Although there are many conditions which affect and involve the liver, I’d like to teach you about the most common and most prevalent one: Fatty Liver Disease. This affects ~25% of Canadians and is closely associated with the other chronic diseases we have recently discussed, such as, Obesity, Type 2 Diabetes, and Dyslipidemia (abnormal cholesterol). And similar to Diabetes, this condition does not really jump up and down to alert us about it, nor does it show symptoms early on. This is precisely why I want you to know about it, so you can be on top of it, screen or test for it, and then of course, prevent and reverse it!

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The term “Fatty Liver Disease” is the simplest way to refer to this condition, but knowing the technical medical term provides better insight into the disease and how it all works. The medical term for Fatty Liver Disease is:

  • MASLD = Metabolic Dysfunction Associated Steatotic Liver Disease

Lots of jargon, yes, but bear with me. Think of MASLD (formerly NAFLD) as an umbrella term that refers to a group of liver conditions that relate to each other. Most people start with the baseline of a healthy liver. Over time, fat builds up in the liver’s cells, which creates “Fatty Liver.” At this stage, you can reverse the condition through the power of lifestyle. However, if this progresses and becomes worse, your liver starts to get inflamed and the cells of the liver become damaged. While you can still reverse things at this stage, if it keeps getting worse, you end up with liver “fibrosis” (aka scarring). But guess what, lifestyle (and medication) can still help you reverse this, assuming you catch it early enough and it is not too advanced. If it progresses beyond this, then you are looking at Cirrhosis (end-stage liver disease) or Hepatocellular Carcinoma (liver cancer), and that is where it really starts to go downhill.

You might be wondering, how does fat build up in the liver to begin with? Excellent question. There are several common risk factors that impact this process. They are the very same major chronic diseases that affect so many of us: Obesity, Type 2 Diabetes, Dyslipidemia, and Hypertension, and Metabolic Syndrome. The more of these risk factors and conditions you have, the greater the chance your liver will build up with fat (specifically, triglycerides).

NOTE: consuming excessive alcohol also puts us at risk of developing Fatty Liver Disease, but this is not the same as MASLD, and is known as AFLD (Alcohol-related Fatty Liver Disease), which is separate to our discussion here.

You may also be thinking, how can I reverse the earlier stages mentioned above? Lifestyle Medicine to the rescue once again! Specific tips and tricks are in your action plan at the end of this post. Really and truly, lifestyle modifications and behaviour changes are foundational for and super effective at reversing Fatty Liver.

One of the best things about the new name, MASLD, is the phrase “Metabolic Dysfunction Associated.” This refers to the actual impact that the condition, and the risk of developing it, has on your metabolism and its underlying disease processes and pathways, such as Insulin Resistance.

As you now know, Fatty Liver Disease is often silent, even for decades before being “suddenly” diagnosed or discovered. Initial testing is commonly conducted by your Primary Care Provider (PCP) or Family Doctor, by checking standard blood tests and a basic liver ultrasound. There are two further tests that I’d like you to be aware of, that may need to be done after initial workup:

  • FIB-4 (Fibrosis-4 Index): a blood test used to screen patients with Fatty Liver Disease for their risk of fibrosis.
  • SWE (Shear Wave Elastography): a specific type of ultrasound that further assesses fibrosis more accurately. This is usually ordered if your FIB-4 test comes back abnormal.

These two tests provide risk stratification (how at risk you are) and understanding of disease progression. As you read above, this is critical because we need to know how bad things are, or what stage we are working with, so we can accordingly focus on reversal, management or preventing further progression. The results of the SWE ultrasound are classified as either low or high risk. If low risk, you can keep working with your Family Doctor or a Lifestyle Doctor like myself to manage and improve things. If the results are high risk, then we recommend connecting you with a Hepatologist (Liver Specialist).

As always, here are some practical strategies to try, along with actionable targets to work towards, to lower your risk of Fatty Liver Disease or at least stop it from getting worse:

  1. Move your body for ~20 minutes of moderate intensity activity nearly every day.
    • At least 150 min/week of movement is your eventual weekly goal to work towards.
  2. Nutrition, nutrition, nutrition.
  3. Maintain a healthy weight.
    • If you are overweight or struggle with obesity, losing 5-10% of total body weight can be profoundly helpful.
  4. Manage your risk factors and other chronic diseases.
    • Keep doing your best to make more and more positive health changes and improve your lifestyle and behaviours to better your health long term.

You don’t have to master all of these actions at once. Take the pressure off. Start small, start somewhere, and keep going.

As always, chase progress, not perfection.

I believe in you,

Dr. Khimji

This Week’s Challenge

Go for a 10 minute walk right after dinner, at least 2 nights this week.

The Bottom Line

Fatty Liver Disease (MASLD) affects 1 in 4 Canadians and is another major chronic disease that does not alert us with obvious signs and symptoms until too late. It occurs when too much fat (triglycerides) builds up in our liver cells. Having other chronic diseases such as obesity, diabetes, high blood pressure, and high cholesterol can affect our risk of having this liver condition. There are important blood and ultrasound tests that help diagnose and assess progression of Fatty Liver called FIB-4 and SWE. The first few stages of Fatty Liver Disease are 100% reversible through optimizing your lifestyle with positive health behaviours, from moving your body more, to prioritizing healthy whole foods and plant protein and fibre, and maintaining a healthy weight. Choose one thing to work on, start small, and keep making progress towards better health!