It's hard to ignore the almost daily reports of our country's expanding waistline and the health consequences that stem from it. Being overweight or obese pushes up the risk of heart disease, stroke, Type 2 diabetes and certain cancers.
But the obesity epidemic is also giving rise to the fastest-growing and most common type of liver ailment - non-alcoholic fatty liver disease (NAFLD), which affects 1.4 million Canadians. It's a potentially life-threatening condition that's been sorely overlooked. Until recently.
The Canadian Liver Foundation is trying to raise awareness about the disease and the fact it has nothing to do with alcohol or drugs.
Non-alcoholic fatty liver disease is a spectrum of liver conditions that develop in people who drink little or no alcohol. It is thought to begin with an accumulation of excess fat in liver cells from fatty foods and sugars that the liver turns into fat. A person has a fatty liver when fat makes up 5 to 10 per cent of the liver.
By itself, fatty liver does not cause liver damage. However, a liver infiltrated with fat is more vulnerable to further injury, which can lead to inflammation and scarring and a more serious form of fatty liver disease called non-alcoholic steatohepatitis (NASH).
About 10 to 20 per cent of individuals with simple fatty liver develop NASH, and up to 20 per cent of those with NASH develop irreversible, advanced scarring called cirrhosis. Scarred liver tissue results in blocked blood flow, making it difficult for the liver to carry out essential tasks such as purifying the blood, making proteins and regulating hormones.
According to the Canadian Liver Foundation, 75 per cent of obese individuals are at risk of developing a fatty liver. Almost one-quarter (23 per cent) are at increased risk of developing fatty liver with inflammation.
But you don't have to be overweight to develop the condition. In the documentary Super Size Me, Morgan Spurlock's month-long McDonald's binge led to signs of a fatty liver. Even at his heaviest, Mr. Spurlock was not considered overweight. Yet his daily intake of fat and sugar exceeded what his liver could handle.
You're also more likely to develop a fatty liver if you have diabetes, high blood cholesterol, high blood triglycerides (fats) or metabolic syndrome. A person is thought to have metabolic syndrome if he or she has a large waist circumference plus other risk factors including high blood triglycerides, high blood pressure, elevated fasting blood sugar and low HDL cholesterol.
Fatty liver disease affects people of all ages. Due in large part to an increase in childhood obesity, the condition affects almost 3 per cent of children and up to 53 per cent of obese kids.
Fatty liver rarely causes symptoms. It's usually detected when routine blood tests show elevated liver enzyme levels. It can also be discovered by an ultrasound examination of the abdomen.
Weight control, proper nutrition and physical activity are the cornerstones of treating - and preventing - non-alcoholic fatty liver disease:
Lose excess weight
If your body mass index is over 25, losing weight can reduce the amount of fat in your liver. Most studies of weight loss in NAFLD have demonstrated an improvement in liver function tests.
The recommended target for weight loss is 10 per cent of a person's body weight over six months. Weight loss should be gradual. Rapid weight loss - more than 1 kilogram a week - can worsen liver damage.
A low-fat, calorie-reduced diet will reduce fatty deposits in the liver. If your LDL cholesterol is also elevated, limit your intake of saturated fats. Choose lean meats, poultry breast, legumes and non-fat dairy products. Avoid commercial baked goods, snack foods and fast foods that are made with cholesterol-raising trans fats.
Choose carbs wisely
Curb your intake of desserts, drinks and other foods that contain refined sugar.
Studies suggest that reducing your intake of all carbohydrates - sugars and starchy foods - can also dramatically reduce liver fat content. Keep portions of cereal, rice, potato, pasta and breads small.
Choose low glycemic
According to animal research, swapping fast-burning (high-glycemic) for slow-burning (low-glycemic) carbohydrates may help treat and prevent fatty liver disease. Low-glycemic foods - which are converted to blood sugar gradually - include grainy breads, steel-cut oats, 100-per-cent bran cereals, brown rice, sweet potatoes, pasta, apples, citrus fruit, legumes, nuts, milk, yogurt and soy milk.
Boost C and E
Vitamins C and E may reduce liver damage caused by free radicals: unstable oxygen molecules that damage cell membranes.
Good sources of vitamin C include citrus fruit, kiwi, mango, strawberries, broccoli, Brussels sprouts, cauliflower, red pepper and tomato juice.
Vitamin E is plentiful in wheat germ, nuts, seeds, vegetable oils, whole grains and kale.
Moderate- to high-intensity
exercise - 30 minutes, three to five times a week - such as power walking or jogging can help improve blood-sugar and blood-fat levels and may reduce liver fat content.
If you have NAFLD, especially non-alcoholic steatohepatitis (NASH), avoid alcoholic beverages to help prevent further liver damage. Speak to a doctor about medications that may harm the liver and should be avoided.
Leslie Beck, a Toronto-based
dietitian at the Medcan Clinic,
is on CTV's Canada AM every Wednesday. Visit her website at lesliebeck.com.