Fatty Liver Disease and Metabolic Syndrome

Patients often come to the emergency department for stomach or gastrointestinal (GI) system issues. After a thorough history, physical exam, and some tests, many are surprised to learn that they have a problem called fatty liver disease (FLD). This is frequently seen incidentally on a CT scan or ultrasound of their abdomen during their evaluation for unrelated problems. It often has no symptoms and is found so commonly that, in the past, we may not have even mentioned it to patients. In fact, you may have it and not even know it. We even find it in children, who are allowed to consume large amounts of sugar and sugary drinks, at ages as young as 5 – 6 years old.  A few years ago, even I was not really sure how to advise patients who had it, nor did I understand how critically important this problem is.

FLD is increasingly common in Western nations due to our high intake of highly processed and refined foods including ingredients like sugar and high fructose corn syrup.  While it is the most common form of chronic liver disease in the United States, affecting a quarter of the population, more importantly, it is now recognized as a key component of the Metabolic Syndrome. The Metabolic Syndrome is the primary cause for many of the diseases that lead to human suffering and early death, including vascular disease, diabetes, dementia, heart attack and stroke, which collectively account for 75% of all healthcare spending.

Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove toxins. Most non-medical people associate liver disease with alcoholism, and they are right, but it is also common in those who do not drink alcohol, typically referred to as non-alcoholic fatty liver disease (NAFLD).  Actually, our liver handles alcohol and fructose in almost the exact same way. 

FLD and its counterpart, Metabolic Syndrome, are caused by consuming refined and processed carbohydrates like sugar, high fructose corn syrup, and refined grains (cereals, bread) and starches, which turn to sugar in our body. When we eat these substances, especially fructose, they are then rapidly converted in the liver to a type of fat called VLDL and triglyceride. Having high levels of this type of fat (triglycerides) is now recognized as a primary risk factor for the development of a specific type of circulatory disease called atherosclerosis. 

Even moderate amounts of foods and drinks containing sugar, and especially fructose, can overwhelm our liver’s capacity to process it and, as a result, get quickly stored as fat within the liver.  In a small percentage of people, this process can lead to liver damage, liver failure, and eventually death.  Far more importantly, it is the primary factor involved in insulin resistance. As such, FLD is a marker for the Metabolic Syndrome, which includes devastating health problems such as type 2 diabetes, atherosclerosis, high blood pressure, dementia, and even increased risk for certain types of cancer. These are strongly related to your risk for heart attacks and strokes in addition to all of the downstream effects of diabetes, including kidney failure, blindness, and neuropathy. 

If you suspect that you have FLD or are diagnosed with it by your doctor, the single most important thing that you should do is eliminate sugared beverages from your diet and moderate or remove sugar and processed foods from your diet entirely. This can be quite difficult at first, since they are in the majority of packaged foods you see in the grocery store and are given many different names. These sugars are included in packaged foods by processed food manufacturers for three reasons:  they are cheap to manufacture; they make foods shelf stable, so they don’t spoil; and they make foods taste better, so that you will eat (and buy) more. There is no pill that can substitute for this important lifestyle change.

As is often the case, prevention is the best medicine, although FLD is reversible. You can both prevent and reverse early fatty liver disease and metabolic syndrome by taking steps to improve your overall health. Start with a whole food diet that limits sugar, soda (even diet soda), and processed/refined grains and starches. The Mediterranean Diet is a great example. Focus on vegetables, eggs, nuts, and anti-inflammatory fats called Omega 3s. If you consume grains, eat them in moderation only, even whole grains. If you eat meat, it is generally better to eat smaller amounts of high quality products such as pasture-raised eggs and chicken, grass-fed meats and wild-caught fish, all of which have higher levels of Omega-3s.  Join your local farm’s CSA (community supported agriculture) program for the best seasonal, locally grown food options. Try to get some exercise every day; even a 20-minute walk is helpful.  Start small and build on your successes.  You will start noticing differences in your energy level very quickly. 

These actions will not only help you to reverse FLD and metabolic syndrome, but they will also help you maintain a healthy weight and have more energy; reduce your triglyceride levels, inflammation, and insulin resistance; and provide the greatest chance that you will  have great health and high functioning throughout your life and into old age.

Adam Cohen, MD, is the medical director and chair of the Department of Emergency Medicine at Southwestern Vermont Medical Center.