Fatty Liver Disease (NAFLD) Causes, Symptoms & Solutions
~ by Jo Jordan
You may have fatty liver disease (NAFLD) without any signs or symptoms. If there are symptoms, they are normally vague and non-specific. In the early stages, you may experience fatigue, malaise, or a dull ache in your upper right abdomen.14
At a more advanced stage of fatty liver disease (NAFLD), you may experience:
- Bleeding from engorged veins in your esophagus or intestines
- Fluid in your abdominal cavity
- Itching of your hands and feet, and eventually your entire body
- Lack of appetite
- Liver failure
- Loss of interest in sex
- Mental confusion, such as forgetfulness or trouble concentrating
- Small, red spider veins under your skin, or easy bruising
- Swelling of your legs and feet from retained fluid
- Weight loss
- Yellowing of your skin and eyes and dark, cola-colored urine
According to the Radiology Department at the University of California, San Francisco, "Up to seventy percent of obese individuals develop non-alcoholic fatty liver disease (NAFLD), which may progress to non-alcoholic steatohepatitis (NASH) and ultimately lead to cirrhosis, end-stage liver disease, and transplantation"1.
The exact cause of NAFLD, or fatty liver disease as it's commonly called, is unclear. Many researchers, however, believe that metabolic syndrome — a cluster of disorders that increase the risk of diabetes, heart disease, and stroke2 — plays a crucial role in the development of fatty liver disease.
Though no established treatment is presently available for a fatty liver, studies point to the ingredients in Puristat's internal cleansing programs, including milk thistle and supplementation with various antioxidant vitamins, for prevention and protection from liver diseases such as fatty liver disease, as well as improved function for an already diseased liver.
Fatty liver disease levels of severity
A normal liver contains approximately five percent fat, and the rest of it is comprised of liver cells that perform the liver's vital work. Healthy liver cells are replaced by fat cells when the liver's fat content surpasses ten percent.3 This condition is referred to as fatty liver, or steatosis.
- Simple fatty liver disease (steatosis): The progression of liver damage begins with deposits of fat in the liver that cause it to become enlarged. The condition usually doesn't cause liver inflammation or scar tissue, and the risk of progressive liver damage is low. There are no symptoms.
- NASH (Non-alcoholic steatohepatitis): The accumulation of excess fat continues; inflammation and signs of necrosis begin to appear. Eventually, scar tissue forms as more liver cell injury occurs. NASH – a relatively new fatty liver disease – ranks as one of the major causes of cirrhosis of the liver in the United States, after hepatitis C and alcoholic liver disease.4
- Cirrhosis: Liver scarring results in a hard liver that is unable to function properly. Cirrhosis can be fatal.
On April 6, 2006, Medical News Today reported that of 152 patients studied with cirrhosis due to fatty liver disease (NASH), twenty-nine had died over a ten-year period.5
Fatty liver disease causes
How a liver becomes fatty is unclear. Some researchers speculate that the excess fat may get absorbed from other parts of the body. Another theory is that the liver – for some reason – loses its ability to transform fat into a form that can be eliminated.
While the exact cause of NASH is also unknown, some believe that the disease progresses from one state to the next through a secondary trigger.
For example, when a person with one of the following conditions...6
- Obesity, especially around the waist
- High blood pressure (hypertension)
- One or more abnormal cholesterol levels: high levels of triglycerides – a type of blood fat – or low levels of good cholesterol (known as high-density lipoprotein or HDL)
- Resistance to insulin, a hormone that helps to regulate the amount of sugar in the blood
...experiences a bacterial infection, hormonal abnormalities, or an accumulation of excess iron in the liver, the liver can change from simple fatty degeneration to an inflamed state.
33% of American adults at risk
While NAFLD affects all age groups, it occurs most often in middle-aged and overweight or obese individuals,7 and in those who may also have elevated cholesterol and triglyceride levels and diabetes.
Some scientists believe that fatty liver disease may be partly genetic. NASH was originally believed to be more common in women,8 and it is the most common cause of liver disease in adolescents.9
With the increasing incidence of diabetes and obesity in Western countries, the relevance and high prevalence of NAFLD came to the forefront in the 1990s, and has become a serious concern among health care professionals. Although exact figures are not yet available, some estimates suggest that fatty liver disease (NAFLD) may affect as many as one-third of American adults.10
While a high percentage of people with simple fatty liver or NASH will not develop serious liver problems, without treatment these conditions can progress to cirrhosis, liver failure, and death.
Unless lifestyle changes are implemented, in fact, ten to twenty percent of people with fatty liver will go on to develop cirrhosis, while thirty to sixty-six percent of those with NASH will develop cirrhosis.11 In some of these cases, the only survival option will be a liver transplant.
The risk of developing cirrhosis and liver failure is greatest in people over forty-five who are affected by obesity, diabetes, or both.12
Its association with obesity means that many people with fatty liver disease (NAFLD) will die of complications related to cardiovascular problems,13 rather than as a result of cirrhosis itself (as compared with hepatitis). In fact, some consider fatty liver disease (NAFLD) a much more significant problem than chronic hepatitis C.
Diagnosing fatty liver disease
Because NAFLD can be a silent disease – one that seldom shows signs and symptoms in its early stages – many people seek advice about treatment after a routine liver test to monitor cholesterol-lowering drugs, for example, returns abnormal readings.
At this point, you will more than likely be advised by your health care provider that further testing is necessary to determine whether or not NAFLD is a factor.
Types of NAFLD testing
Various tests provide details about the extent and type of liver damage you may be suffering from:15
- Liver function test – This blood test can reveal an increased presence of certain enzymes, released by the liver when it is damaged.
