Non-alcoholic fatty liver disease (NAFLD) occurs when liver cells accumulate fat due to causes other than alcohol or liver-damaging substances, viruses, or genetic disorders. A functional medicine approach to non-alcoholic fatty liver disease may address this excess fat buildup in the liver by focusing on underlying imbalances in metabolism and inflammation.
When fat accumulates in the liver with little inflammation or dysfunction, it is known as non-alcoholic fatty liver (NAFL).
When imbalanced inflammation occurs, it may cause injury as NAFL progresses into non-alcoholic steatohepatitis (NASH). When this chronic inflammation scars the liver, cirrhosis and liver function abnormalities can develop.
NAFLD is rapidly rising along with the global trends of obesity and type 2 diabetes mellitus (T2DM), potentially impacting up to 46% of Americans, with 2-5% having NASH. NAFLD can occur at any age, including children. It is becoming a frequent cause of chronic liver disease and liver transplantation in the United States and Europe.
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Non-Alcoholic Fatty Liver Disease Signs & Symptoms
The liver has many functions, including metabolizing chemicals and nutrients, manufacturing proteins for blood clotting, and excreting bile into the intestines to help break down fats and carry waste products away from the liver.
Early NAFLD may not cause noticeable symptoms, but if too much fat accumulates along with inflammation, liver function may decline as NAFL progresses into NASH.
At this stage, symptoms reflecting liver changes may occur, including:
- Tiredness
- Weakness
- Weight loss
- Itching
Physical exam may show signs such as:
- Enlarged liver
- Signs of insulin resistance, such as darkened skin patches over the neck, elbows, and knees
- Yellowing of the skin or eyes
- Spider-like blood vessels on the skin
- Fat around the waist
- Signs of cirrhosis, such as an enlarged spleen, muscle loss, or fluid buildup in the abdomen
If inflammation and changes persist, NASH may progress into cirrhosis as the liver is scarred, potentially causing symptoms due to altered functioning like:
- Fluid retention
- Bleeding
- Muscle loss
- Confusion
- Eventual liver function abnormalities that may require a transplant
The fat and inflammation in the liver may increase the risk for conditions beyond the liver, such as:
- T2DM
- Heart disease
- Chronic kidney disease
Non-Alcoholic Fatty Liver Disease Possible Causes
Dysregulated inflammation, gut bacteria, and metabolism may contribute to NAFLD. Risk factors include:
- Blood Sugar Issues (metabolic syndrome, prediabetes, and T2DM)
- High cholesterol
- High levels of triglycerides in the blood
- Obesity, particularly when fat is concentrated in the abdomen
- Polycystic ovary syndrome
- Sleep apnea
- Underactive thyroid (hypothyroidism)
- Underactive pituitary gland (hypopituitarism)
Risk Factors for NASH
- Older people
- People with diabetes
- People with body fat concentrated in the abdomen
Diet and gut health may contribute to the metabolic changes underlying NAFLD. Imbalances in intestinal bacteria (dysbiosis) may occur in Type 2 Diabetes and NAFLD since gut bacteria can impact the metabolism of glucose and lipids. Imbalanced bacteria and a leaky gut barrier may allow toxins to circulate in the blood and affect the liver.
Choline is needed for fat transport from the liver to cells throughout the body. Choline is abundant in egg yolks, animal protein, and chickpeas. Low choline diets or a microbiome that produces less choline may lead to fat depositing in the liver.
Although fat accumulates in the liver, the primary dietary factor leading to metabolic changes associated with NAFLD may be excess processed carbohydrates and sugars. These sugars may switch on fat production in the liver. Fructose especially may contribute to fatty liver since it goes directly to the liver where it is converted into fat. This sugar is commonly used to sweeten drinks and processed foods in the form of high-fructose corn syrup (HFCS).
As sugars are converted into fat in the liver, inflammation may increase, which can affect blood sugar regulation, insulin resistance, and prediabetes. Excess sugars may contribute to increased belly fat and fat in the blood.
Functional Medicine Labs to Test for Non-Alcoholic Fatty Liver Disease
NAFLD may be confirmed with a biopsy to examine liver tissue for fat, inflammation, and scarring. It is often assessed by less invasive blood tests to check liver function. Liver imaging, like ultrasound or MRI, may show fat deposits and later scarring.
Liver Function Tests
Liver function tests measure liver enzymes (alanine aminotransferase (ALT) and aspartate aminotransferase (AST)), proteins, and bilirubin (a substance in bile) in the blood, which may be normal in NAFL or show elevations as changes progress.
Gamma-glutamyl Transferase
Gamma-glutamyl transferase (GGT) is another enzyme made in the liver that may reflect the body trying to generate glutathione to support detoxification.
