Non-Alcoholic Fatty Liver Disease (NAFLD) is a silent, insidious condition that affects a staggering number of people, both overweight and slim. You might think this liver disease only impacts those who are overweight or obese, but in reality, even those with a healthy weight are at risk. Even more alarming is the fact that it’s now being diagnosed in children as young as two years old. And, it’s a lifestyle disease that’s growing rapidly.

What Are the Symptoms of NAFLD?

One of the scariest aspects of NAFLD is that it’s often asymptomatic. In many cases, there are no noticeable signs or symptoms at all. When symptoms do appear, they are often vague and can easily be mistaken for something else. These may include fatigue, abdominal discomfort, bloating, and occasional nausea. Because these symptoms are so mild and non-specific, many people don't realize they have NAFLD until it’s discovered during routine blood tests.

It’s typically detected when elevated liver enzymes show up in blood tests, often done for other reasons or as part of a regular checkup. The diagnosis is confirmed after other potential liver diseases are ruled out, and an ultrasound is performed to assess the liver.

Defining NAFLD

So, what exactly is Non-Alcoholic Fatty Liver Disease (NAFLD)? In simple terms, it occurs when fat accumulates in the liver (a condition known as steatosis), but without the excessive alcohol consumption that is typically associated with liver damage. In fact, NAFLD is considered the liver manifestation of metabolic syndrome, a cluster of conditions that increase the risk of heart disease, stroke, and type 2 diabetes.

Now, you might be thinking: “Wait, does having NAFLD mean someone who doesn’t drink alcohol at all or someone who isn't an alcoholic? I have a couple of drinks every night—does that make me an alcoholic?”

Defining Alcohol Consumption

It is important to understand what is considered "chronic alcohol consumption" because that plays a significant role in understanding NAFLD. In Australia, a standard drink is defined as 110ml of wine or 375ml of beer. Chronic alcohol consumption is considered two standard drinks per day for women and three 375ml mid-strength beers per day for men.

Isn’t it surprising how easy it is to unknowingly exceed these amounts? Many people don’t measure out their alcohol precisely, and a typical wine glass purchased from a department store holds anywhere between 400ml to 800ml! How many people actually stop at a single 110ml pour? It's a good reminder that our understanding of what constitutes a “standard drink” can often be misleading.

In the United States, the equivalent of a standard drink is 150ml of wine, 355ml of beer, or 44ml of spirits. Chronic alcohol consumption is defined as seven drinks a week for women and 14 drinks a week for men. While this is a useful guideline, the discrepancy between countries only adds to the confusion.

It’s True: You Don’t Have to Be an Alcoholic to Have Fatty Liver, But There Are Certain Risk Factors That Increase Your Chances of Developing NAFLD

It’s a common misconception that only alcoholics are at risk for fatty liver disease. In reality, Non-Alcoholic Fatty Liver Disease (NAFLD) can affect anyone, and there are a variety of risk factors that contribute to its development. Today, I’ll walk you through these risk factors and then dive into something about stress that will truly surprise you.

Risk Factors for NAFLD:

• Gastric bypass surgery

• High cholesterol

• High triglyceride levels in the blood

• Metabolic syndrome

• Obesity

• Polycystic ovary syndrome (PCOS)

• Sleep apnea

• Type 2 diabetes

• Hypothyroidism (underactive thyroid)

• Hypopituitarism (underactive pituitary gland)

• Exposure to environmental toxins

• Family history of liver disease

• Insulin resistance

• Sedentary lifestyle

• Medications (including tamoxifen, synthetic estrogens, corticosteroids, antiretrovirals, and others)

• Gut function and gut microbiome imbalance

• Small intestinal bacterial overgrowth (SIBO)

• Increased intestinal permeability ("Leaky Gut")

• Exposure to PCBs (polychlorinated biphenyls)

