Non-Alcoholic Fatty Liver Disease (NAFLD)

By Mehrdad Torkaman, ND

Non-alcoholic fatty liver disease is the most common chronic liver disease in Western countries and is associated with higher levels of overall and liver related morbidity and mortality. Also, NAFLD is the most common cause of liver disease in children.

Etiology

  • Insulin Resistance and Metabolic Syndrome NAFLD has recently been identified as a risk factor for diabetes and cardiovascular disease
  • High-Fructose Consumption
  • Hepatitis C Infection
  • Endocrine Dysfunction polycystic ovarian syndrome (PCOS , Hypothalamic and pituitary dysfunction can result in a similar presentation to the picture of insulin resistance and risk of developing NAFLD via excessive weight gain, dyslipidemia, impaired glucose tolerance and growth hormone deficiencies.

Signs and Symptoms

  • Non-alcoholic fatty liver disease usually occurs in the fourth to fifth decade of life and although usually asymptomatic, fatigue and/or right upper quadrant abdominal discomfort is often noted. Health problems associated with NAFLD due to the presence of excess adipose tissue include arthritis, non-specific body aches and pains, sleep disturbances, dyspnoea on mild exertion and this may lead to a lower quality of life and depression.

Investigations

  • NAFLD is often diagnosed in asymptomatic patients after raised amino transferases are detected through routine screening or abnormal hepatic ultrasonography is detected during investigations for gallstones. A precise diagnosis of NAFLD requires a liver biopsy
  • laboratory studies show only mild elevations in transaminases with alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) between 1.5 and 3 times the normal level.

 Therapeutic Considerations

  • NAFLD is perhaps one of the more perfect conditions awaiting naturopathic therapy. Provide patients with simple and effective guidelines for weight management, exercise and optimal metabolic performance. The naturopathic approach to the treatment of NAFLD involves recognizing the condition as a symptom of metabolic disharmony compounded by poor diet and lifestyle choices. Thus, naturopathic treatment involves recognizing underlying conditions related to the aetiology of NAFLD and treating them, while improving liver function and fatty acid oxidation in the process.

Supplement Dosage Requirement

•SAM-e (S-Adenosylmethionine: 200–400 mg b.i.d./tds

•Betaine: 10–20 g daily

•Zinc: 25–50 mg daily

•Vitamin E: 1000 IU daily

•Chromium: 250 μg/day

•Magnesium: 250 mg b.i.d

•L-Carnitine: 500 mg b.i.d. or 1000 mg/day

•Alpha Lipoic Acid: 300–600 mg/day

•Taurine: 500 mg tds

•Essential Fatty Acids: 1000 mg EPA/DHA/day

Other therapeutically interventions can include Herbal Medicine, lifestyle modification (weight loss, exercise, self-care and mental support).

Case Report 

A 50-year-old man presented with a diagnosis of NAFLD, high ferritin, lipid panel, abdomen pain and obesity. His job is stressful and feels low energy during the day. He tested negative for both hepatitis C and hemochromatosis. He had drunk no alcohol in the past 6 months.

Clinical Examination: 

BP:135/83 PR:66, BMI:35, Visceral fat: 14, Abdominal bloating, apple shape obesity, tenderness in RUQ

Treatment Protocol

Initial Appointment

Treatment Plan:

  1. Reduce weight, particularly abdominal fat. 
  2. Absolute ban of alcohol and smoking were both implicated in hepatic fibrosis progression
  3. Reduce liver inflammation, boost liver function 
  4. Assist a healthy digestive system
  5. Adaptogens to assist with a stressful work environment.

Supplement: 

• Omega-3: (EPA 402 mg/DHA 201 mg) 1 capsule b.i.d.

• Bromelain 500 mg 1 capsule daily

• Quercetin 500 mg 1 tablet daily

• Phosphatidylcholine 1000 mg 1 capsule b.i.d.

• herbal formula containing : licorice, turmeric, panax ginseng, Astragalus, Schisandra, silybin, dandelion  2 tablet twice daily

• CoQ10 300 mg/day

• ACES+Zinc once daily.

Lifestyle Strategies

  • Increase exercise to assist in weight loss and a reduction in waist circumference which will reduce the metabolic pathways triggering inflammation and reverse hepatic fibrosis which can be a long-term sequela of fatty liver.

Following Laboratory Results (3 months later)

Clinical Findings:

Weight loss – had reduced 5 cm from waist circumference and this is a factor in the reduction in liver inflammation (ALT), lipid panel, ferritin, over the past 6 months. His digestion symptoms (bloating, abdomen pain) and energy level and stress got much better. 

……………….

Dr Mehrdad Torkamaiha ND/MD(from Iran) is a naturopathic physician with a medical background as a Medical Doctor (MD) from Iran. He strongly believes in the Integrative Medicine approach and practice as a Naturopath focused on IV therapy, repetitive medicine and pain management.  He practices at Green Family Wellness Center in Port Coquitlam,  B.C.