Keep your immune system strong by eating healthy, being physically active, getting enough sleep, managing your stress and please wear a face covering. Join the Brody medical students at September’s “Walk with a Doc” at Lake Laupus. This month’s guest speaker is Dr. Jason Higginson, executive dean of the Brody School of Medicine. He will make a few comments and lead the walk around the lake. All are welcome at 9 a.m. on Saturday, Sept. 25.

Q My doctor says I have NAFLD. I don’t understand since I never drink alcohol. He told me to lose weight. Is there a special diet I should follow? — JL, Winterville.

A You received a diagnosis that confuses many people, but it is a condition you can do something about with lifestyle changes. Nonalcoholic fatty liver disease (NAFLD), like other chronic medical conditions linked to obesity, metabolic syndrome, and type 2 diabetes, is on the rise, whether you drink alcohol or not. Up to 1 in 3 adults in the U.S. have this condition in which fat builds up in your liver. Most don’t know it because there are few if any specific symptoms.

This buildup of fat is not caused by heavy alcohol use. The scientists don’t all agree with the definition of heavy alcohol use, but the Dietary Guidelines for Americans suggest that a healthy diet for many adults can include up to 14 drinks by a male and 7 by a female per week — but not all in one day. The guideline defines a drink as 1.5 ounces of 80-proof distilled spirits, 5 ounces of wine (12 percent alcohol by volume) and 12 ounces of regular beer (5 percent alcohol by volume).

If you have NAFLD and don’t make changes in your lifestyle, it could lead to a more serious form of liver disease including cirrhosis of the liver, liver failure and liver cancer. This condition is just one more reason to work toward being at a healthy weight, although some lean people also develop NAFLD. There are no medications approved for the treatment of NAFLD, that’s why your doctor said to lose weight. Studies have shown that weight loss can reduce fat, inflammation, and the loss of healthy liver tissue.

I like to recommend either the DASH or the Mediterranean eating approach along with a small restriction in calories as the way to lose weight for this condition. Decreasing food and beverage intake and/or increasing physical activity to achieve a 500-1,000 calorie deficit would be the goal. It’s not yet “proven” that DASH or Mediterranean diets will make more of a difference in treating your NAFLD but following it certainly will not make the condition worse. Both eating approaches are anti-inflammatory and recognized as healthy way to eat for reducing your risks for heart disease, high blood pressure, dementia, cancer, and other chronic diseases.

Many of my former patients were surprised how much food you were allowed to eat on the DASH plan, so they chose it because they were less likely to be hungry. Ask your doctor to refer you to a registered dietitian nutritionist (RDN) who can tailor the diet to your preferences and budget. Again, it’s not proven but some of the foods you may want to limit to treat your NAFLD include saturated fat (found in animal products) and simple sugars (found in soft and sport drinks, sweetened tea, fruit drinks). Look for the “added sugar” line on the Nutrition Facts labels. The lower the number the better.

If you have trouble losing weight after making a serious attempt with lifestyle changes, you may talk with your doctor about medications to help with weight loss. There are some that have been approved recently. But I always counsel people to try lifestyle changes first.

By the way, both DASH and Mediterranean eating patterns can be followed by the whole family, and it may be important to do so in your home. The number of children and teens developing NAFLD is rising, too — an estimated 1 in 10.

I mentioned NAFLD has no symptoms, but a person may experience fatigue, weakness, weight loss, loss of appetite, nausea, abdominal pain, spider-like blood vessels, yellowing of the skin and eyes (jaundice), itching, fluid buildup and swelling of the legs (edema) and abdomen (ascites) and mental confusion.

I am guessing you had a blood test and your doctor probably saw high levels of liver enzymes and might have had you take other tests to rule out other liver diseases. Often, an ultrasound test is used to confirm the non-alcoholic fatty liver disease diagnosis. Be well and be safe.

Professor emeritus Kathy Kolasa, a registered dietitian nutritionist and Ph.D., is an affiliate professor in the Brody School of Medicine at ECU. Contact her at [email protected].