April 23, 2025 • 17 mins
In this episode of The Health Pulse Podcast, we explore non-alcoholic fatty liver disease (NAFLD)—a condition once thought to affect only those who are overweight. Shocking new data shows that up to 20% of NAFLD cases occur in people with a normal BMI, forcing us to rethink how we define metabolic health.
We discuss how visceral fat, insulin resistance, and poor diet quality can silently damage the liver—even in lean individuals. You'll also learn about the concept of MONW (Metabolically Obese, Normal Weight) and how mildly elevated liver enzymes, energy crashes, and post-meal fatigue may be early signs of trouble.
📞 Need lab work done from the comfort of home? QLM offers fast, reliable mobile phlebotomy services—no clinic visit required.
📅 Book your appointment or learn more at:
👉 Quick Lab Mobile
📧 Contact us: info@quicklabmobile.com
💬 Enjoyed the episode? Leave us a review and let us know what topics you'd like us to cover next! Your feedback helps us bring you the content that matters most.
Disclaimer: The information provided in this podcast is for informational purposes only and should not be considered medical advice. The content discussed is based on research, expert insights, and reputable sources, but it does not replace professional medical consultation, diagnosis, or treatment. We strive to present accurate and up-to-date information, medical research is constantly evolving. Listeners should always verify details with trusted health organizations, before making any health-related decisions. If you are experiencing a medical emergency, such as severe pain, difficulty breathing, or other urgent symptoms, call your local emergency services immediately. By listening to this podcast, you acknowledge that The Health Pulse and its creators are not responsible for any actions taken based on the content of this episode. Your health and well-being should always be guided by the advice of qualified medical professionals.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Nicolette (00:01):
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in, okay let'sunpack this.
Rachel (00:21):
When we think about fatty liver disease, I think
most of us picture someone youknow carrying extra weight.
Mark (00:26):
That's the common image.
Rachel (00:27):
But here's a statistic that might surprise you
Something like 25 to 30 percentof adults globally have this
condition, NAFLD and it'sincreasingly popping up in
younger people, even lean people.
Mark (00:41):
Yeah, exactly, and that's what we're diving into today
this whole idea of non-alcoholicfatty liver disease, afld, but
specifically in people with anormal weight.
They call it lean, nay, fld.
Rachel (00:54):
Lean, nay FLD.
It almost sounds contradictory.
Mark (00:57):
It does because the traditional understanding, the
one we've operated on for years,links fatty liver mostly to
obesity, type 2 diabetes, thatkind of thing.
But that picture, it's becomingclear, is just incomplete.
We're seeing more and morepeople with perfectly healthy
BMIs getting diagnosed.
Rachel (01:13):
Which tells us the causes are probably a bit more
complex than just, you know,body weight.
Mark (01:17):
Definitely more intricate.
Rachel (01:18):
And what makes this really important, I think, is
how sneaky NANFLD can be.
Mark (01:23):
Very silent.
Rachel (01:24):
It can just quietly move from simple fat buildup to nice
H, that's the fat plusinflammation bit.
Mark (01:31):
Which is a key step, that inflammation.
Rachel (01:33):
Yeah, and then onto fibrosis, which is early
scarring, and then evencirrhosis, serious, irreversible
liver damage.
Mark (01:40):
And potentially liver cancer down the line, and often,
like you said, with no obviouswarning signs early on.
Rachel (01:45):
Exactly so.
If the usual risk factors likehigh BMI aren't always there,
why are lean people getting fatin their livers?
And, maybe more importantly,how do we catch it early?
Mark (01:57):
Well, that's the core question, isn't it?
Our main source for thisdiscussion is an article the New
Face of Fatty Liver why EvenLean People Are at Risk, and it
really tries to tackle thosepoints head on.
Rachel (02:08):
Okay, so our mission for this deep dive is basically
understand why NAFLD isn't justabout weight, figure out what's
going on metabolically in theselean individuals and highlight
why finding it early is crucial,even if someone looks perfectly
healthy.
Mark (02:21):
Sounds like a plan.
Where should we start?
Rachel (02:23):
Let's start right at the beginning.
What exactly is non-alcoholicfatty liver disease?
Mark (02:28):
Okay.
So basically, nafld means youhave too much fat stored in your
liver cells.
We're talking more than, say, 5to 10 percent of the liver's
weight being fat.
Rachel (02:37):
And the non-alcoholic part is key.
This is in people who drinklittle to no alcohol.
Mark (02:42):
Precisely that distinguishes it from alcoholic
fatty liver disease, and it'sincredibly common, like you said
, affecting a huge slice of thepopulation and, worryingly, it's
on the rise in younger groupstoo.
Rachel (02:54):
And we mentioned the progression.
It's not always benign.
It starts as NAFLD, simple fat,can become NASH fat, plus
inflammation.
Mark (03:02):
Yeah, non-alcoholic steatohepatitis.
That hepatitis means liverinflammation.
Rachel (03:06):
Then potentially fibrosis, the scarring.
Mark (03:08):
Early scarring yeah.
Rachel (03:13):
And finally cirrhosis, which is that really advanced,
irreversible damage and ups thecancer risk significantly.
