excess glucose consumption are triglycerides and fasting insulin.

  • Liver enzymes can become elevated, and ALT should be 'watched like a hawk'. AST also provides valuable insight.

  • A marker that can give a clue to excess protein consumption is ALP, which is required to break down protein. If your diet is high in protein and low in dietary fibre, then you may have an elevated ALP level, and be on the path to developing NAFLD.

Pathology results should always be viewed closely by a qualified practitioner.


If you would like to discuss your concerns around elevated liver enzymes, or concerns about your diet and lifestyle, or about non-alcoholic fatty liver disease (NAFLD), and put plans in place to correct this reversible condition before it becomes irreversible, then please don't hesitate to make a booking with me.



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