UNDERSTANDING THE NATURE OF NONALCOHOLIC FATTY LIVER DISEASE

Your liver and nonalcoholic fatty liver disease (NAFLD)

Our liver is the largest internal organ in our body. It is the heaviest gland in the body, weighing about three pounds in an average adult. It is one miraculous organ. It has 50,000 to 100,000 small units of cells and over 500 functions. The primary function of the liver is to filter the blood arriving from the digestive tract before it passes through the rest of the body. The liver also secretes bile, which is required for the absorption of dietary fats. In addition to digestion, other vital functions of liver include: metabolism of carbohydrates, fats, and protein, processing of drugs and hormones, storage of certain vitamins and minerals, immune-control, and very important function, detoxification of chemicals.

The liver is the most metabolically active organs in our body. It is normal to have some fat in our livers. However, if fat composes more than 5% to 10% of your liver’s weight, you might be suffering from fatty liver disease. Excessive consumption of alcohol is one common cause of fatty liver disease. The most common type of chronic liver disease in the United States that affects 80 to 100 million people is nonalcoholic fatty liver disease (NAFLD). The NAFLD is a result of fat deposition in the liver, unrelated to alcohol or a virus. The NAFLD is the third most common reason for a liver transplant, and it is going to be the most common cause of end-stage liver disease and liver transplant in the next ten years.

The NAFLD normally affects those with metabolic syndrome. There is a higher incidence of metabolic syndrome and NAFLD among patients of obesity, hypertension, diabetes, hypertriglyceridemia, and hyperlipidemia. The metabolic syndrome has become a common problem, so the rate of NAFLD has also increased tremendously.

Four stages of NAFLD: steatosis, steatohepatitis, fibrosis, cirrhosis

The NAFLD is a spectrum of diseases. It affects about 75% of all obese people, including children. We do not know the exact mechanism of NAFLD. Experts believe that insulin resistance plays an important role. Overtime, insulin receptors in the liver become less responsive to insulin. This causes the liver to go into a state where it increases the fat storage and decreases fatty acid oxidation. Thus, it translates into a lowered secretion of fatty acids into the blood in the form of lipoproteins. There is also an increased synthesis and uptake of free fatty acids from the blood, a process known as steatosis. Steatosis happens when fat is deposited in the liver. Steatosis leads to the formation and growth of fat droplets in liver cells, causing some liver cells to inflame with fat, and push the nuclei to side. The widespread steatosis in fatty liver makes the liver appear large, soft, yellow, and greasy.

Inflammation from steatosis can lead to steatohepatitis. Over a period of time, the fat in liver cells becomes vulnerable to degradation. This process damages lipid membranes, causing mitochondrial dysfunction and cell death. Cell death creates inflammation. Hence, steatosis and inflammation are known as steatohepatitis. In the absence of alcohol, this is called nonalcoholic steatohepatitis (NASH).

Chronic steatohepatitis can cause fibrosis, and ultimately the disease can pave its pathway to cirrhosis. Specifically, chronic steatohepatitis leads to laying down of fibrotic tissue, creating fibrosis. As fibrosis occurs in the liver, the overall structure of the liver becomes altered to the point where the disease is classified as cirrhosis. Cirrhosis is the liver that is filled up with scar tissue, making the organ dysfunctional. Approximately 20% of the individuals with NASH progress to cirrhosis.

Depending on the stage of disease, it can be reversed with healthy nutrition and exercise. A steatosis and a steatohepatitis are generally reversible, but if the disease progresses into fibrosis and cirrhosis, it is usually not reversible.

Diagnosis and symptoms of NAFLD

The diagnosis of fatty liver disease can be made with imaging studies such as ultrasound, CT scan, or an MRI, by looking for fatty infiltrates. Also, a biopsy of the liver can be performed to confirm the diagnosis and evaluate the severity of the disease.

Since the liver cells become destroyed during the course of NAFLD, the liver enzymes might increase in count. There might be an increase in aspartate transaminase (AST) or alanine transaminase (ALT). Progression of steatosis in NAFLD to steatohepatitis to cirrhosis causes an increase in ALT and sometimes AST. In comparison, alcoholic fatty liver disease generally causes a large increase in AST and a lesser extent of an increase in ALT, with an AST to ALT ratio of greater than two.

Even at advanced stage of NAFLD, there may be no symptoms. You could have 90% of your liver destroyed and be functioning good in your body. When there are symptoms, they are ambiguous, such as fatigue or malaise. If there is significant liver damage, the liver might become enlarged or hepatomegaly might occur. There could be pain in the upper quadrant of the abdomen, jaundice, or accumulation of fluid in the upper peritoneal cavity, known as ascites. There also might be bloating, right shoulder pain, issues with the skin, and itching of the bottom of the feet and palms of hands. One very noticeable symptom is a protruding, basketball belly. Many people who have big bellies have a fatty liver. People with body fat concentrated in the abdomen are particularly at a higher risk for NASH.

NAFLD and heart health

The NAFLD can impact heart health as well. There have been studies done recently on NAFLD in relationship with cardiovascular health. Since many patients with NAFLD are overweight and have metabolic syndrome, it is a risk factor for cardiovascular disease. Studies indicate that NAFLD causes structural and functional changes in the heart and vessels, causing an increased heart-related death (Mangi et al. 2017).

