NASH / NAFLD describes a condition in which fatty deposits accumulate in the liver. When the reason is not related to alcohol, the title non-alcoholic steatohepatitis is given if there is inflammation in the liver. The title non-alcoholic fatty liver disease is given if there is fat accumulation without more severe inflammation. 


NASH and NAFLD is one of the most common causes of elevated liver enzyme tests, and is increasing in incidence. The main risk factors are being overweight, having diabetes or being prediabetic, and having high fat levels in the blood.


If a person tends to accumulate fat in the belly, there is usually a higher chance of having fatty accumulations in the liver. Fat accumulation in the liver impairs the liver's ability to function at a normal healthy rate, and thus limits its ability to detoxify toxins and to remove cholesterol from the blood.


Risks include metabolic syndrome, diabetes, heart attack, and liver cancer.  


Naturopathic evaluations


NASH and NAFLD are very commonly seen in my patients. However, it is rarely their chief concern for consulting a naturopathic doctor, as typically they have been told that there is nothing that can be done about it. Fatty liver disease is extremely amenable to naturopathic interventions, and often enough the condition improves when we work on the overall health of the patient.


This makes sense because fatty liver disease is really just a descriptive diagnosis. In the conventional medicine world, there are very few drugs that can be used to "treat" NASH or NAFLD, and they include anti-diabetic agents that improve sensitivity to the hormone insulin. From a naturopathic perspective, there are many ways to:


1) improve insulin sensitivity

2) improve fatty acid metabolism by liver cells (beta oxidation of fats)

3) reduce toxic burden on the liver and protect the liver from further damage


By improving insulin sensitivity, risk of progression to diabetes is dramatically improved, weight loss tends to occur, and of course markers of fatty liver disease can improve. To test for insulin resistance, we simply run a fasting insulin level to look for elevations, or occasionally a two-hour insulin resistance test. 


Fatty acid metabolism, or the lack of it, is usually a problem otherwise fats would not accumulate in the liver. Nutrients such as carnitine, lipoic acid, coenzyme Q10, and niacin are essential for fatty acid metabolism, as are the typical M.I.C (methionine, inositol, and choline) that are in our weight loss injections. The best treatment to help the liver cells to metabolize and mobilize the excess fat is a combination of exercise and ozone therapy.   Ozone therapy helps to stimulate beta oxidation of fats, and is also a very useful treatment in diabetes.


Reducing the toxic burden in the liver is important in some patients with fatty liver disease. Usually the other naturopathic approaches of improving insulin sensitivity and improving fatty acid oxidation are the mainstays of natural treatments for fatty liver disease, but in some patients an assessment of their toxic burdens is essential. This can be the case as one of the main functions of the liver is to detoxify poisons (both metabolic, internally generated toxins, and chemicals which have no function in the body). 


Overall, from a naturopathic perspective, NASH, NAFLD, and fatty liver in general is more of a symptom than a true diagnosis. A true naturopathic "diagnosis" would involve investigating whether or not the fatty liver is a symptom of a more general imbalance, such as the mentioned insulin insensitivity or lack of fatty acid oxidation. Either way, fatty liver disease is one of those conditions that responds extremely well to naturopathic interventions, even though conventional medicine has little to offer in the early to mid-stages.