Important Details About Non-Alcoholic Fatty Liver Disease

Besides cancer, COVID-19, and the usual diseases, Filipino families are pretty vulnerable to Non-Alcoholic Fatty Liver disease, too.

The Liver is an amazing organ in our body, having the ability to regenerate parts of itself even after we donate some of it to people who need it. It also helps manage our sugar levels and with the holidays coming up, it’s got its work cut out for it! But not everyone has a healthy liver. After taking quite a beating from a stressful and unhealthy lifestyle, our livers can succumb to a disease known as Fatty Liver disease — both the alcoholic and non-alcoholic variant — which Filipino families are susceptible to!

1. But there are two kinds of fatty liver disease: non-alcoholic and alcoholic

Alcohol is one of the leading causes of fatty liver disease. But what can cause fatty liver when the person already doesn’t drink alcohol? Non-Alcoholic Fatty Liver Disease (NAFLD) can happen because of a myriad of things, including issues like lipidemia — a genetic trait wherein the body cannot process fat properly, leading to astonishing levels of cholesterol, or constantly working the graveyard shift, leaving the liver no time to replenish and heal itself from the beating.

However, there is a way to prevent further damage. “The key factor to avoid NAFLD is to keep your metabolic parameters normal, keep your numbers normal, whether it’s weight, cholesterol, etcetera,” Immediate Past President of the Philippine College of Physicians Dr. Diana Payawal advised. “Since this is a mitochondrial and multi-factorial disease, you need to hit different aspects of the disease in order to control it.”

2. Unmonitored and left unaware, it can progress into something worse

What’s the next step of fatty liver disease? It’s cirrhosis or liver cancer; hepatitis isn’t the only way to get that kind of liver damage. Managing blood chemistry is no easy job for the liver and the constant abuse from an unhealthy diet of indulging with some sweets, a few salty foods to counter the sweet, and then sleeping late can confuse our metabolisms, making the liver cells eventually mutate into cancer cells.

Unfortunately, over 10 to 20% of Filipinos have liver disease — possibly from smoking, beer, and eating unbalanced diets in order to stave off their hunger.

3. Unlike other diseases, there’s no age requirement

Teens and young adults are now showing signs of having fatty liver, especially when managing their dynamic lifestyles. With vegetables rising in price, the persistent stigma that delicious vegetable dishes don’t exist, and if they do, there’s not enough time for the prep work, teens and young adults end up relying on red meat, carbohydrates, and sugars as their main sources of energy, leaving them more susceptible to Non-Alcoholic Fatty Liver Disease (NAFLD).

4. Antioxidants like Vitamins A, C, and E can help reduce the damage from Non-Alcoholic Fatty Liver Disease (NAFLD)

Vitamins A, C, and E, because they’re antioxidants, can remove the radicals (or oxygen) found in fats (García‐Ruiz and Fernández‐Checa, 2018). It’s also interesting to note that Vitamins A and E are fat-soluble which means the fat around the liver may degrade more because it will absorb those specific vitamins. Vitamin C (also known as Ascorbic Acid) is water-soluble which means maybe a glass of lemon water or freshly squeezed orange juice can help improve our liver’s health (Chen, Ni, Nagata, Xu, & Ota, 2016).

Calamansi juice actually helps, too, but it can be a bit tiresome to squeeze 10 calamansi over 1 lemon. In Tuba, Benguet, lemons are quite common and cheap to get. They may not look like the typical yellow ones but they’re just as good and have more juice.

5. Genetics can contribute to it

Unfortunately, there are also some extraordinary cases wherein even a healthy lifestyle won’t stop its development. Thus, we have to look at the genetic make-up (Severson, Besur, and Bonkovsky, 2016). Some genetic issues don’t present themselves until we’re much older because that’s when our immune systems start to slip. Our genes are made up of proteins that tell our bodies what to produce to break things down. It’s like one big Spotify list; when it’s on shuffle, it will only play the songs that are in it. But when we put it on Smart Shuffle, it will play other songs we haven’t heard before. The new songs are akin to the environmental factors that cause our genes to mutate because the protein sequence changes, making it even more possible for us to get non-alcoholic fatty liver disease (NAFLD) (Sookoian and Pirola, 2017).

However, some studies have discovered the mechanism behind the issue and are looking for ways to treat it on a genetic level (Romeo, Sanyal, and Valenti, 2020).

