By Ramnique Ubhi, Naturopathic Doctor

You might have heard about fatty liver or even been told you have fatty liver but what exactly does it mean? The most common form of fatty liver is Non-alcoholic fatty liver disease (NAFLD). In NAFLD, excess fat accumulates in the liver, known as hepatic steatosis. NAFLD occurs in the absence of high alcohol intake, hereditary conditions and/or medication use that could cause fatty liver.

In Western countries, the prevalence of NAFLD is around 20-30% and increasing. NAFLD is found in:

• 50 to 70% of individuals with diabetes.

• 80 to 90% of obese adults.

• 90% of individuals with hyperlipidemia (such as high cholesterol and/or triglycerides)

There are often minimal symptoms in early stages of NAFLD and it is usually found unintentionally on imaging such as ultrasounds and/or blood work such as liver enzymes. Fatigue, upper abdominal pain, thirst, bloating and issues with sleep are some symptoms that can occur.

NAFLD can worsen over time, impacting the function of the liver, and progress into cirrhosis of the liver or even hepatocellular carcinoma. That is

why it is so important to diagnose fatty liver early and prevent it from worsening.

Why/how does Fatty Liver occur?

Factors such as genetics, age, sex, ethnicity and environment all play a role in the occurrence of NAFLD. While fatty liver can occur at any age, even in children, it is more prevalent in middle age. Males, individuals with first-degree relatives that have NAFLD and ethnicities like Hispanic, non-hispanic whites, and Asian Americans are also at a greater risk for developing fatty liver. Environmental factors like diet and lifestyle also contribute to NAFLD formation because it is strongly associated with metabolic syndrome and insulin resistance. Other risk factors that are associated with fatty liver are: Obstructive sleep apnea, Small intestinal bacterial overgrowth (SIBO), Hypothyroidism, PCOS, and more.

Since almost 80% of individuals with Metabolic syndrome have NAFLD, it is important to determine if you have Metabolic syndrome because further investigations into fatty liver will be warranted.   

Metabolic syndrome is a collection of conditions that worsen cardiovascular health. You have Metabolic syndrome if you have 3 of the following conditions:

• Abdominal obesity/large waist circumference (greater than 88cm in women and 102cm in men)

• High blood pressure

• High blood sugar levels

• High triglycerides

• Low HDL (“good”) Cholesterol

Not only do these conditions increase the risk of fatty liver, but they also increase the risk of cardiovascular disease, diabetes and stroke.

High blood sugar levels and insulin resistance are direct contributors of NAFLD because the body takes this extra sugar and deposits it as fat in liver cells (also in other organs) leading to fatty liver. Sedentary lifestyles and increased fast food and carbohydrate intake can cause and worsen insulin resistance and metabolic syndrome.

Because worsening blood sugar regulation is a driving factor of NAFLD, a new name has been suggested to replace NAFLD: Metabolic dysfunction-associated steatotic liver disease (MASLD).

If you have fatty liver or have any of the factors that are associated with NAFLD, it is important to chat with a medical practitioner to further investigate with imaging and blood work. Speak to one of our Naturopathic doctors to learn more about which labs/blood work can help determine the cause of fatty liver and what treatments, like diet/lifestyle changes, vitamins/minerals and botanical medicine, can help prevent fatty liver from occurring and worsening.

Dr. Ramnique Ubhi, ND
Naturopathic Doctor

References:

Antunes, C., Azadfard, M., Hoilat, G. J., & Gupta, M. (2023). Fatty Liver. In StatPearls. StatPearls Publishing. PMID: 28723021.

Kim, D., Touros, A., & Kim, W. R. (2018). Nonalcoholic Fatty Liver Disease and Metabolic Syndrome. Clinics in liver disease, 22(1), 133–140. https://doi.org/10.1016/j.cld.2017.08.010

U.S. Department of Health and Human Services. (n.d.). Definition & Facts of NAFLD & Nash - NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/definition-facts

U.S. Department of Health and Human Services. (n.d.). What is metabolic syndrome?. National Heart Lung and Blood Institute. https://www.nhlbi.nih.gov/health/metabolic-syndrome