Is what you’re eating, really eating your liver?

[Guest guest]

Is what you’re eating, really eating your liver?

“By the way your liver enzymes are a little high.â€

Something to that effect is one of the more common statements to come out of my mouth in the midst of a routine physical exam or follow-up visit with a patient. So, is that a big deal? Well, usually not, but once in a while, yes. And that’s the difficult part of analyzing blood tests of the liver. Let’s see if we can sort this out a little, and at the same time focus in on fatty liver disease.

I would estimate that, in my adult patients, one of the routine liver function tests (LFT’s) in the blood is high about one-third of the time. The most common cause of this is fatty liver, or more officially, non-alcoholic fatty liver disease (NAFLD). Almost one-third of the U.S. adult population (and a growing number of adolescents) has this, although it doesn’t always elevate the liver enzymes. It used to be thought that this was a completely harmless condition. However, it turns out that about 10 percent of individuals with this have a more serious type called non-alcoholic steatohepatitis (NASH). In this condition, there is actual inflammation and damage going on. Perhaps one-third of those with NASH go on to liver cirrhosis and failure.

So, let’s suppose you’ve been told, “your liver enzymes are a little highâ€. What’s next? If the elevation is only mild, you might be told to stay off things like alcohol and acetaminophen for the next few weeks and recheck it. If it’s a little more substantial (say more than 2-3 times normal) and you’re on a statin cholesterol medicine, you might be asked to stop it and recheck your LFT’s a few weeks later. If the elevation persists, it’s usually time to look for a specific cause. Blood work may be drawn looking for particular diseases such as chronic hepatitis C, hemochromatosis (a genetic problem with excess iron stores in the liver), autoimmune hepatitis and so on. Of course you may be asked for more detail about your alcohol intake. Sometimes as little as 10 drinks per week can trigger significant liver inflammation.

Don’t only consider the prescriptions you’re taking. Recently I had a patient where the culprit was the several supplements he was on. As soon as he stopped them everything went back to normal.

Probably an ultrasound of the liver will be obtained as well. This not only can identify or rule out tumors (benign and cancerous), but can also show whether fatty liver is present. In fact that’s the most common abnormality I get back on my liver ultrasounds.

Now suppose you’re not a big drinker, you’re not on any meds or supplements that are suspect, and your blood testing and ultrasound for specific causes are all normal except that you’ve been told your ultrasound shows “fatty liverâ€. How do you know if you have the rather harmless varieties of NAFLD or the more serious NASH? That’s a tougher one. The only definitive way at present is a liver biopsy – not something to which we want to subject one-third of our population. There are some other slightly less reliable, but noninvasive options being developed.

But let’s look at this very practically. What are the main risk factors for NAFLD and NASH? In both cases, obesity, high triglycerides and diabetes. In fact, over 80 percent of those who are obese have NAFLD and 50 percent of those undergoing bariatric surgery for morbid obesity were found to have the more dangerous NASH. As they lost weight a majority of them saw their liver inflammation resolve. So if your LFT’s are high, you have one or more of these risk factors and you’re not keen on a liver biopsy, the place to start is getting those risk factors under the best possible control: ie. Losing the extra pounds (especially with a diet low in simple carbs – sweets and whites [breads, pastas, potatoes]), treating the high lipids, and getting your glucose as well controlled as possible, while avoiding any liver toxic substances such as alcohol.

Anything else you can do? There are ongoing studies showing some promise of slight benefit from meds such as Actos, metformin, and the statin cholesterol meds. Also just out was a study showing a 40 percent rate of improvement using 800 IU of vitamin E daily.

It’s always amazing to me how often our diseases can be traced back to our lifestyle: too much of the wrong stuff and too little exercise. Reversing that may not be the cure-all, but it’s about as close as we’ll come any time soon. Have pity on your poor liver – an amazing detoxifier that God puts inside of us. Don’t let what you eat (and drink) eat up your liver.

Dr. is board-certified in family medicine and practices at 1503 E. Lamar Parkway, ville. Contact him at 982-0835.

http://www.thedailytimes.com/article/20100503/LIFE/305039994