The Silent Epidemic

Updated on April 1, 2019

By Tony Villiotti

No wristbands. No ribbons. No celebrity ads. Virtually no public awareness. An epidemic that is almost completely ignored. I’m talking about Non-Alcoholic Fatty Liver Disease (NAFLD) and its sibling, Non-Alcoholic Steatohepatitis (NASH). The National Institute of Health estimates that 30-40% of Americans have NAFLD. That’s about 100 million people. For about 20 million or so of those people NAFLD will progress to NASH. 

This situation is progressively getting worse. The incidence of NAFLD and NASH will increase right along that of diabetes and obesity. Some experts estimate that there will be a 60%+ increase in NASH by 2030. Too often those most at risk are unaware of the potentially fatal consequences over time when a fatty liver diagnosis is left unaddressed and not treated as the serious health concern the medical community is now realizing it truly is. Risk factors include diabetes, obesity, high blood pressure, high cholesterol and genetics. The insidious part of this is that there are typically no symptoms so most people don’t know they are affected.

NAFLD occurs when fat accumulates in a person’s liver. When the level of fat exceeds 5 to 10%, and it is not due to alcohol, it is called NAFLD. Usually it’s due to lifestyle. Fast food, lots of sugar, not enough exercise. Fatty liver disease was once thought to be a benign condition and many people, including some doctors, still incorrectly think so. With NAFLD, the liver becomes somewhat enlarged but it still functions normally. But for largely unknown reasons, in 20-25% of cases the liver becomes inflamed and scar tissue begins to form. This is NASH. At this point, it is unusual to be experiencing any symptoms and the liver will continue to function in a normal fashion. Unfortunately, this also makes NASH difficult to diagnose.

About four million people with NASH will develop liver cirrhosis. There is an unfortunate stigma associated with liver cirrhosis and it is generally regarded as a drinker’s disease. Far from it. Actually, cirrhosis occurs more frequently as a result of NASH. In fact, NASH is expected to be the most frequent reason for liver transplantation in the United States by 2020.

 At the cirrhosis stage, liver functions begin to deteriorate as scar tissue replaces healthy cell tissues. Once the scar tissue takes over, the liver will cease to function properly. Sometimes cancer develops as the cirrhotic liver is a breeding ground for the disease. People can die from liver cirrhosis. The scary fact is that the number of non-alcoholics with cirrhosis continues to increase at alarming rates. Chronic liver disease and cirrhosis is the fourth leading cause of deaths in the 45-54 age group and the sixth leading cause for ages 35-74. 

The good news is that the liver is a very forgiving organ and can regenerate itself if a liver-healthy lifestyle is adopted. Liver disease can be reversed but only until scar tissue begins to impact the liver’s ability to function.  In other words, NAFLD and NASH as well as the earlier stages of cirrhosis can be reversed. No reversal can occur once the disease progresses to the later stages of cirrhosis.

Unfortunately, there are currently no drugs that cure or mitigate NASH. While the general public has little awareness of this disease, drug makers have taken note and are working feverishly to develop drugs to address this emerging global health concern. Nearly 50 drugs are in clinical or pre-clinical trials. None of these drugs are expected to receive FDA approval until 2020, at the earliest. Other than lifestyle changes, the only alternative is to treat the underlying conditions, such as diabetes. 

If you are diagnosed with fatty liver, learn about a liver-healthy diet and take action. There is a lot of information on the internet about fatty liver disease so you can certainly do a lot of research on your own but be careful; some of the advice is well-intentioned but inaccurate. It may be wise toconsult a nutritionist because diet changes are a must. It is also important to exercise. 

Awareness plus action equals control.

The author is the President of NASH kNOWledge ( and can be reached at [email protected]

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