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Diet High in Simple Carbohydrates Can Lead to NAFLD in Non-Obese Adults

Lauren Williams

28 March, 2018
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Abstract:
Non-alcoholic fatty liver disease (NAFLD) is an asymptomatic disease involving
accumulation of fat and potential liver scarring if left untreated. Although this is
uncommon in average BMI individuals, it is still a rising trend that can be traced back to
diet and genetics. Fructose is the main enemy when it comes to accumulation of
dangerous fat on the liver, and the mechanism behind this is still being studied in order to
determine why some individuals have a higher rate of this than others. If diagnosed with
NAFLD, there are many treatments that can help stop and reverse this disease including
diet intervention, turmeric and probiotic supplementation, and increased coffee intake. It
is important for parents to be aware of this disease before these steps need to be taken.

Background:
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the
world, with only one approved treatment consisting of lifestyle changes. While this
disease is very common amongst overweight and obese individuals, there are still many
people diagnosed each year that have a normal BMI. So far, there is no specific treatment
for people with normal a BMI because it is unknown why this disease occurs (Mofidi,
2016). This topic is of importance for children of future generations to be aware that
although this disease is asymptomatic in the beginning, it can become life threatening if
left untreated. Just because your BMI is average does not mean that your internal bodily
functions are average too.
Your liver is one of the most important organs in your body. It plays a huge role
in metabolic processes as well as fat metabolism and energy production from fats. For
this reason, it is important to understand that this disease can be very detrimental for
someone diagnosed with NAFLD. Over time, liver cells known as hepatocytes start
storing fat in a process called steatosis. The reason this can happen through the foods you
eat stems from a high consumption fructose (a carbohydrate), as well as ingesting foods
that have fructose as an additive. Fructose is stored as triglycerides in the liver, so the
liver does not put fructose into the bloodstream as it does with glucose. The reason
behind this is because it deals with fructose immediately once ingested. Some fructose
may be burned as ATP, while others may be stored in the form of glycogen. If there is
still a lot left over, the liver stores this excess fructose as fat (Basaranoglu, 2015).
When these hepatocytes become full of fat, the nucleus of the liver cell is forced
to the side because of these macrovesicles taking up too much space. This in turn inhibits
the function in hepatocytes. Over time and with some possible genetic disposition, some
of the liver cells start dying in a process called necrosis, and inflammation can occur.
Collagen fibers begin to replace these dead cells, and consequently the liver begins to
scar and stiffen. This is referred to as NASH, or non-alcoholic steatohepatitis
(Basaranoglu, 2015). Unfortunately, this process happens at different rates with different
people, and research suggests that a part of this may be due to genetics. This is why you
do not need to be obese in order to have NAFLD.

Research/data:
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The big question comes down to, is there a connection between childhood eating
and NAFLD in people with a normal BMI? There have been any studies on how
carbohydrates are directly linked to fat levels in the body. In a study reported in the
American Journal of Clinical Nutrition, the results of one study revealed that a diet high
in fructose causes liver damage. In a 6-week study with animals, (equivalent to 3 months
in humans), animals that were fed a diet high in fructose had more than double the liver
damage than the control group. This shows how extensive liver damage can be before
weight gain becomes a problem. Another study was done with monkeys and had similar
guidelines but allowed one group to be on a low-fat high glucose diet, while the other had
a low-fat low glucose diet. Over 7 years, the animals on a high fructose low fat diet
gained 50% more weight than the other group and developed NAFLD. This shows how
fructose is directly related to NAFLD rather than fat (Kavanagh, 2013).
Another study was done on a man with a normal BMI who eventually reversed his
NAFLD through a lifestyle intervention. The subject was a 35-year-old man who never
smoked nor drank. This man undertook a low carb diet which consisted of foods and
drinks with no added sugars, a low amount of starchy carbohydrates, and grilled foods
rather than fried. He also increased his fiber intake, incorporated more fish and egg into
his diet, avoided animal saturated fats and polyunsaturated fats, and snacked on nuts
during the day to avoid hunger. The results of this diet change were extremely positive.
The subject lost over 13% body weight even though this was not intended because he was
not overweight. There was a further reduction in triglycerides, non-HDL cholesterol, and
an increase in serum HDL. His high insulin resistance (which has been shown to be
directly related to NAFLD) went back to normal, suggesting a reverse in NAFLD. This
study shows that diet interventions can be very beneficial to those with fatty liver in those
who are not overweight (Merchant, 2017).

