The common condition known as non-alcoholic fatty liver disease is being renamed. Here’s why.
The common condition known as non-alcoholic fatty liver disease is being renamed. Here’s why.
Nutrition Diva is hosted by Monica Reinagel. A transcript is available at Simplecast.
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Hello, I’m Monica Reinagel and you’re listening to the Nutrition Diva podcast, a show where I try to keep you up-to-date with the latest nutrition science and down-to-earth in terms of your daily dietary strategies. I’m glad you’re here today.
We’re talking about fatty liver disease, including some new developments on the nomenclature, as well as advice on what to do if you have it. But first, we have time for a quick listener Q&A.
Ken writes:
“I have been listening to your podcast for decades and thank you for your unbiased information. I have heard that milk kefir has many more beneficial probiotics than yogurt made from the same whole milk. Has there been any research to confirm this claim?”
The main difference between these two fermented dairy products is that kefir is fermented with a combination of lactobacillus bacteria and yeasts, while yogurt contains only lactobacillus bacteria.
As they grow and divide, lactobacillus bacteria digest the lactose in milk and produce lactic acid, which gives yogurt and kefir their characteristic tartness.
In kefir, the fermenting yeast also produces carbon dioxide, which makes the kefir slightly effervescent (fizzy), and small amounts of alcohol.
(Most of the commercially produced kefir in the U.S. contains little to no alcohol so it doesn’t have to be labeled or sold as an alcoholic drink. Homemade kefir can contain up to 2% alcohol. By comparison, wine contains between 8 and 12% alcohol.)
Because it’s made with both bacteria and yeast, kefir does have a greater variety of microorganisms. I don’t believe there’s enough research to declare that one is more beneficial to human health than the other, however. I’d go with whichever you prefer—or both!
And now, let’s turn to our main discussion.
The most common chronic liver condition, which affects an estimated one-third of American adults, is getting a bit of a brand refresh. We used to refer to this condition as non-alcoholic fatty liver disease, to distinguish it from a similar condition that can be caused by alcohol abuse. But there’s growing consensus around a move to change the name to metabolic associated fatty liver disease. So, instead of NAFLD, it will be known as MAFLD.
This is not the first time that common diseases have been renamed. What we now refer to as Type 2 diabetes used to be known as Adult Onset Diabetes, to distinguish it from the auto-immune form of diabetes that is typically diagnosed during childhood. The problem was that more and more kids who did not have the autoimmune disease were, in fact, suffering from “adult onset diabetes.” And it just started to feel kind of silly to keep calling it that.
Part of the rationale for changing the name from non-alcoholic to metabolic associated fatty liver disease is that the new name is a more accurate description of the condition. Instead of defining it by what it isn’t, it’s now being characterized according to what it is.
Fatty liver disease is most commonly caused by chronically high blood sugar and insulin resistance—which are symptoms of metabolic disorders such as Type 2 diabetes, prediabetes, obesity, and metabolic syndrome.
So the new name is more accurate. And it also helps remove the stigma that’s inherent in the old name. I’ve noticed that people referring to lung cancer patients often stress the fact that the patient was a non-smoker. The fact that people feel the need to point this out underscores the stigma that often attaches to lung cancer patients who did (or do) smoke. Almost as if to say that when smokers get lung cancer, it’s their own damn fault and they don’t deserve the same sympathy. Or treatment.
All I have to say about that is: glass houses, people. Glass houses.
In addition to avoiding unnecessary finger-pointing, this new name can also help clinicians and patients better identify and cope with this very common issue.
It’s normal to have a certain amount of fat in your liver because processing dietary and blood fats is a big part of what the liver does. But when fat starts to build up in the liver, it can lead to inflammation, liver damage, and even liver cancer.
In its early stages, a fatty liver doesn’t really cause any symptoms. It’s most likely to be detected through a physical exam, during which your doctor might be able to feel that your liver is enlarged. Blood tests, imaging, and/or biopsies can confirm the diagnosis.
As I mentioned, the vast majority of people suffering from fatty liver disease are not alcoholics. I also want to point out that eating a high-fat diet does not necessarily lead to fatty liver disease. As I said, this form of liver disease is primarily caused by high blood sugar and insulin resistance.
Fatty liver disease often goes hand in hand with other risk factors for heart disease as well, such as high triglycerides. In fact, those with MAFLD are much more likely to die of heart disease than liver disease.
OK enough with the bad news. Here’s the good news: Fatty liver disease can often be reversed and the liver can be restored to full health through diet and lifestyle changes. Here’s how:
Lose weight. The number one thing you can do to reverse fatty liver is to lose weight. Losing even 5% of your body weight can be enough to start to roll back the damage, even if you are still significantly overweight.
Although continuing to lose weight may offer further benefits, you are much better off losing a modest amount of weight and keeping it off than you are losing a large amount of weight and then regaining it.
It’s also important to lose weight gradually because rapid weight loss can actually make MAFLD temporarily worse. Fortunately, slow weight loss is easier to achieve and easier to sustain.
Get more exercise. One central feature of metabolic disease is insulin resistance, where the cells can become less responsive to the effects of insulin. When your cells stop responding to insulin you end up with chronically high blood sugar. Exercise is perhaps the most effective, non-pharmaceutical way to improve insulin sensitivity.
As I talked about with dietitian Jill Weisenberger in my episode on pre-diabetes, strength training is particularly useful in this regard. She also recommends taking a brisk walk after meals to lower post-meal blood sugar levels. (For more, please check out that episode.)
In some cases, your doctor may suggest a prescription drug that helps improve insulin sensitivity. This can be useful but doesn’t necessarily have to be a long-term solution.
Get your fat from healthy sources. It’s not necessary to go on a low-fat diet but you do want to emphasize foods that are rich in monounsaturated fats, such as olive oil and avocado, and omega-3 fats, found in fish and flaxseed. Saturated fats from meat, dairy, and butter and omega-6 fat from vegetable oils should be in the background.
Ramp up your intake of antioxidant rich foods. Oxidative stress is another feature common to Type 2 diabetes, fatty liver disease, and heart disease. But research on the use of antioxidant supplements in these conditions has shown mixed results. A better strategy is to increase your intake of antioxidants from foods like non-starchy vegetables, mushrooms, fruits, herbs, spices, tea, and coffee.
The Mediterranean diet pattern tends to promote a healthy balance of fats, a low intake of sugar, and lots of antioxidant rich foods. Not surprisingly, it has been shown to be helpful for those with MAFLD.
Metabolic associated fatty liver disease can be an intimidating diagnosis to receive. It can also be a warning sign of bigger troubles ahead. Fortunately, it’s also one of those things that you can turn around by making a commitment to a healthier diet and lifestyle. The liver has an almost miraculous ability to heal itself if we simply give it a bit of a break.
For more information and resources on fatty liver disease, you can visit the American Liver Foundation at liverfoundation.org.
And if you’re looking for support for sustainable weight loss, please check out the tools at weighless.life