{"id":56283,"date":"2024-11-22T10:00:00","date_gmt":"2024-11-22T18:00:00","guid":{"rendered":"https:\/\/foodrevolution.org\/?p=56283"},"modified":"2026-09-15T00:51:37","modified_gmt":"2026-09-15T07:51:37","slug":"nafld-and-lifestyle","status":"publish","type":"post","link":"https:\/\/foodrevolution.org\/blog\/nafld-and-lifestyle\/","title":{"rendered":"NAFLD: Causes, Symptoms, and Lifestyle Interventions"},"content":{"rendered":"

Philosopher and psychologist William James is quoted<\/a> as saying, \u201cIs life worth living? It depends upon the liver.\u201d<\/p>\n

I\u2019m guessing he was referring to the person living that life \u2014 their goals, passions, circumstances, predispositions, those sorts of things.<\/p>\n

But you might also take his response literally. Your very existence depends upon the liver in your body: the heaviest organ you\u2019ve got and, arguably, the one doing the most complex tasks to keep you alive.<\/p>\n

It\u2019s been described<\/a> as a manufacturing hub, a processing plant, and a storage facility. Without your liver, you couldn\u2019t digest food, build new tissues, remove toxins, or store useful nutrients to be used later.<\/p>\n

That\u2019s reason enough to pay attention to a condition called NAFLD, which is not a new football league but rather the acronym for nonalcoholic fatty liver disease. NAFLD, though not as well-known as diabetes, heart disease, or cancer, is nevertheless incredibly widespread.<\/p>\n

Also known as metabolic dysfunction-associated steatotic liver disease, or MASLD<\/a>, it\u2019s the leading cause of liver disease worldwide, affecting at least a quarter<\/a> of the world\u2019s adult population. More than 75% of people with obesity and up to 90% of those with severe obesity also have NAFLD.<\/strong><\/p>\n

It\u2019s an expensive condition, too \u2014 health economists estimate the annual direct cost of NAFLD in the United States alone to be over $100 billion (yes, with a \u201cB\u201d) \u2014 even though it\u2019s largely undiagnosed<\/a>. That\u2019s because it\u2019s so prevalent and, in its serious later stages, requires expensive, multidisciplinary care.<\/p>\n

Early stages of NAFLD are asymptomatic, so it\u2019s common for people not to catch the condition early enough to treat it effectively. By the time it\u2019s diagnosed, it\u2019s often accompanied by complications<\/a> that current medical standards of care cannot reverse. Alarmingly, having NAFLD increases your risk of dying<\/a> in the next 15 years by 34\u201369%.<\/p>\n

Noting that the rising prevalence of NAFLD closely tracks the twin epidemics of obesity and type 2 diabetes, some health researchers point out that it may share root causes with those and other metabolic diseases.<\/p>\n

So, what causes NAFLD? How do you know if you have it? And can diet and lifestyle help prevent or reverse it?<\/p>\n

What Is Nonalcoholic Fatty Liver Disease (NAFLD)?<\/h2>\n
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NAFLD is a spectrum<\/a> of liver diseases, ranging from an initial buildup of fat in the liver (called steatosis) to dangerous and nonreversible scarring (aka cirrhosis).<\/p>\n

NAFLD typically progresses slowly<\/a>, with each stage of fibrosis (scarring) lasting about seven years. Simple fatty liver, the earliest stage, consists of fat buildup without inflammation. Eventually, it may progress to liver damage via a condition called nonalcoholic steatohepatitis (NASH), and ultimately, cirrhosis (nonreversible scarring and damage) and even liver cancer.<\/p>\n

NAFLD is differentiated from the kind of liver disease that can be caused by excess alcohol consumption. It\u2019s associated not with drinking but rather with metabolic syndrome. NAFLD typically results from an accumulation of excess free fatty acids and triglycerides.<\/strong> Other factors that can fuel it can include some medications, hormonal disturbances such as hypothyroidism, and nutritional imbalances.<\/p>\n