Blood Sugar and Metabolism Markers
An evaluation of metabolic health may uncover the underlying factors of NAFLD. NutraEval FMV provides insights into cellular health, toxin exposure, and how the body handles oxidative stress.
Insulin Resistance
- fasting glucose
- hemoglobin A1c measures average blood sugar level over the previous six weeks
- fasting Insulin
- C-peptide, a marker that the body is producing insulin
These can help identify insulin resistance when sugars remain in the blood, potentially causing inflammation and changes to blood vessels, which may lead to heart disease, T2D, and NAFLD.
Lipids
While a lipid profile including total cholesterol, HDL (“good” cholesterol), LDL (“bad” cholesterol), and triglycerides looks at the balance of fats in the blood, lipoprotein(a), LDL particle number, and ApoB-containing lipoproteins (ApoB) can provide a more specific risk assessment.
Inflammation Markers
High-sensitivity CRP is made by the liver in response to inflammation and can be used over time to track trends in inflammation within the body.
Gut Health
Unaddressed food sensitivities, chemicals, a highly-processed diet, and other factors may make the gut leaky, allowing food and other substances to enter the bloodstream and provoke inflammation that may affect the liver. A Comprehensive Stool Test measures gut bacteria, inflammatory markers, leaky gut, and pathogens to assess the state of the gut and guide approaches aimed at restoring balance.
Functional Medicine Approaches for Non-Alcoholic Fatty Liver Disease
Fortunately, lifestyle changes may help manage or reduce fat buildup in the liver. These may include:
- Slowly losing and maintaining a balanced weight
- Managing fats in the blood
- Supporting balanced blood sugar and insulin function
- Avoiding alcohol, high fructose corn syrup, processed carbohydrates, and other substances that may stress the liver
Eat a Balanced Whole Foods Diet
A Mediterranean diet, emphasizing citrus fruits, vegetables, legumes, and complex carbohydrates with moderate fish and olive oil, may help support blood sugar, insulin, and liver health. Citrus contains a compound that may support liver health, while leafy greens contain chlorophylls that may help remove chemicals from the bloodstream. A personalized diet eliminating processed foods and allergens may help with sustainable weight management while supporting the handling of sugars and gut health.
Cruciferous vegetables like broccoli sprouts, cauliflower, Brussels sprouts, and garlic and onions provide nutrients like sulfur that may support detoxification and liver health. Protein at every meal, especially breakfast, may support balanced blood sugar and liver function.
Eliminate processed sugars like High Fructose Corn Syrup (HFCS)
Along with sodas and sweets, sugars like HFCS are in even healthy-sounding processed foods like salad dressings, tomato sauces, yogurt, and soups. Instead, consider opting for water, herbal teas, vegetables, and fruits in their whole form.
Add Healthy Fats
Healthy fats like olive oil, avocados, grass-fed butter, walnuts, salmon, flaxseeds, and fish oil may help keep blood sugar and appetite balanced.
Balance the microbiome
A diverse plant-based diet may support good gut bacteria that can help detoxify the liver by promoting a healthy gut lining and digestion.
Probiotics may support a diverse microbiome to help reduce inflammation for improved liver function, insulin regulation, and cholesterol balance. Prebiotic foods like garlic, bananas, and asparagus may feed healthy gut bacteria.
Move regularly
Daily exercise may improve the body’s ability to handle sugars, support liver health, and boost glutathione production for detoxification. Since the skin is a major detoxification organ, sweating may help remove toxins, so they don’t stress the liver.
Boost Liver- and Bile-Supportive Nutrients
Oxidative stress may lead to liver changes, so powerful antioxidants like vitamin E, alpha-lipoic acid, and N-acetyl-cysteine may support liver health. Almonds, sunflower seeds, salmon, and avocados contain vitamin E. Herbs like milk thistle and turmeric may support liver regeneration. Pantethine, omega-3 fatty acids, and magnesium may also support balanced fat processing.
Bile transports toxins from the liver into the gut so they can be excreted. Artichokes and bitter foods like dandelion may stimulate bile flow and support liver health.
Summary
NAFLD occurs when the liver accumulates fat due to metabolic imbalances. This includes non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH) and is an increasing cause of liver function changes.
There may not be many symptoms early in the condition, but NAFLD can be associated with chronic liver changes and serious complications. It is linked with inflammation, blood sugar issues, gut health, and bacteria imbalances.
A functional medicine approach to non-alcoholic fatty liver disease may assess and manage inflammation and blood sugar using diet and lifestyle. This may include weight management, reduced refined carbohydrates, especially fructose, and regular exercise. Functional nutrients may also support liver health, such as turmeric, vitamin E, omega-3 fatty acids, and milk thistle.
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