Society’s seemingly singular understanding of how one can damage their liver and get diagnosed with fatty liver disease might be attributed to the popular belief that if a person does not indulge in the dangers of drugs and alcohol, then indulging in life’s simple pleasures courtesy of sweets and pastries should be okay. The reality is far different. While sweets and pastries should be viewed as sugar bombs that are waiting to detonate on a person’s liver, diets that are rich in a variety of starchy foods, as well as carbs in general, can lead to a similar outcome. Despite that people might be more likely to associate fatty liver disease with chronic alcohol use, everyone is susceptible to being diagnosed with a fatty liver, even those that do not engage in any alcohol use. When that is the case, then that diagnosis is known as non-alcoholic fatty liver disease (NAFLD).
In Canada, NAFLD is the most frequently occurring liver disease and it is estimated that one in four Canadians are affected by it, but its prevalence might be even greater given how symptomless NAFLD is during the early stages of the disease and how early-to-mid stage screening tests are non-existent. Although one of the biggest contributors to NAFLD are processed foods and sugary drinks, the frequency that people eat out and how much exercise they get is just as important. It can also occur as a result of starvation and genetic factors. The reason that NAFLD might be one of the most important diseases that Canadians need to acquaint themselves with has to do with recent findings around NAFLD in Canada that seem to suggest that Canada requires further provider education, national practice guidelines, and improved treatment options centered around NAFLD.
The liver can regenerate itself but avoid damaging it if you can.
A likely relief for everyone is that the liver is one of the human body’s most unique organs because of its fully regenerative properties. A liver only requires 51 percent of the organ to be healthy for the liver to fully regenerate itself. Additionally, the liver can be supported in the repair process if people adopt a healthier lifestyle that includes better nutrition, more physical activity, and getting good sleep. This matters because past studies seem to show that it takes an average of about 20 years for a fatty liver to get to the point that a person requires a liver transplant. If NAFLD develops at a faster rate than the 20 years, it may be related to certain risk factors including diabetes, hypertension, and obesity, which can make the disease develop and get worse at a quicker rate.
The liver transplant waitlist may grow even longer.
An area of concern for epidemiologists who focus on NAFLD is that there is no consistent definition for measuring the prevalence of NAFLD in general populations and an absence of simple and easily accessible diagnostic techniques with high positive predictive value. What further complicates this is the fact that estimates of NAFLD tend to be based on historical data, which can result in both current and future predictions to be quite inaccurate as, over the span of a generation, a population’s health can change significantly due to an abundance of factors. This is also why epidemiologists are sounding the alarm by saying that NAFLD has the potential to burden the Canadian health care system over the next decade. Older people are more prone to NAFLD progressing to more serious stages of the disease, and Canada has an aging population whose dietary intake of processed foods and sugary foods has increased.
Perhaps the scariest thing about NAFLD is that some epidemiologists have estimated that the need for transplants is likely to double within the next decade. This may result in the need for liver transplants outpacing the number of livers being donated, and, as of 2020. there were no therapies that were approved for treatment or prevention of NAFLD. To address the limited supply of livers available for organ transplants, it will be necessary for medical breakthroughs in how we treat patients diagnosed with NAFLD. The good news for Canada is that we are one of the leading countries when it comes to such novel treatments, and one of those ways comes by the way of microbiome research.
What “microbiome research” refers to is the study of microbial communities like those found in a person’s gut and how these microbial communities interact with their environments, as well as the impact they may have on the human body, including impacts on digestion and the immune system. Therefore, since the liver directly accepts blood from the gut, it is exposed to intestinal bacteria and recent studies have identified a relationship between gut bacteria and NAFLD. Some of those bacteria that make their way to the liver are quite harmful to it, which can contribute to inflammation and scarring of the liver. However, this process is influenced by something known as a leaky gut, which describes the permeability of a person’s gut that is not functioning as normal and thus allows for unwanted microbes to pass through the gut and into circulation. To address the “leaky gut” problem, fecal transplants are provided from a person with a healthy gut to a person with an imbalanced gut, and that process is somewhat similar to a colonoscopy and the fecal matter is delivered to the start of the small intestine.
Fecal transplants show promise as treatment for NAFLD.
Where fecal transplants could be quite useful may be in the later stages of NAFLD, when there is a significant buildup of scar tissue and when the patient is more likely to experience the effects of an enflamed liver as a result of intestinal permeability. So the ability to manage the inflammation of a scarred liver is important. There are changes that occur in the gut microbiome that have been correlated with NAFLD progression that result in intestinal permeability to increase.
The benefits of fecal transplants may stretch beyond NAFLD as well. They may also be beneficial to help prevent and treat autoimmune diseases such as HIV, multiple sclerosis, lupus, arthritis, metabolic syndrome, and cancers including kidney, pancreatic, and lung cancer, and anything else that may involve an imbalanced gut. This is precisely what researchers are focusing on at Western University’s Schulich School of Medicine and Dentistry. There, the team is need of young, healthy stool donors for fecal transplants. All donors are required to go through a screening process. Those interested in becoming a stool donor can contact Dr. Seema Nair Parvathy, Research Coordinator, Fecal Transplant Program, at 519-646-6100 ext. 61726.
For more information on fatty liver disease and the supports available to those struggling with this disease, please visit: https://www.liver.ca/patients-caregivers/liver-diseases/fatty-liver-disease/.