Understanding Non-Alcoholic Fatty Liver Disease (NAFLD): Causes and Effective Ways to Reverse It
Non-alcoholic fatty liver disease (NAFLD) is a silent threat to your health, affecting millions of people worldwide.
It may sound harmless, but the accumulation of excess fat in your liver cells can impair its normal functions, leading to inflammation, scarring, and even liver failure. Plus, NAFLD often goes undiagnosed until later stages.
But there’s good news!
NAFLD is not a life sentence. You can reverse it with dietary and lifestyle changes in addition to holistic treatments.
If you’re concerned about your liver health or have been diagnosed with NAFLD, this blog post will explore the latest research and share expert-recommended strategies for reversing it.
Let’s dive in!
What is Non-alcoholic Fatty Liver Disease (NAFLD)?
Non-alcoholic fatty liver disease (NAFLD), also known as Metabolic Associated Fatty Liver Disease (MAFLD), is a condition where excessive amounts of fat accumulate in the liver cells of people who drink little to no alcohol. (1)
The liver is an essential organ that performs many critical functions in the body, such as processing nutrients, removing toxins, and producing bile to help you digest fats. (2) However, when too much fat builds up in the liver cells in NAFLD, it can interfere with its normal functioning and cause inflammation and more serious liver damage, such as cirrhosis or liver cancer.
It’s important to remember that NAFLD is the more common type of fatty liver disease, affecting people who abstain from alcohol or consume it in moderation. The other main type is Alcoholic Fatty Liver Disease (AFLD), caused by excessive alcohol consumption. (3)
Causes of Non-alcoholic Fatty Liver Disease (NAFLD)
NAFLD is becoming increasingly common worldwide due to several factors: (4, 5)
Rise in Obesity Rates
The global rise in obesity rates is a major driver of NAFLD. Consuming excess, poor-quality calories, particularly from refined carbohydrates and sugars (COHs), overwhelms the body’s ability to manage them effectively. (6)
The most damaging COH is high fructose corn syrup (HFCS), which has been shown to have a direct influence on the development and progression of obesity, insulin resistance, metabolic syndrome, type 2 diabetes, and NAFLD. (7)
When we take in more COH calories than we burn, the excess sugar gets converted to fat. This fat is stored throughout the body as visceral fat (around the organs), intramuscular fat, and ultimately, body fat, with visceral fat being particularly problematic. The liver plays a crucial role in this process, converting excess sugar into fat. This is why fat accumulation begins in and around the liver.
The problem is compounded by the modern diet, which is often loaded with processed foods and drinks high in HFCS. These are not only high in refined sugars but also contain unhealthy industrialized seed oils, preservatives, and other chemicals. These toxic additives can put an additional burden on the liver and contribute to inflammation, a key player in the development of NAFLD.
Metabolic Syndrome (MetS)
Metabolic syndrome (MetS) is a cluster of conditions that significantly increases your risk for NAFLD. It includes central obesity (excess belly fat), high blood sugar, high blood pressure, and abnormal cholesterol levels (high triglycerides and low HDL “good” cholesterol). (8)
The culprit behind MetS often lies in our lifestyle choices. A direct effect of excess sugar consumption and a sedentary lifestyle creates a perfect storm for NAFLD development.
When we consume excessive amounts of sugar, especially sugary drinks and refined carbohydrates, our bodies struggle to manage it all. Chronic high blood sugar levels, also fueled by this excess sugar intake and a sedentary lifestyle, can lead to insulin resistance (IR), where cells become less responsive to insulin, a hallmark of metabolic dysfunction.
Insulin resistance disrupts the body’s ability to manage sugar effectively. This can lead to a dangerous domino effect: increased fat production from the excess sugar, impaired fat breakdown, and ultimately, fat accumulation in the liver.
This excess fat burden, along with ongoing high sugar levels, drives inflammation, a key component of NAFLD progression.
