ÐÏà¡±á>þÿ =?þÿÿÿ<ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿì¥Á{À ð¿ëbjbjzäzä 8,ŽŽŸKÿÿÿÿÿÿ·øøRRRRRÿÿÿÿfff8ž,Êf°#°ææüüü×××/#1#1#1#1#1#1#$`%²(ˆU#R×××××U#RRüüÛj#©©©×jRüRü/#©×/#©©r"T‡"üÿÿÿÿŒø—ìEÎÿÿÿÿAjk"#€#0°#y"š(«¬š(‡"š(R‡"”××©×××××U#U#WR×××°#××××ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿš(×××××××××ø : NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) Nonalcoholic fatty liver disease is a term used to describe the accumulation of fat in the liver of people who drink little or no alcohol. NAFLD is common and, for most people, causes no signs and symptoms and no complications. But in some people with NAFLD, the fat that accumulates can cause inflammation and scarring in the liver. This more serious form of NAFLD is sometimes called nonalcoholic steatohepatitis. At its most severe, NAFLD can progress to liver cirrhosis. Symptoms: NAFLD usually causes no signs and symptoms. When it does, they may include: fatigue, discomfort in the upper right abdomen. Causes: NAFLD occurs when your liver has trouble breaking down fats, causing fat to build up in your liver tissue. The wide range of diseases and conditions linked to NAFLD is so diverse that it's difficult to pinpoint any one cause. Types of NAFLD: -Nonalcoholic fatty liver. It's not normal for fat to build up in your liver, but it won't necessarily hurt you. In its simplest form, NAFLD can cause excess liver fat, but no complications. This condition is thought to be very common. -Nonalcoholic steatohepatitis. In a small number of people with fatty liver, the fat causes inflammation in the liver. This can impair the liver's ability to function and lead to complications. -Nonalcoholic fatty liver disease-associated cirrhosis. Liver inflammation leads to scarring of the liver tissue. With time, scarring can become so severe that the liver no longer functions adequately (cirrhosis). Risk Factors: diabetes mellitus, high cholesterol, high levels of triglycerides in the blood, malnutrition, metabolic syndrome, obesity, rapid weight loss, Toxins and chemicals (such as pesticides), certain medications, gastric bypass surgery, Wilson's disease. Tests and Diagnosis: -Blood tests: liver enzymes, may help your doctor make a diagnosis. -Imaging procedures: ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI). -Liver tissue testing. If it's suspected that you have a more serious form of NAFLD, a liver biopsy might be required. The tissue sample is examined in a laboratory to look for signs of inflammation and scarring. Treatments: No standard treatment for NAFLD exists. Instead, doctors typically work to treat the risk factors that contribute to your liver disease. For instance, if you're obese, your doctor can help you to lose weight through diet, exercise and, in some cases, medications and surgery. If a drug is causing your fatty liver disease, your doctor may try to switch you to a different medication. Lifestyle and Home Remedies: Along with your doctor's help, you can take steps to control your NAFLD. You can: -Lose weight. If you're overweight or obese, reduce the number of calories you eat each day and increase your physical activity in order to lose weight. Aim to lose 1 or 2 pounds a week. -Choose a healthy diet. Eat a healthy diet that's rich in fruits and vegetables. Reduce the amount of saturated fat (fat that is solid at room temperature, such as butter, shortening, lard, meat fat) in your diet and instead select healthy unsaturated fats, such as those found in fish, olive oil and nuts. Include whole grains in your diet, such as whole-wheat breads and brown rice. -Exercise and be more active. Aim for at least 30 minutes of exercise most days of the week. Incorporate more activity in your day. For instance, take the stairs instead of the elevator. Walk instead of taking short trips in your car. -Control your diabetes. Follow your doctor's instructions to stay in control of your diabetes. Take your medications as directed and closely monitor your blood sugar. -Lower your cholesterol. A healthy plant-based diet, exercise and medications can help keep your cholesterol and your triglycerides at healthy levels. -Protect your liver. Avoid things that will put extra stress on your liver. For instance, don't drink alcohol. Follow the instructions on all medications and over-the-counter drugs. Alternative Medicine: No alternative medicine treatments have been found to be helpful in treating NAFLD Vitamins for liver protection: Researchers have studied vitamin supplements for the treatment of NAFLD, but results have been disappointing. In theory, vitamins called antioxidants could help protect the liver by reducing or neutralizing the damage caused by inflammation. But studies of vitamin supplements haven't supported this. The safest way to increase the antioxidants you get is to eat more fruits and vegetables. If you're interested in vitamin supplements, though, talk to your doctor about the benefits and risks. Large doses of vitamin supplements could interfere with medications or cause other complications. BRICK EDUARDO ALVA, MD, PA GASTROENTEROLOGY & LIVER DISEASES 11738 FM 1960 Rd W. 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