Liver disease is often associated with drinking excessive amounts of alcohol, but the most common liver disease in Canada is no longer caused by alcohol. Non-alcoholic Fatty Liver Disease, NAFLD for short, is the most prevalent liver disease in Canada.
NAFLD is rapidly increasing in North America. Over 25% of all Canadians are estimated to have NAFLD and this number is projected to rise by about 20% by 2030 with NAFLD-associated deaths doubling during this time. To give some context, in 2000 <1% of all liver transplants were due to NASH (secondary outcome form NAFLD) and now NASH is the leading cause of liver transplants.
What is causing this rapid increase?
The high amount of fructose in the standard western diet is largely to blame, along with excess caloric consumption, a lack of movement and the hormonal changes which occur in the body in individuals struggling with obesity.
How do I know if my liver is healthy or not?
You can ask your healthcare practitioner to run liver function tests in your blood work which assess the levels of liver enzymes. Elevated liver enzymes such as ALT (marker for liver fat) as well as AST (mitochondrial function) are signs of poor liver function. ALT can be used as a biomarker to measure the amount of fat on the liver as this enzyme increases when the liver stores fat. Testing for ALT can give information on the function of the liver as well as the storage of fat on the liver without an ultrasound.
I personally like to see my patients under 25 when looking at ALT, although the upper limit for ‘normal’ is 50 U/L. Laboratory ranges are often used to compare an individual to the population, but if you remember the beginning on this article, I mentioned that NAFLD used to be quite rare. In fact, the upper limit for ALT in the 1970’s used to be 25. Now, because NAFLD is so prevalent, the range for liver enzymes has increased as it is more acceptable to have high liver enzymes. Therefore, I like to keep a more conservative approach when assessing liver enzymes in patients. More on this in another blog!
How to treat NAFLD?
If you have been diagnosed with NAFLD or have been told that your ALT or AST is high, there are several things you can do to increase the health of your liver.
1. Cut fructose from your diet. This is one of the most impactful choices you can make when it comes to your liver health. Within just one month of cutting out fructose, you can make significant changes to your AST levels. Fructose is found in fruit and fruit is often demonized for this, however, the actual amount of fructose in fruit is quite small. Major sources of fructose include- high fructose corn syrup, fruit juices, agave nectar, baked goods, sodas, candy, and other processed foods.
2. Exercise. Exercise decreases fatty acid synthesis and oxidizes fatty acids so we can use fats for energy. Fatty acid synthesis means the liver is making fat and storing it in the liver, leading to a fatty liver. Exercise helps reverse this process.
3. Weight loss. If your weight is above the recommended weight range, losing weight, especially visceral fat, can reduce both the amount of fat on the liver as well as future risks associated with NAFLD.
4. Avoid alcohol. Although NAFLD is not caused by alcohol, alcohol does put excess stress on the liver and can contribute to the synthesis of fat in the liver.
5. Limit the burden on your liver. Most drugs, supplements, herbs and environmental toxins are detoxified through the liver. If you are taking several pharmaceuticals or supplements, talk to your healthcare provider to make sure you are not causing harm to your liver.
Depending on your personal health history and risks there are several other treatment options to help manage NAFLD. The good news about this increasingly prevalent condition is that lifestyle changes can make a significant impact. If you have not asked your healthcare provider about your liver health, check in and see what you can do to improve the health of this vital organ.
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