Fatty Liver Disease Is A Serious Risk
Hypertension or high blood pressure is known as “the silent killer” because people who have it don’t have any symptoms. Besides hypertension, there is another medical condition with silent signs, and if left undetected, it can cause serious, if not fatal, harm.
Nonalcoholic steatohepatitis (NASH) can seriously affect the liver while it lurks silently in the bodies of people with the condition. NASH is an aggressive form of fatty liver disease. It develops when fat gradually builds in the liver and causes inflammation.
For the most part, NASH does not cause symptoms in the early stages, except for an occasional pain in the right upper side of the abdomen. However, when NASH is detected, the liver is already damaged.
“Patients do not know they have it, and it does not hurt,” Dr. Blanca Lizaola-Mayo, a transplant hepatologist and the Medical Director of the Liver Transplant Center at the Mayo Clinic in Arizona, told USA Today. “So they are presenting for care when they have decompensated liver failure or even liver cancer.”
While long-term alcohol abuse can cause fatty liver disease, NASH is different because the condition can develop in people who drink little to no alcohol. This is why NASH falls under the category of nonalcoholic fatty liver disease (NAFLD).
An estimated 100 million people in the United States have NAFLD, and of those, about 20 percent have NASH, according to the American Liver Foundation (ALF). Moreover, NAFLD is projected to become the most common cause of liver transplantation in the United States by 2030.
Furthermore, NAFLD is not limited to adults. The ALF reports that NAFLD is the most common form of liver disease in children, and that number has more than doubled over the past 20 years.
The Risk Factors and Symptoms of NAFLD and NASH
Just as there are risk factors for hypertension, the “silent killer,” hypertension is one of the risk factors that can lead to developing NAFLD and NASH. Other serious risk factors include:
• Type 2 diabetes
• Insulin resistance syndrome
• Obstructive sleep apnea
• High cholesterol
• High levels of triglycerides (fat) in the blood
• Medical conditions that cause the body to use or store fat improperly
According to Dr. Lizaola-Mayo, type 2 diabetes and obesity are the primary risk factors for fatty liver disease. However, these risk factors and other severe conditions combine to form “metabolic syndrome,” another risk factor for fatty liver disease. Dr. Lizaola-Mayo says she sees fatty liver as the” liver manifestation of metabolic syndrome.”
Over time, fatty liver disease can turn into cirrhosis, which is severe scarring of the liver. According to ALF, people who have NASH and cirrhosis may also experience symptoms such as:
• Pain in the upper right side of the abdomen
• Bruising and bleeding easily
• Swelling in the belly, legs, feet, or ankles (edema)
• Yellow discoloration in the skin and eyes (jaundice)
• Behavior changes, slurred speech, and confusion
• Itchy skin
• Enlarged blood vessels just beneath the skin’s surface
Who Should Be Screened for Fatty Liver Disease?
Dr. Lizaola-Mayo says primary care and endocrinology providers frequently ask her who should be screened for NAFLD and NASH. She recommends that patients should be screened if they have:
• Two or more metabolic risk factors
• Elevated liver enzymes for more than six months
• Hepatic fat is seen on an ultrasound or computed tomography (CT scan)
Dr. Lizaola-Mayo says patients with a low risk of developing NAFLD or NASH can be seen by their primary care physician or an endocrinologist, a specialist who treats people with diseases and conditions caused by hormones, such as diabetes and thyroid problems. Patients with an increased risk should be referred to a hepatologist, who specializes in treating the liver, or a gastroenterologist, who specializes in treating the digestive system, which includes the liver.
Patients at an intermediate or severe risk can undergo a FibroScan test, which can help determine the elasticity of the liver and how much damage has been done to the liver. Doctors can also perform a liver biopsy (a tissue sample) to determine how far advanced the liver disease has progressed.
Dr. Lizaola-Mayo encourages patients to learn about the risk factors and become their own advocates. “We need to encourage people to ask providers if they have identified themselves as having risk factors (being overweight, having diabetes, having a family history, etc.) and asking their providers to get tested.”
How Do You Treat Fatty Liver Disease?
Currently, no medication treats fatty liver disease. Because of this, Dr. Lizaola-Mayo says she’s asked whether there are supplements that can help the liver.
“The only thing that cleanses the liver is the liver itself,” she told USA Today. “No supplements have been shown to be beneficial for the liver, and we have actually seen patients who have made it to the hospital with acute liver failure because of the supplements.”
Dr. Lizaola-Mayo jokes that what may help is black, caffeinated coffee. “At least 3 cups of coffee a day will keep the hepatologist away,” she said.
Because there is no specific medication for fatty liver disease, doctors recommend that patients make lifestyle changes to improve their health. According to the Cleveland Clinic, doctors generally recommend treatment that includes:
• Avoiding alcohol
• Losing weight
• Taking medications to manage diabetes, cholesterol, and triglycerides
• Taking vitamin E and thiazolidinediones (drugs used to treat diabetes, such as Actos and Avandia) in specific instances.
It’s not all bad news, though. Medical experts say the liver has an incredible ability to heal itself. And it’s possible to minimize liver fat and inflammation and repair early liver damage by avoiding alcohol and losing weight.
Making lifestyle modifications may sound easy to do, but it’s not. Dr. Lizaola-Mayo tells her patients, “One of the toughest things they will ever do is diet and exercise because it is so difficult.”
“We go on a diet, we lose weight, and then we stop the diet, and we gain weight back,” Dr. Lizaola-Mayo explains to USA Today. “So there has been a lot of research into what the best diet is, and it’s the Mediterranean diet, especially when it comes to cardiovascular health.” However, Dr. Lizaola-Mayo said the best diet is the “diet that you are best going to be able to comply with.”