Mark (03:16):
Right, and often it's found totally by accident, maybe
during an ultrasound forsomething else, because those
early symptoms just aren't theremost of the time.
Rachel (03:23):
It's the silent nature again.
Mark (03:25):
Exactly.
That's why we historicallylinked it so tightly with
obesity, diabetes, hightriglycerides.
Those were the more visibleflags, but lean NAFLD is making
us rethink that.
Rachel (03:35):
OK, so let's really dig into this rise of lean NAFLD.
It still feels a bitcounterintuitive.
How does someone at a healthyweight develop this?
Mark (03:45):
It does seem that way, but the evidence is mounting.
The article points out that asignificant chunk, maybe up to
20% of all in AFLD diagnoses arein people with a normal weight,
a normal BMI 20%, that's notinsignificant.
Not at all, and interestingly,the rates seem to be even higher
in some populations,particularly in South and East
Asia.
Rachel (04:05):
And, interestingly, the rates seem to be even higher in
some populations, particularlyin South and East Asia.
Ah right, the article mentionedsomething about that,
potentially linked to how fat isstored Visceral fat maybe?
Mark (04:12):
Spot on.
Even within that normal BMIrange, body composition can vary
wildly.
Some people, and potentiallycertain ethnic groups like South
and East Asians, might tend tostore more fat around their
organs that's visceral fat evenif their overall weight isn't
high.
Rachel (04:26):
And that visceral fat is the metabolically problematic
kind, isn't it?
Mark (04:30):
Very much so.
It's much more active,hormonally speaking, than the
fat under your skin.
It can really drive insulinresistance, which is a huge
factor in NFLD, even if theperson isn't overweight overall.
Rachel (04:42):
Okay, so it's definitely not just about the number on
the scale.
What other key factors does thearticle highlight for lean and
AFLD?
Mark (04:49):
Well, besides visceral fat , insulin resistance itself is a
major one and, crucially, thiscan be happening even if your
standard fasting blood sugar, orA1C, looks perfectly normal.
Rachel (05:00):
So a deeper level of metabolic trouble.
Mark (05:02):
Exactly.
Diet is another big piece,specifically diets high in
refined carbohydrates, sugars,fructose and also certain types
of fats, like the omega-6 isfound in many processed seed
oils.
Rachel (05:14):
Ah, seed oils, that's a hot topic.
So these things can promoteliver fat without necessarily
causing weight gain.
Mark (05:20):
That seems to be the case.
It's about what you're eating,not just how much in terms of
liver fat accumulation.
Then there's mitochondrialdysfunction.
Rachel (05:28):
Okay.
Mitochondria, the cellspowerhouses.
Mark (05:31):
Yep.
Think of them as fat-burningengines in your liver cells.
If they're not workingefficiently maybe they're
overwhelmed or damaged theycan't process fat properly.
So what happens?
It gets stored instead.
Rachel (05:43):
Makes sense Like a bottleneck.
Mark (05:45):
Pretty much.
Physical inactivity is alsomentioned.
Less activity can mean lessmuscle mass, poor insulin
sensitivity and reducedmetabolic flexibility, that's,
the body's ability to switchefficiently between burning
carbs and burning fat.
Rachel (05:59):
So even if you're thin, if you're inactive, your
metabolism might not be handlingfuel very well.
Mark (06:04):
Correct that inefficiency can lead to fat storage in the
liver.
And then, of course, there'sgenetics.
Rachel (06:10):
Right, the PNPLA3 gene was mentioned.
Mark (06:18):
Yeah, that's one specific gene variant that's been
strongly linked to a highergenetic predisposition for fat
accumulating in the liver, kindof irrespective of body size.
But it's important to remembergenetics load the gun, but
lifestyle pulls the triggerusually.
Rachel (06:27):
Good point.
So genetics might increase risk, but choices still matter
hugely.
Mark (06:32):
Absolutely.
The article really sums it upby saying lean and AFLD isn't
just about excess body fat.
It reflects this deepermetabolic stress, maybe a
mismatch between our modern dietand activity levels and our
biology and dysfunction rightdown at the cellular level.
Rachel (06:48):
Okay.
So given all this, why dostandard medical checkups often
completely miss lean NFLD Ifsomeone seems healthy lean?
Mark (06:57):
That's a really critical issue.
Standard screening reliesheavily on those traditional
risk factors High BMI, highblood sugar, abnormal
cholesterol panels.
Rachel (07:06):
Things that might be perfectly normal in a lean
person with early NFLD.
Mark (07:10):
Exactly.
Their blood sugar might be fine.
Their total cholesterol mightbe in range.
Even their liver enzymes, ALTand AST, might be within the
quote-unquote normal laboratoryrange, especially early on.
Rachel (07:20):
So the alarm bells just don't ring.
Mark (07:21):
They don't, and it's worth pointing out that those normal
ranges for liver enzymes arepretty broad and based on
population averages, whichincludes a lot of unhealthy
people.
What's normal might not beoptimal and subtle elevations
even within that range could besignificant.
