What You Should Know About Fatty Liver Disease

An increasing number of obesity cases is driving an epidemic of a condition of excessive fat build-up in the liver. It is commonly called fatty liver disease (FLD) or hepatic steatosis.

A healthy liver contains a small amount of fat but when extra fat builds up in the liver and reaches 5% to 10% of your liver’s weight, it becomes a problem. Thus, understanding, diagnosing, and treating this progressive condition are becoming health priorities.

The Liver

The liver is a reddish-brown, wedge-shaped, unequal two-lobed organ located just below the diaphragm, to the right of the stomach, and overlies the gallbladder. It is around 6 inches wide, and weighs approximately 3.3 pounds, making it one of the largest and heaviest organs in our body.

The liver is responsible for up to 500 separate functions, usually in combination with other body organs and systems. Various liver functions are carried out by the hepatocytes (liver cells). Given its size, the liver has multiple life-supporting functions such as:

• Producing bile that helps with the digestion

• Producing proteins necessary for growth

• Storing iron needed by our red blood cells

• Regulating glycogen storage and converting nutrients into energy

• Producing substances that help blood clot for wound healing

• Producing immune factors for immunity

• Removing bacteria and toxins in our body for detoxification

Types of Fatty Liver Disease

Fatty liver disease has two types:

• Non-alcoholic fatty liver disease (NAFLD)

• Alcoholic liver disease

NAFLD is further subdivided into:

• Simple fatty liver

• Non-alcoholic steatohepatitis (NASH)

Don't let these terms get you confused. It is important to distinguish between simple fatty liver and NASH. Why? Because having a simple fatty liver does not cause liver-related sickness whereas having NASH means you have an inflammation or injury in your liver cells. NASH increases the risk of progression to more serious conditions like fibrosis (scarring) of the liver, liver cirrhosis, and liver cancer.

Statistics

It is not yet clear why some people with NAFLD develop simple fatty liver and others develop NASH. Most people with NAFLD have simple fatty liver and not NASH. In the U.S., about 3% to 7% only of the US population has NASH.

Fatty liver occurs more often in adult males. It also affects about 10% of children in the U.S. NAFLD affects about 30% of people in Western countries and 10% of people in Asia. Fatty liver is more prevalent in Hispanic people than Caucasians, while Black people have the lowest susceptibility. Therefore, you have a greater chance of developing the fatty liver disease if you are Hispanic or Asian.

For people with NAFLD, there is about an 80% 10-year survival or recovery rate. However, the rate of progression of fibrosis is estimated to be 1 per 7 years in NASH and 1 per 14 years in NAFLD, with an increasing speed.

More than 90% of heavy drinkers develop fatty liver while about 25% develop the more severe alcoholic hepatitis.

Recently, the term Metabolic dysfunction-Associated Fatty Liver Disease (MAFLD) has been proposed to replace NAFLD. MAFLD is a more inclusive diagnostic name as it is based on the detection of fatty liver by biopsy, medical imaging, or blood tests but should be accompanied by either overweight/obesity, type 2 diabetes mellitus, or metabolic dysregulation. The new definition no longer excludes alcohol consumption or the coexistence of other liver diseases. Using this more inclusive definition, the global prevalence of MAFLD rises to 50.7%.

If we use the "old" NAFLD definition, 80% of obese people, 35% of whom progress to NASH, and up to 20% of normal-weight people have NAFLD despite no evidence of excessive alcohol consumption.

Signs, Symptoms, Diagnosis

Most individuals with fatty liver are asymptomatic. If there are symptoms, it may be occasional tiredness or pain in the upper right side of the abdomen. Thus, fatty liver disease is usually detected by accident when an abdominal ultrasound, CT scan, or MRI is requested for another reason or unrelated medical conditions and your doctor may be the first one to spot it. Because fatty liver disease often has no symptoms, people would only know it until the disease progresses to liver cirrhosis.

Elevated liver enzymes on a blood test for other conditions may raise a red flag. It is a sign of possible liver injury. To make a diagnosis, your doctor may order:

• Ultrasound or CT scan to get a picture of the liver.

