When was the last time you had a chat with your doctor about your liver? Can’t remember? Maybe never? Well, it’s probably time to do so. Most people who have diabetes think very little about the connection between liver disease and Type 2 diabetes. But statistics show that at least 50% of those with Type 2 will develop fatty liver disease, and some research shows that figure may even be as high as 70%.
What is fatty liver disease?
To be more exact, fatty liver disease is technically called “non-alcoholic fatty liver disease,” or NAFLD, for short. As the name implies, it’s characterized by a buildup of fat in the liver that’s unrelated to drinking alcohol. The extent of fat buildup can determine the extent of liver damage, ranging from a small accumulation of fat (called steatosis) to a large amount that causes inflammation (called steatohepatitis). Without treatment, NAFLD can progress to cirrhosis (chronic scarring and damage), liver failure, and possibly liver cancer.
What causes NAFLD?
NAFLD is becoming increasingly common; in fact, it’s the most common type of liver disease in the developed world. It’s also a very complex condition. There’s no one specific cause, but it appears that this disease is linked to:
• Being overweight or obese
• Having insulin resistance (a condition whereby the body doesn’t use its own insulin properly)
• Having high blood sugar levels (prediabetes or Type 2 diabetes)
• Having high levels of fat, called triglycerides, in the blood
• Having sleep apnea
• Having PCOS (polycystic ovary syndrome)
In addition, NAFLD is more common in older people, men, people who have Type 2 diabetes, and people who have excess weight around their middle (like a “spare tire” or a “muffin top”).
What happens in NAFLD?
The liver, among other things, handles fat. In other words, it removes fat from the blood and ships out fat to other parts of the body. In NAFLD, this “fat handling” is disrupted. The liver continues to take in fat from the blood and the liver cells also make fat. But the liver is unable to export fat, and as a result, fat begins to accumulate. Over time, this fat buildup can cause inflammation, which damages liver cells. If this process continues, liver cells start to die off, and cirrhosis can develop. Cirrhosis can lead to liver failure and liver cancer.
Having NAFLD also boosts the risk for heart disease and stroke, independent of having diabetes, being overweight, and/or having high triglycerides.
How do you know if you have NAFLD?
For the most part, there really aren’t any symptoms of NAFLD unless the condition is advanced. Sometimes abnormal liver tests are found during a routine blood test, and this may lead to further testing that can diagnose the disease. (Keep in mind that abnormal liver function tests, or LFTs, can indicate other liver conditions besides NAFLD). Your doctor may order different tests to rule out other conditions; these tests include checking for hepatitis and celiac disease, a lipid profile (cholesterol and triglycerides), blood glucose, and an A1C.
Imaging procedures are also used to diagnose NAFLD. An ultrasound, CT scan, or MRI can indicate if your liver is enlarged, although these tests don’t definitively diagnose NAFLD. NAFLD is typically diagnosed based on the elimination of other causes or diseases. In some cases, a liver biopsy is ordered to look for the extent of inflammation or scarring.
How is NAFLD prevented or treated?
That’s the million-dollar question. At this time, there is no medication that treats NAFLD. But there’s good news: First, researchers in Sweden are working on a “cocktail” that, in the lab, seems to help the liver “burn off” extra fat. We’ll have to stay tuned on when this might be available. There’s more good news, though, although it’s not a magic pill: Lifestyle changes can help. These changes can reduce the amount of fat that’s in the liver.
Weight loss: Losing between 5% and 10% of your weight can do wonders for your liver health, helping to improve fat buildup, liver cell injury, and inflammation. But skip the quick-fix or fad diets — losing weight too rapidly can actually worsen NAFLD.
Exercise: Exercise can indirectly prevent and help treat NAFLD by helping with weight reduction, improving insulin sensitivity, improving blood sugar control, and lowering the risk for heart disease.
Medicines: Certain types of diabetes pills — metformin and thiazolidinediones (TZDs) — boost insulin sensitivity. Statins and ezetimibe, which are lipid-lowering drugs, may be beneficial, as well.
Liver transplant: A liver transplant may be an option if cirrhosis sets in. However, not everyone is a good candidate for a transplant if there are underlying complications, such as heart disease.
Dietary supplements: Omega-3 fatty acids (aka “fish oil”) can lower triglyceride levels and can reduce the risk of heart disease, as well as lower the risk of dying from heart disease. Some studies show they also can reduce fat in the liver. High-dose vitamin E, an antioxidant, has been shown in several clinical trials to improve fat buildup in the liver. Vitamin D, in one study, also lowered the severity of liver fat and inflammation. Other dietary supplements that show some early promise of helping NAFLD include probiotics and ginger.
Food choices: A Mediterranean-style eating plan is helpful for both diabetes management and reducing the risk of heart disease. Limiting the intake of refined carbohydrate foods, such as sugary foods and high-fructose corn syrup, and replacing some of your carb intake with monounsaturated fat (found in olive oil and nuts) can also be helpful. Limiting saturated fat intake and trans fat intake can improve insulin resistance and lower inflammation.
Limiting alcohol: NAFLD isn’t caused by drinking alcohol. However, alcohol may worsen NAFLD, and your doctor may advise you to avoid it altogether.
Coffee: Studies have shown that coffee drinkers who have NAFLD had less liver damage than non-coffee drinkers with NAFLD. While this isn’t necessarily a reason to start drinking coffee, it’s potential good news if you’re a coffee lover. Just be sure to skip the sugar.
The good news
NAFLD is certainly something that you want to avoid getting at all costs. While the incidence of NAFLD is on the rise, most people with this condition don’t progress to getting severe liver damage or cirrhosis. And many of the lifestyle treatments mentioned above really do help prevent NAFLD from progressing.
As part of your routine visits with your doctor, ask about your liver health. It’s easy enough for your doctor to order liver function tests. If you have risk factors for NAFLD or show early signs of this condition, talk with your doctor and dietitian about steps you can take to reduce your risk or prevent it from worsening. Finally, dietary supplements may seem harmless, and it can be tempting to start taking them. Keep in mind, though, that high doses of supplements can be harmful. Don’t start taking them without first checking with your doctor.
Want to learn more about liver health? Read “Don’t Call My Liver Fat!” and “Healing Leaky Livers.”