When Goldsmith was 55, he went to his doctor for a checkup. It had been a few years since he'd had a physical exam, and although he had no significant problems, he was a little tired and he knew he needed to lose the 30 pounds that had crept up around his belly. When Memon sat down with his doctor to go over his lab results, he was told that he had mild diabetes, borderline hypertension, and liver disease.

The first two things he could understand, but liver disease? He drank no alcohol, not even the occasional beer or glass of wine. He had never had a blood transfusion or engaged in anything that courted the chronic kind of hepatitis, such as unprotected sex. And he'd never even heard of the disease he was diagnosed with: nonalcoholic fatty liver disease (NAFLD). But Goldsmith isn't alone. Contrary to popular belief, alcohol and hepatitis are not the sole reasons for liver problems. Obesity and insulin resistance can also put you at risk for NAFLD. For example: Type-2 diabetics are prime candidates for this condition.


Your liver is a major organ of detoxification, but rather than physically screening out toxins as many people believe, it converts them into compounds that can be eliminated from the body. It accomplishes this through a complex two-part process called phase I and phase II detoxification. During phase I, liver enzymes collectively known as cytochrome P450 neutralize some toxins and ready others for phase 11. Phase II involves a number of processes that transform toxins into safe, water-soluble compounds that can be excreted in the urine and bile.

Non alcoholic fatty liver disease is a progressive disease with three distinct stages. Simple fatty liver, or steatosis, is characterized by elevations in liver enzymes and fatty deposits in the liver (at least 10 percent of the liver cells are replaced by fat). If the disease is arrested in this stage, it remains relatively benign. Unfortunately, for one in five individuals, it progresses to nonalcoholic steatohepatitis, involving inflammation of the liver. From there, half develop cirrhosis, marked by advanced and irreversible scarring, fibrosis, and loss of liver function.

The most significant risk factors for progression include a body mass index greater than 30, type-2 diabetes, and metabolic syndrome. The unifying link here, common to all these conditions, is insulin resistance. When the cells resist insulin's signals to let glucose in, the pancreas secretes higher and higher levels of insulin to get the job done. Elevated concentrations of insulin in the blood create metabolic imbalances that drive up blood levels of free fatty acids. This influx of fatty acids overwhelms the liver's ability to handle them, and they are converted into triglycerides and stored in the organ, setting up a vicious cycle of lipid per oxidation (free radical damage), inflammation, and liver cell


If you've been diagnosed with liver disease, don't despair. Unlike other organs, the damaged liver has the unique ability to regenerate itself, provided that it gets a little help.


Here are a few strategies:-

* The best treatment for preventing and treating NAFLD is weight loss. Losing just 10 per cent of body weight lowers fatty deposits and improves liver enzymes. Slow, gradual loss of a pound or two a week is most desirable, for rapid weight loss may actually worsen the condition.

* Treating diabetes and other manifestations of insulin resistance can only help your liver. In fact, metformin, a diabetes drug that increases insulin sensitivity, has been shown to decrease fatty deposits, inflammation, and fibrosis.

* Move it! Regular exercise offers twin advantages: It aids weight loss and it improves insulin sensitivity. 4 to 5 days of cardiovascular activity (walking, swimming, and cycling) and at least 2 days of weight training should do the

* Go easy on alcohol, a known liver toxin, especially if you're obese — the combination of excess alcohol and obesity is extremely damaging to the liver.


Even if you don't have NAFLD there are things you can do to enhance the health of your liver:

* Stay away from certain drugs or at least monitor liver enzymes if you must take them. These include statins (cholesterol-lowering drugs), NSAIDs, paracetamol, glitazone (diabetic drugs), triglyceride-lowering fibrates, some anticonvulsants, steroids, the Pill.

* Vitamin C, glutathione and lipoic acid (in leafy green, citrus fruit, lean mutton and milk); silymarin (from milk thistle); and selenium (in whole grains and dried beans). These 5 nutrients protect the liver against the free radicals generated during the phase I detoxification process, stimulate the production of new liver cells, and curb the proliferation of the hepatitis virus.

* Vitamin E, because oxidative stress contributes to liver damage, and the antioxidant may help in reductions in fatty liver infiltration; and ellagic acid (found in pomegranates and raspberries). Along with calcium-d-glucarate and n-acetyl-cysteine, these two nutrients support various conjugation reactions that occur in phase II detoxification.

* Chromium and magnesium. These minerals improve insulin sensitivity. Magnesium is widely spread in cereals, pulses and most vegetables, while a surprisingly good source of chromium is betel leaf and areca nut. The mineral is also present in almonds, in lesser quantities, but a better reason to eat a few almonds daily is for its vitamin E.

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