My Doctor Diagnosed Me With Non-Alcoholic Fatty Liver Disease…Now What???

Non-alcoholic fatty liver disease (NAFLD) is one of the conditions I most commonly diagnose as a primary care physician. 

As a patient it can be a difficult diagnosis to receive and there are often several follow up questions once I deliver the news.  I hope to tackle some of these questions and provide methods for how to reverse the diagnosis.  Yes, that’s right, it is a reversible diagnosis

Image: Samuel Ramos

So, first let’s start with some definitions and background about what happens in the body with fatty liver. 

NAFLD is a condition caused by fat deposition in the cells of the liver which are called “hepatocytes.”  When weight is gained it is not just gained in the layers of cells below the skin, it also accumulates within the bodily organs as well.  So, when fat cells invade the hepatocytes, they become irritated and release liver enzymes which are commonly abbreviated “AST” and “ALT.”  When your doctor looks at your blood work, if these enzymes are elevated it is a clue that fatty liver might be one of the causes. 

Image: Hush Naidoo

In order to confirm the suspicion of the diagnosis and evaluate your health further, your doctor will send you for other lab tests. 

This will likely include a viral hepatitis panel to look for other causes of liver inflammation and to check for immunity, as well as studies for other common conditions that can go hand and hand with fatty liver like diabetes or elevated cholesterol.  She will ask you questions about your alcohol intake as well as about use of some common over-the-counter medications and supplements that may also affect liver health.  She will weigh you to calculate your body mass index and check for high blood pressure. 

Finally, to confirm the diagnosis, your doctor will send you for an ultrasound of the liver. 

On ultrasound the Radiologist will examine for classic sonographic evidence of fat deposition within the liver tissue and thus the diagnosis of NAFLD is made.  An overload of fat in liver cells is called “hepatic steatosis.” 

Image: Visual Generation

It is important to halt progression of NAFLD before it leads to inflammation and scarring.

This is because NAFLD can progress to “nonalcoholic steatohepatitis” (also called NASH) which can progress to a fully scarred liver (cirrhosis) which is not a reversible condition.

So back to the title…now what!? 

There are several actions you can take to improve the amount of fat deposition in the liver, which will improve the irritation of the hepatocytes, thus decreasing the AST/ALT numbers – even getting them back to normal – and can result in a reversal of the diagnosis of NAFLD! 

Image: Leigh Skomal

First and foremost is weight loss. 

If your doctor has not already suggested it, ask her for a referral to a Dietician.  I often suggest the Mediterranean Diet (https://my.clevelandclinic.org/health/articles/16037-mediterranean-diet) as a style of eating and more recently the Green Mediterranean Diet has proven to have even further health benefits.

It’s time to get moving! 

Join a gym, try a fitness class or a zoom dance group, go for a hike or a swim; find an exercise that you like to do so that you will continue going back. 

Image: Andrew Dinh

Next, avoid or limit alcohol intake and follow up with your doctor for a review on any over-the-counters or supplements that you take that might be liver toxic. 

Your doctor will suggest vaccination against hepatitis A and B along with other age appropriate vaccines.  In terms of medications for treatment of NAFLD, there are none yet, but some studies have shown evidence for caffeine or vitamin E, but more data is needed so stay tuned on the treatment front. Work with your doctor to manage any other medical conditions such as diabetes, high cholesterol and hypertension as gaining control over these conditions will help your overall health. 

Bottom line is that if you have recently been diagnosed with NAFLD or NASH do not despair, this is a reversible diagnosis, take charge and take your health into your hands.  Good luck on your health journey! 

For more information visit:  

https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/non-alcoholic-fatty-liver-disease/

or 

https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/definition-facts

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