some bad news....
PUBLICATION: The Calgary Sun
DATE: 2005.06.27
EDITION: Final
SECTION: Lifestyle
PAGE: 34
ILLUSTRATION: SUN file photo WAIST-DEEP IN TROUBLE ... A report suggests that being obese or overweight can cause liver scarring.
BYLINE: DR. GIFFORD-JONES
COLUMN: Medicine
BIG BELLY LEADS TO FATTY LIVER
I'd bet a thousand to one that 99.9% of readers have never heard of non-alcoholic fatty liver disease (NAFLD).
Yet, a recent report from Johns Hopkins University claims 25% of North Americans suffer from this disorder. What is it, how can it be prevented and treated?
Today you would have to be living on Mars not to know that heart disease and diabetes are often related to obesity. 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 and elevated liver enzymes, but have no history of excessive consumption of alcohol.
Unfortunately, this can be a progressive disease. It's estimated 15% to 20% of NAFLD patients go on to develop non-alcoholic 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 longer I read the report of NAFLD, 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 non-alcoholic fatty liver disease until routine blood tests show elevated liver enzymes.
The American Gastroenterological Association recommends losing one to two pounds a week along with increased exercise.
They say a loss of 10% 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 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 can cause liver injury. So why would anyone in their right mind take statins when they already have a damaged liver?
The answer is 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 only 2% of patients developed liver damage and it was reversible once statin drugs were stopped. But the study also showed 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 too much faith is placed on drug therapy to cure the health problems of this continent. It concerns me 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.
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