Does My Liver Make Me Look Fat: Non-Alcoholic Fatty Liver Disease

I’m just going to point out that, just because you’re a healthcare professional doesn’t mean that you’re an expert at everything and you aren’t beyond being surprised when medical conditions show up in your friends and family.  Recently I’ve had a couple friends that have presented with cases of non-alcoholic fatty liver disease (NAFLD).  I was a little shocked.  Is this normal?  Do a lot of people have this or do my friends just have rotten luck?  Is it dangerous?  I have quite a bit of experience treating Hepatitis caused by viruses and alcohol, but what causes these individuals do have an unhealthy liver?  Thoughts to ponder.  So here you are.  Research I have done for my friends I am now passing down to you.

First, what in the world is the liver and what does it do?  The liver is this huge organ that sits on the right side of your body and filters your blood, metabolizes drugs, food, toxins, and helps with nutrient and hormone utilization storage.  This organ is so often ignored, but it is basically your body’s processing factory.  It is incredibly important to how your body functions.

So what is NAFLD.  This is a disease of the liver in which more than 5-10% of the liver is made up of fat cells.  It is normal  for the liver to have some fat cells.  This is where the liver stores some of it’s nutrients, but over 10% the liver can become fatty and oversized.  This occurs in 10-25% of the American population.  Waaaay more common than I would have thought.

What are the symptoms of NAFLD?  There really aren’t many.  Your liver is one of the most resilient organs in the human body.  The biggest complaint that most people have is fatigue, quick weight loss, and pain in the upper right hand part of your abdomen.  Some patients even present with elevated liver enzymes (see how important those yearly check-ups are now?).  If the fatty cells of the liver progress it can cause non-alcoholic steatohepatitis (NASH).  NASH can lead to cirrhosis, where the liver becomes fibrotic and can no longer function adequately.    When this occurs spider veins, swollen limbs, yellowing skin and eyes, itching, and various other lovely symptoms that would be difficult (and ridiculous) to ignore.  Only 2-3% of the population will end up with NASH so this is much less common than NAFLD.  In fact many patients

So what can cause NAFLD?  Well, we’re not 100% sure.  There are definitely things that put you at risk.  Obesity, diabetes, and insulin are always risk factors, but so is weight loss that moves too quickly (gotta love starvation mode).  Metabolic syndrome (a lot of weight around the middle) is a risk.  Women are at higher risk for NAFLD and so are those with genetic mutations.  High blood pressure, cholesterol, and triglycerides, and certain drugs also put you at risk.  These are all risks, however, and even patients with these risk factors may not get NAFLD, let alone progress to NASH.  So what seals the deal?  Who will definitely not get NAFLD.  No idea.  Patients who don’t drink, are at a good weight, free of mutation, and are in perfect health may still get NAFLD.  Chock it up to the idea that you’re liver just feels like hoarding fat.  Some people collect cats.  Maybe your liver just wants to collect fat?  This is guided by the assumption that your liver has a personality.  Maybe it does.  Don’t judge.

How does your doctor diagnose NAFLD?  Well, they usually will notice elevated liver enzymes and then do an ultrasound, an MRI, or some other imaging, and ultimately do a liver biopsy to see how the tissue in the liver is holding up.  This sounds horrible, but they just knock you out (with drugs, not a baseball bat) and push a large needle into your abdomen (you won’t feel a thing).  Those of you who have had a thyroid needle biopsy… its way less painful to test your liver.

What do we do to prevent or treat NAFLD?  This is usually where the “Well isn’t there a pill for that?” question comes in and my face turns bright red and I bash my head onto the counter to prevent me from totally losing my mind.  I can honestly say that, “No, there is not a pill that cures NAFLD.”  If the NAFLD is being caused by high triglycerides, blood pressure, cholesterol, or insulin resistance then treating these things may help.  Controlling your diabetes will certainly help.  Exercise and a diet high in fruits, vegetables, and good fats (from fish, nuts, oh just go look at the blog I wrote on it) to reduce weight, central obesity, and introduce antioxidants to the system seem to help.  Plant sterols will help control your lipids and may help, but there are no oral antioxidants that show any promise in healing the liver.  In fact, introducing too much medications and supplements to the system may make things worse.    LESS IS MORE.  Here’s the other funny thing… your liver may also decide to just give up on its habit of hoarding fat and regenerate into a healthy liver again.  Ooooo it’s a tricky organ isn’t it? Worst case scenario it may progress and you may need a liver transplant, but this is INCREDIBLY CRAZY INSANELY RIDICULOUSLY RARE.

So there it is folks.  Non-alcoholic fatty liver disease.  The quick and the dirty.  What do you think?  Care to share some experiences?  You can do it anonymously!  Any other questions?  Email me at

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