This week our contributing writer Doctor Gifford-Jones talks about the importance of maintaining one’s weight and protecting the liver.
I’d bet a thousand to one that 99.9 per cent of readers have never heard of nonalcoholic fatty liver disease (NAFLD). Yet a recent report from Johns Hopkins University claims that 25 per cent of North Americans suffer from this disorder. What is it and how can it be prevented and treated?
Today you would have to be living on Mars not to know that obesity is often related to heart disease and diabetes. Now excessive pounds are also causing liver disease. We all tend to forget that whether we’re dealing with war, love or medicine one problem often leads to a greater one.
In 1640 George Herbert hit the nail on the head when he wrote, “For want of a nail the shoe is lost, for want of a shoe the horse is lost, for want of a horse the rider is lost, for want of a rider the battle is lost, for want of a battle the kingdom is lost.”
So today, for want of keeping thin, diabetes develops, then atherosclerosis, then heart attack, hypertension, stroke etc, etc, etc. Now we can add NAFLD to this growing list of obesity-related problems.
Apple-shaped people who store fat around the abdomen are more likely to develop NAFLD than those who are pear shaped and store fat around the hips. Those who have type 2 lifestyle diabetes are also prone to develop NAFLD.
Patients who have NAFLD exhibit fatty deposits in the liver, elevated liver enzymes but have no history of excessive consumption of alcohol. Unfortunately, however, this can be a progressive disease. It’s estimated that about 15 to 20 per cent of NAFLD patients go on to develop nonalcoholic steatohepatitis (NASH).
NASH is associated with inflammation and scarring of the liver. These pathological changes are indistinguishable from liver damage caused by too much alcohol. And on occasion NASH goes on to develop the irreversible scarring of advanced liver cirrhosis.
The more I read about NAFLD this report the more I thought, “Liver damage and cirrhosis from too many scotch-and-sodas is one thing. Getting it from just being obese is shocking.”
It’s also food for thought that obese people don’t know they have nonalcoholic fatty liver disease until routine blood tests show elevated liver enzymes.
Obviously the prime way to stay clear of NAFLD is buy a bathroom scale and watch it like a hawk. Or if you’ve already developed it lose weight.
The American Gastroenterological Association recommends losing one to two pounds a week along with increased exercise. The say that a loss of 10 per cent of initial body weight will result in lowering of liver enzymes and a decrease in fatty deposits in the liver in some cases.
Patients who also have diabetes must pay particular attention to blood sugar levels. In addition, those who are obese and have NAFLD often have elevated blood cholesterol. The Hopkin’s report says these people should be treated with cholesterol-lowering drugs (statins) , but admits this can be a two-edged sword.
We know that in some cases cholesterol-lowering drugs (statins) can cause liver injury. So why would anyone in their right mind take statins when they already have a damaged liver?
The answer is that statins normally don’t cause serious liver disease. A study published in the Cleveland Clinic Journal of Medicine reviewed the findings of 20,000 patients taking statin drugs. This revealed that only two per cent of patients developed liver damage and was reversible once statin drugs were stopped. But the study also showed that the greater the statin dose the greater the risk of liver damage.
Researchers held out the hope that statins may even be able to reduce fatty changes in the liver. Let’s hope so, but I believe we’re putting too much faith in drug therapy to cure the health problems of this country. It concerns me that so many people are taking these drugs, rather than following a healthy lifestyle. Step on the scale and you won’t need all this medication.