• Liver biopsy to determine how far advanced the liver disease has progressed.

Elevated liver enzymes are found in 50% of patients with simple steatosis. A simple blood test may help to determine the magnitude of the disease by assessing the degree of liver fibrosis. Histological diagnosis by liver biopsy is the most accurate measure of fibrosis and liver fat progression as of 2018. It takes a liver biopsy to know if a person has simple fatty liver or NASH. But the infrequent complications and cost of a liver biopsy make this impractical for people with NAFLD.

Causes

Fatty liver is commonly associated with diabetes, hypertension, obesity, and dyslipidemia, but can also be due to any one of these:

• Alcohol use - it is one of the causes of fatty liver due to the production of toxic metabolites like aldehydes during the metabolism of alcohol in the liver.

• Abnormal metabolism - aside from the mentioned metabolic syndromes, abetalipoproteinemia, glycogen storage diseases, Weber–Christian disease, acute fatty liver of pregnancy, and lipodystrophy are considered to cause fatty liver.

• Nutritional causes - obesity, insulin resistance, and malnutrition are the most common nutritional causes of fatty liver. Total parenteral nutrition, severe weight loss, refeeding syndrome, jejunoileal bypass, gastric bypass, jejunal diverticulosis with bacterial overgrowth may also cause fatty liver.

• Drugs and toxins such as amiodarone, methotrexate, diltiazem, expired tetracycline, highly active antiretroviral therapy, glucocorticoids, tamoxifen, environmental hepatotoxins (e.g., phosphorus, mushroom poisoning)

• Other causes such as celiac disease, inflammatory bowel disease, HIV, hepatitis C (especially genotype 3), and alpha 1-antitrypsin deficiency

Some people get the fatty liver disease without having any pre-existing conditions. But these risk factors make you more likely to develop it:

• Being obese or overweight.

• Having Type 2 diabetes or insulin resistance.

• Having metabolic syndrome (insulin resistance, high blood pressure, high cholesterol, and high triglyceride levels).

• Taking certain prescription medications, such as amiodarone, diltiazem, tamoxifen, or steroids.

Risks & Complications

Fatty liver disease doesn’t cause major problems for most people. However, it can turn into a more serious problem if it progresses into liver cirrhosis. Untreated liver cirrhosis eventually leads to liver failure or liver cancer.

NAFLD is intimately related to conditions like diabetes and obesity. It’s also linked to an increased risk of cardiovascular disease. The primary risks include alcohol, type 2 diabetes, and obesity. Other risk factors include certain medications such as glucocorticoids and hepatitis C.

Less than 10% of people with cirrhotic alcoholic FLD will develop hepatocellular carcinoma, the most common type of primary liver cancer in adults. But up to 45% of people with NASH without cirrhosis can develop hepatocellular carcinoma.

Treatment

If you have been diagnosed with fatty liver disease, it is important to keep your liver as healthy as possible and avoid anything that can further damage your liver. Treatment of NAFLD is generally by dietary changes and exercise to bring about weight loss. Decreasing caloric intake by at least 30% or by approximately 750–1,000 kcal/day results in an improvement in hepatic steatosis. In more serious cases, medications that decrease insulin resistance, hyperlipidemia, and those that induce weight loss such as bariatric surgery as well as Vitamin E have been shown to improve or resolve liver function. For those who are severely affected, a liver transplant may be an option.

Here are some important things you should do:

• Don’t drink too much alcohol. How much is too much remains debatable, but it’s probably best to avoid alcohol completely.

• Make sure that none of your medications are toxic to the liver. Even acetaminophen may be harmful if you take too much for too long.

• Get vaccinated to protect against hepatitis A and B.

• Control other health conditions that might also affect your liver, and check with your doctor if you might have other underlying, treatable diseases contributing to your fatty liver.

• Get regular screening tests for liver cancer if you already have cirrhosis.

