Do I have it & what can I do about it?
It is well known that excess alcohol and hepatitis can cause serious liver disease, which can be fatal. What is much less appreciated is that you can have liver disease without the alcohol or viral infection. In fact, it is extremely common in today’s American society, to a much greater extent than is alcoholic or viral liver disease. It is called Non-Alcoholic Fatty Liver Disease (NAFLD). It would be more accurate to call it a condition, rather than a disease because, unlike cirrhosis of the liver (which is irreversible and fatal), fatty liver is reversible. At B•Strong4Life, we emphasize the importance of weight loss and lifestyle changes to decrease your chance of such conditions.
Like many chronic conditions, liver disease is a “spectrum disorder”, which simply means that there are a host of liver conditions that may progress from the less serious NAFLD, to the more serious (but still potentially reversible) Non-Alcoholic Steatohepatosis or Steatohepatitis (NASH); both of which can advance to the irreversible and eventually fatal cirrhosis. Of course, excess alcohol can cause these conditions as well.
What causes NALFD? While there are many contributing factors, the most common are: overweight and obesity, blood sugar dysregulation (metabolic syndrome and diabetes), gastrointestinal dysbiosis (increased levels of unfriendly bacteria and decreased levels of friendly or probiotic bacteria), and gastrointestinal permeability (also called Leaky Gut Syndrome), coupled with increased levels of circulating bacterial endotoxins. It should also be mentioned that overuse of Non-Steroidal Anti-Inflammatory medications (NSAID’s) are a major cause of liver disease as well as mortality from liver and gastrointestinal damage. Commonly, more than one of these factors is in play at the same time. We always recommend weight loss when necessary to prevent such diseases.
Part of the problem with diagnosing NAFLD is that there are no symptoms, therefore it isn’t commonly evaluated, and is therefore under-reported. For example, a recent study found that 68% of obese children already had NAFLD. Common physical exams and lab tests may miss a large number of cases, as liver enzymes do not need to be elevated for NAFLD to be present. Tests such as MRI, CT scan, and liver ultrasound may also miss diagnosing NAFLD. The gold standard is liver biopsy, but that certainly isn’t indicated in the vast majority of cases. Fortunately there is a very accurate, simple, and free way to assess for the condition; called the waist to height ratio (WHtR). Measure the circumference of your waist at the belly-button. Divide it by your height. This gives you the WHtR. Depending on the research article cited a ratio of greater than 0.5-0.6 is highly predictive of NAFLD. One study compared the WHtR to the gold standard of biopsy and concluded that a ratio of >0.5 was highly indicative. Another compared the measurement to ultrasound and concluded that a ratio >0.59 was significant. Therefore if your WHtR is >0.6, it is highly probable that you have NAFLD. Of course, if you have elevated liver enzymes (GGT, AST, or ALT), or positive CT Scan, MRI, or ultrasound findings, you undoubtedly have NAFLD. Another good indicator (although not specific for NAFLD), is a chronically elevated C-Reactive Protein (C-RP), which is a lab test for chronic inflammation.
If you have NAFLD, you want to catch it early, while it is reversible. So how do you improve liver function? First, stop doing the things that are causing the problem in the first place, including reducing intake of NSAID medications (talk to your doctor first if you have been prescribed these drugs), improve your blood sugar and insulin levels, and lose body fat. In my personal experience, initiating a low-fat Ketogenic diet, such as the Ideal Protein program, has been effective in reducing weight, blood sugar, insulin, and liver enzymes, without exception, in every patient who has complied with the program to date.
There are also a number of natural products, called Nutriceuticals that studies have shown to be helpful in improving liver function. These include, but are not limited to: tocotrienols, resveratrol, curcumin, quercetin, essential fatty acids, and probiotics. For the more severe cases, where liver enzymes are elevated and there is gall bladder involvement, a comprehensive program of liver function improvement may be useful. Two recent clinical trials using a blend of probiotics, combined with a prebiotic blend (prebiotics are basically food for friendly bacteria) to be beneficial for reducing liver enzymes, and reducing C-Reactive Protein in overweight and obese patients with NAFLD.
In our office, we commonly evaluate patients for body fat percent (25-30% is considered overweight and > 30% obese), Waist-height ratio, liver enzymes, C-RP, fasting blood sugar, HbA1C (average blood sugar over 90-120 days), and fasting insulin levels, which assess for the most common causes of NAFLD. If your WHtR is >0.5, you may wish to have further assessment and treatment to reduce your risk for progression to more serious liver diseases. We offer patients the chance to change their lives through weight loss programs, functional nutrition treatments, and advanced chiropractic care.