Non-alcoholic fatty liver disease: give your liver a gift this Christmas

You’d be surprised how many people have non-alcoholic fatty liver disease. It’s so common in fact, that almost one in four of us has it and most don’t even know!

As we overindulge in mince pies and Christmas pudding this holiday to help take our minds off the coronavirus pandemic, Dr Jeremy Cobbold, a consultant hepatologist and gastroenterologist, reminds us of how overeating and excessive amounts of sugar at your upcoming festivities might be leading you down the road to an unhealthy liver.

What is non-alcoholic fatty liver disease?

Non-alcoholic fatty liver disease (NAFLD) is an umbrella term for a whole range of liver conditions of people who drink very little or no alcohol. The main characteristic of this disease is just as the name implies – too much fat stored in the liver cells.

Occasionally, people can develop what is called non-alcoholic steatohepatitis, or NASH for short. This is a subtype and aggressive form of NAFLD, marked by liver inflammation and/or scarring in the liver.

What are the causes and risks of non-alcoholic fatty liver disease?

The most common causes of developing a fatty liver are from being overweight and obese, diabetic and from the use of alcohol. When someone is experiencing non-alcoholic fatty liver disease, only a small amount of people will actually develop complications including cirrhosis of the liver (including complications of chronic liver failure) and liver cancer. People with a fatty liver are also at an increased risk of having a heart attack and stroke because the same things that drive cardiovascular risks (high blood pressure, being overweight, and diabetes) are thought to also be drivers of non-alcoholic fatty liver disease.  

How do you develop it?

Fatty liver disease is increasing all around the world and the main drivers are increasing levels of obesity and prevalence of type two diabetes.

Throughout western societies, there’s easy availability of processed and refined foods, and our lives are becoming increasingly sedentary. When people become more overweight, their body becomes resistant to the insulin hormone and in some people that leads to diabetes. The liver is then exposed to higher levels of sugars and fats in the blood which can damage the liver. Typically, the body’s response to this is to turn these sugars and fats into triglyceride which are stored as fat droplets in the liver cells leading to a fatty liver.

There are other causes of fatty liver which may occur without being overweight or being diabetic, the most important being excessive alcohol consumption. If you routinely drink excessive amounts of alcohol, then that can increase your risk of complications including a fatty liver. If you currently have a fatty liver caused by diabetes and obesity, then alcohol makes this worse.

Considering the causes of fatty liver, we should also remember that certain medications can be the cause, such as steroids, tamoxifen, some anti-psychotic drugs and heart drugs such as amiodarone.

What are the signs and symptoms of having a fatty liver?

Most people with fatty liver don’t show symptoms. Typically, it is picked up on routine blood tests, health checks or ultrasound scans performed for other reasons. But, some people with fatty liver disease can have nonspecific symptoms including fatigue and vague abdominal pain particularly on the right upper side of the abdomen.

Because of this, we need to work towards looking for this condition in people who have the risk factors which means considering it in anyone who has type 2 diabetes and/or obesity. Many specialists would advise people with these conditions to have a test to look for liver scarrings, such as a FibroScan or a specialist blood test. Routine liver tests are not a reliable guide to the severity of the fatty liver disease.

Body mass index is often used to define if someone is overweight or obese but we all know that people have different body shapes. Whereas some people will carry fat on their bottoms and thighs (so-called “pears”) other people carry fat around the middle, particularly around the abdominal organs (so-called “apples”). This is known as central obesity or visceral adiposity and it is this form of fat distribution that is most strongly associated with liver problems and metabolic complications, such as diabetes and cardiovascular disease.

Is non-alcoholic fatty liver disease reversible?

The good news is that most forms of liver disease are reversible. The most effective treatment is weight loss through a combination of dietary modification and exercise.

If you can lose between 7-10% of your body weight, that is likely to lead to a significant improvement in the fat, inflammation and even scarring. Clearly, this will also have other beneficial health effects.

We don’t yet have specific medications for this condition, although there are several agents in late-stage clinical trials that may be available soon. You may be recommended to take medications for blood and cholesterol management and diabetes, some of which have beneficial effects on the liver too.

Are any particular foods good for reducing a fatty liver?

As a general rule, refined carbohydrates and sugars tend to lead to people increasing the number of calories they consume and are associated with people gaining weight. So sweets, chocolate, biscuits, and particularly sweetened soft drinks are major contributors and should be reduced in the diet where possible. Other things like fried foods, crisps and savoury snacks (pastry and sausage rolls) are also energy-rich and can encourage weight gain. If you eat a diet rich or high in these things, you are likely consuming too many calories which can cause fatty liver.

So to improve it minimise sugary, fatty and processed foods. You should be increasing the following foods in your diet:

• fresh vegetables
• fruit (within reason as fruit is often sugary)
• lean
• good quality protein, such as fish and meat (chicken and turkey)
• pulses (lentils, beans, peas)
• vegetable-based foods (soya)

There’s also some more good news for coffee lovers. Coffee has also been shown in several studies to be potentially helpful in reducing the severity of a fatty liver. However, be careful with the cream and syrups!

As we all know it’s important not to lead a sedentary lifestyle as this greatly contributes to non-alcoholic fatty liver disease. Try to be increasing your activity every day, by walking and cycling more, and getting away from your desk as much as possible. Exercise is great for your well-being - it’s recommended to do at least 30 minutes of moderate exercise five times a week.

Dr Jeremy Cobbold is a consultant hepatologist and gastroenterologist at The Manor Hospital in Oxford. To book an appointment with him, check his availability here.