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Non-Alcoholic Fatty Liver Disease: The Silent Killer

"It’s a very dangerous, and silent, disease, but once you know what it is, it’s very easy to take steps to turn it around."

In today's post, Dr. Keller Wortham, MD, will shed some light on a silent killer that’s affecting up to 40% of the population of the United States: Non-Alcoholic Fatty Liver Disease. Many adults in the U.S. might even have this condition and not even realize it. Dr. Keller will discuss how to recognize the symptoms of this serious condition, and how to get diagnosed and treated.

Video Highlights

  • 00:44:  What is Non-Alcoholic Fatty Liver Disease?
  • 01:23: Dangerous Ways Inflammation Affects the Liver
  • 02:29: How the Liver Works
  • 03:34: Causes of Fatty Liver Disease
  • 05:51: Diagnosing Fatty Liver Disease
  • 06:41: Treating Fatty Liver Disease
  • 11:33: Wrap-Up

What is Non-Alcoholic Fatty Liver Disease?

Non-Alcoholic Fatty Liver Disease (NAFD) is fat deposits in the liver, which cause disease, and which arenot related to the use of alcohol. We know that alcohol is hard on the liver and that with time, alcohol can cause inflammation of the liver, leading to cirrhosis, and other issues. But you don’t necessarily have to drink heavily (or at all) to get liver disease. 

Dangerous Ways Inflammation Affects the Liver

Non-Alcoholic Fatty Liver Disease occurs when, for some reason, fat starts to deposit in the liver, and over time that fat starts to change the way the liver is metabolizing, it can cause inflammation, and eventually lead to something calledNon-Alcoholic Steato-Hepatitis (NASH).This means fatty inflammation of the liver, which is not alcohol-related. If this inflammation goes untreated, it can lead to a reduction in liver function, cause major cirrhosis in the liver, and if untreated for too long, can lead to liver failure, and even death. Since this is so important, let’s talk a little about what the liver is and does.

How the Liver Works

The liver is a very important organ. It’s the largest organ in our bodies, weighing almost four pounds, and is extremely important for a multitude of metabolic processes. It serves as our main metabolizer and filter, so anything that we eat or drink gets into the bloodstream and has to pass through the liver, which takes out the toxins and helps to break it down. It also has additional functions: it stores a lot of vitamins, makes proteins for the blood, stores sugar, makes cholesterol, and produces clotting to prevent us from bleeding to death. So the liver is crucial for life and you want to protect it.

Causes of Fatty Liver Disease

So how, if you don’t drink, do you end up getting fatty liver disease? A lot of it comes down to lifestyle factors and diet. We know there are certain lifestyle habits and related syndromes that put us at an increased risk for fatty liver disease, including obesity and diabetes. In fact, 40 - 80% of people with diabetes will end up with NAFD, and up to 90% of people who are obese. So it’s very important to know the associated conditions so you know what to look for, because many of the symptoms are going to be very subtle until the condition is very advanced.

In the beginning you might notice some fatigue, and as it advances you might notice fluid retention, and easy bruising, but these symptoms often don’t appear until the disease is further along. In addition to obesity and diabetes, other associated syndromes include: high cholesterol, high blood pressure, high triglycerides, polycystic ovarian syndrome (a syndrome some women suffer which alters their menstrual cycle and leads to abnormal hormone shifts), and sleep apnea (a condition that cuts off the air to the brain during sleep). 

Again, these are important to be aware of because the symptoms of fatty liver disease are so subtle. If you suffer from any of these conditions, it’s very important to get screened for fatty liver disease by your doctor. 

Diagnosing Fatty Liver Disease

A simple blood test is the best way to start. A lot of people with fatty liver disease will show elevated liver enzymes, which is a good indicator that something could be going on with the liver. Not everyone will show this elevation in liver enzymes, though. For some people with fatty liver disease, it might not show up on a blood test, but that is the primary way to screen for it. If the test does show elevated enzymes, it’s very important to confirm the diagnosis, which can be done by directly imaging the liver. The doctor can use an ultrasound or CAT scan to look for fat deposits in the liver.

Treating Fatty Liver Disease

If you are diagnosed with fatty liver disease, it’s very important to start treating it immediately. This is the most hopeful part of the whole thing! Yes, it’s a very dangerous, and silent, disease, but once you know what it is, it’s very easy to take steps to turn it around. You don’t necessarily need medications, you don’t need surgery — very often, you just need diet and lifestyle changes. So that’s good news!

Let’s talk about some of the changes you can make to turn things around if you have fatty liver disease, or even to prevent it if you’re merely at risk for it. 

Avoid alcohol

No, alcohol is not the main issue with Non-Alcoholic Fatty Liver Disease, but it is a toxin, and it is metabolized in the liver. So if you do have fatty liver disease, you want to cut out any toxins that your liver has to process, and alcohol is a big one. So cut that out immediately and give your liver a break.

Avoid medications that are tough on the liver

An obvious over-the-counter example is Tylenol. Tylenol is metabolized in the liver, so if you want to give the liver a break, reduce or eliminate Tylenol consumption. Other medications like oral contraceptives, certain cholesterol medications, some diabetic medications, and some hormones can also be hard on the liver. Talk to your doctor about any medications you might be able to cut out that could be making your liver situation worse.

Reduce other toxins in your diet

This could include pesticides, antibiotics, and hormones used in the foods you eat, so try to eat organic whenever possible to cut out these chemical exposures. Since your liver is what has to filter out the chemical toxins from your bloodstream, you’ll be giving it a break by eating organic.

Improve existing health conditions

If you can improve diabetes, blood pressure, lower blood sugar, and reduce saturated fats in your diet, that can help combat some of the related health conditions we talked about, and take some of the pressure off your liver.

Eat more fiber

Fiber is like a miracle molecule! It is most readily available in fruits and vegetables: broccoli, kale, bell peppers, and also from whole grains like Farro. A lot of the chewy foods that are high in fiber will help lower cholesterol, they’ll eventually help lower blood sugar, and they’re great for your liver.

Reduce inflammation

Reducing inflammation is a great method for any inflammatory process. We mentioned hepatitis, or inflammation of the liver earlier, and anything you can do to reduce inflammation of the liver will help. There are a couple natural ingredients that can support normal inflammation that you can include in your diet. One is Omega-3 oils, which are found in things like avocados and avocado oil, olive oil, seafood like salmon and in supplement form. Another natural ingredient is curcumin, the active compound found in turmeric. If you take that daily, you can also help encourage normal inflammation responses.


If it seems like this is recommended for everything, that’s because it’s so good for you in so many ways. Exercise can help reduce your weight, reduce the risk of diabetes, reduce cholesterol, and reduce blood pressure. These are just a few of the reasons exercise is so important.


If you have fatty liver disease and you take these steps, there’s a very good chance you’ll reduce this condition, and maybe even get rid of it altogether. This is a common silent killer suspected in over 40% of the population. So if you have some of these conditions: if you suffer from obesity or diabetes, sleep apnea, polycystic ovarian syndrome, or high cholesterol, talk to your doctor about getting screened for NAFD. If you have it, he or she can help you confirm that diagnosis, and you can take these very important steps to reversing the course of the disease, protecting your most vital organ, and moving forward!

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