In naturopathic medicine we often say “love your liver!” Why? Well, it’s one of the most incredible organs that can take a beating and still love you back! Fatty liver disease, also known as Non-Alcoholic Fatty Liver Disease (NAFLD), is incredibly common nowadays and has rapidly become one of the most serious but ignored diseases in our health care system. Patients are routinely told they have fatty liver when they have an abdominal ultrasound or have elevated liver enzymes on a blood test. Are they given any advice, besides lose weight? Nope. What if they aren’t obese? Does anyone dig for the reason a person has a fatty liver? Nope. I speak from professional and personal family experiences that NAFLD is still brushed aside as commonplace and not a concern, until that liver doesn’t want to love you back anymore. The liver is essential in digesting proteins, fats and carbohydrates; supports our muscular and immune systems; stores and releases energy, vitamins and minerals; and maintains blood sugar levels. It removes toxins from the blood stream (medications, environmental pollutants, that third glass of wine, etc.). The liver is rather badass in all the things it can do and is the only organ that can regenerate itself when damaged. Yup, only 51% of the original liver mass is required for the organ to regenerate to full size!
So why do we develop NAFLD? The main risks are being overweight, having high fats in the diet, a history of cardiovascular disease, oxidative stress or insulin resistance. It is one of the leading causes of cirrhosis and chronic liver disease. If a person accumulates more fat in the belly (such as in menopause, cortisol imbalances) there is a higher likelihood that fat will accumulate in the liver. In a 2023 journal article, the International Journal of Molecular Sciences stated “There are many factors influencing NAFLD initiation and progression: environmental exposure, lifestyle, genetic susceptibility, metabolic status and the microbiome. All these factors could induce either steatosis or inflammation, which further triggers, expression of pro-inflammatory cytokines, oxidative stress, hepatic insulin resistance and apoptosis.” In other words, NAFLD can cause cellular death, diabetes and damage to other organs due to cytokines released from an inflamed liver.
Gut dysbiosis in patients has been shown in the development of NAFLD. There is an inverse association between the presence of NAFLD and the abundance of Bacteroidetes in gut microbiota, indicating that the intestine microbiota plays a vital role in NAFLD progression. Recent studies show that lean and obese individuals differ in gut bacterial composition. In fact, obesity has been associated with phylum-level changes in the gut microbiome and reduced bacterial diversity. In a nutshell, your healthy gut bugs can affect your ability or inability to lose weight and contribute to a long-term change in your liver, scarring and damaging its ability to work properly. Those probiotics and fermented foods plus all the great fibre that those healthy gut bugs love for fuel can make a huge difference in the damage that could occur to your liver with NAFLD progression.
In the conventional medical world, there are very few drugs that can be used to “treat” NAFLD. A 2020 article in the journal Frontiers in Pharmacology stated “Although there are advances in conventional medicine, herbal medicine are easily accessible and do not require artificial synthesis, thus herbal medicine seems highly attractive for the effective management of NAFLD.” I almost fell out of my chair reading that! So let’s get into some options for helping that liver out! Herbal medicine-induced cell death had been considered as an anti-inflammatory strategy to show the obvious effects on reducing NAFLD progression. Resveratrol promoted the autophagy pathway to restore liver injury, which was linked with NF-kB activation. In other words, the ability of the liver to regenerate by cleaning up old and damaged cells is supported by resveratrol (a polyphenol that acts like an antioxidant, protecting the body against damage, found in brightly pigmented berries and grapes—but not wine please!)
Helping to regulate insulin resistance is another tool to change the progression of NAFLD. By improving insulin sensitivity, risk of progression to diabetes is dramatically improved and weight loss tends to occur. To test for insulin resistance, we run a fasting insulin blood sample and use that as the starting line for our insulin support treatments. In a previous article I discussed the use of berberine, but other herbs such as ginseng and motherwort have been studied for their benefit.
Fatty acid metabolism is also important to help with breaking down the fats that could accumulate in the liver. Nutrients such as L-carnitine, CoQ10 and niacin are important players to help break down fats. We often use amino acids such as methionine, inositol and choline too in our intravenous medicine, but these can be very helpful when combined with enzymes to stimulate fat breakdown in supplements. Many combinations of herbs and nutrients can help support the liver to efficiently utilize fat as an energy source. Lifestyle and diet are huge components of treating fatty liver disease and should always be the cornerstone of treatment. Treating fatty liver disease can be simple and yet complex, looking at the individual to find the underlying reasons why the liver has become damaged. Utilizing multiple therapies such as diet, exercise, herbs, probiotics and nutritional supplements, we can help treat the underlying lipid metabolism issues and inflammation. Love your liver—it wants to love you!
