Nonalcoholic Fatty Liver Disease and Healing from Environmentally Triggered Illness

by Dr. Susan Tanner, MD

Have you heard of fatty liver disease?  Many have not unless they have been diagnosed with it.  Fatty liver disease has become quite common, though, and now affects an ever-increasing number of people. In fact, recent data suggests that as many as one in three Americans is diagnosed with fatty liver disease! Non-alcoholic fatty liver disease or NAFLD is a condition not caused by alcoholic cirrhosis and can begin when as little as 5% of the liver becomes clogged with fat. A fat-clogged liver is obviously problematic for a multitude of reasons, but we are dedicating our discussion of NAFLD to how it relates to environmentally triggered illness and the ways in which things like mold exposure may both aggravate an existing liver condition and also make healing from mold illness more difficult.

Causes and Characterizations of Fatty Liver Disease

Fatty liver has a number of causes, with the leading ones being obesity and type 2 diabetes. Additionally, as the number of people who are affected by these diseases grows, this also certainly contributes to the increase in NAFLD diagnoses. In this way, it is a disease both perpetuated and caused by another disease.

Some other causes of NAFLD may be genetic, in part.  Alpha-1 antitrypsin deficiency is a very serious genetic form of NAFLD and is well recognized for causing severe cirrhosis, even in children.  The vast numbers of NAFLD, however, are linked to other causes.  Researchers believe that the epidemic of NAFLD is driven by skyrocketing rates of obesity, diabetes, and high cholesterol/triglycerides.  These disorders may, again, be started by specific genetics, but lifestyle, foods, environmental toxins (including mold), viruses, such as hepatitis B and C, all play a part as well.

Fatty liver is characterized by the accumulation of fat throughout the liver body and can range from small and relatively benign amounts to more serious and scarring infiltrations of fat, leading to inflammation. When liver inflammation progresses to cirrhosis, extensive scarring prevents the liver from functioning normally.  At this stage in the damage, a liver transplant becomes the only treatment option.  And, while there are currently several promising trials of treatments at Cedars-Sinai’s Fatty Liver Disease Program to try to reverse the fibrosis and damage, these are not yet available for other patients.

Diagnosing Nonalcoholic Fatty Liver Disease

NAFLD is first suspected when liver enzymes, which are measured on routine bloodwork, begin to rise.  Many times, not much thought is given to this until these numbers have reached levels well above the normal range.   I think that monitoring liver enzymes and watching even for slight increases can give some indication that the liver is working harder than would be desired. The numbers to watch on these profiles are the ALT, AST, and GGT.  These are usually included on a blood exam called a comprehensive metabolic panel (CMP), which is usually part of a routine physical exam. If liver enzymes are elevated from the get-go, then a reason needs to be found.  Taking a thorough patient history for hepatitis, family medical history, and then past and current environmental history is very important! Exposure to mold, for example, is a BIG cause of elevated liver enzymes, which is why, as you will see later, everything we should be using for and aiming to do with our treatments for mold or any toxin-induced illness should be geared toward removing the burden on the liver and supporting it in all of its vital functions.

What Does Mold Have to Do With It?

Mold-related illness and mycotoxin-induced inflammation may both aggravate an existing liver condition such as NAFDL but also may make the mold illness much harder to treat. If the liver is already impaired, it cannot perform vital Phase I and Phase II detoxification activities to deactivate and covert fat-soluble mold toxins into water-soluble waste and ready them for excretion from the body. As a result, the mold toxins continue to build causing increased inflammation, sickness, and disease. In other words, you wouldn’t try to clean a dirty countertop with a dirty sponge, would you? Well, the same is true for your liver! If your liver is already damaged and overworked, living in a moldy environment may not only contribute to NAFLD by increasing your toxic load, but it will also make healing from the mold exposure a longer and more difficult process because your liver is going to need added support, cleaning, and attention BEFORE the mold toxins can be properly cleared. This is often why healing from mold illness is quite a lengthy process for some sufferers even after they are no longer living in a moldy environment or being exposed.

Preventing or Halting Fatty Liver Disease

Our feeling is that anything we can do proactively to prevent or halt early NAFLD is the essence. To do so, we look to the cause of the disease and use our tools and knowledge to eliminate and mitigate as many of those causative factors as possible.

