For starters, it's more common than you think.

By Andrea Blair Cirignano
September 18, 2019
Kateryna Son/Science Photo Library/Getty Images

A fatty liver sounds like something reserved for heavy drinkers. So, as a yoga instructor and runner who drinks in moderation, I was unpleasantly surprised when I was diagnosed with this myself.

But, as it turns out, it shouldn't have been so shocked. The American Association for the Study of Liver Diseases (AASLD) estimates that approximately 25 percent of Americans have non-alcoholic fatty liver disease and that number includes many young, otherwise healthy women.

What Is Non-Alcoholic Fatty Liver Disease?

Non-alcoholic fatty liver disease, or NAFLD, is just as it sounds: fat in the liver, but not due to alcohol consumption. And even though high body weight and diabetes may increase your risk, you can develop this problem at any shape, size, or health. In fact, one study published in Digestive Disease Week found that NAFLD in lean patients actually tends to be more deadly.

"This is the most common liver condition in the United States," says Monika Sarkar, M.D., associate professor of medicine at University of California, San Francisco, "It's pretty startling. About one in four women have fatty liver."

So what is a fatty liver exactly? Fatty liver disease is when fat droplets deposit within the main cells (known as hepatocytes) in the liver, commonly due to excess fat, carbohydrates, and sugars in the diet and metabolic risk factors such as diabetes, high cholesterol, and visceral fat (fat around the belly). (Related: Can the Keto Diet Help with Type 2 Diabetes?)

Is fatty liver disease dangerous? "For many people, fat in the liver doesn't cause liver damage, but in about a quarter of people with fatty liver, that fat will cause inflammation and possible liver scarring," says Dr. Sarkar. "Over time this inflammation and scarring can lead to the risk for liver cancer and impaired liver function. That's why some people with cirrhosis (severe scarring of the liver, or fibrosis) will need a liver transplant." (Related: Can the Keto Diet Cause Liver Damage?)

What Non-Alcoholic Fatty Liver Disease Means for Your Health

"In terms of a public health concern, [NAFLD] is already the leading cause for liver transplant in women," says Dr. Sarkar.

Of course, not all women with a fatty liver will need a liver transplant. If the condition progresses to include inflammation or scarring (fibrosis), then NAFLD becomes what's called non-alcoholic steatohepatitis (NASH). This happens for approximately 20 percent of all NAFLD patients and more likely in women than men, according to the American Liver Foundation. Doctors can only make a NASH diagnosis following a liver biopsy. If the scarring is severe or at the worst stage, this is considered cirrhosis and cause for a liver transplant.

Why is this such a concern? Put directly, "the liver is a key organ for human survival," says Dr. Sarkar. "It is responsible for detoxifying your body from things you ingest (like alcohol and medications) and also makes many important proteins, like those you need to help your blood clot. When the liver fails, it affects every organ in the body."

How to Identify Non-Alcoholic Fatty Liver Disease

Unfortunately, non-alcoholic fatty liver disease is asymptomatic, says Dr. Sarkar.

While there isn't a routine screening for NAFLD, she suggests staying up to date on all age-appropriate screenings to hopefully catch risk factors. Pre-diabetes, diabetes, and insulin resistance are all red flags, she adds. In fact, some statistics report that more than half of those with type 2 diabetes also have NAFLD.

Additionally, a liver enzyme panel can provide helpful information—high liver enzymes indicate inflammation and low enzymes can be reassuring but cannot rule out inflammation—but not act as a diagnosis. Some non-invasive tests, including imaging, are being employed more and more to detect NAFLD, but a liver biopsy may be required in some cases.

Another potential precursor to the condition is actually polycystic ovary syndrome (PCOS). "About 50 percent of PCOS women will develop NAFLD," says Dr. Sarkar.

Women with PCOS "tend to have high androgens (what we think of as male hormones), irregular periods, and ultrasounds that show an increased number and size of follicles." While it's not entirely clear why the two conditions are connected, some studies indicate that the high level of androgens might play a role somehow. (Related: Everything You Need to Know About Polycystic Ovarian Syndrome)

What to Do If You Have Fatty Liver Disease

Although there are no FDA-approved drugs to treat non-alcohol fatty liver disease, Dr. Sarkar says if you have liver damage from the condition, there are things you can do to slow down or even reverse the effects.

Lose weight if needed. A high-quality diet and increased activity can both reduce inflammation in people with NAFLD or otherwise, and Dr. Sarkar says weight loss, if appropriate, can regress or even reverse the amount of fat in the liver. However, you'd need to lose approximately five to seven percent of your body weight to improve the amount of fat in the liver and ten percent to see a decrease in inflammation and/or scarring. (Related: 15 Anti-Inflammatory Foods You Should Be Eating Regularly)

Exercise. "Exercise causes fat loss from many parts of your body," says Dr. Sarkar. "Just as exercise helps to decrease fat from your belly, the same can happen with the liver."

Improve your diet. Although fat in foods does not directly cause fat to deposit in the liver, food choices can make an impact. For instance, one study found a decrease in the severity of NAFLD in patients who followed a low glycemic index Mediterranean Diet. If you are already at a healthy weight, little changes in your eating patterns still make a difference. "Maybe you can grab a higher protein snack if you're a high-carb snacker or eat dessert every other night if you're used to sweets every night," says Dr. Sarkar. (Related: What Is the Mediterranean Diet Anyway?)

Breastfeed. Research suggests that breastfeeding can help with insulin resistance and protect women against type 2 diabetes, two known risk factors for NAFLD. These potential benefits might even transcend to the baby, as research found that a child who breastfed exclusively for at least six months had a reduced risk of NAFLD as an adult later in life.

As far as my own case of non-alcohol fatty liver disease, I seemed to have caught it early enough. I don't have any signs of inflammation or scarring, but I'm still working to make small changes to improve my already healthy lifestyle to prevent further damage.

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