• Lack of oxygenation

• High levels of circulating sugar and fat

• Stress – particularly the fight/flight response

As you can see, this list is extensive, and one factor I’d like to focus on is stress. Not just the usual “feeling stressed” kind of stress, but the type of stress that sends your heart racing and your adrenal glands into overdrive. Here's why this is so important:

The Stress Factor: A Hidden Contributor to NAFLD

We live in a world that’s dramatically different from the one our ancestors experienced just a few generations ago—heck, even from just 50 years ago. Our food now has a much higher caloric value than it used to. Portions are larger, and we tend to eat much more than we ever did before. Many of us now eat several times a day—breakfast, lunch, dinner, snacks in between, and even an after-dinner treat. Yet, despite this constant intake, many of us don’t get enough physical activity to balance it out.

So, what happens to all this extra energy? Well, our incredibly adaptive bodies store it. And guess where it goes? Right into the liver. The body stores the excess energy to use later—when it's needed, like in times of physical exertion. But here’s where things get tricky.

The Modern Stress Response

Think about your typical day. You wake up, and perhaps you have to drive to work. While stuck in peak-hour traffic, someone cuts you off. Instant irritation. Your heart starts racing, adrenaline surges, and you enter "fight-or-flight" mode. But here’s the catch: Instead of fleeing or fighting, you’re sitting in the car, fuming.

Now, imagine this happening repeatedly throughout the day—perhaps you face another stressful encounter at work, or you're dealing with a tight deadline. Each of these daily frustrations triggers your body’s stress response, and it happens multiple times a day.

Why is this important?

The key issue here is that our bodies are designed for short bursts of physical exertion—like running from danger or fighting for survival. But in today’s world, those bursts of energy are being triggered multiple times a day in response to daily frustrations, not actual physical danger.

And when this stress response is constantly activated, your body releases hormones like cortisol, which encourages fat storage in the liver. Over time, this repeated cycle of stress combined with an unhealthy energy balance (eating too much and moving too little) can lead to NAFLD.

The Daily Stress Cycle and Its Impact on Fatty Liver

The process of stress-induced fat and sugar release happens repeatedly throughout the day—day in, day out. And it continues year after year. So why is this kind of stress response so detrimental to our health, and what does it have to do with fatty liver? Well, that’s a fantastic question, and I’m glad you asked.

When our body undergoes a fight-or-flight stress response, it releases stored fat and sugar into the bloodstream, preparing us to either fight or flee from danger. This is a survival mechanism that evolved for times when we were actively fleeing from predators or fighting for our lives. However, in today’s world, these responses are triggered constantly, but rarely by physical danger. Instead, it could be something as simple as traffic, a frustrating co-worker, or an impending deadline.

The problem arises when this energy—sugars and fats—gets released, but we don’t use it up through physical activity. Instead, it gets reabsorbed by the body, and where does it go? You guessed it: straight to the liver. Now, think about how many times a day your body releases this stored energy during your fight-or-flight responses. And then consider how often it gets reabsorbed into the liver. It's a vicious cycle, isn’t it?

What You Can Do to Break the Cycle

One thing you can do, if your physical condition allows it, is to jump up and down or do star jumps for 30 seconds to burn off that released energy. Or, you can take deep breaths—this is actually a better approach, as NAFLD is also linked to a lack of oxygen in the body. It’s essential that we oxygenate our bodies more effectively.

Many of us have become shallow breathers, only using the top part of our lungs instead of engaging our entire diaphragm. You know you're breathing deeply when your tummy moves in and out as you inhale and exhale.

Next time Mr. Inconsiderate cuts you off in traffic, ask yourself: Is it really worth getting angry? Did getting angry change the situation? Or, did it harm your health by releasing sugars and fats that I won’t use right now? This constant cycle of stress and energy release contributes to non-alcoholic fatty liver disease (NAFLD), cardiovascular disease (due to the rise in blood pressure), and even cancer, as the chemicals released can trigger the growth of cancer cells.

