Treatment options for Nonalcoholic fatty liver disease (NAFLD)


Q: I have been diagnosed with Non-alcoholic fatty liver. I am not obese 5ft 127lbs and dieting. I don't have diabetes. What can I do to cleanse the liver? I've read about parasites in the liver as well and wonder if that could also be part of the fatty liver problem. How can I rid myself of the parasites and fat in the liver?


A:   Non-alcoholic fatty liver disease (NAFLD) results from excessive accumulation of lipids (fats) in the cells (hepatocytes) of the liver. Fatty liver can be associated with the use of alcohol, even with as little as 10 oz of alcohol ingested per week, and this is known as alcohol-related fatty liver. Nonalcoholic steatohepatitis or NASH refers to fatty accumulation in the liver cells, in addition to inflammation of the liver (hepatitis). Simple fatty liver is believed to be benign, but NASH can progress to cirrhosis and can be associated with a form of liver cancer. The main risk factors for simple fatty liver (NAFLD) and NASH are obesity, diabetes type 2, and high triglyceride levels such as in the metabolic syndrome. Drugs, alcohol, metabolic abnormalities, nutritional status (eg, overnutrition or starvation diet) or underlying diseases such as celiac sprue or Wilson’s disease may contribute to fatty liver disease. There are also reports of lean NASH families.
Treatment is aimed at gradual weight loss with a high protein-to-calorie diet ratio and regular exercise in addition to dietary changes. There are several studies at present investigating the use of anti-diabetic drugs the thiazolidinediones or glitazones (eg pioglitazone) in the treatment of fatty liver. Pioglitazone has been shown in a short-term study to improve liver function tests (especially AST and ALT) and reduce liver fat accumulation. However further long-term evaluation is required and currently these drugs are under FDA investigation due to a potential increased risk of heart attack (MI) and heart-related death associated with their use. Lipid-lowering agents (statins) have also proven effective. I would advise discussing treatment options with your gastroenterologist or hepatologist.

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