Lifestyle Modifications for Nonalcoholic Fatty Liver Disease (NAFLD)

Nonalcoholic fatty liver disease (NAFLD) is a condition that is characterized by the buildup of fat in the liver. It is the most common cause of chronic liver disease in the United States, affecting up to 25% of the population. 

NAFLD can affect people of any age, including children.  Roughly 10% of US children aged 2-19 have NAFLD.  NAFLD is most common in Hispanics, followed by non-Hispanic whites and Asian Americans.  Asian Americans with NAFLD often have a lower BMI than non-Hispanic whites with NAFLD.   

NAFLD can progress to a more serious condition called nonalcoholic steatohepatitis (NASH), which can lead to cirrhosis and even liver failure.

NAFLD is commonly asymptomatic, but is frequently associated with insulin resistance, obesity, diabetes, hypertension, high cholesterol, and metabolic syndrome.  One-third to two-thirds of people with type 2 diabetes have NAFLD. Research also suggests that NAFLD is present in up to 75% of people who are overweight and in more than 90% of people who are obese.

Treatment and management of NAFLD requires a comprehensive approach that includes lifestyle modifications and medical interventions.

What can I do to treat NAFLD or help prevent its occurrence?

Weight loss

There is a dose dependency of weight loss with NAFLD improvement.  Meaning the more you lose, the better improvement in disease.  However, weight reduction of even 5-10% can improve disease and prevent complications.

Physical Activity

Physical activity improves insulin sensitivity and enhances fatty acid metabolism.

The higher the intensity of exercise, the greater the effect on disease prevention and treatment.

Conversely, an increased amount of daily sedentary time correlates with increased disease risk.

Nutrition

·        Limit intake of saturated fat and high glycemic foods

·        Avoid added sugars

·        Limit fructose consumption (except fructose found in whole fruits)

o   Fructose is found in sweetened soft drinks, sports drinks, sweetened tea, and juices.

o   Table sugar, called sucrose, is rapidly changed to glucose and fructose during digestion.  Making it a major source of fructose.

·        Limit alcohol

Dietary plans that have shown benefit:

·        Mediterranean diet enhanced with additional green plants (green-Med diet)

·        Mild caloric restricted diet (10% of caloric needs)

·        Alternate day fasting

·        Modified low carbohydrate diet which limits saturated fats (meat) and includes polyunsaturated fats (fish) and low glycemic fruits, vegetables, and whole grains

Medications and Supplements

While no specific medications have been approved for treating NAFLD, metformin and glucagon-like peptide-1 (GLP-1) agonists might be beneficial.

Check for Nutrient Deficiencies & Cellular Dysfunction

NAFLD is associated with deficiencies in:

·        Copper

·        Vitamin D

·        Omega 3 fatty acid

·        Vitamin E

Vitamin D deficiency correlates with disease severity.

Higher levels of oxidative stress and mitochondrial dysfunction are seen in NAFLD.  Oxidative stress is an imbalance of free radicals and antioxidants in the body, which can lead to cell and tissue damage.  Uncontrolled oxidative stress can accelerate the aging process and may contribute to the development of several conditions.  Mitochondria are found in every cell in our body and are often referred to as “the powerhouse of the cell”.  Mitochondrial dysfunction is characterized by decreased efficiency in the production of energy (ATP) by mitochondria. 

Keep your gut healthy

NAFLD is commonly associated with gut inflammation, IBS, dysbiosis, and small intestinal bacterial overgrowth.  All of these diseases can lead to increased gut permeability and bacterial translocation to the liver. 

The gut liver axis refers to the bidirectional relationship between the gut, and its microbiota, and the liver.  Growing evidence indicates the pathogenetic role of microbe-derived metabolites, such as trimethylamine (TMAO), secondary bile acids, short-chain fatty acids and ethanol, in the pathogenesis of NAFLD.

Supplements that might be beneficial for NAFLD

·        Bergamot

·        Globe artichoke

·        Garlic

·        Curcumin

·        Resveratrol

·        EGCG

·        Omega 3 fatty acids

·        Vitamin E

·        Alpha lipoic acid (ALA)

·        Probiotic

Consult with your healthcare provider before beginning any supplementation to ensure it is right for you.

NAFLD is an increasingly relevant public health issue that is closely linked with the worldwide epidemics of diabetes and obesity. While pharmacologic therapies are lacking, sustained weight loss is the most effective treatment for NAFLD.  Lifestyle modification through diet and exercise must be the first-line therapy of any treatment plan for patients with NAFLD.