Did you know that fatty liver disease isn’t just for those who love happy hour at the local bar? Here’s what you need to know to keep your liver healthy.
Do you feel tired, uncomfortable and a slight niggling pain in your right upper abdomen? Well, Darren* did and he didn’t think much about it. He went to see the doctor, got a blood test and was told he had fatty liver disease. Darren was shocked. “I don’t even drink shandy but I’ve got an alcoholic’s disease!” The truth is, fatty liver disease can affect teetotallers too.
To clear up misconceptions and ensure that you know the important facts about fatty liver disease, Urban Health speaks to Sunway Medical Centre’s Consultant Gastroenterologist and Hepatologist, Dr. Sheikh Anwar Abdullah.
Alcoholic vs Non-alcoholic
“Fatty liver disease (FLD) happens when there is an accumulation of fat in liver cells. This can contribute to inflammation (hepatitis) and liver disease,” explains Dr. Sheikh Anwar Abdullah. “Risk factors of alcoholic FLD varies in both men and women. “For men, those who take more than 30 grams of ethanol (alcohol) a day and in women, consumption of about 10 grams daily, could put them at risk for alcoholic FLD.”
Most of the alcohol that a person consumes will be filtered through the liver. During the detoxification process, certain inflammatory by-products are produced and these can cause inflammation, cell death and eventually, scarring of the liver. This can also occur in non-alcoholics but is referred to as non-alcoholic FLD,” explains Dr. Sheikh Anwar Abdullah adding that this condition is reversible if detected and treated early. He also says that for people who do not consume alcohol, being obese, having type 2 diabetes, hyperlipidaemia (high amount of fats in blood) and metabolic syndrome are also risk factors.
For non-alcoholics, it is their existing problems that may cause accumulation of fat cells in the liver. Diseases that interfere with a person’s fat metabolism may cause an excessive amount of fat to accumulate at the liver.
Fatty liver disease is usually asymptomatic – there is no outward evidence of the disease, which means you can have it and not realise it. The disease is generally diagnosed through a health screening or when the patient receives an abnormal blood test result. “A blood test (liver function test) is usually ordered to differentiate between alcoholic fatty liver disease and non-alcoholic liver disease. It depends on the level of liver enzyme, alanine transaminase.”
Dr. Sheikh Anwar Abdullah also mentions that in some cases, the enlarged liver can be felt under the ribs. Sometimes, discomfort or even pain can be felt in the upper right abdomen “Depending on the case, to differentiate between alcoholic FLD or non-alcoholic FLD and non-alcoholic steatohepatitis (NASH), a liver biopsy is usually done.” NASH is one of the complications of non-alcoholic FLD which causes inflammation and scarring of the liver.
“For non-alcoholic FLD, we try to target the patient’s lifestyle which includes exercise and diet. Excercising for about 30 minutes a day, five times a week is good. We also aim to reduce at least 10 percent of their original weight. This’ll reduce inflammation and accumulation of fat,” says Dr. Sheikh Anwar Abdullah.
A low fat diet along with reduced simple carbohydrates (sugar) in sweetened food and drinks will go a long way toward managing the disease. Dr. Sheikh Anwar Abdullah also mentions that management of conditions such as metabolic syndrome, diabetes, hyperlipidaemia and hypertension with medication is another big step in the right direction.
“In the case of alcoholic FLD, if inflammation is still present even after lifestyle changes are made, we suggest an increase in vitamin E intake. However, vitamin E isn’t suitable for diabetics. Pioglitazone, a type of medication for diabetics, has been shown to help FLD.” If the patient’s BMI is above 40, bariatric surgery would be recommended to reduce weight which will lead to lower levels of inflammation.
Dr. Sheikh Anwar Abdullah stresses that the most important thing to do is to prevent the progression of the disease. “15 to 20 percent of patients will get worse and non-alcoholic FLD will become NASH. Majority of NASH cases progress to fibrosis (accumulation of proteins in liver) and cirrhosis (scarring) of the liver which can lead to liver failure. Patients tend to have elevated cardiovascular disease risks as well.”
The best way to find out whether you’ve have fatty liver disease is to schedule an appointment with your general practitioner. He or she will definitely be able to help you especially in areas such as weight management, diabetes and hyperlipidaemia. However, after treatment and the liver enzymes are still high, they can refer you to a hepatologist for further treatment.
What to say to your GP or specialist
- Make a note of your symptoms. Have you experienced any pain or swelling in your abdomen?
- Do you drink alcohol?
- Existing conditions (diabetes, high blood pressure) and types of medication you’re on.
- Do you have hepatitis or have been told that you have it?
- Is there a family history of liver disease?
*Name changed to protect privacy.
References: Mayo Clinic; The Sun Daily.