Other Contributing Factors
Type 2 diabetes
Obstructive sleep apnea
High blood pressure
High cholesterol and triglyceride levels (dyslipidemia)
Certain liver diseases
Certain medications (e.g., acetaminophen, certain antibiotics, statins, tamoxifen) (9)
How Do I Know If I Have NAFLD?
Like many chronic lifestyle diseases, NAFLD often progresses silently, with no symptoms in the early stages. It’s frequently incidentally discovered during routine blood tests or imaging studies done for other reasons.
However, as the disease advances, some people may experience symptoms such as: (10, 11, 12, 13)
Loss of appetite
Abdominal pain or discomfort
Nausea or vomiting
Insulin resistance
Jaundice (yellowing of the skin and eyes)
Enlarged liver or spleen
If you experience any of these symptoms, I encourage you to get to the root of these symptoms by consulting a functional medicine doctor who can work with you to help you restore your health and potentially collaborate with your allopathic doctor if your case is more severe.
Diagnosing Non-alcoholic Fatty Liver Disease (NAFLD)
Diagnosing NAFLD typically involves a multi-step approach, combining a physical exam with laboratory tests and imaging studies. This combined approach helps identify the presence of NAFLD and assess its level of severity.
Here’s a breakdown of the common methods used to diagnose NAFLD:
Blood Tests
While some blood tests, like liver function tests (LFTs), including ALT and AST, are commonly used for initial screening, they are not enough for a definitive diagnosis. Elevated LFT results can indicate liver damage from various causes, not just NAFLD.
More comprehensive blood tests are available to provide a clearer picture. These tests include:
A comprehensive lipid panel including particle size and ApoB
Alkaline phosphatase (ALP)
Gamma glutamyl transferase (GGT)
A full iron panel, including ferritin
High-sensitivity C-reactive Protein (hs-CRP)
Erythrocyte sedimentation rate (ESR)
Fasting insulin
Fasting glucose
Fasting hemoglobinA1C
More advanced tests may include APRI (AST to platelet ratio index), FIB4, and FibroScan.
All these tests go beyond basic liver cell integrity to assess:
Fat accumulation in the liver
Dyslipidemia
Hepatobiliary congestion
Iron levels
Inflammation
Insulin resistance
Level of fibrosis (scarring)
These tests offer valuable insights and improve the accuracy of diagnosing NAFLD. They also rule out other liver conditions and allow for a comprehensive understanding of the condition and its underlying causes.
Imaging Studies
Imaging techniques can provide further insights into evaluating the extent of liver fat accumulation and liver damage. Some commonly used methods include:
Ultrasound: This non-invasive technique utilizes sound waves to create images of the liver. It can help identify fatty liver and assess its severity.
FibroScan: This painless test measures liver stiffness, indicating the presence and severity of fibrosis. It’s a valuable tool for assessing NAFLD progression and liver damage.
MRI or MREndoscopy: These advanced imaging techniques offer detailed information about liver fat content, inflammation, and fibrosis. They are more sensitive than ultrasound but may not be readily available in all healthcare settings.
The importance of screening for NAFLD and other associated lifestyle diseases is undeniable. A clinical study involving patients with type 2 diabetes revealed a dramatic rise in NAFLD prevalence with increasing weight.
While only 8% of lean individuals had NAFLD, this number jumped to a staggering 66% for those with a BMI exceeding 40. (14)
This highlights the crucial role of screening, especially for those at risk due to obesity, metabolic syndrome, insulin resistance, and/or various other factors. Early detection allows for timely interventions, management, and even reversal of NAFLD, potentially preventing further, more serious complications such as cirrhosis or liver cancer.
Effective Ways to Reverse Non-alcoholic Fatty Liver Disease (NAFLD)
The good news is that NAFLD is often reversible through dietary and lifestyle changes and holistic treatments.
While it may take time and dedication (as any healing journey does), significant progress can be made.
Here are some key strategies to combat NAFLD:
Treat Insulin Resistance
Managing insulin resistance is crucial for reversing NAFLD. The foundation for tackling insulin resistance lies in a healthy weight. Regular exercise and a healthy diet are your essential tools. Focus on limiting refined sugars, processed foods, and pro-inflammatory seed oils. These choices contribute to blood sugar imbalances and fat accumulation around the liver and other organs.
