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Article Summary:

• Fatty liver disease is reaching epidemic levels, and it’s not only a problem among heavy alcohol users.
• Non-alcoholic fatty liver disease (NAFLD), like alcohol-induced fatty liver disease, typically begins as a silent disease with few or no symptoms.
• NAFLD usually develops in middle age, but children can get it, too.
• The increasing worldwide incidence of metabolic syndrome and obesity are the main reasons NAFLD has become the most common cause of chronic liver disease.
• NAFLD is not just a “liver disease,” it is a multi-system disease that is an underlying cause of numerous other health issues.
• NAFLD is linked to several severe chronic and potentially fatal diseases and ranks amongst the most serious public health concerns of our time.
• Simple fatty liver disease is a condition where there is fat in the liver but little or no inflammation or liver cell damage.
• A significant percentage of people with fatty liver disease have nonalcoholic steatohepatitis (NASH). In this condition, there is fat in the liver, plus inflammation and liver cell damage.
• NASH impairs the liver’s ability to function correctly. If left unaddressed, NASH may worsen, leading to cirrhosis, liver cancer, or liver failure.
• Although fatty liver disease may initially be asymptomatic, symptoms will appear as it progresses.
• Fat gets into the liver from the body’s own adipose tissue, dietary fat, and the conversion of carbohydrates to fat. 
• Obesity has an extreme correlation with fatty liver disease.
• Obese individuals are over their personal fat threshold, which is the point at which an individaul can handle all the excess caloric energy from their diet and store the fat efficiently.
• Choline status and oxidative stress are two things that impact the personal fat threshold.
• Fixing NAFLD involves holding a healthy body weight, reducing dietary fat and sugar, and increasing the liver’s ability to export fat.
• TUDCA is an excellent supplement with many liver, digestive, and drainage benefits. It has been shown to reduce inflammatory responses, obesity, insulin resistance, and fat buildup in the liver.

Most people associate fatty liver disease with alcohol consumption. People who drink too much over a length of time tend to get fatty livers, right? Yes, that is true. But there is also a type of fatty liver disease that is becoming an increasingly problematic, even epidemic, health problem. It is called non-alcoholic fatty liver disease (NAFLD). Both alcohol-induced fatty liver disease and NAFLD are typically silent diseases with few or no symptoms.¹ However, both of them can lead to cirrhosis. If the cirrhosis causes liver failure, you may need a liver transplant.

Fatty liver disease is rapidly becoming more of an epidemic worldwide. It isn’t confined to any one particular group of people, and there doesn’t seem to be significant gender differences. Studies suggest that Latinos may be more likely to have it. It’s mainly a condition that develops in middle age, although children can get it, too. 

What is Fatty Liver Disease?

The liver is the largest organ and the detoxification lifeline of the body. It helps to digest food, store energy, and remove toxins. Fatty liver disease is a health condition characterized by fat building up in the liver. There are two main types:

1. Alcoholic fatty liver disease (alcoholic steatohepatitis)
2. Nonalcoholic fatty liver disease (NAFLD)

What is Non-Alcoholic Fatty Liver Disease?

NAFLD is a disease of the modern-day. It has exploded in prevalence into the clinical mainstream in the last 25 years.² It is not associated with heavy alcohol consumption. The increasing worldwide incidence of metabolic syndrome and obesity are the main reasons NAFLD has become the most common cause of chronic liver disease. Recent discoveries have shown that NAFLD is not just a “liver disease.” It is a multi-system disease that is an underlying cause of an increasing number of other health issues. 