Often, those enzymes only shootup once there's already
substantial inflammation ordamage.
Rachel (07:42):
Okay, but are there any clues?
The article mentions some moresensitive ones.
What should people, or maybedoctors, be looking out for?
Mark (07:51):
Yes, there are definitely subtler signs, potential red
flags, things like even mildlyelevated ALT or AST, maybe
consistently in the upper end ofthe normal range.
Rachel (08:00):
Okay, not just way over the limit.
Mark (08:03):
Right.
Also looking beyond justglucose checking, fasting
insulin levels or calculating ahome IR score to assess insulin
resistance directly.
That can be revealing even withnormal blood sugar.
What else, a high triglycerideto HDL cholesterol ratio is
another metabolic marker towatch Elevated ferritin, which
can indicate iron overload orinflammation, or GGT, another
(08:24):
liver enzyme sensitive tooxidative stress.
Rachel (08:26):
Hmm, interesting Even things not directly liver
related.
Mark (08:29):
Yeah, sometimes symptoms like significant fatigue after
meals or those afternoon energycrashes and sugar cravings, even
if your A1C is normal, canpoint towards underlying insulin
issues that contribute to NAFTand visually, that pattern of
central adiposity belly fatdespite thin arms and legs can
be a clue.
Rachel (08:48):
The skinny fat idea.
Mark (08:50):
Sort of yeah, or what the article calls the clinical
insight.
Normal BMI does not equalnormal metabolism.
Silent liver stress can brewfor years.
Rachel (08:59):
And actually seeing the fat imaging like ultrasounds.
Mark (09:01):
Imaging like ultrasound or , better yet, FibroScan or MRI.
Pdff can detect liver fat quiteaccurately, but the problem is
they're often not ordered forlean individuals because the
perceived risk is low based onstandard criteria.
Rachel (09:15):
Which brings us neatly to this concept of metabolically
obese, normal weight M-O-N-W.
Tell us more about that.
It sounds key to understandinglean NAF belly.
Mark (09:23):
It really is.
M-o-n-w describes exactly thatsituation.
Someone with a normal BMI lookshealthy on the outside, but
internally they have metabolicissues, typically associated
with obesity.
Rachel (09:33):
Like what kind of issues ?
Mark (09:34):
Things like insulin resistance, chronic low-grade
inflammation, maybe higherlevels of that problematic
visceral fat we talked about.
Their internal metabolicenvironment resembles that of
someone overweight.
Rachel (09:44):
So what are the giveaways, the subtle signs
someone might be M-O-N-W.
Mark (09:49):
A lot of it overlaps with those sensitive clues for lean
NAFLD.
We just discussed thatpost-meal fatigue or afternoon
slump, the cravings for carbs orsugar, the visible belly fat,
even if they're otherwise slim.
Sometimes it's just a feelingunwell, tired, despite having
normal labs from a standardcheckup that mismatch between
(10:10):
how you feel and what the basictests say.
Exactly.
And then looking deeper at thelabs, those mildly elevated
liver enzymes, GGT, ferritin,maybe high fasting insulin or
HOMA-IR, or that high TGHDLratio, even while the A1C is
still in the normal range.
Rachel (10:25):
So a standard physical might easily miss all this.
Mark (10:31):
Very easily, which is why the article suggests the need
for more comprehensive testing,in some cases, not just the
basic panel.
Rachel (10:35):
What kind of tests we're talking about.
Mark (10:36):
Thinking beyond just fasting glucose to include
fasting insulin, looking atinflammatory markers, analyzing
the pattern of liver enzymesover time.
Not just single snapshots.
It gets to reference range,getting a clearer picture of the
underlying metabolic function.
Rachel (10:52):
Okay, Now the article also takes a step back and
suggests NEMD isn't purely aliver problem but more like a
symptom of wider metabolicdysfunction.
Mark (11:01):
Yeah, I love the analogy.
They used the liver as thecanary in the coal mine.
Rachel (11:05):
Right Meaning.
When the liver startsaccumulating fat, it's a warning
signal that the whole system isunder stress.
Mark (11:10):
Precisely.
It points to more fundamentalroot causes.
Insulin resistance is probablydriver number one.
Even slightly elevated insulinchronically tells the liver to
make and store fat, especiallyif there's a lot of carbohydrate
coming in.
Rachel (11:24):
Okay, what else?
Mark (11:25):
The type of fat in the diet Again, especially excess
linoleic acid, that omega-6fatty acid that's just pervasive
in processed foods made withcheap vegetable oils soybean,
corn, sunflower, canola.
Rachel (11:37):
So those heart-healthy vegetable oils might not be so
great for the liver.
Mark (11:40):
Well, the excessive intake , particularly from processed
sources, seems to contributesignificantly to oxidative
stress, mitochondrial strain andinflammation right in the liver
.
It's about balance and ourmodern diet is often way out of
balance.
Swapping those for whole foodfats like olive oil, avocado
nuts makes a difference.
Rachel (12:00):
And the mitochondrial overload.
How does that fit in?
Mark (12:03):
It connects back to energy balance.