In addition to improving the quality of your diet, intermittent fasting is a phenomenal tool for promoting weight loss and restoring blood sugar balance.
Physical activity is a potent regulator of blood sugar. Include a variety of exercises in your routine, but prioritize resistance training. Building muscle mass (lean tissue) increases your body’s natural ability to utilize glucose for energy. Resistance training also activates a non-insulin-dependent glucose transporter, further enhancing blood sugar control and improving insulin sensitivity (15)
Consider incorporating short walks (at least 15 minutes) after meals, especially dinner. Postprandial exercise has a significant impact on managing blood sugar levels. Conversely, research suggests that elevated blood sugar after meals is particularly detrimental to long-term glycemic control (16)
Addressing other underlying conditions like obesity, high blood pressure, and high cholesterol is crucial. These conditions often coexist and can exacerbate insulin resistance.
Weight Loss
Gradual, sustainable weight loss plays a fundamental role in reversing NAFLD. Shedding excess weight can significantly improve liver health and reduce fat accumulation.
Weight loss helps by:
Reducing liver fat content
Improving insulin sensitivity
Decreasing inflammation
Supporting Gut Health
A healthy gut microbiome is vital to overall health, including NAFLD management.
Here’s how to support your gut:
Probiotics: Eating probiotic-rich foods or supplements to promote a healthy gut balance, better digestion, nutrient absorption, and overall metabolic health.
High-fiber diet: Increase your dietary fiber intake to aid digestion, regulate bowel movements, and manage blood sugar levels.
Limit processed foods: Processed food with refined sugars, unhealthy fats, and artificial additives can disrupt gut bacteria and contribute to liver inflammation.
Minimize antibiotic use: Overuse of antibiotics can negatively impact gut health by disrupting the balance of beneficial gut bacteria.
Remember, gut health support works best when combined with other lifestyle modifications for optimal results.
Nutritional Supplements
While dietary and lifestyle modifications are the cornerstone of reversing NAFLD, some supplements can help reduce liver fat and improve liver function.
Here are a few examples:
Glutathione: This antioxidant and its precursor, NAC, can help elevate glutathione levels in the liver, improving liver function and reducing inflammation. (17)
Fish Oil: Rich in omega-3 fatty acids, fish oil supplements may help reverse NAFLD by reducing liver fat accumulation, improving insulin sensitivity, and promoting a healthier lipid profile. (18)
Phospholipids: Essential components of cell membranes, phospholipids can help reduce liver fat content, improve liver enzyme levels, and enhance overall function. They may also promote fat breakdown, export of fats from the liver, and liver cell repair and regeneration. (19)
Soluble fiber: Dietary soluble fiber can reduce dyslipidemia by various potential mechanisms, including delayed gastric emptying, increased bile acid production, improved gut microbiome, and may decrease lipid uptake across the intestinal wall. (20)
Herbs
Beyond dietary and exercise interventions, certain herbs can help support blood sugar control, liver function, and healthy lipid levels, all crucial factors in managing NAFLD.
Here are a few examples:
Berberine: An alkaloid found in several plants has gained significant interest for its potential blood sugar management properties, leading some to call it “nature’s metformin.” Studies suggest that berberine may be as effective in reducing blood sugar levels and improving insulin sensitivity in individuals with type 2 diabetes by helping cells absorb glucose from the bloodstream, decrease the liver’s production of glucose, and improve blood sugar control. (21, 22, 23)
Fenugreek: Helps to regulate blood sugar levels by delaying carbohydrate absorption and improving insulin sensitivity. (24)
Milk thistle (silymarin): This herb has a long history of use in supporting liver health. Studies suggest milk thistle can protect liver cells from damage and promote detoxification. (25)
Turmeric (curcumin): Curcumin has anti-inflammatory properties that help lower LDL (“bad”) cholesterol while potentially increasing HDL (“good”) cholesterol. (26)
Acupuncture
Acupuncture, the practice of inserting thin needles at specific body points, is an excellent complementary therapy for NAFLD.
