Did you know that your liver is the single largest organ in your body? It helps to remove toxins from your body by cleaning your bloodstream, processes nutrients into usable energy, and produces bile to aid in digestion. Your liver sits just below your ribs and on your stomach on your right side. (1)
Your liver can work through damage or even if a part of it is gone, but it's vital to your survival. A serious condition that can negatively impact how well your liver functions is NAFLD or nonalcoholic fatty liver disease. If you've never heard of it, this is for you.
Our in-depth guide to NAFLD will give you everything you need to know about this medical condition. We'll cover common symptoms, causes, how you know you have it and so much more by the end of this post.
As we mentioned, NAFLD stands for nonalcoholic fatty liver disease. There are two kinds of NAFLD, and neither one of them come from alcohol use. The two different kinds of NAFLD include (2):
- Nonalcoholic steatohepatitis (NASH) means that you have inflammation in your liver that can or has caused cell damage or death. You can end up with fibrosis or scarring of the liver if you don't treat it. This can eventually lead to liver cancer or liver cirrhosis. (3)
- The second, and arguably less severe form of NAFLD, is simple fatty liver. You'll have small amounts of fat present in your liver, but you won't have inflammation or damage to your liver cells. If left untreated, it can progress to something more serious. (4)
Understanding the Difference Between NAFLD and AFLD
On the other end of the spectrum, you have AFLD or alcoholic fatty liver disease. You get this condition if you abuse alcohol or drink excessively. When you drink, your liver works to break down a large portion of the alcohol. However, this process can start to generate harmful substances that can promote inflammation, damage liver cells and weaken your body's immune system as a whole. (5)
The more alcohol you consume, the more damage it does to your liver over time. It can eventually lead to cirrhosis of the liver and alcoholic hepatitis.
The main difference between these two conditions is the root cause. One is from drinking far too much alcohol, and the other is inflammation. They both result in damage to your liver, and they can both progress to the point where it interferes of stops your liver from functioning as it should. (6)
Common Symptoms of NAFLD
The problem with NAFLD is that the majority of people who have it are asymptomatic. This means that they don't show or feel anything different. This allows the disease to progress to dangerous levels like cirrhosis. This is typically the point where you start to experience symptoms. However, some people do have symptoms in the early stages. (7)
The most commonly reported symptoms associated with NAFLD include but are not limited to:
- Fatigue- Fatigue is a symptom that can occur at any point during NAFLD's progression. When your liver isn't working as it should, your body works harder to make up for it because it's trying to protect itself by pushing more blood toward the organ. It's common to feel drained, weak, tired or to have trouble concentrating. (8)
- Jaundice- As your NAFLD progresses, it's common to experience jaundice. This is the biggest indicator that there is something going on related to your liver. When bile gets blocked from exiting the liver by scar tissue or an obstruction, your skin and the whites of your eyes turn yellow. (9)
- Urine Changes- Having a very dark coloured urine that may or may not have a strong odour can also occur as your NAFLD gets worse. Toxins cause this, and your liver would usually screen them out. However, since your liver isn't working correctly, the toxins slip through. You may also experience pain when you urinate. (10)
- Skin Changes- Once you move into the first stages of liver failure and the last stages of NAFLD, your skin can start to change in appearance. There is typically discolouration on your neck and arms, your spider veins pop out and you may have broken blood vessels in your face. (11)
- Abdominal Pain- Discomfort or pain in the right upper quadrant or in the right centre quadrant of your abdomen is a red flag that there's something wrong with your liver. This pain may also come with fluid retention and mild vomiting. The pain can come and go or be a dull, constant ache. (12)
- Confusion- Your body will push more blood to your liver when it stops working as it should. Toxins will also start to build up in your bloodstream and carry throughout your body. These things can cause confusion or disorientation that comes and goes. In severe cases, this can result in a coma. (13)
- Easily Bruising- A final red flag that something could be wrong with your liver is broken blood vessels and it's very easy for you to bruise. You might also bleed a lot from even the smallest cut. This is due to the fact that your liver can't create clotting proteins to stop it. Fluid retention can cause bruising as well. (14)
- Swelling in Your Abdomen- When your liver doesn't screen out toxins and your body rushes excess blood to the area, you can get swelling. You may notice that the area directly around your liver feels tight to the touch, hard, and you may look bloated. If you get fluid retention with this as well, your entire abdomen can swell. (15)
Causes of NAFLD
Now that you know what NAFLD is along with a few common symptoms that you could experience, we'll move into the causes of this problem. We're going to highlight the biggest four causes of NAFLD so you can see if any of them apply to your own life.
1. Metabolic Syndrome and Insulin Resistance
If you have metabolic syndrome, you have a group of significant risk factors that increases your risk for diabetes, stroke, heart disease and other cardiovascular events. When people talk about "metabolic," they're talking about all of the biochemical processes that comes with your body's normal function.
These risk factors include things like having an "apple" shape or large waist, high triglyceride levels, low HDL cholesterol, high blood pressure or high fasting blood sugar. These risk factors cause your organs to work harder as a whole, and this can put more stress on a liver that is already having problems. (16)(17)
Your pancreas produces a hormone called insulin. Insulin helps your cells absorb the glucose (sugar) in your blood. When your liver isn't functioning well, it doesn't help your cells or other organs absorb as much glucose. In turn, your pancreas will start to make more insulin to counteract the excess glucose in your blood.
