The New Epidemic
3/2/2017 1:42 PM
A recent study in the Journal of Hepatology (January 2017) stated the NAFLD is now considered to be the most common liver disease in the Western world and has no approved pharmacological therapy.
NAFLD is an asymptomatic accumulation of triglycerides and other fats in liver cells, (hepatocytes). By definition the fat content exceeds 5% of liver volume. A similar condition can occur with regular consumption of alcohol (approximately 2.5 drinks per day.)
NAFLD is often diagnosed incidentally with common serological blood testing, (ALT, GGT). These markers are part of a routine blood test performed by all doctors.
Approximately 2-3% of patients with NAFLD are diagnosed with NASH or Non-Alcoholic Steatohepatitis (NASH). Characterized by chronic inflammation, fibrosis, scarring and necrosis of the liver. NASH is the 3rd most common indication for liver transplantation in the U.S. A recent study in the Annals of Surgery projected that 25 million Americans will develop NASH by 2025. With 20% progressing to cirrhosis and liver cancer. These conditions may require liver transplantation.
NAFLD is the hepatic manifestation of metabolic syndrome. There is a close association with being overweight/obesity and insulin resistance. 40-90% of obese individuals with a BMI > 30 have NAFLD, but it can also occur in lean people.
There are certain lifestyle factors that increase your risk of NAFLD. These include:
· Sedentary lifestyle
· Caloric excess
· Refined carbohydrates
· Fructose / high fructose corn syrup(Hepatobiliary Surg Nutr. 2015 Apr; 4 (2): 109)
High fructose intake increases lipogenesis, which contributes to fat accumulation in the liver and the development of NAFLD.
In March of 2016 Douglas Dieterich, MD, Professor of Medicine, Division of Liver Disease at Icahn School of Medicine at Mount Sinai in NYC stated, “High fructose corn syrup has a direct proportion to obesity in the U.S. and to fatty liver; both of which are rising exponentially in parallel.”
High fructose corn syrup found in processed foods and especially soda is currently the “biggest cause of NAFLD.”
NASH etiology’s first hit is NAFLD. This is caused by hepatic fat accumulation resulting from chronic caloric intake coupled with a sedentary lifestyle. Hyperinsulinemia increases hepatic accumulation of ‘bad’ fats. Phosphatidylcholine deficiency (PC) is needed to export triglycerides out of the liver.
Additional contributory factors include:
- Oxidative stress
- Chronic inflammation
- Environmental toxicants and metals
- Mitochondrial dysfunction
The end result is necrosis and fibrosis of the liver.
If you or a loved one has NASH or NAFLD the following are strategies that can be implemented.
- Weight loss: >3-5% of total body weight to reduce steatosis
- Dietary Strategies: Caloric restriction and elimination of refined carbohydrates, especially sucrose, fructose and high fructose corn syrup.
- Exercise benefits are independent of weight loss: Aerobic and resistance, minimum of 150 minutes per week
- Dietary Supplements: Choline/Phosphatidylcholine, Curcumin: (phytosome), Berberine, Vitamin E,C & D, Pantethine, Omega 3 Fatty Acids, Glutathione, Alpha Lipoic Acid, and Melatonin
With appreciation to Dr. Robert Roundtree, MD for opening my eyes to this epidemic.