Research suggests it can benefit several aspects of NAFLD management:
Blood sugar control: Studies show acupuncture can improve insulin sensitivity and lower blood sugar in type 2 diabetes, likely due to its effect on blood-sugar-regulating hormones. (27, 28)
Weight loss support: Research indicates acupuncture helps regulate appetite and reduce cravings, aiding weight loss efforts – a crucial factor in NAFLD management. (29)
Dyslipidemia management: Early studies show that acupuncture improves lipid profiles, potentially lowering LDL and triglycerides while increasing HDL. (30)
Improved liver function: Studies suggest acupuncture may help reduce oxidative stress and inflammation in the liver, promoting improved liver function. (31)
Taking Control of Your Liver Health
NAFLD, while serious, is a condition you can manage and potentially reverse with dedication to a healthy lifestyle.
By incorporating the strategies discussed here, you can empower your liver and support its vital functions. And remember, early detection is critical!
If you have concerns about your liver health or have questions about NAFLD, don’t hesitate to contact us!
Request a free 15-minute consultation with me, Dr. Martina Sturm.
I’m here to help you navigate your path to optimal health.
During our consultation, I will listen to your unique concerns, assess your needs, and discuss the next steps in developing a comprehensive and personalized plan that addresses your liver health concerns.
Together, we can create a plan to support your well-being and empower you to take control of your liver health!
Resources
1. “What's in a name? Renaming 'NAFLD' to 'MAFLD.'” PubMed, https://pubmed.ncbi.nlm.nih.gov/32301554/. Accessed 13 May 2024.
2. "The liver - PMC - NCBI." 6 Nov. 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5897118/. Accessed 13 May. 2024.
3. “Alcoholic Liver Disease - StatPearls.” NCBI, 13 July 2023, https://www.ncbi.nlm.nih.gov/books/NBK546632/. Accessed 13 May 2024.
4. “Nonalcoholic Fatty Liver - StatPearls.” NCBI, https://www.ncbi.nlm.nih.gov/books/NBK541033/. Accessed 13 May 2024.
5. “Nonalcoholic Fatty Liver Disease (NAFLD).” American Liver Foundation, 7 May 2024, https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-fatty-liver-disease-nafld/. Accessed 13 May 2024.
6. Bryant, Erin. “How high fructose intake may trigger fatty liver disease.” National Institutes of Health (NIH), 15 September 2020, https://www.nih.gov/news-events/nih-research-matters/how-high-fructose-intake-may-trigger-fatty-liver-disease. Accessed 20 May 2024.
7. Mai, Brandon H. “The negative and detrimental effects of high fructose on the liver, with special reference to metabolic disorders.” NCBI, 27 May 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549781/. Accessed 24 May 2024.
8. “Added Fructose in Non-Alcoholic Fatty Liver Disease and in Metabolic Syndrome: A Narrative Review.” NCBI, 8 March 2022, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8950441/. Accessed 20 May 2024.
9. “Drug-induced Fatty Liver Disease: Pathogenesis and Treatment.” NCBI, 14 September 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8516847/. Accessed 23 May 2024.
10. “Serum Testosterone Level Within Normal Range Is Positively Associated with Nonalcoholic Fatty Liver Disease in Premenopausal but Not Postmenopausal Women.” PubMed, https://pubmed.ncbi.nlm.nih.gov/30653387/. Accessed 13 May 2024.
11. “Relationship between Hypothyroidism and Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-analysis.” Frontiers, https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2017.00335/full. Accessed 13 May 2024.
12. “Symptoms & Causes of NAFLD & NASH - NIDDK.” National Institute of Diabetes and Digestive and Kidney Diseases, https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/symptoms-causes. Accessed 13 May 2024.
13. “Clinical Manifestations and Diagnosis of Nonalcoholic Fatty Liver Disease.” PubMed, 1 April 2017, https://pubmed.ncbi.nlm.nih.gov/29515630/. Accessed 13 May 2024.