If our mitochondria areconstantly bombarded with more
fuel from carbs, fats then theycan efficiently process.
The excess energy has to gosomewhere.
The body converts it to fat andthe liver is a primary storage
depot.
Rachel (12:17):
Got it.
The article also mentions thegut-liver axis.
Mark (12:21):
Right.
This is a fascinating area.
Increased intestinalpermeability, sometimes called
leaky gut, can allow bacterialcomponents or toxins from the
gut to travel directly to theliver via the portal valve.
Rachel (12:32):
And that triggers inflammation in the liver.
Mark (12:34):
Exactly, it sets off an immune response.
Choline deficiency is anotherfactor mentioned.
Rachel (12:39):
Choline.
What does that do?
Mark (12:40):
Choline is crucial for packaging up fat in the liver
and exporting it into thebloodstream in VLDL particles.
If you don't get enough cholineand many processed diets are
low in it fat can get trapped inthe liver.
Eggs and liver are greatsources.
Rachel (12:54):
Interesting and finally, stress and sleep.
Mark (12:57):
Yeah, the chronic stressors of modern life and
poor sleep habits mess with ourhormones, particularly cortisol.
High cortisol can worseninsulin resistance and directly
promote fat storage in the liverand inflammation.
It's all interconnected.
Rachel (13:10):
So fatty liver isn't just about fat, it's about
energy processing, nutrienthandling, inflammation, stress,
the whole metabolic picture.
Mark (13:19):
That's the key message.
It reflects how well or howpoorly our bodies are coping
with everything we throw at them.
Rachel (13:25):
Okay, this might sound a bit daunting, but the article
does offer hope.
It stresses that lean NAFLD isreversible right, Especially if
caught early.
Mark (13:33):
Absolutely.
That's a really important point.
It's not necessarily a one-waystreet Reversing.
It isn't just about dieting,especially for lean people, but
about improving that metabolicflexibility, taming the
inflammatory drivers and reallysupporting liver health.
Rachel (13:47):
So what are some practical steps someone, even a
lean person, could take?
Mark (13:51):
Well, number one is often cleaning up the diet, really
cutting down on processed foods,refined carbs, sugary drinks
and especially those omega-6rich seed oils For whole
unprocessed foods, focusing onfiber from vegetables, quality
protein, healthy fats like oliveoil, avocados, nuts, seeds.
Cooking more at home helpscontrol ingredients, basically
(14:13):
eating real food.
Rachel (14:15):
Makes sense.
What about lifestyle beyonddiet?
Mark (14:18):
Improving insulin sensitivity is huge.
Simple things like dailymovement, even just a short walk
after meals, can make adifference.
Maybe exploring time-restrictedeating, like compressing your
eating window to eight 10 hours,or just ensuring a solid 12,
14-hour overnight fast.
Rachel (14:32):
Giving the liver a break .
Mark (14:33):
Exactly.
Building meals around protein,fiber and healthy fat helps keep
blood sugar stable and thenactively supporting liver and
mitochondrial function.
Rachel (14:42):
How do you do that?
Mark (14:43):
Ensuring adequate intake of nutrients like choline, eggs,
liver, cruciferous veggies aregood magnesium, b vitamins,
antioxidants, reducing thingsthat stress the liver like
alcohol and maybe frequentsnacking or late-night eating,
and definitely addressing sleepquality and chronic stress
levels.
Those have a real metabolicimpact.
Rachel (15:02):
And testing you mentioned being more strategic.
Mark (15:05):
Yeah, perhaps talking to your doctor about going beyond
the basics, checking fastinginsulin, hmakr, the TGHDL ratio,
ggt, ferritin, maybeinflammatory markers like HSCRP
and, if they're concerning signs, considering imaging like an
ultrasound or a fibroscan, evenif your BMI is normal.
Rachel (15:24):
So the takeaway is that even lean people need to be
proactive and aware.
Mark (15:27):
Absolutely.
Getting insight into yourmetabolic health trends early is
powerful, and the good news isthat reversing course often
doesn't require extreme measures, but rather consistent, smart
choices about food quality,movement, stress, movement,
stress, sleep and being aware ofwhat your labs are telling you.
Rachel (15:41):
Okay.
So, wrapping up this deep dive,the big message seems to be
fatty liver disease is not justfor the overweight, it's showing
up in lean people and it'soften a signpost for deeper
metabolic imbalances.
Mark (15:54):
Spot on.
It really forces us to ditchthat old simplistic idea that
thin automatically equalshealthy.
Lean AFLD is proof thatinternal health isn't always
visible from the outside.
Rachel (16:06):
And the drivers.
Whether it's insulin resistance, mitochondrial issues, maybe
too many seed oils, gut problems, it signals that the body's
struggling with modern inputs,regardless of overall weight.
Mark (16:17):
Yeah, it's a systems issue really.
Rachel (16:18):
But and this is crucial it is often reversible.
Early detection, targetedchanges to diet supporting
metabolic health, payingattention to those subtle
signals, it can make a hugedifference.
Mark (16:28):
Definitely there's a lot of potential for positive change
.
