Dr Eric Pugliesi
You are not alone when your GP points out extra fat build up in you liver on your annual check up. Non-alcoholic fatty liver (NAFLD) or “Fatty Liver” is on the rise in Australia and is the most common liver disease and leading cause of cirrhosis and liver cancer.
Fatty liver is divided into two groups:
Non-alcoholic fatty liver (NAFL): simple fatty liver
Non-alcoholic steatohepatitis (NASH): an inflamed lived due to fat infiltration
The distinction between these two entities is crucial. Why? Because NAFL or simple fatty liver doesn’t cause illness and is simply a poor state of your liver whereas, those with NASH have inflammation due to the fatty infiltration. The former increases the risk of damage to liver cells and has the risk of progression towards scarring (fibrosis), cirrhosis and cancer.
Unfortunately, it takes a liver biopsy to make the distinction between NAFL and NASH however, we are trying to find non invasive ways to identify who is at greatest risk of damage and direct them to an earlier biopsy and diagnosis.
People who drink too much can get a condition similar to NASH. But NASH is not related to drinking too much alcohol.
What causes NASH?
Doctors do not know what causes NASH. We do know that NASH happens more often in some people, such as those who:
Have diabetes or impaired sugar levels
Have high cholesterol
Take certain medications
What are the symptoms?
NASH is asymptomatic and the suspicion is made when you are having a routine blood test or medical imaging of your liver.
NAFL and NASH are not typically treated directed but the conditions can get better when your lifestyle is optimised. Obesity/overweight, insulin resistance, sedentary lifestyle and a diet rich in processed food and sugars are key factors in the development of these conditions.
It is for this reason that all patients with “Fatty Liver”, whether obese or normal weight, should be informed that a healthy diet has many benefits in addition to weight reduction. They should reduce added sugar/saturated fats to a minimum and also minimise unhealthy fast eating and, conversely, increase their fibre intake. Physical exercise and intermittent fasting are also important pillars in the long term treatment.
Keep your liver in optimal shape by:
Not drinking too much alcohol
Make sure none of your medications and multivitamins are toxic to your liver
Optimise your diet and consider healthy carbohydrates and fats
Consider a Mediterranean diet
Get regular screenings for your liver
Manage your excess weight
Do not trust FAD diets and obscure “detox” programs