Nonalcoholic fatty liver disease (NAFLD) affects about 25% of the population, yet many people are unaware they have the condition. That’s because the disease doesn’t produce symptoms in its early and middle stages. But once the disease advances, it can be life threatening. That’s why early detection and lifestyle modifications are key. Dr. Arun J. Sanyal, a liver specialist at VCU Health and professor at the VCU School of Medicine, shares what you need to know about this condition and how to prevent or manage it.
What is nonalcoholic fatty liver disease?
Fatty liver can be caused by heavy alcohol use, but in this case, the fat buildup is related to metabolic complications of insulin resistance and obesity, which are risk factors for the disorder. Consider it the perfect metabolic storm where your fat tissue releases excessive fat into your bloodstream, which then becomes available to your liver. At the same time, insulin resistance paves the way for excess sugar in the liver to be stored as fat. This sets up other metabolic abnormalities and promotes cell injury, death and inflammation in the liver. Over time, this leads to scarring and irreversible liver damage.
A nutritious diet may protect against NAFLD
A balanced, nutritious diet can help you manage your weight and reduce your risk of insulin resistance, and therefore help protect against developing NAFLD. Additionally, you can help offset more serious liver damage with lifestyle changes, such as modifying your diet. Sanyal recommends sensible dietary changes that you can sustain over time. “Yo-yo dieting doesn’t help,” he says. Instead, he suggests making healthy eating a family affair. “If one person in the family is trying to change their eating habits while everyone else is maintaining the same pattern of eating, it can feel like a punishment. And that’s unlikely to lead to long-term changes.”
The best diet is one that promotes healthier blood-sugar levels and cardiovascular risk factors, he says. Here are some helpful strategies:
- Eat more plant foods, including fruits, vegetables, pulses, nuts and seeds. These foods supply protective compounds, including fiber and antioxidants. They’re also filling, which can help you manage your weight.
- Replace processed grains with whole grains. Refined carbohydrates, such as white bread and crackers, turn to sugar in your blood more quickly. This faster rise in sugar makes your body’s insulin response work harder, which sets the stage for insulin resistance.
- Cut way back on soda. These drinks are the leading source of added sugar in our diets, and they’re particularly harmful. They’re highly tied with NAFLD because the sugar from soda takes a shortcut to your liver, where it promotes fat deposition. Other sweetened drinks, like sports drinks and lemonade, are also culprits.
- Cook with and eat healthy fats. We under-eat the family of omega-3 fatty acids, which includes fats from seafood, walnuts, chia seeds and flax seeds. Yet these fats are protective since they have beneficial anti-inflammatory properties and have been associated with better markers of liver functioning. Studies also link walnuts with a lower risk of Type 2 diabetes, so they may be especially protective. When cooking, choose extra virgin olive oil or avocado oil — these oils have antioxidants and anti-inflammatory compounds that may protect against liver damage.
- Discuss your alcohol intake with your doctor. Alcohol is devoid of nutritional value and may further damage your liver. Talk to your provider about how much, if any, alcohol is safe for you to drink.
- Watch your portion sizes. Even on the healthiest diet, you can’t ignore how much you eat because if you consume more than your body needs, it will be converted to fat, explains Sanyal.
Staying active can reduce your risk of NAFLD
Sanyal says muscles are an underappreciated metabolic tissue. Normally, insulin helps usher sugar from your blood into your muscle, where it can be used for energy. But when you develop insulin resistance, your muscles are resistant to this action, so sugar accumulates in your blood. With excess sugar in the blood, you produce more insulin, and ultimately, the extra sugar gets converted to fat in your liver. Staying active can help guard against these abnormalities and protect you from insulin resistance and NAFLD. Even if you have insulin resistance, movement helps improve insulin sensitivity, so your muscles can take up the sugar in your blood — both during and after periods of activity.
Develop healthy sleep habits and stress-management practices
Sanyal points out that feeling stressed and being under-rested can play a part in the development of liver damage. For example, your circadian clock genes, which are genes that interact with each other to regulate your circadian rhythm, are also involved in managing fat metabolism in your liver. Plus, your circadian rhythm is involved in regulated glucose metabolism. Therefore, for these processes to function correctly, it’s crucial to get the recommended seven to nine hours of sleep per night.
Additionally, a heightened stress response — which, these days, can be a common reaction to ordinary daily stressors — can activate the sympathetic nervous system, which worsens insulin resistance. So be it a few minutes of deep breathing or journaling, finding healthy ways to cope with stress has a positive influence on your health.
NAFLD is often asymptomatic until later stages when it’s irreversible. Developing some healthier lifestyle habits and monitoring for liver damage — especially if you have Type 2 diabetes, insulin resistance or obesity — can help protect against more severe forms of liver disease. However, it’s important to work with a patient-centered provider who understands the barriers you face making lifestyle changes. Together, you can work on a manageable plan to help protect you from irreversible liver damage.