Rachel (16:30):
Which leaves us with a final thought, maybe for
everyone listening Beyond justthe number on the scale, how
much thought do you give to yourmetabolic health?
Are there subtle signals,fatigue, cravings, maybe that
belly fat that your body mightbe sending?
Perhaps prevention, true health, starts less with focusing just
on weight and more with thisdeeper awareness of our internal
(16:50):
landscape.
Mark (16:52):
Something to chew on for sure.
It's about listening to yourbody, not just looking at it.
Nicolette (17:04):
Thanks for tuning into the Health Pulse.
If you found this episodehelpful, don't forget to
subscribe and share it withsomeone who might benefit.
For more health insights anddiagnostics, visit us online at
wwwquicklabmobilecom.
Stay informed, stay healthy andwe'll catch you in the next
episode.
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in, okay let'sunpack this.
Rachel (00:21):
When we think about fatty liver disease, I think
most of us picture someone youknow carrying extra weight.
Mark (00:26):
That's the common image.
Rachel (00:27):
But here's a statistic that might surprise you
Something like 25 to 30 percentof adults globally have this
condition, NAFLD and it'sincreasingly popping up in
younger people, even lean people.
Mark (00:41):
Yeah, exactly, and that's what we're diving into today
this whole idea of non-alcoholicfatty liver disease, afld, but
specifically in people with anormal weight.
They call it lean, nay, fld.
Rachel (00:54):
Lean, nay FLD.
It almost sounds contradictory.
Mark (00:57):
It does because the traditional understanding, the
one we've operated on for years,links fatty liver mostly to
obesity, type 2 diabetes, thatkind of thing.
But that picture, it's becomingclear, is just incomplete.
We're seeing more and morepeople with perfectly healthy
BMIs getting diagnosed.
Rachel (01:13):
Which tells us the causes are probably a bit more
complex than just, you know,body weight.
Mark (01:17):
Definitely more intricate.
Rachel (01:18):
And what makes this really important, I think, is
how sneaky NANFLD can be.
Mark (01:23):
Very silent.
Rachel (01:24):
It can just quietly move from simple fat buildup to nice
H, that's the fat plusinflammation bit.
Mark (01:31):
Which is a key step, that inflammation.
Rachel (01:33):
Yeah, and then onto fibrosis, which is early
scarring, and then evencirrhosis, serious, irreversible
liver damage.
Mark (01:40):
And potentially liver cancer down the line, and often,
like you said, with no obviouswarning signs early on.
Rachel (01:45):
Exactly so.
If the usual risk factors likehigh BMI aren't always there,
why are lean people getting fatin their livers?
And, maybe more importantly,how do we catch it early?
Mark (01:57):
Well, that's the core question, isn't it?
Our main source for thisdiscussion is an article the New
Face of Fatty Liver why EvenLean People Are at Risk, and it
really tries to tackle thosepoints head on.
Rachel (02:08):
Okay, so our mission for this deep dive is basically
understand why NAFLD isn't justabout weight, figure out what's
going on metabolically in theselean individuals and highlight
why finding it early is crucial,even if someone looks perfectly
healthy.
Mark (02:21):
Sounds like a plan.
Where should we start?
Rachel (02:23):
Let's start right at the beginning.
What exactly is non-alcoholicfatty liver disease?
Mark (02:28):
Okay.
So basically, nafld means youhave too much fat stored in your
liver cells.
We're talking more than, say, 5to 10 percent of the liver's
weight being fat.
Rachel (02:37):
And the non-alcoholic part is key.
This is in people who drinklittle to no alcohol.
Mark (02:42):
Precisely that distinguishes it from alcoholic
fatty liver disease, and it'sincredibly common, like you said
, affecting a huge slice of thepopulation and, worryingly, it's
on the rise in younger groupstoo.
Rachel (02:54):
And we mentioned the progression.
It's not always benign.
It starts as NAFLD, simple fat,can become NASH fat, plus
inflammation.
Mark (03:02):
Yeah, non-alcoholic steatohepatitis.
That hepatitis means liverinflammation.
Rachel (03:06):
Then potentially fibrosis, the scarring.
Mark (03:08):
Early scarring yeah.
Rachel (03:13):
And finally cirrhosis, which is that really advanced,
irreversible damage and ups thecancer risk significantly.
Mark (03:16):
Right, and often it's found totally by accident, maybe
during an ultrasound forsomething else, because those
early symptoms just aren't theremost of the time.
Rachel (03:23):
It's the silent nature again.
Mark (03:25):
Exactly.
That's why we historicallylinked it so tightly with
obesity, diabetes, hightriglycerides.
Those were the more visibleflags, but lean NAFLD is making
us rethink that.
Rachel (03:35):
OK, so let's really dig into this rise of lean NAFLD.
It still feels a bitcounterintuitive.
How does someone at a healthyweight develop this?
Mark (03:45):
It does seem that way, but the evidence is mounting.
The article points out that asignificant chunk, maybe up to
20% of all in AFLD diagnoses arein people with a normal weight,
a normal BMI 20%, that's notinsignificant.
Not at all, and interestingly,the rates seem to be even higher
in some populations,particularly in South and East
Asia.
