04 Apr 2018 The hidden liver crisis
Nonalcoholic fatty liver disease now affects up to a third of Americans, taking a toll on the nation’s collective health. Nutrition and lifestyle changes can turn it around.
Our livers are in trouble. Up to one in three American adults and one in 10 American children have fatty liver disease, a condition in which fat accumulates in the liver and compromises its function. Yet, despite many doctors calling this a pandemic, it’s making few headlines.
These facts may come as a surprise, but the liver is a stealth organ. Essential to health, it performs some 500 bodily processes, playing a crucial role in detoxification, digestion, hormone balance, blood-sugar regulation, and immune-system function — mostly without ever calling attention to itself. Liver problems often remain hidden until they cause other serious health issues.
“Fatty liver disease is like hypertension,” says Robert Lustig, MD, a pediatric endocrinologist at the University of California, San Francisco. “People walk around not knowing they have a problem until it’s too late. They used to call hypertension the ‘silent killer.’ Now it’s fatty liver disease.”
Fatty liver affects 70 percent of diabetic adults and up to 45 percent of obese children in Western societies. Though the disorder is commonly associated with a high body-mass index, it is not exclusively tied to that metric: Lean people can have fatty livers, too, says Robert Rountree, MD, a Boulder, Colo.–based integrative practitioner who has diagnosed the condition in patients of all sizes.
Fatty liver is traditionally connected with alcohol abuse, but today nonalcoholic fatty liver disease
(NAFLD) is the most common form of chronic liver ailment in developed nations, and sufferers may never even imbibe, or they do so only moderately.
Adding to the sense of alarm, NAFLD is typically asymptomatic until it has advanced to more serious liver conditions, explains Lustig. Most cases are diagnosed only after running routine blood work for other health complaints.
NAFLD is dangerous because the triglyceride fats a damaged liver releases into the bloodstream are “a better predictor of heart disease than LDL cholesterol ever was,” says Lustig. NAFLD is also closely associated with metabolic syndrome, which involves high blood pressure, high blood sugar, and weight gain; it’s a precursor to diabetes, stroke, and cognitive decline.
Left untreated, NAFLD may progress to nonalcoholic steatohepatitis (NASH), an inflammatory condition of the liver. The damage from NASH can cause fibrosis in the liver, which may then lead to cirrhosis and, ultimately, liver failure.
“By 2020, NAFLD will be the No. 1 reason we’re doing liver transplants,” says Dina Halegoua-DeMarzio, MD, a gastroenterologist who specializes in liver disease at Thomas Jefferson University Hospitals in Philadelphia.
The situation is serious, but there is a bright spot: Almost all the factors that contribute to NAFLD are related to lifestyle. Changing what you eat, exercising more, and reducing toxins in your environment can significantly improve your liver’s health. With these interventions, NAFLD is largely preventable and, until its latest stages, reversible.
The other drinking problem
How has a disease once associated primarily with alcoholics ensnared a third of Americans in just a few short decades?
The answer may lie, at least in part, in a beverage that’s legal at any age: soda.
According to many healthcare experts, the steep rise in NAFLD cases is likely connected to the two- to three-fold increase in the number of overweight and obese children in the US in the last 20 years. These conditions tax the liver early in life and set the stage for a host of health problems down the road.
NAFLD itself appears to be fueled by a combination of factors, including the consumption of high-fructose corn syrup (HFCS) in soda and other processed foods, a sedentary lifestyle, and exposure to environmental toxins.
Of the three, HFCS may make the biggest impact. Many liver experts connect the preponderance of HFCS in the Western diet to the rise in fatty liver: Current estimates show the average American consumes 41 pounds of HFCS per year. (Remarkably, this is a decrease from an annual per capita consumption of 62 pounds in 2000, possibly thanks to public-health campaigns to reduce sugar and soda consumption.)
Still, Rountree calls HFCS “the new tobacco”.
Unlike the fructose in fruit, honey, and cane sugar, the fructose in HFCS comes in an unbound form, thanks to the industrial process used to create it.
This makes HFCS sweeter, cheaper (because it’s more concentrated than sugar), and easier to over consume than other sources of fructose. It also damages liver and gut health.
Still, on the surface this sounds all wrong: If something we consume triggers fatty liver, wouldn’t it be dietary fat? Oddly, no. Instead, multiple studies suggest it is not dietary fat but overall caloric intake that provokes the accumulation of fat in the liver.
Rountree explains that excess fat in the liver either comes from surrounding adipose tissue (in a process sparked by elevated insulin, which triggers fat storage) or is created in the liver when we eat high concentrations of fructose. This second process is known as de novo lipogenesis, which translates as “making new fat.”…..