Non-alcoholic fatty liver disease (NAFLD) occurs when liver cells become replaced by 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 addresses this excess fat buildup in the liver by treating underlying imbalances in metabolism and inflammation.
When fat replaces the liver with little inflammation or dysfunction, it is known as non-alcoholic fatty liver (NAFL).
When imbalanced inflammation occurs, it causes injury as NAFL evolves into non-alcoholic steatohepatitis (NASH). When this chronic inflammation scars the liver, cirrhosis and liver failure develop.
NAFLD is rapidly rising along with the global epidemics of obesity and type 2 diabetes mellitus (T2DM), impacting up to 46% of Americans, with 2-5% having NASH. NAFLD occurs 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 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 declines as NAFL evolves into NASH.
At this stage, symptoms reflecting liver damage occur, including:
- Tiredness
- Weakness
- Weight loss
- Itching
Physical exam shows 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 damage persist, NASH turns into cirrhosis as the liver is scarred, causing symptoms due to poor functioning like:
- Fluid retention
- Bleeding
- Muscle loss
- Confusion
- Eventual liver failure requiring a transplant
The fat and inflammation in the liver increase the risk for diseases beyond the liver, such as:
- T2DM
- Heart disease
- Chronic kidney disease
Non-Alcoholic Fatty Liver Disease Possible Causes
Dysregulated inflammation, gut bacteria, and metabolism 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 contribute to the metabolic dysfunction underlying NAFLD. Imbalances in intestinal bacteria (dysbiosis) occur in Type 2 Diabetes and NAFLD since gut bacteria impact the metabolism of glucose and lipids. Imbalanced bacteria and a leaky gut barrier allow toxins to circulate in the blood and burden 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 lead to fat depositing in the liver.
Although fat takes over the liver, the primary dietary culprit leading to metabolic dysfunction causing NAFLD is excess processed carbohydrates and sugars. These sugars switch on fat production in the liver. Fructose especially contributes 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 increases, which triggers worsening blood sugar regulation, insulin resistance, and prediabetes. Excess sugars contribute to increased belly fat and fat in the blood.
Functional Medicine Labs to Test for Non-Alcoholic Fatty Liver Disease
NAFLD is confirmed with a biopsy to examine liver tissue for fat, inflammation, and scarring. It is often diagnosed 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 dysfunction or damage progress.
Gamma-glutamyl Transferase
Gamma-glutamyl transferase (GGT) is another enzyme made in the liver that reflects the body trying to generate glutathione to deal with detoxification.
Blood Sugar and Metabolism Markers
An evaluation of metabolic health uncovers the underlying causes 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 identify insulin resistance when sugars remain in the blood, causing inflammation and damage to blood vessels, which leads 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 make the gut leaky, allowing food and other substances to enter the bloodstream and provoke inflammation that taxes the liver. A Comprehensive Stool Test measures gut bacteria, inflammatory markers, leaky gut, and pathogens to assess the state of the gut and guide treatment aimed at restoring balance.
Functional Medicine Treatment for Non-Alcoholic Fatty Liver Disease
Fortunately, lifestyle changes often control or reverse fat buildup in the liver. These include:
- Slowly losing and maintaining a balanced weight
- Lowering fats in the blood
- Balancing blood sugar and insulin function
- Avoid alcohol, high fructose corn syrup, processed carbohydrates, and other substances that 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, helps improve blood sugar, insulin, and NAFLD. Citrus contains a compound that reduces liver damage from a high-fat diet, while leafy greens contain chlorophylls that remove chemicals from the bloodstream. A personalized diet eliminating processed foods and allergens helps with sustainable weight loss while improving the handling of sugars and gut health.
Cruciferous vegetables like broccoli sprouts, cauliflower, Brussels sprouts, and garlic and onions provide nutrients like sulfur that support detoxification and liver healing. Protein at every meal, especially breakfast, supports 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, opt 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 keep blood sugar and appetite balanced.
Balance the microbiome
A diverse plant-based diet supports good gut bacteria that detoxify the liver by promoting a healthy gut lining and digestion.
Probiotics support a diverse microbiome to reduce inflammation for improved liver function, insulin regulation, and cholesterol balance. Prebiotic foods like garlic, bananas, and asparagus feed healthy gut bacteria.
Move regularly
Daily exercise improves the body’s ability to handle sugars, reduces fatty liver, and boosts glutathione production for detoxification. Since the skin is a major detoxification organ, sweating helps remove toxins, so they don’t stress the liver.
Boost Liver- and Bile-Supportive Nutrients
Oxidative stress leads to liver injury, and NASH, so powerful antioxidants like vitamin E, alpha-lipoic acid, and N-acetyl-cysteine heal the liver. Almonds, sunflower seeds, salmon, and avocados contain vitamin E. Herbs like milk thistle and turmeric stimulates liver regeneration. Pantethine, omega-3 fatty acids, and magnesium 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 stimulate bile flow and protect the liver.
Summary
NAFLD occurs when the liver gets filled with fat due to metabolic imbalances. This includes non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH) and is an increasing cause of liver dysfunction.
There may not be many symptoms early in the disease, but NAFLD can cause chronic liver dysfunction and serious complications. It is associated with inflammation, blood sugar problems, gut health, and bacteria imbalances.
A functional medicine approach to non-alcoholic fatty liver disease assesses and manages inflammation and blood sugar using diet and lifestyle. This includes weight loss, reduced refined carbohydrates, especially fructose, and regular exercise. Functional nutrients can also address fatty liver, such as turmeric, vitamin E, omega-3 fatty acids, and milk thistle.
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