MAFLD what?? Metabolic Associated Fatty Liver Disease

More common than you may think…..

🤫 It’s called a silent disease because most people have NO symptoms.

😮 At least 25% of all US adults are thought to have it. However, since it is often undiagnosed, this number may be way higher. 

😢 It was first described in 1980 as non-alcoholic fatty liver disease (NAFLD) to differentiate this chronic condition from alcohol-induced liver disease, which has a similar presentation.

😢 In 2020 the name was changed to help doctors and people with the liver disease better understand the root cause.

😢 It is associated with other metabolic diseases including diabetes, heart disease, overweight, and obesity.

😮 Being overweight does not cause metabolic disease but weight gain can be a symptom of metabolic disease.

 😮 Skinny people can also have MAFLD, especially if they don’t have good muscle mass. 

😮 Early signs of MAFLD include joint pain, insomnia, anxiety, fatigue, weakness and mental confusion. MAFLD can progress to cirrhosis and to liver cancer.

😮 There is no approved drug therapy but the good news is that lifestyle can reverse MAFLD. 

😮 The least expensive test to screen for MAFLD is on a comprehensive metabolic panel (CMP) specifically looking at ALT (alanine aminotransferase). A healthy number is less than 25 for men and less that 23 for women.  

How do you know if you should screen for fatty liver?

Here are the top 3 risk factors:

➡️ Weight gain, especially belly fat (remember, weight gain does not CAUSE MAFLD but weight gain and fatty liver may have the same roots)

➡️ Diabetes or pre-diabetes

➡️ Metabolic Syndrome (a diagnosis made when many lab values are abnormal and blood pressure is high-normal)

 Plenty of people probably have fatty liver without knowing it because it’s not exactly straightforward to diagnose.

🩸Bloodwork is the place to start:

●      ALT, as mentioned above, is a liver enzyme that increases with MAFLD. However, the “normal” reference range is way higher that the cut-off of 23 for women and 25 for men. Most labs have a reference range with a high of around 42. That is because the lab reference range is not a value based on health but a value based on the average of all the people who had that test run.

●      In addition to flagging ALT at a way lower number, we can look at other metabolic numbers such as hip-to-waist measurements, blood pressure and an array of other blood tests.

🩺Imaging can also be considered:

●      An ultrasound may pick up fat deposits in the liver but is not a reliable test for ruling in or ruling out the fatty liver.

●      Biopsy is the only real test that confirms the diagnosis. Yikes! Not a routine test your doctor is likely to order nor one that you would lightly do!

If you do have fatty liver, what is to be done?

The main conventional approach to fatty liver is weight loss, with some doctors recommending weight loss surgery. I agree that weight loss is a cornerstone of treatment, however, loss of weight without reversing the cause of the weight gain will not achieve lasting results.  

7 Root Causes of Metabolic Associated Fatty Liver Disease

“Multi-Hit” is how researchers describe the development of metabolic fatty liver disease. We know it’s strongly linked with diabetes and obesity, but functional medicine goes deeper to understand what mechanisms are involved.

Here are some of the possible “hits,” or factors that might contribute to fatty liver:

1.     “Truncal” weight gain. Which is weight gain around the waistline. The extra fat on the outside, the “inch(es) you can pinch” is subcutaneous fat and is not such a big problem. The more dangerous fat accumulation is what is under the skin that cushions your organs, referred to as visceral fat. This fat causes inflammation putting stress on many organs including your liver. 

2.    Metabolic Syndrome. Insulin resistance is at the center of metabolic syndrome. Cells lose their ability to properly metabolize glucose and fat, again contributing to fat deposits in the liver. 

3.    Microbiome Changes. Small intestinal bacterial overgrowth (SIBO) has been found in 50% of people with the inflamed version of fatty liver (NASH). Gut dysbiosis may lead to intestinal permeability and the release of endotoxins from the gut—going to the liver where they create inflammation.

 4.   Mitochondrial Damage. Environmental toxins (like pesticides, heavy metals, or pollutants) can create free radicals that damage liver mitochondria. This can impair fat metabolism in the liver and also lead to inflammation.

5.   Impaired Methylation. The cellular process of methylation is involved in exporting fats from the liver. If methylation is impaired (by genetics and low nutritional B vitamin intake), the liver produces less of the antioxidant SAMe, increasing the risk for liver inflammation.

6.   Diet & Lifestyle. High intakes of fructose (like high-fructose corn syrup in soda) lead directly to increased free fatty acids that can deposit in the liver. Alcohol is also damaging to liver cells, even if consumed in amounts that are generally considered acceptable.

7.    Environmental chemicals. Especially a class of chemicals called obesogens, chemical that triggers weight gain without any lifestyle factor involved.

