Have you had a test recently for insurance or as part of a medical aid programme and been told you have NAFLD? You probably got (or should have got) a ‘fasting metabolic panel’ where your blood sugar, electrolytes, kidney and liver function is assessed, together with quite a few other readings – one of which is GGT (gamma-glutamyltransferase) – and this is seen as a marker for liver or gallbladder disease.
Liver inflammation is looked at through some other readings but there are two in particular AST and ALT which, if some of the others are in normal range, give an indication of problems in the liver or gallbladder area. These can be raised even if you don’t drink alcohol (hence the non-alcoholic part of NAFLD). If your triglycerides are raised (common in type 2 diabetes and insulin resistance) there is a strong chance you have or are on your way to, NAFLD. Fat accumulates in the liver cells, which then decreases the chances of fat being exported out of the liver. Obesity plays a part here and most people who are obese will have NAFLD, but there are those who are not obese who will also have NAFLD.
The ALT and AST ranges are set too high in fact, and should be far lower for ‘normal’ upper limits by about 10 points. Ultrasound is sometimes used to diagnose this but if the person is obese it is very difficult to make a diagnosis – typically the liver will have a fat percentage of more than 12,5% in an obese person to be diagnosed, where NAFLD is generally a state of having more than 5% liver fat in the absence of alcohol consumption. So it’s a tricky one.
But there are other confounding factors such as hypothyroidism and gut dysbiosis – both of which can cause NAFLD. Subclinical hypothyroidism is a largely undiagnosed condition and studies have shown that if you are hypothyroid, you have twice the risk of NAFLD, and about four times more likely to have the variant known as NASH (non-alcoholic steatohepatitis), characterised by inflammation accompanying the fatty infiltration. Hypothyroidism then could be an independent risk factor for NAFLD. Hypothyroidism is also associated with metabolic changes like insulin resistance, dyslipidemia and obesity, each of which is an independent risk factor for NAFLD.
The evidence continues to mount which shows the gut and liver have multiple levels of associated interdependence – disturbing the gut-liver axis has been implicated in conditions such as obesity, diabetes and NAFLD. Elevated liver enzymes and fatty liver changes are commonly seen in gut dysregulation such as SIBO (small intestinal bacterial overgrowth), celiac disease and inflammatory bowel disease. The common denominator here is the lack of integrity of the gut mucosal barrier – or Leaky Gut – the term used for increased intestinal permeability, which is present in all of these conditions. A nasty bacterial-derived endotoxin (LPS) can pass through this barrier into the bloodstream and trigger a defensive inflammatory response – and then all the wheels come off.
Helicobacter pylori infection in the stomach (an organism which is often the cause of ulcers), antibiotics, cortisone and other medications, alcohol and stress all contribute to intestinal permeability and the related endotoxemia. This causes backup of bile flow in the liver, causing inflammation and damage. Reduced flora in the gut will reduce motility, and dysbiotic flora may in themselves contribute to fatty liver changes through alcohol and other toxic metabolites. Increased levels of alcohol-producing gut bacteria lead to elevated blood alcohol levels and can even occur in children – it’s not always the consumption of alcohol which does it. Your gut health is key.
So what can we do, you may ask. This is a multifactorial problem, so definite steps must be taken.
- Make sure your diet is along the lines of low carb, healthy fat with enough animal protein.
- Consider taking Milk Thistle and Berberine (both available in my online store ) as these are powerful at regenerating the liver and the evidence shows they improve NAFLD by stimulating a receptor in the liver known as farnesoid X receptor (FXR) which regulates bile acids, glucose and lipid balance in the body. Bile acids prevent bacterial overgrowth while stimulating metabolism by biding FXR.
- My Pure Hydrolysed Collagen (my brand is the purest in the country and grass fed, non-GMO) is an extremely potent liver detoxifier (find it here )
- Take glutamine to help heal leaky gut (read more about it here)
- Address leaky gut (the subject for another post another day) also restores the liver to a state of health.
Milk Thistle is a powerful liver protector against liver injury from alcohol, acetaminophen, iron overload and even radiation. I recommend you take it daily together with my Pure Hydrolysed collagen as these two will stimulate the production of the potent antioxidant glutathione – and restore the liver to health over time. Berberine supports bile acid metabolism, restoring gut integrity. Glutamine has a very similar but different job here – and is well worth taking daily to restore liver health and recovery. You will find these all in my online store.