When Drugs Aren’t An Option: NAFLD

Shilpa P. Saxena, MD

prescripton drugs

Non-alcoholic fatty liver disease (NAFLD) is predicted to replace hepatitis C as the most frequent indication for liver transplantation in the next 10-15 years.1 While hepatitis C rates decline with effective pharmaceutical therapy, no similar drug option exists for NAFLD. Making matters worse, it is evident that NAFLD additionally increases risks for extrahepatic diseases such as type 2 diabetes mellitus (T2DM), cardiovascular and cardiometabolic conditions, chronic kidney disease, and more.1 Fortunately, research has also revealed NAFLD and its associated diseases stem from metabolic dysfunction, a modifiable mechanism.

“When NAFLD occurs in combination with obesity and insulin resistance (as it frequently does), there is a marked increase in incident T2DM with possible synergism occurring between liver fat accumulation, insulin resistance and obesity to further increase risk of development of T2DM.”1 Functional Medicine helps practitioners utilize a systems biology approach to link these seemingly disconnected organ systems (i.e., liver, pancreas, arteries, adipose) through a common underlying cause: chronic inflammation.

Distinct from the short-term protective effects of acute inflammation, chronic inflammation is harmful and disease promoting. At IFM’s Cardiometabolic Advanced Practice Module (APM), we review modifiable drivers of chronic inflammation through advanced training in nutritional biochemistry and exercise physiology. In addition to showing you how to help patients optimize these lifestyle choices, we also elaborate on underdiagnosed yet prevalent etiologies of prolonged inflammation. For example, dysbiosis has a key role in T2DM,1 and genetics are known to play a role in NAFLD independently of T2DM.2 When treatment is personalized, these novel strategies can reduce liver transplantation and extrahepatic disease risks for those with NAFLD.

The Cardiometabolic APM provides a logical method to identify the unique drivers of each patient’s cardiometabolic disease using common lab markers and genetic principles. Join me for the Cardiometabolic APM to learn about the discrete mechanisms that underpin these diseases and how to implement personalized care plans, which may include such interventions as an anti-inflammatory food plan, a personalized exercise prescription, or probiotics. Functional Medicine can help you implement evidence-based interventions to ultimately reverse NAFLD and improve patient outcomes.

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  1. Scorletti E, Byrne CD. Extrahepatic diseases and NAFLD: the triangular relationship between NAFLD, type 2-diabetes and dysbiosis. Dig Dis. 2016;34(Suppl 1):11-18. doi:10.1159/000447276.
  2. Lallukka S, Yki-Järvinen H. Non-alcoholic fatty liver disease and risk of type 2 diabetes. Best Pract Res Clin Endocrinol Metab. 2016;30(3):385-95. doi:10.1016/j.beem.2016.06.006.

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