Unfortunately, there are no FDA-approved medications for fatty liver disease. So far, the two best drug options affirmed by the American Association for the Study of Liver Diseases for biopsy-proven NASH are vitamin E (an antioxidant) and pioglitazone (used to treat diabetes). However, not everyone will benefit from these treatments, and there has been some concern about safety and side effects. If you have NASH, it’s best to ask your doctor whether these treatments are appropriate for you, as they are not for everyone.

Conclusion

Our body has an amazing ability to repair itself. So is our liver. Thus, fatty liver can be reversed. If you avoid alcohol, lose weight, and change your diet it is possible to reduce liver fat, inflammation, and reverse liver damage.

If you have questions regarding fatty liver disease, feel free to schedule a consultation. I will help and work with you and suggest changes that would help you. Who knows? One of the plans we offer might suit your needs. Or if you want to hear from me talk about Lifestyle Medicine, feel free to listen to our podcast or contact us.

Sources:

Armand, Wynne. 2019. “Fatty Liver Disease: What It Is and What to Do About It” Harvard Health Blog. January 10, 2019.

Castera, Laurent, Mireen Friedrich-Rust, and Rohit Loomba. 2019. “Noninvasive Assessment of Liver Disease in Patients with Nonalcoholic Fatty Liver Disease.” Gastroenterology 156 (5): 1264-1281.e4.

Francque, Sven M., Giulio Marchesini, Achim Kautz, Martine Walmsley, Rebecca Dorner, Jeffrey V. Lazarus, Shira Zelber-Sagi, et al. 2021. “Non-Alcoholic Fatty Liver Disease: A Patient Guideline.” JHEP Reports: Innovation in Hepatology 3 (5): 100322.

Wikipedia Contributors. 2019a. “Liver.” Wikipedia. Wikimedia Foundation. July 6, 2019.

———. 2019b. “Fatty Liver Disease.” Wikipedia. Wikimedia Foundation. November 2, 2019. https://en.wikipedia.org/wiki/Fatty_liver_disease.

Is Prolonged Sitting The New Smoking?

Ever since Dr. James Levine of the Mayo Clinic coined the phrase “Sitting is the new smoking”, there have been debates if this is truly so. Some health gurus made this phrase their mantra and inspired other people worldwide to work on their desk standing. On the other hand, some people think that the phrase sounds like a curse.

Studies showed that prolonged sitting is linked to diseases such as cancer, diabetes, and cardiovascular diseases --- the same health problems linked to smoking. This comparison became the reason why the phrase came to be.

And if we are going to look at the chart below, it seems that Americans are sedentary more than half of the day.

Is it really true?

Let the Numbers Speak For Themselves

People tend to become less active as they age. Obviously, elderly people aged 75 and above have the lowest level of activity achieving around 20 minutes of physical activity daily. Only one in four elderlies are considered sufficiently active.

According to the Centers for Disease Control and Prevention (CDC), 8.3% of deaths of non-disabled adults ages 25 and older were attributed to physical inactivity. Any extended sitting --- such as at a desk, or behind a wheel, or in a car, on long plane flights, or in front of a computer --- can be harmful. An analysis of 13 studies of sitting time and activity levels found that those who sat for more than eight hours a day with no physical activity had a risk of dying similar to the risks of dying posed by obesity and smoking.

One study said the men who think they sat almost 100% of the time were more likely to be obese than men who think they sat almost none of the time. Watching TV for 3 hours or more per day was associated with increased mortality regardless of physical activity.

What Happens When You’re Sitting For Too Long?

Humans are built to stand upright. Your heart and cardiovascular system work more effectively that way. Your bowel also functions more efficiently when you are upright. Even mobile phones were designed to be used standing but it turns out that people use them more while sitting. So what happens when you’re sitting for too long?

Stiff Neck and Shoulders

Working on your desk and in front of your computer for a long time can lead to pain and stiffness in your neck and shoulders.

Hips and Back

Prolonged sitting shortens your hip flexor muscles which can lead to problems with your hip joints. Poor posture causes compression in the discs in your spine, leading to premature degeneration, which can be very painful.

