Living Well It's the silent disease nearly 30% of Americans already have without even realizing it. Symptoms typically involve feeling tired and occasionally a pain in the side. Both are easy to dismiss, especially in times of stress.
Worse, researchers think we're going to see a jump in liver-cancer deaths because of it.
I'm talking about nonalcoholic fatty liver disease, or NAFLD.
Last week, we highlighted the risk of hepatitis C and its link to liver cancer. We're worried because both hepatitis C and NAFLD can lead to liver cancer. And we know that liver cancer is one of the deadliest cancers you can get. The overall five-year survival rate for all stages is just 18%... If you're diagnosed at stage 4 (where the cancer has spread to other areas of the body), that survival rate is just 2%.
One of the best ways to beat cancer is to understand it and know how to prevent it when possible. Fortunately, we can prevent many cases of NAFLD. Here's what you need to know...
What is fatty liver disease?
The liver has a number of important functions:
- Filters out drugs and some bacteria
- Produces substances for blood clotting
- Makes bile for breaking down food for digestion
- Makes proteins for the body
- Makes and stores cholesterol
- Stores sugar and vitamins
Over time, your liver may start to store excess fat. This happens if the body makes too much fat or if you have problems breaking down fats in your body. The clinical definition is when fat in the liver contributes to 10% or more of the liver's total weight.
Who gets fatty liver disease?
Only about 10% to 15% of people of normal weight get it, but 70% of obese folks get it. Many people don't experience symptoms. So undiagnosed cases could put that number higher.
And it's only rising. About 38% of all Americans are now obese, with middle-aged Americans (40 to 59 years old) and those over 60 having the two highest rates of obesity at 41% and 38.5%, respectively.
What causes fatty liver disease?
We don't know exactly why certain people's livers wouldn't break down fat as effectively, but we do know some common risk factors for fatty liver disease.
Risk factors include:
- Obesity
- Type 2 diabetes
- High cholesterol
- High blood pressure
- High triglycerides
More recent research points to other contributors like genetics, rapid weight loss, liver diseases like hepatitis, and certain medications such as steroids.
What are the symptoms?
For the most part, there aren't any symptoms. You might feel tired or have some discomfort in your abdomen (the upper right side under your ribs is usually where you feel it).
Symptoms from very severe cases include a loss of appetite along with nausea and vomiting. Some folks might also appear jaundiced, or yellow in the skin or eyes.
Your doctor will likely order blood tests to check your liver enzymes first. That might lead to an ultrasound and a possible biopsy to confirm your diagnosis.
Does fatty liver really cause cancer?
Fatty liver can cause inflammation, which we know damages tissue and may lead to cancer. But fatty liver also leads to scarring in the liver tissue called cirrhosis, which has an increased risk of cancer.
NAFLD may not develop into anything. Or it could develop into nonalcoholic steatohepatitis, or NASH. NASH means there's inflammation in your liver, which may lead to cirrhosis and cancer. About 20% of those with NAFLD have NASH (that's about 6% of the total population).
Here's the thing... we read about a study presented at the European Association for the Study of the Liver International Liver Congress in 2015. The study demonstrated that over a five-year period, researchers saw an increase in the number of liver cancer patients. The annual increase was 5% each year. Worse, the percentage of cases caused by fatty liver also increased, more so than the number of cases due to hepatitis.
What can I do to prevent fatty liver?
The numbers are against us. Leading liver journal Hepatology forecast that the number of NAFLD cases will reach 100.9 million by 2030. It also predicted an increase in NASH cases from 16.5 million in 2015 to 27 million in 2030 – that's a 63% increase.
We have to fight back. Keeping a healthy weight is crucial to preventing this disease. Following my guidelines for a Mediterranean diet and getting plenty of exercise will help. Replace trans fats with healthy ones, like olive oil.
A few studies point to a connection between monosodium glutamate and fatty liver. It's a common flavoring added to food. Many folks know it's common in Chinese takeout, but it's also present in pre-made bottled sauces (like hot sauce), protein powder, croutons, salad dressings, and pre-mixed spice rubs.
I already have fatty liver. Can I reverse it?
Yes and no. The scarring and damage done by NASH is permanent. However, if you have NAFLD, you may be able to reverse the fat buildup with simple lifestyle choices. That includes things like losing weight and exercising. For NASH, you may be able to stop the damage from progressing if you also make the same adjustments. You might consider adding vitamin E to your diet.
Don't forget, coffee helps prevent liver cancer as well. If you don't already enjoy a cup or two in the morning, now is a perfect time to start.
Both NAFLD and NASH are growing problems in the U.S. As we continue our sedentary, ultra-processed-food lifestyles, we're slowly killing our livers. Cut out trans fats, start fasting, and get up and exercise every day. No matter what else you do this year, make sure taking care of your liver is a top priority.
What We're Reading...
- Something different: A new device that can retrain your brain to restore movement after a stroke.
Here's to our health, wealth, and a great retirement,
Dr. David Eifrig and the Health & Wealth Bulletin Research Team
June 16, 2021