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Ask the Pharmacist

By: Ron and Marla Chapleau
September 11, 2017

Q: My doctor has told me that I have Non-Alcoholic Fatty Liver Disease (NAFLD) and that I need to make major changes in my life in order to deal with it. What is NAFLD and what does it mean for my future?

A: NAFLD is a diagnosis we rarely hear about in the pharmacy which is somewhat surprising given that recent studies have indicated that up to 20 per cent of Canadians have this build-up of fat within their liver.

Perhaps the reason behind this is that it usually doesn’t present with any symptoms (therefore, there is no short-term “pain” to prompt you into action) and is almost always accompanied by such other pressing concerns as diabetes, insulin resistance, obesity and/or high cholesterol.

However, given its potentially-life-altering consequences, it is a disorder that should grab your attention and force you into needed lifestyle changes.

The liver, the second largest organ, is located on the right side of your body just under the rib cage. While the liver has many functions, we’ll scale that down for simplicity’s sake to two. It is partly responsible for changing what we eat and drink into nutrients and energy for our body to consume, and it plays a major role in eliminating toxic substances from our circulation.

NAFLD is the accumulation of extra fat cells within the liver that is not caused by excessive alcohol consumption (there is a separate condition called alcoholic fatty liver disease as well).

While it is normal for the liver to contain some fat cells, this diagnosis is made when more than five to 10 per cent of the liver’s weight (a normal liver weighs roughly three pounds) is due to fat. The diagnosis is usually made by an initial blood test which shows elevations of liver enzymes. Once other liver diseases have been ruled out (such as hepatitis), an ultrasound will usually confirm the diagnosis.

While there are frequently no symptoms, some will experience fatigue, weakness, weight loss, loss of appetite, abdominal pain, spider-like blood vessels, yellowing of the skin and eyes (jaundice), itching, fluid retention and mental confusion.
The risk with NAFLD is that it may eventually cause the liver to swell, a condition known as steatohepatitis. This condition is associated with an increased level of inflammation that damages the liver to the point that it is comparable to someone who has alcoholic hepatitis.

Down the road, this can progress to scarring of the liver (cirrhosis), portal hypertension (elevation of the blood pressure within the liver’s circulatory system) and possibly, liver failure (with the need for a transplant) or even liver cancer.

Thus far, drugs have not been shown to decrease the risk of any of these lousy outcomes from occurring. The key is to dropping your weight through a combination of diet and exercise. A three- to five-per-cent drop in weight will reduce the amount of fat in your liver and a seven- to 10-per-cent decrease will lower the inflammation that may be occurring within that organ.

While there are no drugs directly aimed at this disorder, we do use drugs to treat the associated conditions that the vast majority of these patients also have.

Getting their diabetes and cholesterol disorders under better control is of paramount importance so statins are frequently prescribed (to lower cholesterol) and all the standard diabetes drugs (such as metformin, januvia) can all be safely used.

For those in whom NAFLD progresses to steatohepatitis, there are specific drugs that have been shown to help reduce the risk of some of the more dire complications from occurring. The diabetic drug pioglitazone seems to reduce liver fat, inflammation and fibrosis, but has been linked to fluid retention, weight gain and heart failure (which is why it is almost never used in diabetes anymore where there are many safer alternatives).

High dose Vitamin E - in the range of 800 International Units (IU) per day - can also possibly reduce liver fat and inflammation but has been associated with prostate cancer and hemorrhagic stroke, and should not be used in diabetics.
Note once again, that these two therapies should be reserved for those who have progressed from simple NAFLD to the more severe form.

At the end of the day, there is a path forward for the many who are diagnosed with this disorder; but that path is dependent upon making difficult and sustained lifestyle changes with which so many of us struggle.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at and the Facebook page at


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