NAFLD Symptoms<\/h2>\n

One of the most dangerous things about NAFLD is that most people don\u2019t experience any symptoms<\/a> in the early stages of the disease when they might be able to do something about it before it causes permanent damage.<\/p>\n

If NAFLD progresses to the NASH stage, symptoms often include fatigue, unexplained weight loss, weakness, and, most specifically, a dull pain or ache in the top right of the stomach, under the ribs (known to medical professionals as the RUQ<\/a>, or right upper quadrant of the abdomen, home to the liver, gallbladder, pancreas, and sections of the small intestines).<\/p>\n

If NAFLD further progresses to cirrhosis, it can lead to jaundice and edema.<\/p>\n

Fatty Liver Disease Screenings<\/h2>\n
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There are a few potential diagnostic tests that can help discover NAFLD. Before we get into them, it\u2019s important to note that most medical associations do not recommend<\/a> using them to screen the general population. That\u2019s because insurance companies have not deemed screening cost-effective.<\/p>\n

Insurance companies don\u2019t think NAFLD screening is cost-effective in most cases because of the widespread belief that there aren\u2019t any useful therapies for it.<\/strong> While that\u2019s true in the narrow sense that there aren\u2019t many billable medical interventions that can slow, halt, or reverse the condition, as we\u2019ll see below, there are powerful lifestyle strategies that can drastically change the disease\u2019s trajectory in many, if not most, cases.<\/p>\n

Diagnostics in High-Risk Patients<\/h3>\n

International medical associations recommend NAFLD evaluation in high-risk patients. These include people with type 2 diabetes or prediabetes, elevated levels of an enzyme produced by the liver called serum alanine aminotransferase (ALT), or the presence of fatty liver on imaging studies.<\/p>\n

So, how is NAFLD diagnosed? Unfortunately, the least invasive options, such as a liver function test or ultrasound, are the least reliable. The gold standard method of assessment, liver biopsy, has a few downsides: high cost, potential sampling error (since fatty deposits are unevenly distributed in the liver, the results could be skewed based on where the sample was taken), and complications such as bleeding, infection, and pain (although the risks of these complications are low).<\/strong><\/p>\n

Other newer diagnostic methods<\/a> are noninvasive and are often used to monitor the presence and progression of NAFLD in high-risk patients. Some of these tests are called (get ready for some \u201cacronym soup\u201d here) FIB-4, NFS, ELF, VCTE, and MRE.<\/p>\n

What Causes NAFLD?<\/h2>\n
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NAFLD has its roots in genetic, environmental, and lifestyle factors. Genetic predispositions to the disease can be either conferred at birth or due to gene mutation. Environmental triggers for the development and progression of NAFLD include chemicals like inorganic arsenic<\/a> and plastics like vinyl chloride<\/a>.<\/p>\n

But the biggest factor is lifestyle \u2014 especially diet.<\/p>\n

NAFLD typically accompanies<\/a> other conditions related specifically to poor diet. As we\u2019ve seen, most obese adults also have NAFLD, and 90% or more of people with hyperlipidemia (high cholesterol levels) have it, too.<\/p>\n

One of the major mechanisms of NAFLD is insulin resistance<\/a>.<\/strong> That\u2019s because insulin acts as a shuttle to get carbohydrates into cells so they can use them as energy. When the body struggles with this process, those carbohydrates have no place else to go, and they can end up turning into fatty deposits in the liver.<\/p>\n

Other people at risk for developing nonalcoholic fatty liver include those with polycystic ovary syndrome<\/a>, underactive thyroid<\/a>, high blood pressure, chronic kidney disease, obstructive sleep apnea, or people who smoke. These conditions are all largely associated with low-quality diets.<\/p>\n

The Worst and Best Foods for NAFLD<\/h2>\n

If NAFLD is largely caused and worsened by diet, what are the foods to avoid and the ones to double down on?<\/p>\n

The worst foods for NAFLD include<\/a> the following:<\/strong><\/p>\n