What to Do if You've Been Diagnosed with NAFLD

If you've been diagnosed with NAFLD and your GP tells you that there’s nothing you can do about it, remember—what they are likely saying is that there’s nothing more they can do medically at this stage. But here’s the good news: You can always take responsibility for your health, no matter where you are in your life.

Here are some dietary and lifestyle changes that can make a big difference:

• Increase Your Vegetable Intake: Focus on green leafy vegetables. They’re rich in nutrients and fiber that can help support liver health.

• Cut Out Alcohol and Reduce Coffee Intake: Alcohol and excess caffeine can both stress the liver and worsen NAFLD.

• Supplements: Consider supplementing with Vitamin D (although remember, it's contraindicated for those taking Digoxin), Vitamin K (be cautious if you’re on Warfarin), and low-dose natural Vitamin E, such as Sunfoods Tocotrienols. Nothing beats the benefits of good old-fashioned sunshine on bare skin for Vitamin D, though.

• Eliminate Chemical Fructose: Avoid artificial fructose and focus on increasing your natural fruit intake. Real, whole fruit is far better for your liver than processed sugars.

• Say No to Aspartame and Caramel Colors: These additives (like those in diet sodas and processed foods) have been linked to a variety of health issues and should be avoided.

• Choose Healthy Fats: Not all fats are equal! Saturated fats from animal products can harm your liver, but coconut oil is an exception. Just 1-3 tablespoons a day is plenty. Also, add in some hempseed oil, which is packed with essential nutrients and omega fatty acids.

• Cut Out Refined Carbs: Bakery items like cakes, muffins, cookies, and pastries are simple carbohydrates that not only contribute to NAFLD but also promote other health problems. Your taste buds might love them, but your body doesn’t need them.

• Increase Carotenoid Antioxidants: These are found in red, orange, and yellow fruits and vegetables. Go for the natural sources—fresh, raw, or lightly cooked is best. Add some seeds, nuts, or fruit to your salads for extra nutrients.

• Support Liver Health with Supplements: Many people benefit from glutathione, the liver’s most powerful antioxidant. NAC (N-acetylcysteine) is a great precursor to glutathione and comes in powder form for easy absorption.

• Boost Vitamin C: Citrus fruits, tomatoes, and chlorella powder (not tablets) are excellent sources of Vitamin C, which supports the immune system and helps detoxify the liver.

• Gut Health is Key: Speak to your naturopath or natural health practitioner about probiotics and prebiotics. A healthy gut microbiome can improve liver function. Dr. William Davis’ yogurt recipe, enriched with L. Reuteri bacteria, is a great place to start. It’s both delicious and beneficial when combined with fresh berries and homemade granola.

• Other Nutrients: Consider supplementing with choline, taurine, carnitine, milk thistle (a herbal preparation), broccoli sprout powder, and alpha-lipoic acid (under practitioner supervision). Activated B complex or nutritional yeast can also support liver health.

I have personally had the privilege of helping individuals reverse liver damage, even in cases that seemed dire. One particularly inspiring example was a woman who was on the verge of undergoing a liver transplant. Through a carefully tailored approach, we worked together to repair, nourish, and support her liver. As a result, she was able to regain normal liver function, completely transforming her health and avoiding the need for a transplant.

Exercise: The Ultimate Liver Boost

The most crucial health measure I can recommend is exercise. Aim for at least 400 calories burned during each exercise session, 2-3 times a week. It doesn’t have to be complicated—why not have a fun dance session at home? Dance to your favorite tunes in the living room! Or take a brisk walk that gets your heart rate up, but still lets you chat with a friend. Swimming, rowing, or joining an exercise group can also be great options. Find something you enjoy and stay motivated!

All in all, it’s time for us to reclaim our health. By taking responsibility for our own well-being, we can make positive changes that support our liver and overall health. It’s never too late to start making better choices for your future.