Q: My son-in-law has just been diagnosed with fatty liver syndrome. His mother also has this problem. What is it and how is it treated? Also, his daughter, my granddaughter, has celiac disease. No one else in the family except a first cousin tests positive for celiac. Is there any connection between a fatty liver and celiac disease?
A: Fatty liver is an accumulation of triglycerides and other fats within the cells of the liver. A healthy liver regulates our fat metabolism and is considered the major fat-burning organ in the body. Not only does the liver burn fat, it actually pumps excesses out of the body through the bile. On the reverse, however, a fatty liver behaves in just the opposite manner. The liver stores fat but doesn’t excrete it. If the condition progresses for years, unwanted consequences will likely occur. Some fat in the liver is normal but when that fat makes up more than 5 to 10% of the weight of the liver, an individual may be diagnosed with fatty liver disease that can either be related to alcoholism or has no connection with alcohol consumption. The condition is not restricted to adults, but can occur in children, as well. Up to 20% of the general population has fatty liver and the incidence is higher still in obese individuals.
Because there is alcoholic fatty liver and non-alcoholic fatty liver, a non-alcoholic is at increased risk if he or she is obese, if there is a family history, may have high cholesterol or triglyceride levels, is pre-diabetic or has true diabetes. Other causes include having an autoimmune inherited liver disorder, viral hepatitis, being on specific medications, experiencing rapid weight loss, and suffering from malnutrition. Severe fatty liver disease patients may experience jaundice (yellowing of the skin and eyes, internal bleed, have fluid retention, diminished muscle strength, and ultimate liver failure.
Diagnosis can be made by a combination of a physician palpating the liver to determine if there is enlargement, by ordering laboratory testing of specific liver enzymes, requesting radiologic testing, or through biopsy.
Treatment will be directed toward the cause for the disorder. An alcoholic should discontinue consuming alcohol. For others, rapid weight loss is definitely discouraged and will have a negative impact on the liver; rather, a loss of between 5 and 10% of initial body weight over a six month period (or no more than 3 l/2 pounds per week) is appropriate. Because the liver burns fat less efficiently and metabolism is slowed, the process can be discouraging and lengthy but will be beneficial in the long run. Essentially, the liver must be re-trained from being that of a fat storage container to being a fat-burning unit once again. This can be done by avoiding refined carbohydrates such as sugar, pastas, desserts, breads, fried foods, and all margarines or spreads that contain hydrogenated vegetable oils, while simultaneously increasing the consumption of vegetables, either raw or cooked.
Celiac disease damages the lining of the small intestine, preventing it from absorbing nutrients important for maintaining good health. Those individuals who have the disease and consume gluten may develop inflammation of the small intestine which can lead to other significant problems in the intestine. The disorder can affect individuals of all ages but those with a family history will be at increased risk. The person may also be diagnosed with Addison’s disease, rheumatoid arthritis, type I diabetes, a thyroid disorder and more.
Symptoms may include abdominal pain, indigestion, constipation or diarrhea, nausea and vomiting, and more. The patient may suffer from joint pain and muscle cramping, mouth ulcers, hair loss, fatigue, easy bruising, epistaxis (nose bleeds), mouth ulcers and more.
Diagnosis can be made through newer blood testing if there are symptoms present, but testing is not recommended for everyone. With positive results, an upper endoscopy may be ordered for purposes of biopsy.
Treatment is directed toward the practice of a life-long gluten-free diet once the individual is diagnosed with celiac disease. Strict attention must be given to ingredient panels on purchased foods. Nutritional deficiencies can be modified with daily supplements, perhaps under the direction of a licensed dietitian. There may be instances when short-term use steroids may be prescribed by a physician.
Celiac disease is connected with a variety of hepatic disorders, to include primary biliary cirrhosis, autoimmune hepatitis, primary sclerosing cholangitis, and diabetes. Because nearly one in every three Americans diagnosed with celiac disease is overweight or obese, there is a known pathogenic correlation with nonalcoholic fatty liver disease. Your family should be under the direction of a gastroenterologist familiar with both fatty liver and Celiac disease and they will likely benefit from the direction provided by a dietitian familiar with the disorders. Good luck.