Also, when the liver becomes inflamed, it puts pressure on the heart, creating heart arrhythmia problems, and heartbeat begins to skip. It can also cause high blood pressure and an increased pulse rate. The liver is right next to the heart, and it compresses the heart. Particularly, if an individual with an enlarged liver sleeps on their left side, the liver compresses the heart, and it makes it difficult to breathe and sleep at night. Hence, if you have a liver condition, try to sleep on the right side of your body.

NAFLD and your lifestyle choices

You can judge a person’s liver health by their lifestyle habits. The NAFLD is a lifestyle-based inflammatory condition in the liver. The aim is to reverse the factors that contribute to insulin resistance, primarily through a healthy diet, an exercise regimen, and appropriate supplements. Every time you eat junk food, you create inflammation in your liver. Even when you take Tylenol or other NSAIDs like Ibuprofen, your liver cells get inflamed. Acetaminophen (Tylenol) is the number one cause of liver failure in the world. It is worth noting that some of the cholesterol-lowering medications such as Lipitor, for example, will severely stress the liver and increase the liver enzymes by 500%, damaging your liver.

The good news is that liver is the only organ in the body that can regenerate completely, but it can take time. However, we have to alter our lifestyle. We cannot regenerate our liver by eating junk food and drinking alcohol, even in moderation. This poses a stress on our liver, and it could take a long time for the liver to recover.

We have to eliminate the foods that destroy the liver and add the ones that create a healthy liver. Cut down on your carbohydrate intake, and consume very little or no sugar at all. I recommend eating bitter vegetables, such as mustard greens, collard greens, kale, spinach, and radishes routinely. Also, avoid deep fried foods and hydrogenated oils completely. However, do consume healthy fats, which are very important for liver health. The medium chain triglycerides (MCTs) found in coconut oil are very good for the liver. Coconut oil is beneficial for liver health and does not strain the liver. Other oils which are good for the liver are olive oil and avocado oil. You can take a teaspoon of apple cider vinegar in your water a few times a day to help your liver.

Indian population and NAFLD

Most Indians have a vegetarian diet, but they also have a high incidence of NAFLD. One of the main reasons is that they are consuming too much carbohydrates in their diet. Also, they are using fried foods. Even every vegetable they eat is fried virtually, because they are using this method of “tadka” or sautéing. Sauté is done on a hot oil and added with vegetables and spices. This makes the food more rancid. Our systems are not used to eating rancid foods. Secondly, again, the excessive carbohydrate intake of refined foods such as white rice and white breads is a problem. Our systems are not used to eating such refined foods. Traditionally, we ate rice, but those rice were hauled on the same day. We ate wheat rotis, but the wheat berries were grounded on the same day. This meant that our rice and roti had all the live enzymes. When the food is shelled or wheat flour is grounded, the enzymes, the nutrients, and the good bacteria are dead. This does not help our system to get better.

Many Indian people are prone to having NAFLD because of their excessive use of carbohydrates. They need to learn how to balance their food. Basically, in every lecture, I tell to increase your dietary intake of vegetables. Vegetables should not be fried. The oil is good, but not excessive oil. When you fry in the oil, that makes it the worse. I tell my patients to steam the vegetables, and then add the green spices and the dry spices, freshly grounded up. Add the oil in the end. That way you have not made your food rancid. It will be easy on your system to digest your food in this way. Especially the Indian folks out there, increase the vegetable intake and cut down on the refined carbohydrates.

This fatty liver disease is also making Indians more diabetic, because you are becoming insulin resistant. As discussed earlier, insulin resistance is one of the causes for why people are getting fatty liver disease. This is because it triggers inflammation. When the liver is inflamed, it gets into fibrosis and cirrhosis. By adding more vegetables, you are flushing your liver, and you are helping your liver cells to breathe better and stay healthy.

Ayurvedic herbs for NAFLD

There are many Ayurvedic herbs you can take to treat NAFLD. Triphala is one such herb. Triphala is a combination of three medicinal herbs: Amlaki, Haritaki, and Baheda. Studies show that Triphala naturally protects the liver against toxicity. It is hepatoprotective (Gupta et al. 2015). Turmeric is another amazing herb for the NAFLD. In animal studies, curcumin has shown to lower inflammation associated with NAFLD. Research shows that curcumin reduces the detrimental effects of diabetes on a fatty liver (Seth et al. 2013).

Other Ayurvedic herb which is really good for the liver is Eclipta alba or Bhringraj. There is lots of research available in the animals and humans, which shows that Bhringraj reverses liver diseases. Other liver herbs are Phyllanthus amarus, Solanum nigrum, Boerhaavia diffusa, and Mimosa pudica. All these herbs have a very wonderful liver detoxification action and function in the regeneration of the liver cells. I have put a formulation together into “Ayush Herbs Livit-2” to help stimulate the liver and make the liver function better. This product is also available in health food stores as “R.U.Ved Livtone”. All these herbs support the liver, and help the liver functions, thereby, aiding in the prevention.

Conclusion

To make your liver healthy and stay healthy, eat healthy food. Avoid alcohol and drugs. Also, avoid over-the-counter drugs and prescription drugs, which can have a harmful effect on the liver. Walk daily, do your yoga, and have a good sleep. These are the basics which will take care of almost any disease.