Rachel (04:05):
And, interestingly, the rates seem to be even higher in
some populations, particularlyin South and East Asia.
Ah right, the article mentionedsomething about that,
potentially linked to how fat isstored Visceral fat maybe?
Mark (04:12):
Spot on.
Even within that normal BMIrange, body composition can vary
wildly.
Some people, and potentiallycertain ethnic groups like South
and East Asians, might tend tostore more fat around their
organs that's visceral fat evenif their overall weight isn't
high.
Rachel (04:26):
And that visceral fat is the metabolically problematic
kind, isn't it?
Mark (04:30):
Very much so.
It's much more active,hormonally speaking, than the
fat under your skin.
It can really drive insulinresistance, which is a huge
factor in NFLD, even if theperson isn't overweight overall.
Rachel (04:42):
Okay, so it's definitely not just about the number on
the scale.
What other key factors does thearticle highlight for lean and
AFLD?
Mark (04:49):
Well, besides visceral fat , insulin resistance itself is a
major one and, crucially, thiscan be happening even if your
standard fasting blood sugar, orA1C, looks perfectly normal.
Rachel (05:00):
So a deeper level of metabolic trouble.
Mark (05:02):
Exactly.
Diet is another big piece,specifically diets high in
refined carbohydrates, sugars,fructose and also certain types
of fats, like the omega-6 isfound in many processed seed
oils.
Rachel (05:14):
Ah, seed oils, that's a hot topic.
So these things can promoteliver fat without necessarily
causing weight gain.
Mark (05:20):
That seems to be the case.
It's about what you're eating,not just how much in terms of
liver fat accumulation.
Then there's mitochondrialdysfunction.
Rachel (05:28):
Okay.
Mitochondria, the cellspowerhouses.
Mark (05:31):
Yep.
Think of them as fat-burningengines in your liver cells.
If they're not workingefficiently maybe they're
overwhelmed or damaged theycan't process fat properly.
So what happens?
It gets stored instead.
Rachel (05:43):
Makes sense Like a bottleneck.
Mark (05:45):
Pretty much.
Physical inactivity is alsomentioned.
Less activity can mean lessmuscle mass, poor insulin
sensitivity and reducedmetabolic flexibility, that's,
the body's ability to switchefficiently between burning
carbs and burning fat.
Rachel (05:59):
So even if you're thin, if you're inactive, your
metabolism might not be handlingfuel very well.
Mark (06:04):
Correct that inefficiency can lead to fat storage in the
liver.
And then, of course, there'sgenetics.
Rachel (06:10):
Right, the PNPLA3 gene was mentioned.
Mark (06:18):
Yeah, that's one specific gene variant that's been
strongly linked to a highergenetic predisposition for fat
accumulating in the liver, kindof irrespective of body size.
But it's important to remembergenetics load the gun, but
lifestyle pulls the triggerusually.
Rachel (06:27):
Good point.
So genetics might increase risk, but choices still matter
hugely.
Mark (06:32):
Absolutely.
The article really sums it upby saying lean and AFLD isn't
just about excess body fat.
It reflects this deepermetabolic stress, maybe a
mismatch between our modern dietand activity levels and our
biology and dysfunction rightdown at the cellular level.
Rachel (06:48):
Okay.
So given all this, why dostandard medical checkups often
completely miss lean NFLD Ifsomeone seems healthy lean?
Mark (06:57):
That's a really critical issue.
Standard screening reliesheavily on those traditional
risk factors High BMI, highblood sugar, abnormal
cholesterol panels.
Rachel (07:06):
Things that might be perfectly normal in a lean
person with early NFLD.
Mark (07:10):
Exactly.
Their blood sugar might be fine.
Their total cholesterol mightbe in range.
Even their liver enzymes, ALTand AST, might be within the
quote-unquote normal laboratoryrange, especially early on.
Rachel (07:20):
So the alarm bells just don't ring.
Mark (07:21):
They don't, and it's worth pointing out that those normal
ranges for liver enzymes arepretty broad and based on
population averages, whichincludes a lot of unhealthy
people.
What's normal might not beoptimal and subtle elevations
even within that range could besignificant.
Often, those enzymes only shootup once there's already
substantial inflammation ordamage.
Rachel (07:42):
Okay, but are there any clues?
The article mentions some moresensitive ones.
What should people, or maybedoctors, be looking out for?
Mark (07:51):
Yes, there are definitely subtler signs, potential red
flags, things like even mildlyelevated ALT or AST, maybe
consistently in the upper end ofthe normal range.
Rachel (08:00):
Okay, not just way over the limit.
Mark (08:03):
Right.
Also looking beyond justglucose checking, fasting
insulin levels or calculating ahome IR score to assess insulin
resistance directly.
That can be revealing even withnormal blood sugar.
What else, a high triglycerideto HDL cholesterol ratio is
another metabolic marker towatch Elevated ferritin, which
can indicate iron overload orinflammation, or GGT, another
(08:24):
liver enzyme sensitive tooxidative stress.
Rachel (08:26):
Hmm, interesting Even things not directly liver
related.
