Featured on The Star Newspaper, 25 June 2019
“What if you had a potentially life-threatening disease and didn’t know? Fatty liver disease is one such disease. With often no symptoms whatsoever in the beginning, symptoms soon appear when significant and sometimes irreversible damage to the liver has already occurred.
“Symptoms include experiencing abdominal pain and distension, vomiting blood, and jaundice. This silent progression is what makes this disease all the more dangerous,” says Dr Prabhjot Singh Sidhu, Gastroenterology and Hepatology Consultant at Ara Damansara Medical Centre.
Fatty liver occurs when there is excessive fat deposition in the liver. Its causes are many excessive alcohol consumption, viral hepatitis, autoimmune conditions and metabolic syndrome.
Dr Prabhjot shares that with our extremely high rates of obesity, diabetes mellitus and hypertension all contributing to the metabolic syndrome, it is this that is the commonest culprit of fatty liver disease in our country.
“The risk of having a fatty liver, or in this case, non-alcoholic fatty liver disease (NAFLD), by way of the metabolic syndrome is by having risk factors such as weight gain, significant weight loss, diabetes mellitus, raised lipid levels, hypertension and hypothyroidism. You only need two of these factors to be at increased risk of developing NAFLD.”
Many people, including doctors, used to think that fatty liver disease is nothing serious because it’s just fat and we all have a little. However, Dr Prabhjot warns, “This fat deposit causes inflammation over time, which can lead to fibrosis, cirrhosis and even liver cancer. Yes, it can take years at times for the condition to progress from one stage to the next, but the progression can be more rapid and even skip a stage in some people.
“It is important to remember that the top two killers in people with fatty liver disease are heart disease and cancer, not liver failure, as previously assumed. Having a fatty liver also significantly increases your risk of heart disease, diabetes mellitus (by up to five times), colorectal cancer (by up to three times) and colonic polyps (by 1.5 times).”
“The severity varies between individuals, but the risk factors are there, so it is essential to diagnose fatty liver as early as possible to address its causes.”
Lack of proper awareness
“There is a common misconception that only obese people are susceptible to NAFLD. People with obesity are at risk, but people with centripetal obesity (fat accumulation around the stomach region) are more at risk. Let’s not forget that between 7% and 20% of patients with fatty liver disease are considered slim or of normal weight.”
Many people misjudge their fat accumulation because they depend on body mass index, which is not an accurate measure since it doesn’t consider muscle weight. A better way is to find out your body fat percentage.
“Since there are no symptoms in the early stages of fatty liver disease, it is best to go for a screening if you have the risk factors or are worried. However, for those with diabetes mellitus or obesity, screening is a must!” says Dr Prabhjot.
“Diagnosis of fatty liver is fairly easy since it can be detected with a simple ultrasound and blood test. The treatment can be simple if the right approach – addressing the root cause – is taken. For instance, if obesity is the cause, the treatment is to lose weight. If drinking excessive alcohol is the cause, then quitting alcohol is the remedy. As for NAFLD, aside from exceptional cases, the only recognised treatment is weight loss. There are no recommended drugs as a form of treatment as it stands.”
Beware of randomly popping pills
“When faced with a serious disease and in this case the treatment course requires some work, we often see people look for “short-cuts” and reach for supplements and/or herbal remedies. This practice can in fact be very dangerous.”
Dr Prabhjot has a word of warning for such people, “Medicines must pass stringent tests to be classified safe and effective by an appropriate governing body but when it comes to herbal remedies and supplements, the rules are different. The requirements are much more relaxed.
“There is often little evidence that these remedies work and sometimes even less of safety data. Drug-induced liver injury (DILI), although rare, is serious, with anabolic steroids, weight-loss supplements, herbs and green tea extracts topping the list of its causes.
“Between 20% and 70% of DILI can be attributed to herbal remedies. Even though it’s rare, we should still worry because treatment is limited and outcomes can be poor. Aside from mislabelling, many ingredients in these products are often not listed. It is important to remember that something ‘natural’ does not automatically mean it is safe. Do the research and make educated, informed decisions. If unsure, see your doctor.”
The ignored powerhouse
While he is all for people wanting to be healthy and taking care of themselves, Dr Prabhjot stresses that there is no shortcut to achieving it.
“Keeping healthy is a continuous process that takes dedication and hard work through eating well, exercising regularly and maintaining a healthy lifestyle overall. Unless you have conditions that require medication, you can never achieve good health by just popping a pill because, for the moment at least, there is no such thing, especially for liver health,” he says.
Dr Prabhjot emphasises that the liver is one of the most neglected and often abused organs in our bodies, and people must put in more effort in being aware of and preserving their liver health.
Extra: Proper awareness can save lives
While it is true that, thanks to the Internet, people are more informed today about their health then they were a few decades ago, there is still a dire lack of proper awareness.
Dr Prabhjot Singh Sidhu, Gastroenterology and Hepatology Consultant at Ara Damansara Medical Centre, says, “It is good that people read up about diseases and ailments and take a keen interest in their health, but it is important to remember that there a lot of misinformation on the Internet. I would recommend that patients at least discuss their concerns or queries with a healthcare professional before embarking on self-medication endeavours.”
An example of such endeavours would be taking supplements and medications that claim to be able to detoxify your liver. Dr Prabhjot questions: “Why would an organ that is responsible for cleansing your entire system need external assistance to detoxify itself?”
Similarly, many people take probiotics, thinking it will help improve their gut health. According to Dr Prabhjot, with so many options available, people are often at best just guessing when selecting one.
“Probiotics can be helpful in specific situations such as in the treatment of antibiotic-related diarrhoea, irritable bowel syndrome, bloating pains and ulcerative colitis, but you have to know which strain of bacteria at what dosage would be most beneficial in treating that symptom-based on prior studies for any chance of efficacy. Randomly taking just any probiotic off the shelf is certainly not a recommended approach.”
By taking such supplements and medications without proper guidance, you risk damaging your liver even more instead of making it healthier, so make sure you are not just aware of the dangers, but also have the right information.