This can cause your body to force your liver to work harder to filter out the excess glucose and insulin in your body. Your liver won't be able to store everything like it should, and this can overwhelm it. Depending on how severe your NAFLD is, this could even cause more scar tissue to form or more cell damage. (18)(19)
2. Gut Dysbiosis
There at between 300 and 500 species of bacteria alive and well in your gut. This works out to around two million bacteria at any given time. In a healthy gut, the "good" bacteria and the "bad' bacteria balance each other and prevent problems. However, gut dysbiosis is where the "bad" bacteria outnumber the other bacteria. (20)
When this bacteria gets unbalanced, it can cause problems throughout your body. While most people would automatically think that this refers to problems with your digestive system, it can also cause acute problems with your liver. There are several studies around that support this theory. (21)
Research has found that your gut microbiota play a vital role in encouraging your body to increase its energy uptake. Since your liver plays a huge role in energy production, this puts more pressure on it to work harder to keep up with the increased demands. (22)
Additionally, gut dysbiosis can lead to inflammation that makes its way to your liver. If this inflammation gets into your liver's cells, it can cause a lot of damage in a very short amount of time. Eventually, the cells can die and form scar tissue. This scar tissue will make it even harder for your liver to work, and these bacteria can also cause an increase of the presence of fat in your liver. (23)
Unfortunately, there is very little that you can do with your genetics. You're either born with an elevated risk factor for NAFLD or you're not. One of the central genetic factors that researchers focus on is the PNPLA3 gene. You can find this particular gene in your fat cells as well as in your liver cells. (24)
Scientists believe that this gene is responsible for helping to regulate, process and store the fat in your blood and cells. When this gene has a variation, it can cause your liver cells to store too much fat. In turn, this can quickly lead to the start of NAFLD. (25)
Another genetic factor that influences your risk for NAFLD is having a family history of Type II diabetes. Studies show that people who have a family history of Type II diabetes have as much as a 66.67% higher chance of developing NAFLD themselves. They believe that obesity combined with insulin resistance increases your chances of having issues with NAFLD at some point during your life. (26)
A final significant cause of NAFLD is a person's diet quality and composition. People who have an unhealthy diet typically experience an increased disease progression from the beginning stages of NAFLD to NASH and fibrosis of the liver. (27)
Researchers found that people who eat a diet that has a very high Omega-6 fatty acid content along with fructose sugar and lipids speed up the progression of this condition. Fats are generally very high in calories, and this can cause you to gain weight and store more fat in and around your liver. (28)
Fructose sugar is responsible for causing inflammation throughout your body, but it concentrates in and around your liver because your liver helps your body store and process fat. It increases the amount of hepatic fat in your body, and this can make NAFLD worse. (29)(30)
Lipids are another class of fatty acids that are insoluble in water. If your liver cells don't work as well as they should, lipids build up. This can lead to liver cell death by a condition called Lipotoxicity. Along with negatively impacting your liver, it also impacts your skeletal system, heart and kidneys. (31)(32)
How You Know You Have or Are at Risk for NAFLD
If you experience the symptoms we listed above, or if you have some of the risk factors we talked about, you can ask your doctor for a specific test. The alanine aminotransferase (ALT) blood test measures your body's levels of ALT. This is an enzyme that your liver produces that plays an essential role in your metabolism by helping to turn the food you eat into energy. (33)
You find ALT in your liver cells. However, when your liver becomes damaged or inflamed as it can with NAFLD, ALT gets released into your bloodstream and goes throughout your body. This is an outpatient lab test that only takes a few minutes. There isn't any special preparation that you have to do prior to having the test.
Normal ALT levels can fluctuate from medical facility to medical facility and by gender to gender. Two decades ago, anything 20 and below was normal. Today, it can fluctuate between 29 and 33 units per litre for males and it can fluctuate between 19 and 25 units per litre for females. Anything below 42 is widely considered normal, and results higher than that are warning signs of NAFLD. (34) However, the figure that people should be going by is 20 - this figure was determined decades ago when diets were not so heavily processed.
Fortunately, there are treatment options available for people who received a diagnosis of NAFLD. You do want to start these treatment options very quickly after your diagnosis to minimise the damage this condition can do to your liver. Once you figure out the root cause of your NAFLD, you can begin treating it.
- Lifestyle and Diet Changes- One of the surest ways to treat this condition is by lifestyle and diet changes. This can help to reverse the damage due to NAFLD. You'll want to start incorporating more vegetables and fruits into your diet, as well as whole grains because they're less processed and easier for your body to digest. (35) You also want to avoid drinks and foods that contain large amounts of fructose or sugars. This means cutting out soda, sports drinks, juices and sweetened teas. You can start an exercise routine to help you lose weight or maintain a healthy weight. (36)
- Heal Your Gut- If you find that your gut is the root cause of your NAFLD, you can work on healing it. You can help heal your gut and reduce your system-wide inflammation by incorporating certain foods into your diet. They include:
- Bone Broth- Bone broth contains a lot of vitamins, minerals and nutrients that help to seal your gut's lining and prevent any bacteria from seeping through. This can reduce any inflammation you may have, and decrease your intestinal permeability. (37)
- Collagen Peptides- Collagen peptides are essential building blocks that help to stop and reverse cell damage. They trigger your cells to form new collagen fibres, and this improves your tissue structure. (38)
- Glutamine- Glutamine is an amino acid that helps your liver and other organs fend off bacteria and stay healthy. It also supports healthy cell growth, and this can slow down the progress of NAFLD. (39)
NAFLD can be a serious health condition that can progress rapidly depending on your diet and lifestyle choices. We outlined the difference between NAFLD and AFLD, common symptoms, four big causes, how you diagnose it and a few treatment options that you can try. They can help to slow and even reverse the progression of your NAFLD. As always, check with your physician before you make any significant lifestyle changes.