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Fatty Liver Facts

"Symptoms, diagnosis, treatment, prevention"
By: Mel Mordeno Beluan, MDFatty Liver Facts

Here’s the usual scenario. You are fat and having some vague symptoms of fatigue, poor concentration, nausea, poor appetite, fullness, and some ache or discomfort in your tummy (particularly the upper right aspect) - or you’re just having a routine mandatory executive health exam, and your doctor orders some tests. Then, incidentally, the ultrasound shows your liver is a plus size.

What is fatty liver? It’s the liver with fatty deposits in excess. A normal liver has some fat in it but not much. You’ve got to expect some fat because the liver processes a lot of fats. But when the liver cannot handle a lot of fat, the metabolic highway can pile up a lot of fat in the liver, fattening it up in the process.

The trouble with fatty liver is:

  1. it signals the past or an ongoing underlying problem—something made (or is making) it fat; and 
  2. it can signal what the future may bring—it can cause potential problems (say, cirrhosis).

Are you a habitual moderate-to-heavy alcoholic beverage drinker? Do you have an alcoholic history? Bad news: a majority of alcoholics develop fatty liver (technically called alcoholic fatty liver disease). Genes also play a role as they can determine how much the body can handle alcohol and how much one can become addicted to it. Genes aside, diet, excess body iron and fat, hepatitis, and obesity can also contribute to having an alcoholic fatty liver.       

Non-alcoholics can still get fatty liver. In fact, nonalcoholic fatty liver disease (NAFLD) is probably the most common long-lasting liver problem in the world. In most cases, the problem is decidedly benign. In others, it can lead to some inflammation (called steatohepatitis), which can cause liver damage.

Some factors that are associated with a risk of getting NAFLD include obesity, certain meds (such as amiodarone, methotrexate, corticosteroids, tetracycline, and tamoxifen), hepatitis, genetic liver disorder, immune and metabolic system disorders, calorie- and fat-rich diet, malnutrition, middle or old age, obesity, rapid weight loss, diabetes or pre-diabetes, hypertension, abnormal blood lipid/cholesterol profile, bacterial overgrowth in the gut, and genes. How about pregnancy? Rarely but yes. In some cases, however, no risk factor can be identified at all.

In most cases of fatty liver, there are no obvious signs and symptoms at all. There’s no damage and inflammation. That’s why the finding turns up incidentally in routine lab work up. If the problem worsens, there’s yellowing of the eyes and skin, edema, easy bruising, confusion, among others. If fatty liver remains unchecked, what are the consequences? Well, there‘s the problem that it can progress to inflammation, and then eventually, scarring and abnormal liver growth, resulting in cirrhosis, cancer, and death.

How do you determine if you have fatty liver? The doctor examines your health history and performs a physical exam. But fatty liver may just incidentally turn up in routine tests. The tests include abdominal ultrasound and levels of blood markers of liver damage. Liver biopsy is the last resort to confirm fatty liver but it is usually done to rule out other underlying problems.

The risk factors and the underlying problem of fatty liver should be identified and addressed first. If the patient already has cirrhosis, the cirrhosis needs to be addressed, too. In most cases, fatty liver cannot be undone (and there is no symptoms or damage) but you can do preventive measures to stem the progression.

So what are you going to do? In general, live healthily.

  • That is, eat right (more on fruits and veggies);
  • supplement right (vitamin C, resveratrol, curcumin, and a host of other antioxidants come to mind, maybe—better yet, get them from the diet);
  • exercise right;
  • maintain a healthy weight;
  • avoid unnecessary physical contact with people with open wounds (hepatitis alert),
  • avoid contracting hepatitis by practicing sexual abstinence (if single) and Fidelity (married);
  • avoid unnecessary medication;
  • safely use or avoid cigarette smoke, toxins, pesticides, alcohol, and other chemicals and pollutants;
  • control your diabetes if you have it;
  • have a regular checkup with your health adviser;
  • and lastly—choose your genes wisely (kidding on this one as you can’t really cherry-pick your genes, e.g., your parents, and besides, gene therapy is far-fetched).                                    

Fat isn’t always cute. For the liver lover, it never is.

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