- Ultrasound (ultrasonography) – A non-invasive test, this technology uses sound waves to create an image of your liver.
- Computerized tomography (CT) – CT X-rays produce cross-sectional images of your liver.
- Magnetic resonance imaging (MRI) – MRI technology produces an image of your liver via a magnetic field and radio waves. Contrast dye is sometimes used for this test.
- A liver biopsy– A biopsy is the only way to conclusively diagnose NAFLD. Normally performed under local anesthesia, this procedure involves the removal of a small sample of tissue from the liver – usually with a thin cutting needle. The sample is then examined under a microscope.
Treating fatty liver disease
Lifestyle changes, including liver cleansing with products containing milk thistle and supplementing with advanced multi-vitamins, offer the hope of prevention. Milk thistle is believed to protect the liver from damage caused by alcohol, certain drugs, toxins, and viruses. For this reason, many researchers believe that milk thistle cleanses and vitamin supplementation can halt the progression of liver disease, as well as aid in its recovery.
While there is currently no standard for treating NAFLD, trials are presently being carried out in order to determine the course of effective treatment.
General recommendations include:
- Reducing alcohol intake
- Treatment of lipid disorders (problems that impair the way the body uses dietary fat)
- Strict control of diabetes (since insulin may act as a trigger)
- Avoidance of certain drugs and other substances known to cause liver damage
Eating fatty foods does not itself cause fatty liver. However, recommended treatments for NAFLD also include weight loss, exercise, and the use of cholesterol-lowering medications. Bariatric surgery is indicated in some cases.
Unfortunately, most of the available treatments are ineffective at improving liver function, and they do not delay or decrease the amount of fibrosis.16 However, gradual weight loss, and possibly bariatric surgery, may reduce liver abnormalities in obese patients.
Some health care providers recommend medications such as ursodeoxycholic acid (Actigall), which may help to lower elevated levels of liver enzymes in people with liver disease.
Once a patient reaches the fatty liver stage, lifestyle habits may have already contributed to weight problems, and possibly obesity. This, in turn, can lead to diabetes and high blood cholesterol, which contributes to the fermentation process in the liver that catalyzes fatty liver...a process that mirrors the results of alcohol consumption.
In the United States, the Agency for Healthcare Research and Quality (AHRQ) cited sixteen studies on milk thistle's effectiveness for treating various types of liver disease. Significant improvements in liver function were found in five of seven studies evaluating the herb for alcoholic liver disease. Milk thistle was most effective for those with mild forms of liver disease.17 Puristat's Liver Cleanse includes Milk Thistle along with other effective natural ingredients.
In addition to milk thistle, herbs and nutritional supplements containing alpha-lipoic acid, N-acetyl cysteine, and Omega 3 fatty acids are also cited by some physicians as being helpful to damaged liver.
The National Institute of Diabetes and Digestive and Kidney Diseases notes that experimental approaches currently under review for NASH patients include antioxidants, such as vitamin C, vitamin E, selenium, and betaine18. The antioxidants vitamins C and E are believed to be helpful in reducing liver damage caused by destructive, unstable oxygen molecules.
Complications from untreated non-alcoholic fatty liver disease (NAFLD) can be grim. The seriousness of its ranking as one of the major causes of cirrhosis of the liver makes NASH a potential health problem that should not be taken lightly. If you suffer from any kind of metabolic disorder – particularly diabetes or high cholesterol – and you are overweight, it's doubly important to do everything you can to protect one of your most valuable assets: your liver.
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1. Fergus V. Coakley, MB, Bch, et al, "What's New in Abdominal Imaging," Department of Radiology, University of California, Research News, ,
2. Mayo Foundation for Medical Education and Research (MFMER), "Nonalcoholic fatty liver disease,"
3. Richard Kim, MD, "Fatty Liver: Your Liver Lets You Live," gihealth.com e-newsletter,.
4. The National Institute of Diabetes and Digestive and Kidney Diseases, "Nonalcoholic Steatohepatitis," http://digestive.niddk.nih.gov/ddiseases/pubs/nash/index.htm#treatment.
5. Medical News Today, "Relative Risks Of Cirrhosis From Non-alcoholic Steatohepatitis," April 6, 2006,
6. Mayo Foundation for Medical Education and Research (MFMER), "Nonalcoholic fatty liver disease,"
7. The National Institute of Diabetes and Digestive and Kidney Diseases, "Nonalcoholic Steatohepatitis," http://digestive.niddk.nih.gov/diseasespubs/nash/index.htm#treatment.
8. Ludwig J, Viggiano, "Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease," United States National Library of Medicine and National Institutes of Health,
9. Richard Kim, MD, "Fatty Liver: Your Liver Lets You Live," gihealth.com e-newsletter,.
10. Mayo Foundation for Medical Education and Research (MFMER), "Nonalcoholic fatty liver disease,"
11. Medscape from WebMD, "Clinical Gastroenterology: Highlights of the American Gastroenterological Association 2000 Spring Postgraduate Course - Part I CME,"
12. Mayo Foundation for Medical Education and Research (MFMER), "Nonalcoholic fatty liver disease,"
13. Medical News Today, "Relative Risks Of Cirrhosis From Non-alcoholic Steatohepatitis,",
14. Mayo Foundation for Medical Education and Research (MFMER), "Nonalcoholic fatty liver disease,"
16. Medscape from WebMD, "Clinical Gastroenterology: Highlights of the American Gastroenterological Association 2000 Spring Postgraduate Course - Part I CME,"
17. University of Maryland Medical Center, "Milk thistle,"
18. The National Digestive Diseases Information Clearinghouse, "Nonalcoholic Steatohepatitis," http://digestive.niddk.nih.gov/ddiseases/pubs/nash/index.htm#treatment.