NAFLD is linked to chronic kidney disease, type 2 diabetes, cardiovascular disease, insulin resistance, metabolic syndrome, high cholesterol, visceral abdominal fat, and several other severe chronic diseases. These findings demonstrate that NAFLD ranks amongst the most serious public health problems of our time. There are two types of NAFLD, which include:³ 

1. Simple fatty liver
   In this condition, there is fat in the liver but little or no inflammation or liver cell damage. Simple fatty liver typically is not severe enough to cause liver damage or complications. However, as time goes on, if the cause of simple fatty liver is not addressed, it can progress to nonalcoholic steatohepatitis (NASH).
2. Nonalcoholic steatohepatitis (NASH)
   About 20% of people with non-alcoholic fatty liver disease have NASH. In this condition, there is fat in the liver, plus inflammation and liver cell damage. If certain genetic conditions are present, or too much fat builds up, the fatty liver tissue can become inflamed and cause the liver cells to be damaged or destroyed. Inflammation and liver cell damage can lead to scarring of the liver (fibrosis). As inflammation continues, scarring can spread and take up more and more liver tissue.

Between 25-40% of people with NAFLD progress to NASH, which is the more severe form of the disease. NASH, or nonalcoholic steatohepatitis, is fat buildup (steatosis) combined with hepatitis (inflammation). NASH impairs the liver’s ability to function correctly. If left unaddressed, NASH may worsen, leading to cirrhosis or liver cancer. 

Cirrhosis can lead to a buildup of fluid in the abdomen, swelling of veins in the esophagus, drowsiness, slurred speech, and confusion. The risk of liver cancer and end-stage liver failure increases with cirrhosis. If liver failure occurs, a transplant is necessary for continued survival.

What are the Symptoms of Fatty Liver Disease?

When simple fatty liver disease is present, there may not be symptoms. If there are symptoms, they likely include fatigue and pain or discomfort in the upper right abdomen.

As fatty liver disease progresses over time, other symptoms may appear. These symptoms can include: 

• Enlarged liver
• Weakness
• Nausea
• Loss of appetite
• Weight loss
• Dark urine
• Pale stools
• Bruising easily

If fatty liver disease progresses to NASH or cirrhosis, symptoms can include:

• Swollen abdomen
• Enlarged spleen
• Enlarged blood vessels beneath the skin’s surface
• Enlarged breasts (in men) 
• Red palms
• Jaundice (yellowing of the skin and eyes)

Medical testing can help to detect NAFLD. Blood tests may reveal elevated liver enzymes, and imaging techniques may show an enlarged liver. However, a definitive diagnosis can only be achieved by doing a liver biopsy.

How Does Fat Get Into the Liver?

As I stated before, there is an epidemic of fatty liver disease. Estimates suggest that as many as 25% of people of all ages have some degree of fatty liver disease, including children. Fatty liver disease used to occur almost exclusively in those who drank excessively. However, nowadays, obesity and diabetes are key contributors, as 70% and 90% of people with those conditions have fatty livers.⁴ As obesity and diabetes rates climb, so do instances of fatty liver disease.

Fat gets into the liver in various ways.

From adipose (fat) tissue

The majority of fat that accumulates in the liver comes from the body’s own adipose (fat) tissue. Fatty acids that are released from the body’s adipose tissue go to the liver. In the liver, those fatty acids are made into triglycerides and then cycled back to the fat tissue to be stored. It is a cyclical process. If the liver can export triglycerides adequately, fatty liver disease will likely not be a problem. However, if triglycerides can’t be readily transported out, they can get stuck in the liver, leading to a fatty liver.

From dietary fat

The second most common source of fat found in the liver is from dietary fat. Dietary fat will always make its way into the liver. How much dietary fat the liver receives depends on how much of that dietary fat other organs and tissues in the body use up. The liver will get a lot more of it if the body is getting a significant amount of dietary fat that is not used up. 

From de novo lipogenesis 

The third and least significant source of fat that ends up in the liver comes from a process called de novo lipogenesis. De novo lipogenesis is the process that turns carbohydrates into fat. This process is responsible for approximately 5-15% percent of the fat found in the liver.⁵ In a very healthy person, about 5% comes from de novo lipogenesis. It increases a little bit for metabolically-challenged people, but it’s still only amounts to about 15% of the fat in the liver being generated by de novo lipogenesis.

It’s significant to note that low carb diets aimed at resolving fatty liver disease focus on this percentage (5-15%) of fat coming from carbs being turned into fat. However, the more substantial portion (85%) of the two other contributing factors listed above is more important quantitatively. So, the “fat doesn’t make you fat; carbs do” belief that is often circulated as a dietary recommendation is inaccurate. Even if someone is gaining weight from overeating carbohydrates, most of the fat going into the adipose tissue is from dietary fat.

