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Could you have this common liver disease and not know it?

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Most people with nonalcoholic fatty liver disease (NAFLD) have no symptoms. And for some, that can lead to serious complications. Here’s what you need to know about NAFLD and how to protect your liver for life.
Written by Jennifer Thomas
Updated on December 15, 2021

The liver is an amazing organ. Among its many functions: It helps your body digest food, store energy and remove bacteria and other toxins from your system. It can even regrow itself after being damaged.

But one of the biggest threats to one of your largest organs is nonalcoholic fatty liver disease (NAFLD). And just as it sounds, it’s a condition caused by having too much fat buildup in your liver.

Though NAFLD doesn’t have a lot of name recognition, it’s very common. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) estimates that 24% of Americans have NAFLD. And that number is growing, including among kids, says Sami Adib, MD. He’s a gastroenterologist at Austin Regional Clinic in Texas.

Fatty liver isn’t always serious. But for some, it gets worse over time. Excess fat can lead to inflammation in the organ. That can damage tissue and lead to a progressive form of the condition called nonalcoholic steatohepatitis (NASH).

About 20% of people with NAFLD go on to have NASH, according to the American Liver Foundation. If left untreated, it can cause severe scarring and hardening of the liver known as cirrhosis. And all that damage can make it hard for your liver to do its job. Worst-case scenarios involve liver cancer or even liver failure.

“In a few years, NASH will be the most common cause of cirrhosis,” Dr. Adib says.

On the positive side: You have the power to prevent or even reverse fatty liver disease. Here’s what you need to know.

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What causes NAFLD?

Unfortunately, experts don’t know exactly what causes the disease. But it seems to be more common in people who have chronic conditions such as type 2 diabetes. In fact, up to 75% of people with obesity are thought to have NAFLD, according to the NIDDK.

Genetics and other health factors play a role, too. That includes having:

  • High levels of fats in your blood, such as cholesterol and triglycerides
  • Polycystic ovary syndrome (PCOS)
  • Sleep apnea
  • Underactive or overactive thyroid
  • High blood pressure
  • Certain infections, such as hepatitis C

People who develop NASH are more likely to be older, have diabetes and/or have excess belly fat. Unlike fat that sits under our skin, fat that gathers in and around internal organs can be particularly dangerous. Experts think these fat cells are more likely to release chemicals that affect our health.

Let’s be clear, though: Fatty liver can happen to anyone. There are also people with NASH who are lean and don’t drink much or any alcohol, Dr. Adib says. The exact reason isn’t known. But it’s most likely caused by the body having trouble breaking down fats, he says.

What are the symptoms of NAFLD?

There often aren’t any. That’s why many people don’t even know they have it.

If there are symptoms, the most common ones are extreme tiredness and pain in the upper right part of the belly, says Alka Gupta, MD. She’s a clinical assistant professor of medicine at George Washington University and chief medical director of Bluerock Care in Washington, D.C. “But even those aren’t very common,” adds Dr. Gupta.

If NAFLD progresses to NASH or cirrhosis, possible symptoms can include:

  • Abdominal swelling
  • Enlarged spleen
  • Red palms
  • Yellowing of the skin and eyes (called jaundice)

So how do people find out they have it? The most common ways are through a CAT scan that shows an enlarged liver or when a routine blood test shows high liver enzyme levels, Dr. Adib says. High liver enzymes are usually a sign of damaged liver cells.

Doctors don’t routinely screen patients for NAFLD, so “it’s worth bringing up with your provider if you’re at higher risk,” Dr. Gupta says. To make a diagnosis, doctors may review your health history, check for an enlarged liver or signs of jaundice, and run blood tests.

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How is NAFLD treated?

For the majority of people with NAFLD, the condition may never have serious health complications. That said, it’s still crucial to try to improve your liver health.

There are no medications that have been approved to address NAFLD directly. That’s why it’s “very important to treat the root cause of the illness,” Dr. Gupta says. “If you have elevated weight, blood sugars or cholesterol, it’s key that we address these to delay progression or even reverse fatty buildup in the liver.”

If you have excess weight, your doctor may talk to you about weight loss. Some people with NAFLD can go back to normal fat levels in their liver by losing just a small amount of weight, Dr. Adib says. People with NASH may need to lose between 10% and 15% of their body weight to undo some of the inflammation and scarring, he adds.

Managing your cholesterol, blood sugar and blood pressure are important for general health. But they can help stave off NAFLD, too.

Your diet can also play a big role in preventing, treating or reversing damage from NAFLD or NASH. Here’s how:

  • Avoid or limit alcohol. NAFLD is not caused by drinking too much alcohol (that’s called alcoholic fatty liver disease). But alcohol still damages liver cells. Try to stick to the recommended limit of no more than 2 drinks a day for men and no more than 1 for women.
  • Lower your intake of added sugar. Foods filled with added sugar are also usually high in calories and low in nutrients and can lead to weight gain. Some examples are sodas, desserts and breakfast cereals.
  • Eat the right kinds of fat. Your liver actually loves fats, but the healthy kind. These are the monounsaturated and polyunsaturated fats found in nuts or fatty fish such as salmon. Avocados and olive oil are also great choices. They can cause less fat to accumulate in the liver.
  • Choose more low-glycemic index foods. These include foods such as fruits, vegetables and whole grains. They are loaded with fiber, so your body digests them more slowly — keeping your blood sugar steadier — than high-glycemic foods such as white bread, white rice and french fries.

Some NAFLD risk factors are out of your control. But you can certainly give your liver a helping hand by eating well, exercising and focusing on your self-care.

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Additional sources
Background on NAFLD and NASH:
National Institute of Diabetes and Digestive and Kidney Diseases
Rates of NAFLD progressing to NASH: Cleveland Clinic