Fatty Liver Disease and The Insulin Connection

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Fatty Liver Disease

Ladies, let’s have a heart-to-heart about something that might be affecting your health without you or even your doctor  realizing it. When I started my low carb keto journey after being diagnosed with pre-diabetes, I had no idea that I was also dealing with fatty liver disease. My doctor never mentioned it as a concern, and maybe many of you might be in the same boat.

Halfway through 2023, more than 200 experts in liver disease formalized their decision to rename Non-Alcoholic Fatty Liver Disease (NAFLD) to metabolic dysfunction-associated steatotic liver disease (MASLD). For the purpose of this blog post, we will continue to use Non-Alcoholic Fatty Liver Disease (NAFLD)

Non-alcoholic fatty liver disease (NAFLD) is a silent epidemic, affecting about 25% of the U.S. population. That’s one in four people! If you’re over 45 and struggling with weight issues, this information could be important for you. But here’s the empowering part: with the right knowledge and lifestyle changes, it’s possible to reverse this condition and dramatically improve your overall health.

This post isn’t about pointing fingers at our healthcare providers. Instead, it’s a call to action for all of us to become more involved in our own health journey. Let’s look at what NAFLD is, why it matters, and most importantly, what we can do about it.

What is Non-Alcoholic Fatty Liver Disease?

Imagine your liver as your body’s hardworking housekeeper. It processes nutrients, controls blood sugar levels, manages cholesterol, and even helps metabolize alcohol and other toxins. When it’s healthy, your liver is dark red, smooth, and silky to the touch. But with NAFLD, it becomes filled with fat droplets, changing its color and texture.

NAFLD occurs in three stages:

1. Simple fatty liver: This is when fat starts accumulating in your liver cells. At this stage, there’s little to no inflammation or liver cell damage. About 25% of U.S. adults are at this stage.
2. Non-alcoholic steatohepatitis (NASH): Here, not only is there fat in the liver, but inflammation has set in and some liver cells are damaged. Up to 30% of people with simple fatty liver may progress to this stage.
3. Cirrhosis: This is the most severe stage. Scar tissue replaces healthy liver tissue, stiffening the liver and seriously impairing its function. About 11% of NASH patients may progress to this stage.

Here’s the kicker: NAFLD often has no obvious symptoms in its early stages. You might feel perfectly fine while your liver is quietly struggling. That’s why it’s so important to be aware of the risk factors and get regular check-ups.

The Connection to Insulin Resistance:

Now, here’s where things get really interesting. Insulin resistance is the strongest known predictor of developing NAFLD. In fact, it increases your risk by 15 times compared to someone with normal insulin sensitivity. This was my wake-up call when I was diagnosed with pre-diabetes and started keto and learned the fatty liver was a concern.

Insulin resistance occurs when your body’s cells don’t respond well to insulin, the hormone that helps regulate blood sugar. When your cells are resistant to insulin, your pancreas produces more and more insulin to try to get the job done. This can lead to high blood sugar levels and, eventually, type 2 diabetes. But before that happens, it can contribute to the development of fatty liver.

Think of insulin resistance and NAFLD as two sides of the same coin. They often go hand in hand, creating a vicious cycle that can lead to more serious health issues if left unchecked.

Risk Factors:

As women over 45, we need to be especially aware of our risk factors for NAFLD. These include:

• Age: Our risk increases as we get older, particularly after menopause.
• Weight: Obesity is highly correlated with NAFLD. The higher your BMI, the greater your risk.
• Insulin resistance or type 2 diabetes: If you’re insulin resistant or diabetic, your risk of NAFLD jumps dramatically.
• High cholesterol or triglycerides: These often go hand-in-hand with NAFLD.
• Metabolic syndrome: This cluster of conditions (high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels) significantly increases your risk.

Interestingly, while NAFLD is more common in men overall, post-menopausal women catch up quickly due to hormonal changes. This is why it’s so important for us to stay vigilant about our liver health as we age.

Diagnosis:

Here’s where my story might resonate with many of you. Diagnosing NAFLD often starts with a blood test to check liver enzymes, particularly ALT (alanine aminotransferase). However - and this is crucial - “normal” levels aren’t necessarily “optimal.”