Mark (08:29):
Yeah, sometimes symptoms like significant fatigue after
meals or those afternoon energycrashes and sugar cravings, even
if your A1C is normal, canpoint towards underlying insulin
issues that contribute to NAFTand visually, that pattern of
central adiposity belly fatdespite thin arms and legs can
be a clue.
Rachel (08:48):
The skinny fat idea.
Mark (08:50):
Sort of yeah, or what the article calls the clinical
insight.
Normal BMI does not equalnormal metabolism.
Silent liver stress can brewfor years.
Rachel (08:59):
And actually seeing the fat imaging like ultrasounds.
Mark (09:01):
Imaging like ultrasound or , better yet, FibroScan or MRI.
Pdff can detect liver fat quiteaccurately, but the problem is
they're often not ordered forlean individuals because the
perceived risk is low based onstandard criteria.
Rachel (09:15):
Which brings us neatly to this concept of metabolically
obese, normal weight M-O-N-W.
Tell us more about that.
It sounds key to understandinglean NAF belly.
Mark (09:23):
It really is.
M-o-n-w describes exactly thatsituation.
Someone with a normal BMI lookshealthy on the outside, but
internally they have metabolicissues, typically associated
with obesity.
Rachel (09:33):
Like what kind of issues ?
Mark (09:34):
Things like insulin resistance, chronic low-grade
inflammation, maybe higherlevels of that problematic
visceral fat we talked about.
Their internal metabolicenvironment resembles that of
someone overweight.
Rachel (09:44):
So what are the giveaways, the subtle signs
someone might be M-O-N-W.
Mark (09:49):
A lot of it overlaps with those sensitive clues for lean
NAFLD.
We just discussed thatpost-meal fatigue or afternoon
slump, the cravings for carbs orsugar, the visible belly fat,
even if they're otherwise slim.
Sometimes it's just a feelingunwell, tired, despite having
normal labs from a standardcheckup that mismatch between
(10:10):
how you feel and what the basictests say.
Exactly.
And then looking deeper at thelabs, those mildly elevated
liver enzymes, GGT, ferritin,maybe high fasting insulin or
HOMA-IR, or that high TGHDLratio, even while the A1C is
still in the normal range.
Rachel (10:25):
So a standard physical might easily miss all this.
Mark (10:31):
Very easily, which is why the article suggests the need
for more comprehensive testing,in some cases, not just the
basic panel.
Rachel (10:35):
What kind of tests we're talking about.
Mark (10:36):
Thinking beyond just fasting glucose to include
fasting insulin, looking atinflammatory markers, analyzing
the pattern of liver enzymesover time.
Not just single snapshots.
It gets to reference range,getting a clearer picture of the
underlying metabolic function.
Rachel (10:52):
Okay, Now the article also takes a step back and
suggests NEMD isn't purely aliver problem but more like a
symptom of wider metabolicdysfunction.
Mark (11:01):
Yeah, I love the analogy.
They used the liver as thecanary in the coal mine.
Rachel (11:05):
Right Meaning.
When the liver startsaccumulating fat, it's a warning
signal that the whole system isunder stress.
Mark (11:10):
Precisely.
It points to more fundamentalroot causes.
Insulin resistance is probablydriver number one.
Even slightly elevated insulinchronically tells the liver to
make and store fat, especiallyif there's a lot of carbohydrate
coming in.
Rachel (11:24):
Okay, what else?
Mark (11:25):
The type of fat in the diet Again, especially excess
linoleic acid, that omega-6fatty acid that's just pervasive
in processed foods made withcheap vegetable oils soybean,
corn, sunflower, canola.
Rachel (11:37):
So those heart-healthy vegetable oils might not be so
great for the liver.
Mark (11:40):
Well, the excessive intake , particularly from processed
sources, seems to contributesignificantly to oxidative
stress, mitochondrial strain andinflammation right in the liver
.
It's about balance and ourmodern diet is often way out of
balance.
Swapping those for whole foodfats like olive oil, avocado
nuts makes a difference.
Rachel (12:00):
And the mitochondrial overload.
How does that fit in?
Mark (12:03):
It connects back to energy balance.
If our mitochondria areconstantly bombarded with more
fuel from carbs, fats then theycan efficiently process.
The excess energy has to gosomewhere.
The body converts it to fat andthe liver is a primary storage
depot.
Rachel (12:17):
Got it.
The article also mentions thegut-liver axis.
Mark (12:21):
Right.
This is a fascinating area.
Increased intestinalpermeability, sometimes called
leaky gut, can allow bacterialcomponents or toxins from the
gut to travel directly to theliver via the portal valve.
Rachel (12:32):
And that triggers inflammation in the liver.
Mark (12:34):
Exactly, it sets off an immune response.
Choline deficiency is anotherfactor mentioned.
Rachel (12:39):
Choline.
What does that do?
Mark (12:40):
Choline is crucial for packaging up fat in the liver
and exporting it into thebloodstream in VLDL particles.
If you don't get enough cholineand many processed diets are
low in it fat can get trapped inthe liver.
Eggs and liver are greatsources.