In other words, if you eat an excess of carbs that exceeds your caloric balance, you will gain weight from eating too many carbs, because that’s the thing that was added. But, since the adipose tissue is going to be derived almost exclusively from dietary fat, an excess of carbs makes you fat by preventing you from burning the fat in your diet for energy and metabolism. The dietary fat which is not used then gets locked in adipose tissue. 

How are Obesity and Fatty Liver Connected?

Obesity has an extreme correlation with fatty liver disease. Individuals vary in the amount of weight gain they can tolerate before becoming resistant to insulin, developing type 2 diabetes, and accumulating fat in their livers. These variations are associated with genetic differences, lifestyle habits, and other factors. 

Visceral Abdominal Fat

Visceral abdominal fat is especially problematic. The abdominal fat pad empties directly into the liver; it doesn’t travel through the circulating blood first. An obese person’s visceral abdominal fat is constantly flooding the liver with fatty acids that can’t get out, leading to fatty liver disease.

The Personal Fat Threshold

Obese individuals are over their personal fat threshold, which is the point at which they can handle all the excess caloric energy from their diet and store the fat efficiently. When the personal fat threshold is exceeded, it becomes harder and harder for the body to store the excess energy that’s floating around. Furthermore, at an increased weight and reduced activity level, the pancreas can’t produce enough insulin to keep the levels of blood sugar and fat under control. The liver becomes overwhelmed as well and begins storing excess fat in its own liver cells.

However, it’s also notable that when the body is in a caloric excess, then all the other factors leading to fatty liver start to be more significant. There will be more de novo lipogenesis—not a lot, but more carbs will be converted to fat. Plus, there will be a lowered ability to store and/or dispose of all that energy, and some portion of that energy is going to end up going to the liver. 

Two things typically determine the personal fat threshold. They include:⁶ 

1. Choline status: Choline is a vitamin-like essential nutrient which synthesizes and transports fats. Choline helps to export fat from the liver.
2. Oxidative stress: Oxidative stress damages and interferes with the process of removing fat from the liver.

How Can I Fix My Fatty Liver?

The matter of resolving fatty liver has become a popular discussion. Some helpful suggestions include:

Attain and maintain a healthy body weight 

Pretty much everyone agrees that it is essential to achieve a healthy body composition. How each fatty liver patient does it may be individualized—you can choose low-carb or low-fat or both. However, getting from an overweight state to a healthy weight is a critical factor if obese patients wish to resolve their fatty liver issues. Obesity and fatty liver disease go hand-in-hand.

Reduce dietary fat and sugar 

Remember, fat from the diet is a much more significant factor than carbs that are turned into fat through de novo lipogenesis. Dietary fat is way more predisposing to fatty liver than dietary carbohydrate. But, among carbohydrates, fructose is more readily converted to fat, so cutting out sugar is going to help substantially. Thus, reducing both dietary fat and sugar is a solid game plan. 

Increase the ability to export fat from the liver 

Additionally, fatty liver disease patients need to increase the ability to transport fat out of the liver to restore better functioning. That means getting enough choline and having sufficient antioxidant protection for the liver. Promoting healthy export of fat from the liver through these methods addresses all the fat, no matter where it came from.

Limit exposure to glyphosate and other sources of oxidative stress

Our modern-day environment is flooded with oxidative stressors. Glyphosate, for one. Animal studies show that even exposure to low levels of glyphosate can damage the liver.⁷ Glyphosate is ever-present in our environment, having been found in everything from drinking water to breakfast cereals to disposable diapers.⁸ To limit exposure to glyphosate, choose organic foods, particularly those rich in antioxidants, and non-genetically modified (GMO) products.

Another environmental factor that can cause oxidative stress is EMFs, the energies that come from cell phones, WiFi, Bluetooth, digital “smart” electric meters, “smart” home products, 5G, and more.⁹ These energies are ever-present in our environments. Even small habit changes can help. Turn off WiFi when it is not in use, remove the Bluetooth headset from your ear, or turn the cell phone off or to airplane mode when charging it.

