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Updated: April 24, 2010 17:55 IST

When your liver gets fat

Dr. ANAND KHAKHAR
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Lose weight: Obesity is a major cause for fatty liver. File Photo
The Hindu
Lose weight: Obesity is a major cause for fatty liver. File Photo

Not all liver problems are because of alcohol. With obesity and diabetes on the rise, more cases of fatty liver are being reported. Here's what you need to know to stay safe.

The liver performs hundreds of vital functions. Without it, one cannot digest food and absorb nutrients, get rid of toxic substances from the body or even stay alive. Serious complications can arise if one develops liver problems. For those who think that liver disease is solely alcohol-related; think again. Liver diseases affect more than one out of every 10 Indians. There are over 90 different forms of liver disease ranging from infectious to hereditary diseases that affect all age groups.

Of late there has been an alarming rise in the diagnosis of fatty liver largely due to the rising incidence of diabetes, central obesity and elevated cholesterol (particularly triglycerides).

What is fatty liver?

Fatty liver is, as its name suggests, the build-up of excess fat in the liver cells. Normally your liver contains some fat, but if fat accounts for more than 10 per cent of your liver's weight, then you have fatty liver and you may develop more serious complications.

Fatty liver may cause no harm, but sometimes the excess fat leads to inflammation. This condition, called steatohepatitis, causes liver damage. Sometimes inflammation from a fatty liver is linked to alcohol abuse; this is known as alcoholic steatohepatitis. Otherwise the condition is called non-alcoholic steatohepatitis, or NASH. An inflamed liver may become scarred and hardened over time. This condition, called cirrhosis, is serious and often leads to liver failure requiring liver transplant. NASH is one of the top three leading causes of cirrhosis world-wide.

What are the symptoms?

A fatty liver produces no symptoms on its own. It shows up during preventive health checks or medical tests for other conditions. NASH can damage your liver silently for years or even decades. If the disease gets worse, you may experience fatigue, weight loss, abdominal discomfort, weakness and confusion.

What causes the problem?

Eating excess calories causes fat to build up in the liver. Obesity, diabetes, high triglycerides, alcohol abuse, rapid weight loss and malnutrition may also cause fatty liver. However, some people develop fatty liver even if they have none of these conditions.

How is it diagnosed?

Your doctor may see something unusual in your blood test or notice that your liver is slightly enlarged during a routine check-up. To make sure you don't have another liver disease, your doctor may ask for more blood tests, an ultrasound. Sometimes a CT scan may be needed. If other diseases are ruled out, you may be diagnosed with NASH. Although rarely needed, a liver biopsy is the only way to diagnose NASH for sure.

Are there any new treatments?

Fatty liver is currently the focus of intense research to provide us with better tools for treatment in the future. Scientists are studying whether various medications can help reduce the inflammation on the liver, including new diabetes medications that may help even those who are not diabetic.

What is the best way to prevent this problem?

The best way to reduce risk of developing fatty liver is to maintain a healthy weight and normal triglyceride levels. Avoid excess alcohol and other substances that could harm the liver.

What other things help keep the liver healthy?

The liver is a resilient organ. It can remain functional after losing most of its cells to disease. It can regenerate in a few weeks even after much of it has been removed during surgery. But it isn't indestructible; prolonged alcohol consumption, viral hepatitis, non-alcoholic fatty liver disease and certain hereditary and auto-immune diseases can lead to serious liver problems.

To keep healthy and avoid any potential problems, here's a checklist:

Don't mix other drugs with alcohol. Acetaminophen (paracetamol and others) can be toxic to the liver even if you drink in moderation.

Get vaccinated. If you're at increased risk of contracting hepatitis or if you've already been infected with any form of the hepatitis virus, talk to your doctor about getting the hepatitis B vaccine. A vaccine is also available for hepatitis A.

Use medications wisely. Use prescription and non-prescription drugs only when you need them and take only recommended doses. Talk to your doctor before taking herbal supplements along with other medication.

Beware of certain supplements. Herbal supplements that can be toxic to the liver include African kava, comfrey, chaparral, kombucha tea, pennyroyal and skullcap. Also avoid high doses of vitamins A, D, E and K.

Avoid contact with other people's blood and body fluids. Hepatitis viruses can be spread by accidental needle sticks, improper cleanup of blood or body fluids, and sharing intravenous needles. It's also possible to become infected by sharing razor blades or toothbrushes or by having unsafe sex.

Be careful with aerosol sprays. When you use an aerosol cleaner, make sure the room is ventilated, or wear a mask. Take similar protective measures when spraying insecticides, fungicides, paint and other toxic chemicals.

Don't eat too many fatty foods. The liver makes all the cholesterol the body needs. Eating a well-balanced, nourishing diet and a regular exercise programme will help your liver do its job properly.

Watch your weight. Obesity can cause ‘non-alcoholic fatty liver disease', which may include fatty liver, hepatitis and cirrhosis.

Drink alcohol in moderation, if at all. There is no absolutely safe way to drink alcohol. But more than one drink a day for women and more than two drinks a day for men over a few years may be enough to lead to cirrhosis. Use of certain drugs, including some illegal drugs, also can cause liver disease. Take ‘alcohol free breaks', say three months in a year.

Don't use recreational drugs. They're often addictive and can cause a multitude of health problems, including liver failure

Plan for pregnancy. Several rare disorders of pregnancy can cause acute liver failure, so see your doctor for prenatal care. If you live in an area where hepatitis E is endemic, make sure that you have access to safe drinking water. If you contract hepatitis E while pregnant, you're at risk of developing acute liver failure.

What you can do

If you have fatty liver, particularly NASH, you should:

Lose weight safely! That usually means losing no more than one or two pounds a week

Lower your triglycerides through diet, medication or both

Avoid alcohol

Control diabetes

Eat a balanced, healthy diet

Increase your physical activity

Get regular checkups from a liver specialist

Warning signs

See your doctor if you notice a combination of the following symptoms:

Discoloured skin and eyes that appear yellowish

Abdominal pain and swelling

Itchy skin that doesn't seem to go away

Dark urine colour

Pale stool colour

Bloody or tar-coloured stool

Chronic fatigue

Nausea

Loss of appetite

Risk factors

The most common ones are:

Obesity: People with a body mass index of 25-30 or above 30

Diabetes: Those who have trouble maintaining their blood sugar levels

High Cholesterol: specially those with elevated triglyceride levels

Abdominal surgery: Operations to remove large sections of the small intestine, treat obesity (stomach or small intestinal bypass) often lead to rapid weight loss. This may increase risk of fatty liver disease.

Medications: particularly oral steroids e.g. Prednisone, synthetic estrogens for menopause, certain medications e.g. amiodarone (for irregular heart beat), tamoxifen (for breast cancer) and methotrexate (for rheumatoid arthritis).

Other conditions: Like Wilson's disease, Glycogen storage diseases, Abetalipoproteinemia, Galactosemia.

The author is a Senior Consultant Liver Transplant and Hepatobiliary Surgeon based in Chennai.

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