Nutrients to Support Liver Health

Conventional wisdom says the key to addressing fatty liver is weight loss. I absolutely agree, but there are ADDITIONAL ways we can support liver health—based on what we know about cellular mechanisms and root causes.

Let’s take a look at some key nutritional supplements to consider when it comes to liver health. 

💊 S-adenosyl methionine (SAMe). SAMe is a methyl donor and antioxidant that is generally found in high amounts in the liver—but has been found in lower amounts in people with fatty liver. SAMe supplementation supports antioxidant defenses and glutathione levels in the liver.

💊 Berberine. Berberine is an active compound in several herbs and plants. It supports healthy cholesterol metabolism and blood sugar balance—both of which influence liver health. 

💊 Omega-3s. Omega-3s are essential fatty acids that play a role in inflammation, liver enzyme metabolism, and many other cellular processes. 

💊 Silymarin & Antioxidants. Supplements with antioxidant activity support mitochondrial function and inflammatory pathways. Some top antioxidants that have been studied for liver health include silymarin, resveratrol, astaxanthin, coenzyme Q10, and curcumin.

 💊 Probiotics. Not all probiotics are the same. Specific probiotic strains that have shown promise for supporting liver health include L. bulgaris, S. thermophilus, L. rhamnosus GG, and the combination of L. acidophilus and B. lactis.

The best approach is to decide on a combination of supplements that is specific to you and based on your health history, labs, and health goals.

4 Habits for Liver Health

In all the info I’ve been sharing about the metabolic fatty liver disease (MAFLD), I would be remiss if I didn’t talk about diet and lifestyle!

 Here are some diet and lifestyle considerations for anybody at risk for fatty liver disease.

1.     Eat for Blood Sugar Balance. Insulin resistance is central to the development of fatty liver, so avoiding a sugary diet is a top priority. Looking for a liver-friendly diet? Consider the Mediterranean Diet—high in fruits and vegetables and low in saturated fats. 

2.    Cut Alcohol. While alcohol is not the cause of MAFLD, even modest amounts of alcohol can put a strain on the liver. The best case scenario is to dramatically reduce or even eliminate alcohol altogether.

3.    Exercise Regularly. Exercise supports blood sugar and fatty acid metabolism. It is also an essential component of any weight loss plan.

4.   Live Clean. Your liver has to process every chemical, pesticide, and environmental pollutant that enters your body. Choosing organic foods and chemical-free products can decrease the burden, support mitochondrial health, and give your liver a chance to heal.

The excellent news? Your body has an amazing capacity to heal. Fatty liver can be reversed—as long as it has not progressed too far and you TAKE ACTION.

What do I recommend in my practice to treat fatty liver?

Step 1:

Seasonal Cleanse to transition off processed foods and chemicals that are driving fatty liver. At the very least, a 28-day cleanse takes the pressure off your overworked liver.

Step 2:

Keto-adaptation, is a way to train your body to burn fat. This is an excellent choice if you struggle with losing weight and your labs are starting to increase glucose levels, high triglycerides, poor cholesterol ratios, and high-normal liver enzymes. However, if you are having these health challenges, you need the support of a practitioner who can monitor your labs and offer support for side effects that can happen with unsupervised ketogenic diets used for weight loss.

References

Maurice J, Manousou P. Non-alcoholic fatty liver disease. Clin Med (Lond). 2018; 18: 245-250. [link]

Godoy-Matos AF, Silva Júnior WS, Valerio CM. NAFLD as a continuum: from obesity to metabolic syndrome and diabetes. Diabetol Metab Syndr. 2020; 12: 60. [link]

Xu Y, Guo W, Zhang C et al. Herbal Medicine in the Treatment of Non-Alcoholic Fatty Liver Diseases-Efficacy, Action Mechanism, and Clinical Application. Front Pharmacol. 2020; 11: 601. [link]

Wigg AJ, Roberts-Thomson IC, Dymock RB, McCarthy PJ, Grose RH, Cummins AG. The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia, and tumour necrosis factor alpha in the pathogenesis of non-alcoholic steatohepatitis. Gut. 2001; 48: 206-211. [link]

Cicero AFG, Colletti A, Bellentani S. Nutraceutical Approach to Non-Alcoholic Fatty Liver Disease (NAFLD): The Available Clinical Evidence. Nutrients. 2018; 10: E1153. [link] 

Noureddin M, Mato JM, Lu SC. Nonalcoholic fatty liver disease: update on pathogenesis, diagnosis, treatment and the role of S-adenosylmethionine. Exp Biol Med (Maywood). 2015; 240: 809-820. [link}

Do you think you may suffer from fatty liver?

(Remember, it is often silent until it becomes worrisome).

Book a discovery call to find out if we are a good fit to work together.

While reversing fatty liver may feel daunting, I have the tools to help you succeed.   

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