Legs and Gluteal Muscles

Prolonged sitting weakens your large leg and gluteal muscles. These large muscles are important for walking and for stabilizing you. If these muscles are weak you are more likely to injure yourself from falls, and from strains when you do exercise.

Weight

Physical activity helps your body digest the fats and sugars you eat. If you spend a lot of time sitting, digestion is not as efficient, so you retain those fats and sugars as fat in your body which leads to weight gain. Even if you exercise but spend a large amount of time sitting, you are still at risk of having metabolic syndrome. Research suggests you need 60 to 75 minutes of moderate-intensity activity per day to combat the dangers of excessive sitting.

Anxiety and depression

We know that the risk of both anxiety and depression is higher in people who sit more because they miss out on the positive effects of physical activity and fitness.

Cancer

Studies suggest the dangers of sitting include increasing your chances of developing lung, uterine, and colon cancers although the reason behind this is not yet known.

Heart disease

Sitting for a long time cannot remove the fat from your blood after eating a meal, and that puts you at 147% higher risk of cardiovascular disease, heart disease, and stroke. A study found out that men who watch more than 23 hours of television a week have a 64% higher risk of dying from cardiovascular disease than men who only watch 11 hours of television a week.

Diabetes

If you spend long periods sitting, then you cannot dispose of the glucose in the food that you’re eating. Glucose accumulates in your blood and increases the risk of diabetes. Studies have shown that five days lying in bed can lead to increased insulin resistance in your body which causes your blood sugar to rise. Another research suggests that people who spend more time sitting have a 112% higher risk of diabetes.

Varicose Veins

Prolonged sitting causes blood to pool in your legs which can lead to varicose veins or spider veins (a smaller version of varicose veins). Varicose veins are not usually dangerous.

Deep Vein Thrombosis

In rare cases, prolonged sitting can lead to blood clots which can cause serious problems. Deep vein thrombosis is a blood clot that forms in the veins of your leg. DVT is a serious problem because if part of a blood clot in the leg vein breaks off and travels, it can cut off the blood flow to other parts of the body, including your lungs, which can cause a pulmonary embolism. This is a medical emergency that can lead to major complications or even death.

What To Do?

It is important to reduce sitting time AND do regular exercise to combat the negative effects of physical inactivity. Being active is not as difficult as you think. One study found out that even a two-minute light activity every 30 minutes will keep your blood glucose at a normal level. Another study said five minutes of walking the dog, folding laundry, or taking out the trash for every hour of sitting is sufficient to reduce the negative effects of prolonged sitting. Thus, it is better to build more activity into your day.

Conclusion

The phrase “sitting is the new smoking” should not be taken at its face value. It would be better to say sitting is associated with the same health risks as smoking but both could not be compared.

The damage caused by smoking cannot be offset, but moderate physical activity can offset high levels of inactivity. However, this does not mean that having your regular daily 1-hour exercise allows you to slouch on the couch the rest of the day and still reap the health benefits. No. Meeting the recommended hours of physical activity is helpful but what you will be doing for the next 23 hours is another thing.

To combat the effects of obesity and other chronic diseases, reducing the time you spend sitting is the key. And since you decide what you do in a day, you have that key!

Sources:

Barlow, Carolyn E. 2016. “Association between Sitting Time and Cardiometabolic Risk Factors after Adjustment for Cardiorespiratory Fitness, Cooper Center Longitudinal Study, 2010–2013.” Preventing Chronic Disease 13.

Becker, Lara. 2020. “Sitting Isn’t the New Smoking, Apparently.” Medical Daily. October 21, 2020.

Better Health Channel. n.d. “The Dangers of Sitting: Why Sitting Is the New Smoking” www.betterhealth.vic.gov.au. Accessed December 18, 2021.

Chandler, Meredith. 2018. “Sitting Disease: The Terrifying Facts of Prolonged Sitting.” Ergonomics Health Association. April 19, 2018.