Rachel (12:54):
Interesting and finally, stress and sleep.
Mark (12:57):
Yeah, the chronic stressors of modern life and
poor sleep habits mess with ourhormones, particularly cortisol.
High cortisol can worseninsulin resistance and directly
promote fat storage in the liverand inflammation.
It's all interconnected.
Rachel (13:10):
So fatty liver isn't just about fat, it's about
energy processing, nutrienthandling, inflammation, stress,
the whole metabolic picture.
Mark (13:19):
That's the key message.
It reflects how well or howpoorly our bodies are coping
with everything we throw at them.
Rachel (13:25):
Okay, this might sound a bit daunting, but the article
does offer hope.
It stresses that lean NAFLD isreversible right, Especially if
caught early.
Mark (13:33):
Absolutely.
That's a really important point.
It's not necessarily a one-waystreet Reversing.
It isn't just about dieting,especially for lean people, but
about improving that metabolicflexibility, taming the
inflammatory drivers and reallysupporting liver health.
Rachel (13:47):
So what are some practical steps someone, even a
lean person, could take?
Mark (13:51):
Well, number one is often cleaning up the diet, really
cutting down on processed foods,refined carbs, sugary drinks
and especially those omega-6rich seed oils For whole
unprocessed foods, focusing onfiber from vegetables, quality
protein, healthy fats like oliveoil, avocados, nuts, seeds.
Cooking more at home helpscontrol ingredients, basically
(14:13):
eating real food.
Rachel (14:15):
Makes sense.
What about lifestyle beyonddiet?
Mark (14:18):
Improving insulin sensitivity is huge.
Simple things like dailymovement, even just a short walk
after meals, can make adifference.
Maybe exploring time-restrictedeating, like compressing your
eating window to eight 10 hours,or just ensuring a solid 12,
14-hour overnight fast.
Rachel (14:32):
Giving the liver a break .
Mark (14:33):
Exactly.
Building meals around protein,fiber and healthy fat helps keep
blood sugar stable and thenactively supporting liver and
mitochondrial function.
Rachel (14:42):
How do you do that?
Mark (14:43):
Ensuring adequate intake of nutrients like choline, eggs,
liver, cruciferous veggies aregood magnesium, b vitamins,
antioxidants, reducing thingsthat stress the liver like
alcohol and maybe frequentsnacking or late-night eating,
and definitely addressing sleepquality and chronic stress
levels.
Those have a real metabolicimpact.
Rachel (15:02):
And testing you mentioned being more strategic.
Mark (15:05):
Yeah, perhaps talking to your doctor about going beyond
the basics, checking fastinginsulin, hmakr, the TGHDL ratio,
ggt, ferritin, maybeinflammatory markers like HSCRP
and, if they're concerning signs, considering imaging like an
ultrasound or a fibroscan, evenif your BMI is normal.
Rachel (15:24):
So the takeaway is that even lean people need to be
proactive and aware.
Mark (15:27):
Absolutely.
Getting insight into yourmetabolic health trends early is
powerful, and the good news isthat reversing course often
doesn't require extreme measures, but rather consistent, smart
choices about food quality,movement, stress, movement,
stress, sleep and being aware ofwhat your labs are telling you.
Rachel (15:41):
Okay.
So, wrapping up this deep dive,the big message seems to be
fatty liver disease is not justfor the overweight, it's showing
up in lean people and it'soften a signpost for deeper
metabolic imbalances.
Mark (15:54):
Spot on.
It really forces us to ditchthat old simplistic idea that
thin automatically equalshealthy.
Lean AFLD is proof thatinternal health isn't always
visible from the outside.
Rachel (16:06):
And the drivers.
Whether it's insulin resistance, mitochondrial issues, maybe
too many seed oils, gut problems, it signals that the body's
struggling with modern inputs,regardless of overall weight.
Mark (16:17):
Yeah, it's a systems issue really.
Rachel (16:18):
But and this is crucial it is often reversible.
Early detection, targetedchanges to diet supporting
metabolic health, payingattention to those subtle
signals, it can make a hugedifference.
Mark (16:28):
Definitely there's a lot of potential for positive change
.
Rachel (16:30):
Which leaves us with a final thought, maybe for
everyone listening Beyond justthe number on the scale, how
much thought do you give to yourmetabolic health?
Are there subtle signals,fatigue, cravings, maybe that
belly fat that your body mightbe sending?
Perhaps prevention, true health, starts less with focusing just
on weight and more with thisdeeper awareness of our internal
(16:50):
landscape.
Mark (16:52):
Something to chew on for sure.
It's about listening to yourbody, not just looking at it.
Nicolette (17:04):
Thanks for tuning into the Health Pulse.
If you found this episodehelpful, don't forget to
subscribe and share it withsomeone who might benefit.
For more health insights anddiagnostics, visit us online at
wwwquicklabmobilecom.
Stay informed, stay healthy andwe'll catch you in the next
episode.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Special Summer Offer: Exclusively on Apple Podcasts, try our Dateline Premium subscription completely free for one month! With Dateline Premium, you get every episode ad-free plus exclusive bonus content.
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!