6. Obesity is a symptom of non-alcoholic fatty liver disease

Obesity isn’t always because of a lack of discipline or an eating problem. It can be because the body isn’t producing the right chemical to break down the fat. Think of a lock and key: we need a specific key to open a specific door. Otherwise, anyone can just break into our houses! The same thing applies; certain chemical components like lipids (or fats), alcohol, and starch require specific enzymes like lipase, alcohol dehydrogenase (ADH), and amylase to break it down so it doesn’t build up and destroy our bodies.

Other symptoms include our skin and the whites of our eyes turning bright yellow which we also know as “jaundice.”

7. A fatty liver has a lot of other diseases accompanying it

Fatty liver isn’t usually alone and is a sign that there’s another disease raring to go. One of the most common ones is diabetes — because much of the Filipino lifestyle is an imbalance of rice and sugar with lowered physical activity, the body finds no need to burn fat for that extra energy. In a study done last 2008, over 69% of the patients who had fatty liver disease also had diabetes.

Hormone-based diseases like polycystic ovarian syndrome (PCOS) and hypothyroidism — when your thyroid is underperforming — can also cause Non-Alcoholic Fatty Liver Disease (NAFLD) hence why some diabetic medications help those with polycystic ovarian syndrome (Lonardo, Mantovani, Lugari, and Targher, 2019; Riemann, Blaschke, Jauho-Ghadimi, Siggelkow, and Gollisch, 2022).

8. It does affect mental health, too

This is also why greeting someone with “tumaba ka” isn’t a good idea. Those with non-alcoholic fatty liver disease are undergoing medical treatment to further reduce the damage but, it’s not something that happens overnight! While the treatment is ongoing, the patient will still have to face the frustration of the treatment not possibly working or being too slow.

At the same time, sudden weight gain can also mean they’re not metabolizing enough which deprives the brain of certain nutrients it needs to work alongside the psychiatric medicines that they’re taking and eventually weaning off (Soto-Angona, Anmella, Valdés-Florido, De Uribe-Viloria, Carvalho, and Berk, 2020; Shea, Lionis, Kite, Atkinson, Chaggar, Randeva, and Kyrou, 2021).

Non-Alcoholic Fatty Liver Disease (NAFLD): “The Silent Liver Disease”

Because the symptoms don’t show up right away, we’re often chasing and beating off the Non-Alcoholic Fatty Liver Disease when we could have prevented prior. Although it may be a bit of a hassle to go see your doctor, and change your diet, these things don’t have to happen all at the same time. Doing everything one step at a time also gives you a chance to adapt and try a treatment plan that best suits your lifestyle. For all we know, it might even be better than our current lifestyle!

References

Chen, G., Ni, Y., Nagata, N., Xu, L., & Ota, T. (2016). Micronutrient antioxidants and nonalcoholic fatty liver disease. International journal of molecular sciences, 17(9), 1379.

García‐Ruiz, C., & Fernández‐Checa, J. C. (2018). Mitochondrial oxidative stress and antioxidants balance in fatty liver disease. Hepatology communications, 2(12), 1425-1439.

Lonardo, A., Mantovani, A., Lugari, S., & Targher, G. (2019). NAFLD in some common endocrine diseases: prevalence, pathophysiology, and principles of diagnosis and management. International journal of molecular sciences, 20(11), 2841.

Riemann, A., Blaschke, M., Jauho-Ghadimi, A., Siggelkow, H., & Gollisch, K. S. C. (2022). Metformin improves the hepatic steatosis index in non-obese patients with polycystic ovary syndrome. Journal of Clinical Medicine, 11(15), 4294.

Romeo, S., Sanyal, A., & Valenti, L. (2020). Leveraging human genetics to identify potential new treatments for fatty liver disease. Cell metabolism, 31(1), 35-45.

Severson, T. J., Besur, S., & Bonkovsky, H. L. (2016). Genetic factors that affect nonalcoholic fatty liver disease: A systematic clinical review. World journal of gastroenterology, 22(29), 6742.

Shea, S., Lionis, C., Kite, C., Atkinson, L., Chaggar, S. S., Randeva, H. S., & Kyrou, I. (2021). Non-alcoholic fatty liver disease (NAFLD) and potential links to depression, anxiety, and chronic stress. Biomedicines, 9(11), 1697.

Sookoian, S., & Pirola, C. J. (2017). Genetic predisposition in nonalcoholic fatty liver disease. Clinical and molecular hepatology, 23(1), 1.

Soto-Angona, Ó., Anmella, G., Valdés-Florido, M. J., De Uribe-Viloria, N., Carvalho, A. F., Penninx, B. W., & Berk, M. (2020). Non-alcoholic fatty liver disease (NAFLD) as a neglected metabolic companion of psychiatric disorders: common pathways and future approaches. BMC medicine, 18, 1-14.

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