Fatty Liver/Steatosis

Background: Understanding Hepatic Steatosis

Fatty liver is classified into two broad categories:

• Non-Alcoholic Fatty Liver Disease (NAFLD): Fat accumulation without significant alcohol use, commonly associated with insulin resistance, obesity, and metabolic syndrome.
  
• Alcoholic Liver Disease (ALD): Related to chronic alcohol intake causing inflammation, fat deposition, and potential liver damage.

NAFLD may progress to Non-Alcoholic Steatohepatitis (NASH), fibrosis, cirrhosis, and liver cancer if not appropriately managed.

Signs and Symptoms

Fatty liver is often asymptomatic early on. Common symptoms when present may include:

• Fatigue or malaise
  
• Upper abdominal fullness or discomfort
  
• Unexplained weight loss
  
• Elevated liver enzymes such as ALT

Signs of advanced liver disease include jaundice, ascites, and peripheral edema.

Diagnostic Evaluation of Fatty Liver

Early identification allows for effective intervention. Evaluation involves:

Blood Tests:

• ALT and AST for hepatocellular injury
  
• GGT to assess cholestasis
  
• Hemoglobin A1c and glucose for glycemic control
  
• Ferritin to assess oxidative stress and hepatic inflammation

Imaging Studies:

• Ultrasound for initial fat visualization
  
• CT or MRI for detailed evaluation
  
• FibroScan® to assess liver fibrosis and steatosis

Liver Biopsy:

Reserved for cases where staging or diagnostic clarity is needed.

Causes and Contributing Factors

Common root causes include:

• Insulin resistance promoting hepatic lipogenesis
  
• Diets high in refined sugars and low in fiber
  
• Physical inactivity
  
• Chronic alcohol use
  
• Metabolic syndrome and obesity

Conditions Associated with Fatty Liver

If untreated, fatty liver increases the risk of:

• Liver cirrhosis
  
• Hepatocellular carcinoma
  
• Cardiovascular disease
  
• Type 2 diabetes mellitus

Interfering Factors and Clinical Considerations

Confounding factors when evaluating fatty liver include:

• Medication effects (e.g., corticosteroids, methotrexate)
  
• Acute illness or systemic inflammation
  
• Non-hepatic causes of elevated AST/ALT
  
• Inconsistent fasting status for labs

Functional Medicine Approach at Intercoastal Health

Our strategy emphasizes metabolic restoration and root-cause resolution.

Nutrition Strategies:

• Anti-inflammatory, low-glycemic diet
  
• Emphasize vegetables, fiber, healthy fats, and lean proteins
  
• Avoid refined carbohydrates and trans fats
  
• Support liver detoxification with cruciferous vegetables and antioxidant foods

Exercise Recommendations:

• Moderate aerobic exercise and strength training
  
• Target 150+ minutes weekly

Targeted Supplementation:

• Omega-3 fatty acids (EPA/DHA)
  
• Berberine and curcumin for metabolic support
  
• Milk thistle and NAC for hepatoprotection

Weight Optimization:

• 5–10% weight loss shown to significantly reduce liver fat

Monitoring:

• Periodic assessment of liver enzymes, glucose, and lipid profile
  
• Imaging as needed to assess hepatic fat and fibrosis

Conclusion

Fatty liver disease is a critical marker of systemic metabolic dysfunction, but it is reversible with early functional intervention. Addressing underlying causes through individualized care helps prevent disease progression and supports long-term liver and metabolic health.

In conclusion, a comprehensive evaluation by a functional medicine nurse practitioner in Florida facilitates identification of cellular-level and molecular imbalances driving cardiometabolic dysfunction. By integrating evidence-based therapies with regenerative medicine and medical weight loss services—where cardiovascular health is often impacted—we offer patients a regenerative, preventive framework to rebuild resilience and optimize wellness. Call tel:(904) 799‑2531 or schedule online to request your personalized cardiovascular and metabolic health assessment.

Further Reading

• Diagnosis and Evaluation of Nonalcoholic Fatty Liver Disease
  Chalasani, N., Younossi, Z., Lavine, J. E., Diehl, A. M., Brunt, E. M., Cusi, K., … & Sanyal, A. J. (2011). Diagnosis and evaluation of nonalcoholic fatty liver disease. Hepatology, 54(1), 1-6. https://pmc.ncbi.nlm.nih.gov/articles/PMC3205741/

• Effects of dapagliflozin on liver steatosis in patients with moderate to severe nonalcoholic fatty liver disease
  Kim, H. S., Lee, Y. H., Kim, S. R., Kim, S. G., & Kim, Y. S. (2024). Effects of dapagliflozin on liver steatosis in patients with moderate to severe nonalcoholic fatty liver disease. Hepatology International, 18(1), 123-134. https://pubmed.ncbi.nlm.nih.gov/39625600

• Advancements in the treatment of non-alcoholic fatty liver disease: A brief review
  Wang, Y., Zhang, Y., & Ma, Y. (2023). Advancements in the treatment of non-alcoholic fatty liver disease: A brief review. Frontiers in Endocrinology, 13, 1087260. https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.1087260/full

• Pathogenesis and treatment of non-alcoholic steatohepatitis and its related fibrosis
  Chen, X., & Xu, M. J. (2023). Pathogenesis and treatment of non-alcoholic steatohepatitis and its related fibrosis. World Journal of Gastroenterology, 29(4), 362-376. https://pubmed.ncbi.nlm.nih.gov/36226471/