My doctor has just told me I’m in danger of getting cirrhosis of my liver. He tested me for viral hepatitis and says I’m clear. I’ve never taken alcohol in my life. I am a vegetarian. My weight is the only problem I have. Could you explain the situation for me?
We hear a lot about heart disease and diabetes as consequences of our high-fat, affluent lifestyles, but the effect of such lifestyles on our liver is only recently becoming better understood.
Most overweight people have some fat stored in their liver, but it’s a smaller proportion who have fatty liver disease. In fact, nonalcoholic fatty liver disease (NAFLD) has become the most common cause of liver disease following viral causes and alcohol. NAFLD is divided into two kinds: simple fatty liver disease and nonalcoholic steatohepatitis (NASH). “Steato” means fatty. Both these conditions occur more commonly in persons with the “metabolic” syndrome, which is a condition of obesity, insulin resistance, and probably well known to regular readers of this column.
In all probability, NAFLD and NASH represent a continuum on the same theme. It’s possible that certain drugs such as tamoxifen, amiodarone, and some petrochemicals can cause this condition, and it’s been reported in some people who have undergone weight-reducing jejunal bypass surgery.
Most people with NAFLD have insulin resistance, but not all are diabetic. The substance leptin, which regulates appetite, has been implicated in moving NAFLD to NASH.
Hepatitis, or inflammation of the liver, is thought to occur on the backdrop of a fatty liver as a result of elevated leptin levels. People with the condition are usually symptom-free, but may be found to have abnormally high liver enzymes. The profile of the liver-enzyme elevation is not clear enough to make a clear-cut diagnosis of NASH, which is the forerunner of cirrhosis; a biopsy is required to do this. A biopsy is usually not done unless the liver enzymes are twice as high as normal. The ultrasound shows a bright picture in NAFLD, but cannot determine if hepatitis (NASH) is present. The biopsy in NASH looks the same as in alcoholic fatty liver.
Your immediate and necessary plan should be to reduce your weight. Though a medicine called metformin may be helpful, weight reduction must be the goal. Assuming you were healthy and of normal weight when you married, take your weight at that time, give yourself some 10 or 15 pounds leeway, and set that as your target weight.
It requires a long-range outlook to lose weight effectively. Plan a daily 45-minute brisk walk, and then reduce your daily caloric intake to 1,400 to 1,500 calories. Avoid high-caloric fatty foods, and eat more fiber. Fiber is the key to maintaining proper bowel function. Eating fruits in moderation, green leafy vegetables, carrots, celery, legumes (beans), and whole grains (in moderation) will provide the fiber. Cut out creamy dishes and fried foods, and avoid fats as much as you can. A few nuts—about a large spoonful a day—will provide the fat you need.
This is serious business. Once you get NASH, you’re on the road to cirrhosis. Drastic weight reduction and maintenance of the reduction will help you to do a U-turn, but cirrhosis can shorten your life. Liver transplantation could become the only way out of liver failure, and that is a very complicated and arduous surgery for all concerned.
The good Lord loves you. Make weight loss a matter of prayer, and He will strengthen your resolve and give you the power. But it all starts with the first step.
Send your questions to Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland, 20904. Or e-mail them to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend you consult with your personal physician on all matter of your health.
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Allan R. Handysides, a board certified gynecologist, is the director of the Health Ministries department of the General Conference. Peter Landless, a board certified nuclear cardiologist, is an associate director of GC Health Ministries. This article was published May 10, 2012.
