April 10, 2021
Have you heard of the acronyms NAFLD and NASH? If not, it is time to face the reality of the actual liver conditions of people in the United States. According to the American Liver Foundation, an estimation of almost 1 in 4 Americans have Non-alcoholic Fatty Liver Disease (NAFLD) and 1 in 5 of those individuals with NAFLD will develop into Non-alcoholic Steatohepatitis (NASH). And according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) an estimated 30% to 40% of American adults have NAFLD and 3% to 12% of American adults have developed NASH. Whether the number is 40% or 25%, it doesn’t change the fact that NAFLD is growing into a prominent disease and it is time for a reality check.
NAFLD has become one of the most prominent types of liver disease in the United States. It is a condition when there is too much fat deposited in the liver and this extra fat is not caused by the consumption of alcohol. At the stage of NAFLD, the liver cells have not been damaged and there is no inflammation; however, if not treated, NAFLD may progress into NASH which is marked by inflammation of the liver and liver cell damage. At this stage, the liver damage is still reversible and can be treated; however, if left alone, NASH can progress into liver cirrhosis or even liver cancer, which then causes damage to the liver that becomes irreversible. At the stage of cirrhosis, the liver is extremely scarred and hardened, causing the blood-filled with nutrients to have a hard time flowing into the liver. Eventually, cirrhosis will lead to liver failure and at this point, a liver transplant is deemed necessary or death may be imminent.
NAFLD is considered to be a silent disease because it is often asymptomatic; however, some patients do report fatigue, malaise, and upper right quadrant abdominal pain/discomfort. Liver biopsy is the gold standard for diagnosing NAFLD; however, liver biopsy is not very convenient and often physicians will use ultrasound, CT scans, and MRI to diagnose the disease.
The short answer to that question is well… because it is essential to your survival, without the liver, you cannot live. The longer answer involves a more intricate description of what the liver actually does. Your liver helps you to filter blood, remove toxins, store nutrients and vitamins, and even helps with blood coagulation. The liver processes the blood received from your small intestines and then purifies that blood through filtration. The liver will obtain the nutrients that are required by the body and get rid of the junk that is not needed through urine or feces. The liver also monitors your blood for any bacteria in there and eradicates them. In addition, the liver also stores excess energy (glucose) for the body in the form of glycogen and can later convert them back into glucose when the body needs energy again. The liver also serves as an emergency reservoir for blood, approximately 10% of the body’s total blood is stored in the liver.
Just like many other chronic diseases, liver disease is most of the time silent. The noticeable symptom of constant fatigue and severe tiredness is also often overlooked and pushed to other causes such as not sleeping well or stress from work. If you constantly feel tired or low on energy levels, it is a good idea to see your physician to get your health checked as the damage could be silently building up inside the body. Other symptoms of liver disease include jaundice, dark urine, pale stool, abdominal pain, loss of appetite, unreasonable weight loss, nausea, vomiting, and swelling of the legs.
In the most ideal cases, you want to have liver disease diagnosed when it does not show symptoms yet so it can be treated while it is mild. However, more often than not, this does not occur because we often do not screen for liver disease. The earliest intervention will usually lead to the best possible outcome. Therefore, when the NAFLD is still mild, prior to developing into NASH or even cirrhosis, is when we should start taking care of the disease. As the saying goes “The best time to plant a tree was 20 years ago, the second-best time is now.” So now is the time to start taking action on getting your liver checked up and start taking care of it before it is too late. This is especially true if you have concomitant health problems such as type 2 Diabetes, obesity, dyslipidemia, and metabolic syndrome because conditions such as these often promote the deposit of fat into liver cells. 
Lastly, this article is not meant to treat, diagnose, or prevent any disease; it is for informational purposes only so make sure to consult with your physician and pharmacist before starting any new medications, medical food, or supplements.
 American Liver Foundation Staff. “The Facts About Non-Alcoholic Fatty Liver Disease.” American Liver Foundation, 20 May 2020, https://liverfoundation.org/the-facts-about-non-alcoholic-fatty-liver-disease/
 NIDDK Staff. “Nonalcoholic Fatty Liver Disease & NASH.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, Nov. 2016, https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash
 Hall, John Edward, and Arthur C. Guyton. "Chapter 70: The Liver as an Organ." Guyton and Hall Textbook of Medical Physiology. N.p.: Saunders Elsevier, (2011): 837-40.
 Schroeder, Michael. “Liver Disease Is One of the Leading Causes of Death in the U.S. Here's What You Need to Know.” U.S. News & World Report, U.S. News & World Report, 5 Feb. 2020, https://health.usnews.com/conditions/liver-disease#symptoms
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