When Becky McKeown developed a nagging pain in her side, she brushed it off as a potentially weird side effect of weight gain. Since having her first son at age 16, her weight had begun creeping up, and by the time the pain started, she estimates she was around 100 pounds overweight.
So she expected her doctor to bring up her weight when she went in for a routine check-up when she was 22. What she didn’t expect was to hear that her liver was in serious trouble—to such a degree that the doc suggested she might have full-blown cirrhosis by the time she hit 40. The kicker was that she rarely drank alcohol.
“For someone who isn’t really a drinker, and is in her early 20s, to have liver problems was just not something I would have thought was possible,” she says. “I didn’t get it.”
McKeown had developed a condition called nonalcoholic fatty liver disease (NAFLD).
NAFLD happens when fat builds up in the liver. It’s normal for the liver to contain some fat. But when more than 10 percent of the liver’s weight is from fat, this is considered NAFLD, and there are two types: simple fatty liver and nonalcoholic steatohepatitis (NASH).
With simple fatty liver, you have fat in the liver but little to no inflammation or liver damage, and you can live with it often without complications, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NASH is far more serious, since inflammation and liver cell damage can lead to scarring, and that might eventually prompt cirrhosis or liver cancer. With those conditions, you may face organ failure and would need a liver transplant.
Simple fatty liver and NASH are two separate conditions, although sometimes you can have one form and see it progress to the other, which is what happened with McKeown.
After her diagnosis, McKeown monitored the issue with liver biopsies and liver function tests. Then, five years ago, she got a horrible wake-up call.
“My liver was in such overdrive that they thought I had liver cancer, and that there was nothing they could do,” she recalls. “They told me to get my affairs in order, and they sent me home to die.”
As her skin yellowed from jaundice—a sign that the liver is shutting down—the pain in her side intensified so much that she ended up in the ER, where a doctor realized she had a parasite, not cancer. The liver, so damaged at that point, hadn’t been able to flush the wily critter from her system. McKeown knew she needed to do something.
“When you’re forced to draw up custody papers, a will, and an advanced medical directive because you think you only have a couple weeks to live, you tend to get focused,” she says. “I felt like I was given another chance, so I took it.”
Nonalcoholic fatty liver disease is surprisingly common—in fact, some experts believe it could be the next epidemic.
It’s estimated that between 30 to 40 percent of adults in the U.S. have NAFLD, and about 3 to 12 percent have NASH.
NAFLD is more common in people who have certain conditions like obesity and type 2 diabetes. In research that tested bariatric surgery patients for the condition, more than 90 percent of those studied had NAFLD. Although you’re more likely to develop NAFLD as you age, research suggests that close to 10 percent of U.S. children have the issue, most likely prompted by the surge in child obesity rates.
“To get an idea of the extent of the issue, think of it like this: If you’re hanging out with two friends, it’s very likely one of you has a fatty liver problem,” says Wayne Eskridge, CEO of the nonprofit Fatty Liver Foundation. “It is the coming epidemic of our time because, although medicine is making progress against most other major diseases, there is no treatment for fatty liver disease.”
Although it’s strongly associated with obesity and type 2 diabetes, NAFLD can also happen to those who aren’t overweight—especially if they have a poor diet and don’t get much activity. In fact, doctors typically look at diet as the major culprit. Consistently eating highly processed, high fat, high sugar diets can overtax the liver, which has to deal with shuttling the gunk from your system.
But how would you know whether your drive-thru runs are becoming a liver bomb? That’s the tricky part.
While McKeown had distinctive symptoms that tipped her off to a problem, it’s more common for people to have signs that are more vague, like fatigue, itching, brain fog, abdominal tenderness, and general weakness. According to the American Liver Foundation, most people have no symptoms at all.
“Most people would chalk up symptoms like this to a cold or the flu, because you usually feel achy,” Shoshana Ungerleider, M.D., a hospitalist in San Francisco, tells SELF. “If there’s pain, they’ll think they pulled a muscle. Rarely do you get something that indicates it’s the liver, like jaundice.”
Because those symptoms don’t send people off to the doctor asking about liver issues, screening rates for NAFLD are low, which means it’s difficult to pinpoint the extent of the problem.
The good news is that NAFLD is usually reversible if you catch it early—and you can prevent it to a large degree.
Although there is currently no medical or surgical treatment for NAFLD, changing up your eating habits can make a drastic difference.
“If your condition is happening as a result of your habits, and you change those, then you have a good chance of reversing the disease,” says Eskridge. “But even if you’re not dealing with NAFLD now, consider the fact that you might need to be doing more in terms of prevention.”
He notes that for some people, the condition may take a decade to develop, and if there are no symptoms, you could get fairly far along in terms of disease progression—perhaps even all the way to cirrhosis, which is basically the point of no return when it comes to switching up your habits.
“The liver is one tough little organ,” he says. “You can almost completely destroy it before it complains.”
It’s also not clear how much your fatty liver cells transform back to healthy, functioning liver cells, adds Dr. Ungerleider. Because of that, she suggests a strong focus on prevention. In other words, keep eating your vegetables, cut down on the fast food, and maybe don’t drink as much alcohol (sorry).
Since McKeown’s health scare, she turned her focus to healthy eating and fitness, eventually dropping 80 pounds with a goal of losing more. And as that number came down, so did her liver enzyme count. She’ll still have to get a biopsy every 10 years, but only as a double-check that she’s still on track.
At this point, she knows that any weight gain will put her back in danger. “I know this is something I can control, and I won’t go back,” she says. “I got lucky.”