In both Canada and the USA:

1. Traditional “normal” ranges:
   • For women: typically below 33-35 IU/L
   • For men: typically below 45-50 IU/L
2. Updated guidelines for clinical evaluation (American College of Gastroenterology):
   • For women: above 25 IU/L
   • For men: above 33 IU/L
3. Suggested optimal levels (based on recent research):
   • For women: below 19 IU/L
   • For men: below 30 IU/L

The key point to emphasize is that the traditional “normal” ranges may not reflect optimal liver health, and that lower thresholds are now being recommended for clinical evaluation. This means you could have early-stage NAFLD even if your doctor says your liver function tests are “normal.” It’s a perfect example of why we need to be proactive about our health and dig deeper into our test results.

Other diagnostic tools for NAFLD might include:

• Ultrasounds
• CT scans
• MRI scans
• In some cases, a liver biopsy

If you’re concerned about NAFLD, don’t hesitate to ask your doctor for these tests. Remember, you are your own best advocate! I joined a 5-year fatty liver study here in Canada and they used ultrasound to show us our liver and actually explained what I was seeing. It was very informative!

The Role of Diet:

This is where my personal journey really comes into play. The biggest dietary culprit in NAFLD? Sugar, especially fructose. And it’s not just about table sugar - even “natural” sweeteners like honey and agave can be problematic due to their high fructose content.

Here’s a breakdown of fructose content in common sweeteners:

• Table sugar: 50% fructose
• High fructose corn syrup: 55% fructose
• Honey: 40-60% fructose
• Agave nectar: up to 90% fructose

Fructose is particularly harmful because it’s primarily metabolized in the liver. When we consume too much, it overwhelms the liver’s capacity to process it, leading to fat accumulation.

Switching to a low-carb or ketogenic diet can be incredibly beneficial. These diets naturally reduce sugar intake and help improve insulin sensitivity. When I made this change after my pre-diabetes diagnosis, I saw significant improvements in my blood sugar levels, and I now know it was also helping my liver health.

Steps to Reverse NAFLD:

Based on my experience and the latest research, here are some detailed steps you can take to reverse NAFLD:

1. Reduce sugar intake, especially from beverages:
   • Eliminate sugary drinks, including soda, fruit juices, and sweetened teas.
   • Be cautious with “healthy” smoothies, which can be high in fructose.
   • Read labels carefully - sugar hides in many processed foods.
2. Limit alcohol consumption:
   • While NAFLD isn’t caused by alcohol, drinking can exacerbate liver problems.
   • If you do drink, stick to the recommended limit of one drink per day for women.
3. Adopt a low-carb or ketogenic diet:
   • Focus on whole, unprocessed foods.
   • Include plenty of non-starchy vegetables.
   • Choose healthy fats like olive oil, avocados, and nuts.
   • Incorporate lean proteins like fish, poultry, and legumes.
4. Increase physical activity:
   • Aim for at least 150 minutes of moderate-intensity exercise per week.
   • Include both cardio and strength training exercises.
   • Even small increases in activity can help - take the stairs, park farther away, or go for a short walk after meals.
5. Maintain a healthy weight or work towards weight loss if needed:
   • Even a 5-10% reduction in body weight can significantly improve liver health.
   • Focus on sustainable, long-term changes rather than crash diets.
6. Get regular check-ups and monitor your liver enzymes:
   • Ask for detailed liver function tests, not just the standard panel.
   • Keep track of your results over time and discuss any changes with your doctor.
7. Manage stress:
   • Chronic stress can contribute to insulin resistance and inflammation.
   • Try stress-reduction techniques like meditation, yoga, or deep breathing exercises.

Ladies, I know firsthand that discovering you have fatty liver disease - or realizing you might be at risk - can be overwhelming. But remember, knowledge is power. By understanding NAFLD and its connection to insulin resistance, you’re taking the first step towards better health.

My journey from pre-diabetes and undiagnosed fatty liver to better health wasn’t always easy, but it was absolutely worth it. With the right diet and lifestyle changes, you too can improve your liver health and overall wellbeing.

Remember, it’s never too late to start taking care of yourself. Don’t be afraid to ask questions, seek second opinions, and make changes that support your health. You are your own best advocate, and you have the power to make a real difference in your health.Let’s educate ourselves, ask the right questions, and make the changes we need to live our best lives. After all, we’ve earned it.

Here’s to your health, ladies - you’ve got this!

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