14. “Advanced Liver Fibrosis Is Common in Patients With Type 2 Diabetes Followed in the Outpatient Setting: The Need for Systematic Screening.” PubMed, 21 December 2020, https://pubmed.ncbi.nlm.nih.gov/33355256/. Accessed 13 May 2024.
15. “Resistance Training for Diabetes Prevention and Therapy: Experimental Findings and Molecular Mechanisms.” NCBI, 9 December 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881442/. Accessed 20 May 2024.
16. “After Dinner Rest a While, After Supper Walk a Mile? A Systematic Review with Meta-analysis on the Acute Postprandial Glycemic Response to Exercise Before and After Meal Ingestion in Healthy Subjects and Patients with Impaired Glucose Tolerance.” NCBI, 30 January 2023, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10036272/. Accessed 20 May 2024.
17.“Efficacy of glutathione for the treatment of nonalcoholic fatty liver disease: an open-label, single-arm, multicenter, pilot study.” PubMed, 8 August 2017, https://pubmed.ncbi.nlm.nih.gov/28789631/. Accessed 13 May 2024.
18. He, Lei. “Fish oil alleviated high-fat diet–induced non-alcoholic fatty liver disease via regulating hepatic lipids metabolism and metaflammation: a transcriptomic study - Lipids in Health and Disease.” Lipids in Health and Disease, 1 February 2016, https://lipidworld.biomedcentral.com/articles/10.1186/s12944-016-0190-y. Accessed 13 May 2024.
19. Popovic, Branko. “Essential phospholipids for nonalcoholic fatty liver disease associated with metabolic syndrome: A systematic review and network meta-analysis.” NCBI, 6 November 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674728/. Accessed 13 May 2024.
20. “Soluble Fiber Supplementation and Serum Lipid Profile: A Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials.” NCBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10201678/. Accessed 20 May 2024.
21. “Berberine and Its Study as an Antidiabetic Compound.” MDPI, https://www.mdpi.com/2079-7737/12/7/973. Accessed 20 May 2024.
22. “Metformin and berberine, two versatile drugs in treatment of common metabolic diseases.” NCBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839379/. Accessed 20 May 2024.
23. “Effects of Berberine on the Gastrointestinal Microbiota.” NCBI, 19 February 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933196/. Accessed 20 May 2024.
24. “Role of Fenugreek in the prevention of type 2 diabetes mellitus in prediabetes.” NCBI, 2 October 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591578/. Accessed 20 May 2024.
25. “Milk Thistle: Effects on Liver Disease and Cirrhosis and Clinical Adverse Effects: Summary.” NCBI, https://www.ncbi.nlm.nih.gov/books/NBK11896/. Accessed 20 May 2024.
26. “Effects of curcumin/turmeric supplementation on lipid profile: A GRADE-assessed systematic review and dose-response meta-analysis of randomized controlled trials.” PubMed, 23 May 2023, https://pubmed.ncbi.nlm.nih.gov/37230418/. Accessed 20 May 2024.
27. “Acupuncture for Treating Hypertension and Type 2 Diabetes Mellitus as Comorbidities in Patients with COVID-19.” NCBI, 16 June 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8236290/. Accessed 20 May 2024.
28. “Acute Effect of Acupuncture on Glycemic Control in Type 2 Diabetes Measured by Continuous Glucose Monitoring: A Pilot Study.” NCBI, 16 February 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894033/. Accessed 20 May 2024.
29. “Effect of Acupuncture on Body Weight Reduction and Inflammatory Mediators in Egyptian Obese Patients.” NCBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4877795/. Accessed 20 May 2024.
30. “Acupuncture and related therapies for hyperlipidemia - PMC.” NCBI, 4 December 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717718/. Accessed 20 May 2024.
31. Wu, Huanwen. “Acupuncture improved hepatic steatosis in HFD-induced NAFLD rats by regulating intestinal microbiota.” NCBI, 16 March 2023, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10061080/. Accessed 20 May 2024.