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NAFLD: The Silent Killer

How does one go into liver failure?

Liver failure is defined as the inability of the liver to perform its normal synthetic and metabolic functions as part of normal physiology. Liver failure is due to long term cirrhosis (scarring and inflammation) of the liver hepatocytes (liver cells).

The most common causes of liver failure are chronic alcohol use and or abuse, Hepatitis B or C, and / or long-term fatty deposit buildup from years of poor eating habits. However, the problem of liver cirrhosis requiring liver transplantation is becoming more and more frequent from diagnosed conditions such as non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH).

Hepatitis B and C are bloodborne viral infections that infect and cause damage to the hepatocytes of the liver. If left untreated, this can lead to liver fibrosis (scarring), cirrhosis, and lastly acute liver failure.

Long-term use of alcohol can lead to the same sequelae as the aforementioned. Patients with an alcohol intake of 30 or more grams per day (one standard drink contains 14 grams of alcohol) are at increased risk of cirrhosis, although the majority of patients will not develop cirrhosis despite heavy alcohol intake. There is, however, a 1% increase for those who drink 30 to 60 g/day and 6% for those who drink 120 g/day.

So What is NAFLD?

Non-alcoholic fatty liver disease (NAFLD) is becoming a much more common disorder in the U.S., and refers to a group of conditions where there is accumulation of excess fat in the liver of people who drink little or no alcohol.

Chart Showing Progression of NAFLD Disease - Various Stages from Health to NAFLD to NASH to Cirrhosis.

It encompasses a spectrum that ranges from fat accumulation in hepatocytes without inflammation or fibrosis all the way to NASH. NASH is all of the above, plus a necroinflammatory component (cell death and inflammation). Today, it is estimated that between 30 and 40 percent of adults in the United States have NAFLD and / or NASH.

Number of Hospital Admissions for Non-Alcoholic Fatty Liver Disease, from 1998 to 2010

How is NAFLD diagnosed?

During a routine physical exam, an incidental elevation of liver enzyme lab values may be noted (AST, ALT and GGT). Note: elevations of these labs merely show damage to the liver, however not actual liver function. After all other causes for liver damage (such as: viral hepatitis, excess alcohol consumption or medication induced), have been ruled out, and imaging or liver biopsies have been performed, a presumptive diagnosis of NAFLD can be made.

What can cause NAFLD?

Genetics and high triglycerides (mainly).

What are triglycerides and how did they get there in the first place?

Triglycerides are a type of lipid (fat) found in your blood. When one eats, the body converts any calories it doesn’t need to use right away into triglycerides. These triglycerides are stored in your fat cells and liver. Later, hormones release triglycerides for energy between meals. This conversion to triglycerides is so rapid a process, that when we as practitioners see an extreme elevation in triglycerides in a lab report, our first question will usually be, “did you remember to fast before completing your labs?”.

Triglyceride Model - Showing Fatty Acids and Layout

Your liver also makes them. When you eat extra calories, especially carbohydrates, your liver increases the production of triglycerides, leading to more fatty deposits within the liver.

Examples of foods that will elevate triglycerides:

  • Starchy Carbs: bread, rice, pasta, potatoes, cereals, crackers etc.
  • Fructose containing foods: candy, soda, fruit juices, syrups, many fruits etc.
  • Starchy vegetables: Beans (kidney, navy, pinto, black), chickpeas, corn, lentils, peas, sweet potatoes and yams
  • Alcohol
  • High fructose corn syrup: it’s in everything.

How can I lower my triglycerides, and thereby reduce my risk for NAFLD?

Less triglycerides in and more triglycerides out.

While the first (less in) is an easy idea to understand: a significant change in one’s diet (low carb and low sugar diet) can help to reverse these fatty deposits that have been made within the liver.

The second (more out) can be a touch more complicated:

A Graph Showing Hyperinsulinemia / Insulin Resistance from Adipose Tissue and the Liver

Well informed practitioners and patients have supplemented with and have used a unique combination of vitamin / supplement that have proven to hasten the excursion of fatty build-up within the liver, helping to decrease the incidence of NAFLD and thereby reducing the risk of acute liver failure. The supplement used has gone by many names, such as: Tri-lipotropic capsules, liver caps, IC caps, and MIC caps.

‘MIC’ caps?

This vitamin / supplement is an oral capsule and / or injectable formulation of methionine, inositol and choline. This formula, when taken as directed, has proven to promote a healthy liver by enabling it to metabolize fatty deposits.

What are methionine inositol & choline?

Methionine is an amino acid. Amino acids are the building blocks our bodies use to make proteins found in meat, fish, and dairy products. It is involved in many detoxifying processes, as the sulphur provided by methionine protects liver cells from pollutants, slows cell aging, and is essential for absorption and bioavailability of selenium and zinc.

Inositol, or more precisely known as myo-inositol, is a carbocyclic sugar (sugar alcohol) made naturally in humans from glucose, and is abundant in our tissues. It mediates cell signalling in response to a variety of hormones, neurotransmitters and growth factors and participates in osmoregulation (human salt/water concentrations). Additionally, inositol works by increasing cell insulin sensitivity, thereby helping glucose to enter the cell and not forming into triglycerides. Foods containing the highest concentrations of inositol include fruits, beans, and grains.

Choline is an essential nutrient that is naturally present in foods such as fish, beef, poultry, eggs, and some beans and nuts. Choline is a source of methyl groups which are needed for many steps in human metabolism. The body needs choline to synthesize phosphatidylcholine and sphingomyelin, two major phospholipids vital for cell membranes and cellular metabolism.

Infographic on Daily Choline Needs and How to Build a Diet with Choline. Stating 550mg Total per Day.

Additionally, research studies with patients being monitored with total parenteral nutrition (total IV nutrition) have shown that those with low levels of choline in the blood were at an increased risk for NAFLD. Although a small amount of choline is produced by your liver, the rest must be supplied through your diet.

An estimated 90 percent of the U.S. population are deficient in choline. This and other small studies have shown that it may not only be a crucial key for the prevention of, but could also possibly completely reverse fatty liver disease.

Conclusion

It has been shown that a diet high in starchy carbohydrates and sugars leads to an increase in triglycerides and fatty deposits within the liver. This, coupled with a genetic predisposition, sedentary lifestyle and a diet deficient in choline can lead to non alcoholic fatty liver disease. An active lifestyle, along with a diet high in choline and low in carbohydrates and sugars, could help to prevent NAFLD liver failure in the future.

Joe Franceschi PA-C

Author Joe Franceschi PA-C

Joe earned his physician assistant degree at Stanford University and completed his training at the Stanford Medical Center Veterans Administration Palo Alto. With 23 years in medicine serving as a Marine Corps Naval Combat corpsman, firefighter paramedic, and Yosemite search and rescue paramedic, Joe has worked on the front lines alongside medical professionals and athletes while training those whose lives depended on the finest medical treatment available. Joe is fueled by his desire to optimize performance health and longevity which has driven these lifelong endeavors.

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