1.  Normalizing body weight and reduction of type 2 diabetes are paramount; less fat in the body equals less fat in the liver.

The meds used to treat adult diabetes are sort of a double-edged sword, though:  They reduce the effects of altered metabolism induced by diabetes, but they also must be metabolized through the liver which can then add to the burden the liver already carries.  A similar situation occurs when using traditional medications to treat elevated levels of cholesterol and triglycerides.  While these medications may lower the fats that then sequester into liver cells, they also have the capacity to reduce liver function. I am not at all recommending that one should cease taking these medications, but if other lifestyle and supplemental practices can be implemented instead, then the use of them may no longer be necessary or at least, reduced in dosage amounts. (Note: Reduced liver function can also be problematic with the use, and especially the prolonged use, of certain bile sequestrants for mold patients. While binding mold toxins so that they cannot be recirculated into the body prior to secretion is the goal, we do NOT want to compromise liver function in the process. It can be a fine balance and is why it is important for most mold sufferers to work with a skilled and properly trained practitioner.)

2. I would be remiss if I did not, once again, remark on the need for clean air, clean water, and clean food. 

Moldy or chemically laden air introduces increased levels of toxins that not only have to be cleared from the bloodstream through the liver but are inflammatory in their own right.  Mold must be remediated, and contaminated belongings cleaned or eliminated!  Drinking filtered water helps to reduce pesticides and heavy metals, particularly cadmium and mercury.  I would suggest having your water tested to see if these are concerns in your area.  There are pockets of communities in which the incidence of NAFLD is quite high, and this is thought to be in part to the higher than acceptable levels of cadmium in the water supplies, likely from industrial runoff.   Pesticides are an equal concern, including glyphosate.

3. Maintaining healthy digestion with the elimination of yeast overgrowth is the next step. 

Yeast in its own metabolism creates mycotoxins that the liver then has to deal with.  The anti-yeast diet may help in weight normalization.  Digestive enzymes such as Digest Assist, decrease the burden on digestion energy generally such that more efficient processing can occur.  They also gently assist the liver in providing the enzymes necessary for proper fat and protein breakdown.  Glutathione and MycoDetox Liver Support both can help the liver with a gentle and continual clearing,  and should both be used in most patients with suspected mild NAFLD. Other supplements which individually or in a combined program that are helpful are alpha-lipoic acid, N Acetyl Cysteine, and resveratrol.  Fibers and binders are also helpful to “bind up” what is released by the liver and taken out through the colon.  In cases of both early and more advanced NAFLD, phosphatidylcholine has been very effective in reducing the ravages of the fatty infiltration and possibly reducing the amount, as long as the other steps above are adhered to.

4. Follow some fairly simple dietary rules.

–  Avoid sugar and refined carbs, and especially high fructose corn syrup  These continue the abnormal processing and metabolic problems associated with type 2 diabetes but are also simply very pro-inflammatory.

–  Include lots of foods from the cabbage family (cabbage, broccoli, brussels sprouts, and cauliflower) in your diet. These are high in a substance called Di-Indole-methane, which is very helpful and supportive in liver function.  These foods may also help normalize how estrogens are broken down in the body and decrease the risk of breast and prostate cancer, but that is a topic for another time!

–  Avoid chemicals in foods, both as preservatives and flavorings.  Look at labels, for BPH, BPA, and “flavorings”.  These are all chemicals that the liver has to deal with.

–  Buy organic foods and free-range, pasture-raised meats, eggs, and chicken. Pesticides and hormones contribute to that liver load!

5. Avoid any pharmaceuticals that you do not have to take, including Tylenol and non-steroidal anti-inflammatories. 

Again, I will state do NOT stop taking any prescribed medications without discussion with your physician, but implementing the strategies here MAY help reduce your need for prescriptions!

6. Exercise, both aerobic and with weights.

Exercise helps to improve insulin resistance, helps induce sweating, and increases metabolism in general.  Do something every day.  Meditation, prayer, and quiet time all help in regulating the stress response, which increases insulin levels.

In conclusion, please remember that your body, including the liver, has a remarkable ability to heal when given the right ingredients and while avoiding the things that cause damage. Knowledge is power and knowing more about conditions like NAFLD will help you to safeguard your body from silent diseases that can rob you of your health and make your recovery from mold illness more difficult.

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