What are the Benefits of Supplementing with TUDCA? 

TUDCA  (tauroursodeoxycholic acid) is a nutritional supplement that continues to show more and more benefits in clinical research studies. I have long been an advocate of TUDCA for promoting drainage from the liver/bile duct. This biliary system is at the core of phase I, II, and III liver detox. When drainage flow from the liver/bile duct is sluggish, toxins fail to be eliminated and can even be recycled. 

A water-soluble bile acid, TUDCA can cleanse the liver, counteract the toxicity of regular bile, and aid in cellular protection.¹⁰ TUDCA has been shown to reduce inflammatory responses, obesity, insulin resistance, and fat buildup in the liver (hepatic steatosis).¹¹ Additionally, TUDCA lessened gut inflammatory responses, improved intestinal barrier function, and reduced the components involved in ileum lipid transport. Furthermore, TUDCA-treated subjects eating a high-fat diet showed a different gut microbiota composition than those who consumed a high-fat diet.

In summary, TUDCA can:

• Cleanse the liver
• Counteract bile toxicity
• Aid in cellular protection
• Reduce inflammatory responses
• Lessen obesity and insulin resistance
• Reduce fat buildup in the liver
• Improve intestinal barrier function
• Help to normalize gut microbiota composition

This is an excellent supplement with many benefits.

Where Can I Get Help?

Fatty liver disease is quickly becoming a widespread problem, one that is best caught and addressed in the early stages, as the long-term prognosis may be fatal. If you would like to work through your own problems with NAFLD or other chronic illnesses, my At-Home Program can guide you step-by-step toward recovery.

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1. “Fatty Liver Disease.” MedlinePlus, U.S. National Library of Medicine, 30 May 2019. Web
2. Qureshi, Kamran, and Abrams, Gary A. “Metabolic Liver Disease of Obesity and Role of Adipose Tissue in the Pathogenesis of Nonalcoholic Fatty Liver Disease.” World Journal of Gastroenterology, Baishideng Publishing Group Inc, vol. 12, no. 26, 14 July 2007. Web
3. “Definition & Facts of NAFLD & NASH.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, 1 Nov 2016. Web
4. Harvard Health Publishing. “When the Liver Gets Fatty.” Harvard Health, 9 May 2018. Web
5. Masterjohn, Chris, and Whitten, Ari. “The Science On Protein, Detox, MTHFR, and More w/ Dr. Chris Masterjohn Ph.D. & Ari Whitten.”, 13 July 2019. Web
6. Masterjohn, Chris, and Whitten, Ari. “The Science On Protein, Detox, MTHFR, and More w/ Dr. Chris Masterjohn Ph.D. & Ari Whitten.”, 13 July 2019. Web
7. Olorunsogo, Olufunso O., et al. “Effect of Glyphosate on Rat Liver Mitochondria in Vivo.” SpringerLink, Springer-Verlag, vol. 22, no. 1, Dec 1979. Web
8. Willsher, Kim. “Traces of Dangerous Chemicals Found in Disposable Nappies in France.” The Guardian, Guardian News and Media, 23 Jan 2019. Web 
9. Jeong, Ye, et al. “Impact of Long-Term RF-EMF on Oxidative Stress and Neuroinflammation in Aging Brains of C57BL/6 Mice.” International Journal of Molecular Sciences, vol. 19, no. 7, 19 July 2018. Web
10. Vang, S et al. “The Unexpected Uses of Urso- and Tauroursodeoxycholic Acid in the Treatment of Non-liver Diseases.” Global Advances in Health and Medicine, Vol. 3, No. 3, May 2014. Web
11. Wang, Weijun, et al. “Tauroursodeoxycholic Acid Inhibits Intestinal Inflammation and Barrier Disruption in Mice with Non-Alcoholic Fatty Liver Disease.” British Journal of Pharmacology, John Wiley and Sons Inc., vol. 175, no. 3, Feb 2018. Web