Ekelund, Ulf, Jostein Steene-Johannessen, Wendy J Brown, Morten Wang Fagerland, Neville Owen, Kenneth E Powell, Adrian Bauman, and I-Min Lee. 2016. “Does Physical Activity Attenuate, or Even Eliminate, the Detrimental Association of Sitting Time with Mortality? A Harmonised Meta-Analysis of Data from More than 1 Million Men and Women.” The Lancet 388 (10051): 1302–10.

Graff-Radford, Michelle. 2020. “Sitting Is the New Smoking.” https://Connect.mayoclinic.org/. February 11, 2020.

Khan, Coco. 2021. “Is Sitting the New Smoking? We Ask the Expert.” The Guardian. November 5, 2021.

Laskowski, Edward. 2018. “Sitting Risks: How Harmful Is Too Much Sitting?” Mayo Clinic. 2018.

Loh, Roland, Emmanuel Stamatakis, Dirk Folkerts, Judith E. Allgrove, and Hannah J. Moir. 2019. “Effects of Interrupting Prolonged Sitting with Physical Activity Breaks on Blood Glucose, Insulin, and Triacylglycerol Measures: A Systematic Review and Meta-Analysis.” Sports Medicine 50 (2): 295–330.

The Heart Foundation. 2019. “Is Sitting the New Smoking?” The Heart Foundation. August 10, 2019.

Why Gange, A Vegetarian, Would Not Have To Go On Medications Anymore

Note: Below is a testimonial I actually received via text, image, audio, or video submission. It is the patient's reflection of his experiences during the course of or after using our services in some way or another. Since it is a personal experience, results do vary for each individual. The testimonial was given verbatim and edited for grammar, syntax, and brevity. My name would appear as the author because I posted this on this website as a blog/article under the category "Testimonials". I’m Gange, and my story begins with getting my blood work done. When I was in New York, I was working with a primary care physician who wanted to get my blood work done annually. My numbers were fluctuating here and there, but these were not of any major concern to my primary care physician at that time. We then moved to Arizona about three years ago, and I had my first blood work done here in November 2019. My test results showed that some numbers have increased significantly; and being a vegetarian, I was surprised by how high these numbers can be. This time, I was told that if my numbers don’t come down, I may need medication.

Coincidentally, my wife, who was attending yoga classes in the community center here in Arizona, met Dr. Edelita Jamis. She explained to my wife that there are many patients who have had various illnesses that she has treated through lifestyle medicine, and got them off their medication. When I decided to meet her, I naturally had a lot of questions in mind, which she addressed one by one. She explained well how the program works, and that’s how we started. I knew I was lucky that I didn’t have to start any medication for either my A1C or cholesterol yet, and she told me that I actually came at the right time. She emphasized that I needed to take the program seriously and follow what she told me, and then I wouldn't have to go on any medications.

In January 2020, I started the program and incorporated certain dietary and lifestyle changes. Being a vegetarian, continuing with the whole-food plant-based diet was not a challenge. But, it took a lot of discipline when it came to not using too much salt or oil when cooking, or having too much sugar in anything I eat. I also learned how to read food labels and buy proper food. The exercise I do for 20 minutes everyday also helps in combination with my diet. And, in just four months of being in the program, the first blood work already showed some changes and the numbers went down. My A1c which has been at 6+ for decades came down to 5.8. Initially, I was on two blood pressure medications and I was only taking one in just 2 months. I continued everything that Dr. Jamis taught me even after the program. I'm glad I did because on July 2021, my A1c continued to drop to 5.2. My triglycerides came down to 101, and then down to and my total cholesterol came down from 217 to 175. My LDL dropped from 122 to 88. My prostate test (PSA) which had been elevated for at least three decades also finally normalized.

Even my family doctor was surprised to learn about my results, so I told her about Dr. Edelita’s program. And, I would like everyone to know that she is the kind of doctor who’s very dedicated and professional. As long as you have a goal before you start and you’re willing to be disciplined, you will succeed. “If I start this, I’m going to finish this” — that kind of mindset. I recommend everybody to try this program if your numbers in your blood work are not good. Dr. Jamis is a very good lifestyle medicine doctor.

P.S. I now grow my own garden at home!