Recommendations:
Based on these studies and evidence suggesting the reasons behind NAFLD, there
are many recommendations that are relevant in order to help reduce and reverse this
disease. Diet is one factor that should be changed immediately. As research suggests,
fructose is a huge contributing factor to this disease. Foods high in fructose include fruit,
juice, and soda. Fructose is also commonly used as an additive such as high fructose corn
syrup. This is a sweetener often seen added to baked goods, yogurt, condiments, salad
dressing, boxed dinners, granola bars, cereal, nutrition bars, and sports drinks. The diet
recommended for NAFLD would be a Mediterranean style diet in order to reduce
carbohydrate intake. This revolves around a collection of eating habits that are
traditionally followed by countries bordering the Mediterranean Sea. This plant-based
diet primarily consists of fruits, vegetables, complex carbohydrates, legumes, olive oil,
poultry, and fish (Merchant, 2017)). It completely eliminates processed foods and soda
that are typically the leading sources of fructose. It is also suggested that you cook at
home instead of buying packaged meals and breads, for those are common sources of
added fructose. Paying close attention to food labels is also a very important factor when
changing your eating habits because this added sugar is in many more products than
expected.
Turmeric has been in the spotlight nowadays when it comes to improving overall
health. Although turmeric is shown to have a wide range of benefits, one of the most
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effective outcomes is the positive effect the curcumin aspect of it has on liver health. In a
randomized controlled trial, patients with NAFLD were assigned 70 mg of curcumin
while others took a placebo for 8 weeks. Liver fat content, glycemic lipid profile, and
transaminase levels were evaluated before and after the study. The results of the study
showed that curcumin is associated with a huge reduction of liver fat content- 78.9% in
the curcumin group compared to 27.5% in the placebo group. A large reduction in
triglycerides and BMI were recorded as well. These findings suggest that a
supplementation of curcumin (found in turmeric) is proven to be very beneficial to reduce
fatty liver content (Rahmani, 2016).
Another solution to NAFLD is something commonly ingested in everyday
morning routine-coffee. Drinking 3 cups or more of coffee a day has shown in multiple
studies that it can inhibit the scar formation of the liver as well as block toxin-induced
liver cirrhosis. In a study by Freedman, they found that among patients with advanced
fibrosis, those who consumed absolutely no coffee had a risk of hepatic decompensation
of 11.1 per 100 years compared to just 6.3 in those consuming 3 or more cups of coffee
per day. They found no beneficial effects seen from tea or other sources of caffeine. The
reason why coffee has been shown to have these affects are because its consumption
blocks liver scarring by preventing adenosinergic signaling which sends extracellular
messages in the liver. The potential reason behind this are the antioxidant and anti-
inflammatory properties of coffee, but there still needs to be more studies in order to
confirm this theory (Dranoff, 2014). Because there is sufficient evidence to suspect that
coffee can be used as an anti-fibrotic and other treatments with significant results are
lacking, 3 cups of coffee daily are recommended in order to protect your liver against
potential scarring from NAFLD.
Probiotics are live microbes that have shown many beneficial effects on the body. If
taken regularly, they have been shown to reduce pathogenic bacteria and inflammation
due to its close link to the gut. ALT is a substance that is looked for in the blood to see if
the liver is healthy. High levels of this enzyme indicate the possibility that there is trauma
or disease to the liver, which happens when fatty liver disease is present. In four
randomized trials, results of probiotic therapy had a large reduction of ALT in the blood
as well as many other significant results (Ma, 2013). In another Trial, 28 patients either
received probiotic therapy or a placebo. In the probiotics group, ALT and other levels
decreased significantly, where it remained unchanged for the placebo group (Panko,
2018). These significant results indicate that Probiotics can help heal liver damage in
NAFLD.

Conclusion:
Non-alcoholic fatty liver disease in normal BMI individuals is a topic that has
been barely touched by researchers, and more needs to be done in order to find a reliable
treatment plan. Additional research must be conducted specifically on why fat causes
liver cells to die and scar at different rates, and a possible genetic disposition behind this.
It would also be beneficial to conduct more research behind the mechanism of why coffee
reduces scar formation and why it is that you must have more than 3 cups of coffee a day
in order to see significant results on fatty liver cirrhosis. Overall, this topic is not widely
studied, and more research would be beneficial to find a solid plan in order to heal
NAFLD.
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NAFLD in non-obese individuals is something that has been developing more and
each upcoming year. This disease forms over time (decades) and is thought to be related
childhood eating habits as well as genetic disposition. Although there still needs to be
more research done on this topic, there have been many treatments proven through
studies and trials to help prevent and reverse the production and scarring in fatty liver.
Diet intervention is necessary at an early age in order to determine risk for NAFLD.
Some people may have a higher risk of development of this disease than others, and it is
important to identify this before irreversible damage occurs. It is important for parents to
know the powerful role food takes on your body. A generally healthy diet is
recommended in order to prevent this disease as much as possible. If diagnosed with
NAFLD, there is hope through supplementation and incorporation of certain types of
food that can help with treatment. Although there are still questions on why NAFLD
happens in low BMI individuals, there is hope that with correct nutrition practices this
disease can be treated effectively.
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References

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Dranoff, J. A., Feld, J. J., Lavoie, É. G., & Fausther, M. (2014). HOW DOES COFFEE
PREVENT LIVER FIBROSIS? BIOLOGICAL PLAUSIBILITY FOR RECENT
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467. http://doi.org/10.1002/hep.27032

Kylie Kavanagh, Ashley T Wylie, Kelly L Tucker, Timothy J Hamp, Raad Z Gharaibeh,
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357, https://doi.org/10.3945/ajcn.112.057331

Ma, Y.-Y., Li, L., Yu, C.-H., Shen, Z., Chen, L.-H., & Li, Y.-M. (2013). Effects of probiotics on
nonalcoholic fatty liver disease: A meta-analysis. World Journal of Gastroenterology:
WJG, 19(40), 6911–6918. http://doi.org/10.3748/wjg.v19.i40.6911

Merchant, H. (2017). Can Diet Help Non-Obese Individuals with Non- Alcoholic Fatty Liver
Disease (NAFLD)? Journal of Medicine, 6(9). Doi: 10.3390/jcm6090088

Mofidi, Fatemeh & Yari, Zahra & Poustchi, Hossein & Merat, Shahin & Nourinayyer, Babak &
Malekzadeh, Reza & Hekmatdoost, Azita. (2016). Effects of Synbiotics Supplementation
in Lean Patients with Nonalcoholic Fatty Liver Disease: Study Protocol of a Pilot
Randomized Double-blind Clinical Trial. Archives of Iranian medicine. 19. 282-284.

Panko, J. (2018). Power of Probiotics. Chrysalis Nutrition and Health.

Rahmani, S. (2016). Treatment of Non-alcoholic Fatty Liver Disease with Curcumin: A

Randomized Placebo-controlled Trial. US National Library of Medicine National
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