A friend of my older brother recently complained loudly, to any and all who would listen, after his doctor sent an email that said something to the effect of "quit drinking or your liver will be shot." Funny thing, though: Everyone who knows this guy can vouch that he rarely touches even a drop of alcohol. So it was no surprise to hear that he fired back a scathing response to his doctor.
Seems the back and forth email volleys all started when routine blood tests for my brother’s friend showed elevated levels of two liver enzymes, alanine amontransferase (ALT), and aspartate animontransferase (AST).
Since excess alcohol can be the culprit behind rising liver enzymes, it’s the first thing many doctors focus on. A steady diet of Bloody Mary, whiskey or beer puts stress on a liver and causes it to become fatty. Eventually, continued damage can lead to cirrhosis and liver failure.
Yet researchers are finding that a steady diet of fast food, sugary soft drinks and artery-clogging saturated fat can elevate liver enzymes and damage the liver, too.
And while this non-alcoholic fatty liver disease (NAFLD) can be caused by any number of different ailments, scientists suggest that obesity, unhealthy diets and sedentary lifestyles are probably behind the high prevalence of the disease. Estimates from the American Liver Foundation suggest that more than 20 percent of the population has NAFLD.
Don't Hold the Mayo, Cheese or Anything Else
An extreme example of this diet-liver damage connection is seen in the 2004 documentary Super Size Me. In a self-inflicted experiment, director Morgan Spurlock spends one month eating every meal at McDonald's and not exercising. No surprise, he gains 24 pounds, hikes his cholesterol level 65 points and damages his liver. "My liver basically turned to fat," Spurlock told CBS News. "It was so filled with fat the doctors said it was like paté; it was reaching a toxic level, putting me at risk of having non-alcoholic type of hepatitis, hardening of the liver, cirrhosis.”
A 2008 Swedish study with healthy young adults mirrors Spurlock’s findings. Scientists asked volunteers to dine on two fast-food meals per day (with the goal of doubling their normal caloric intake) and to curtail exercise for four weeks. The result: Levels of the liver enzyme ALT shot up quickly, signaling problems. “Our study clearly shows that in the evaluation of subjects with elevated ALT the medical history should include not only questions about alcohol intake but also explore whether recent excessive food intake has occurred,” write these researchers in the journal Gut.
After Age 40 Your Risk Increases
You may be walking around with a fatty liver and not know it. In most cases, the disease shows no symptoms. So routine blood tests and medical check-ups are a good idea, particularly if you’re a middle-aged woman (40 to 60 years old) — women are more likely than men to develop NAFLD. Serious problems can kick in when untreated NAFLD progresses to what’s called non-alcoholic steatohepatitis (NASH). Once NASH develops it causes the liver to swell and may cause scarring (cirrhosis) over time. In fact, according to the American Liver Foundation, NASH is one of the leading causes of cirrhosis in adults in the United States.
(MORE: Is Reckless Youth Putting Your Liver at Risk?)
At present, there are no proven medical treatments for NAFLD. But preliminary reports suggest positive lifestyle changes could prevent and even reverse liver damage. Experts lay out a two-step process:
1. Lose a few pounds if you're overweight or obese — even a small amount, say 5 or 10 percent of your current weight. For a 250-pound man that would be as little as 13 to 25 pounds.
2. Clean up your eating habits. A 2011 report in the World Journal of Gastroenterology outlines the diet rehab process this way:
- Minimize fast food meals.
- Reduce saturated fat and trans fat.
- Increase omega-3 fatty acids from fatty fish, like salmon and sardines.
- Reduce sugar, including soft drinks and fruit juices.
- Increase fiber intake.
As for my brother’s friend, there’s no word yet on whether he and his doctor are back on speaking terms. Yet, to look at him, this friend seems like a potential case of NAFLD. He’s at least 50 or 60 pounds overweight and sports a big belly. He doesn’t exercise at all. And he loves to eat out, including fast food. It's hoped his doctor (or a new one!) can do further tests — an ultrasound can confirm the diagnosis — and then outline a course of treatment.