Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons.

A healthy liver should contain little or no fat (up to 2.5% by weight).

Fatty liver simply means fat deposits in the liver. In the early stages, fatty liver is not harmful and can be reversed. However, as the disease progresses it leads to inflammation and scarring of the liver, and decreased liver function – this is the serious stage of the disease.

There are two main types:

  • Alcoholic fatty liver disease, also called alcoholic steatohepatitis
  • Nonalcoholic fatty liver disease (NAFLD)

30 years ago, advanced fatty liver disease (non-alcoholic steatohepatitis (NASH)) was so rare there wasn’t even a medical name for it!

NAFLD affects about 25 percent of people in the world. And as the rates of obesity, type 2 diabetes, and high cholesterol are rising in the UK, so is the rate of NAFLD.

It’s estimated that up to 1 in every 3 people in the UK has early stages of NAFLD, that is where there are small (but increasing) amounts of fat in their liver. Because of this, NAFLD is the most common chronic liver disorder in the UK.

 

The Dangers

Early-stage NAFLD doesn’t usually cause any harm, but it can lead to serious liver damage, including cirrhosis, if it gets worse. Having high levels of fat in your liver is also associated with an increased risk of problems such as diabetes, heart attacks and strokes.

If detected and managed at an early stage, it’s possible to stop NAFLD getting worse and reduce the amount of fat in your liver.

 

What is nonalcoholic fatty liver disease (NAFLD)?

NAFLD is a type of fatty liver disease that is not related to heavy alcohol use. There are two kinds:

  • Simple fatty liver, in which you have fat in your liver but little or no inflammation or liver cell damage. Simple fatty liver typically does not get bad enough to cause liver damage or complications.
  • Non-alcoholic ste-ato-hepatitis (NASH), in which you have inflammation and liver cell damage, as well as fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer.

What is alcoholic fatty liver disease?

Alcoholic fatty liver disease is due to heavy alcohol use, as your liver breaks down most of the alcohol you drink, removing it from your body. But this process of breaking it down can generate harmful substances which can damage liver cells, promote inflammation, and weaken your immune system.

The more alcohol that you drink, the more you damage your liver. Alcoholic fatty liver disease is the earliest stage of alcohol-related liver disease.

The next stage is alcoholic hepatitis and cirrhosis.

Stages of NAFLD

Non-Alcoholic Fatty Liver Disease (NAFLD) develops in 4 main stages, and most people will only ever develop the first stage, usually without realising it.

 In a small number of cases, it can progress and eventually lead to liver damage if not detected and managed.

The main stages of NAFLD are:

  • simple fatty liver (steatosis) – a largely harmless build-up of fat in the liver cells that may only be diagnosed during tests carried out for another reason
  • non-alcoholic steatohepatitis (NASH) – a more serious form of NAFLD, where the liver has become inflamed; this is estimated to affect up to 5% of the UK population
  • fibrosis – where persistent inflammation causes scar tissue around the liver and nearby blood vessels, but the liver is still able to function normally
  • cirrhosis – the most severe stage, occurring after years of inflammation, where the liver shrinks and becomes scarred and lumpy; this damage is permanent and can lead to liver failure (where your liver stops working properly) and liver cancer

 

It can take years for fibrosis or cirrhosis to develop. It’s important to make lifestyle changes to prevent the disease getting worse.

 

Am I at risk of NAFLD?

The definite cause of NAFLD is not fully known, but it is known that the condition is more common in people who:

  • Have type 2 diabetes and prediabetes
  • Are obese, and therefore likely a poor diet. Estimated that 90% of people that are obese will have some form of Fatty Liver Disease
  • A diet heavy in added sugars, particularly non-natural fruit sources of fructose
  • Are middle aged or older (although children can also get it)
  • Have high levels of fats in the blood, such as cholesterol and triglycerides
  • Have high blood pressure
  • Take certain drugs, such as corticosteroids and some cancer drugs
  • Have certain metabolic disorders, including metabolic syndrome
  • Have rapid weight loss
  • Have certain infections, such as hepatitis C
  • Have been exposed to some toxins
  • Smoke 

What are the symptoms of fatty liver disease?

Both NAFLD and alcoholic fatty liver disease are usually silent diseases with few or no symptoms at the early stages, which makes them potentially very dangerous. A person probably won’t know they have it unless it’s diagnosed during tests carried out for another reason.

If you do have symptoms, you may feel tired or have discomfort in the upper right side of your abdomen. In addition, occasionally, people with NASH or fibrosis (more advanced stages of the disease) may experience:

  • a dull or aching pain in the top right of the abdomen (over the lower right side of the ribs)
  • fatigue (extreme tiredness)
  • unexplained weight loss
  • weakness

If cirrhosis (the most advanced stage) develops, you can get more severe symptoms such as yellowing of the skin and the whites of the eyes (jaundice), itchy skin, and swelling in the legs, ankles, feet or tummy.

If you are in any doubt, you may want to speak with your doctor.

 

What are the treatments for fatty liver disease?

Doctors recommend weight loss for nonalcoholic fatty liver as weight loss can reduce fat in the liver, inflammation, and fibrosis.

If your doctor thinks that a certain medicine is the cause of your NAFLD, you should stop taking that medicine. But check with your doctor before stopping the medicine. You may need to get off the medicine gradually, and you might need to switch to another medicine instead.

As of the time of writing, there are no medicines that have been approved to treat NAFLD.

However, not wishing to miss out on a profit-opportunity, Big Pharma have spent billions to find a drug to treat non-alcoholic fatty liver disease. Watch this space…

The most important part of treating alcohol-related fatty liver disease is to stop drinking alcohol.

 

What are some lifestyle changes that can help with Fatty Liver DIsease?

If you have any of the types of fatty liver disease, there are some lifestyle changes that can help:

  • Lose weight if you are overweight or obese – losing more than 10% of your weight can remove some fat from the liver and improve NASH if you have it
  • Eat a healthy diet – try to have a balanced diet high in fruits, vegetables, protein and complex carbohydrates, but low in fat, sugar and salt; eating smaller portions of food can help too
  • Stop eating foods with sugar added to them – specifically High Fructose Corn Syrup – and control your overall sugar intake
  • Cut out sugar-sweetened drinks – one study found that adults who drank more than one sugar-sweetened drink per day were 55% more likely to have fatty liver than those who didn’t consume sugary drink
  • Exercise regularly – aim to do at least 150 minutes of moderate-intensity activity, such as walking or cycling, a week; all types of exercise can help improve NAFLD, even if you don’t lose weight
  • Stop smoking – if you smoke, stopping can help reduce your risk of problems such as heart attacks and strokes
  • Reduce or cut-out alcohol consumption
  • NAFLD isn’t caused by alcohol, but drinking may make the condition worse. It is therefore advisable to cut down or stop drinking alcohol.