Can obesity cause the same kind of liver damage as alcohol abuse?

“My doctor says that if I don’t lose weight, I could be at risk for the same kind of liver damage that alcoholics develop. Is this true? I’m overweight and diabetic, but I’ve never been a drinker.”

Answer provided by Mark Thompson, M.D., family medicine physician, Providence Medical Group-North Portland

It’s true – while obesity and alcoholism are two very different health issues, their impact on the liver can be quite similar. Both can cause fatty deposits to build up in the liver – a condition called fatty liver disease. Almost all heavy drinkers develop this condition, but it is climbing quickly among nondrinkers, too – especially among people who are overweight or have Type 2 diabetes. When it occurs in moderate or nondrinkers, we call it nonalcoholic fatty liver disease, or NAFLD.

NAFLD is now the most common cause of chronic liver disease in our country, far surpassing alcohol-related liver disease. An estimated 20 to 30 percent of Americans have NAFLD, although most probably don’t know it, because it progresses without symptoms. While the short-term effects are minimal, the potential long-term complications – gastrointestinal bleeding, anemia, encephalopathy (abnormal brain function), cirrhosis, liver cancer and liver failure – are the same serious problems that often occur after decades of alcohol abuse.

It sounds dire – and unfortunately, for many people, it is. But most people can affect how healthy their liver is by attending to their lifestyle choices. Here is some information to help you understand what’s going on, and most importantly, how to prevent it from becoming a bigger problem.

How your weight affects your liver

Due to genetic differences, lifestyle habits and other factors, people vary in the amount of weight gain they can tolerate before becoming resistant to insulin and developing Type 2 diabetes. Once people pass a certain threshold in terms of high weight and low activity level, however, the pancreas just can’t produce enough insulin to keep the levels of blood sugar and blood fat (cholesterol) under normal control. NAFLD appears to develop when the liver, which normally helps to process and regulate the amount of sugar and fat in the blood, becomes overwhelmed, as well, and starts storing excess fat in its own liver cells.

If too much fat builds up, or if certain genetic conditions are present, the fatty liver tissue can become inflamed and the liver cells can be damaged or destroyed. About 25 to 40 percent of people with NAFLD progress to this more severe form of the disease, called nonalcoholic steatohepatitis, or NASH. (Steatohepatitis is steatosis, or fat buildup, combined with hepatitis, or inflammation.) If the damage continues, it can lead to cirrhosis – permanent scarring of the liver, which progressively destroys the liver’s ability to function.

How to take control and protect your health

Anyone who carries a lot of extra weight – especially the “central obesity” that collects around the belly – should be seeing a doctor regularly for advice about their weight and for an evaluation of all of their health risks – not just NAFLD. This should include treatment or monitoring for insulin resistance or Type 2 diabetes and high cholesterol. All of these conditions contribute not only to NAFLD and NASH, but also to a host of other serious ills.

Your doctor has already told you that your liver may be at risk, so take heed: although there is no medical treatment for NAFLD or NASH, most people can stabilize or even reverse the liver disease process by losing weight and choosing lifestyle habits that support, rather than harm, the liver. Start by making these changes:

  • Focus most of your diet – about 40 to 50 percent – on vegetables (not counting root vegetables like beets, potatoes, yams, etc., which are high in carbohydrates).
  • Limit – but don’t eliminate – carbohydrates. Your brain requires carbs, but most Americans consume them in quantities that are far too great. Carbohydrates – including fruits, root vegetables and grains (preferably whole, but watch the sugar content), should make up about 25 percent of your diet, or no more than a quarter of your plate. Think of carbs as dessert: if you decide to have French fries or mashed potatoes at lunch or dinner, that’s your dessert – which means that you’ll have to forego the ice cream, cookies, chips, juice, pop or whatever other carb source you had hoped to enjoy to cap off your meal.
  • Fill in the rest of your diet – about 25 to 35 percent – with lean, high-protein foods such as low-fat dairy, lean meat, fish, eggs, nuts and legumes.
  • Get on a program of regular exercise (walk, swim, bicycle, dance, join a recreational sports team – whatever you enjoy), gradually working your way up to 30 to 60 minutes per session, three to seven days a week. Talk to your doctor first to make sure you get off to a safe start.
  • Limit or eliminate alcohol, which not only contributes to potential liver damage, but also is another source of empty carbohydrates.

No medication, surgery or doctor can do more to protect your liver’s health than you can do for yourself. Moving your body more and feeding it more wisely are the two most important health interventions that you – or anyone – can make. These changes will not only help you combat fatty liver disease, but could very well help you shed pounds, fend off diabetes and high cholesterol, and reduce your risk for heart disease, stroke and cancer, as well. I hope you’ll take them to heart – and to your liver.