How to avoid fatty liver

Fatty liver disease is the accumulation of excess fat in the liver. It is well known that excessive alcohol consumption leads to an enlarged liver and this can lead to serious liver damage if an individual continues to drink alcohol in excess.

But in the last 30 years, doctors have noted that there are a large number of patients who drink very little or no alcohol, but continue to have excess fat in the liver.

This condition is known as non-alcoholic fatty liver disease (NAFLD). It has also been found that this form of fatty liver disease can cause further swelling (inflammation), liver scarring (cirrhosis), liver cancer and liver failure. Fatty liver is an extremely common disease and it is estimated that it affects up to 5 -20 per cent of Indians.

NAFLD can affect men, women, and children of all ages. It is most common in people who are overweight. The risk is further increased if an individual has diabetes, high cholesterol or high blood pressure. Consumption of a diet rich in fat, calories and fructose is also associated with a fatty liver. With one in six persons overweight, 15 per cent of Indian children overweight, there is also an increase in the occurrence of diabetes.
Fatty liver generally progresses through the following stages:
*Simple fatty liver: Fatty liver with inflammation. Also known as non-alcoholic steatohepatitis or NASH.
*Fatty liver with liver hardening and liver scarring (known as liver cirrhosis)
It is estimated that the simple fatty liver may affect 5-20 per cent of Indians. But the good news is that most individuals almost never progress to severe liver damage. However, if the person develops liver cirrhosis, there is a high risk of liver failure, liver cancer and death.

Symptoms

Most people with fatty liver will not show any obvious signs. Some may experience a dull pain on the right side of  the belly due to enlargement of the liver. Other symptoms are general fatigue, nausea and loss of appetite. Once cirrhosis develops and liver failure sets in, there may be a yellowness of the eyes, accumulation of fluid in the body (edema), vomiting of blood and jaundice.

Diagnosis

Fatty liver is usually noticed during routine checkups when a doctor spots an enlarged liver through a scan. Blood tests of the liver may be abnormal or an ultrasound scan may show fat in the liver.

It is also popularly called the “silent disease”. There are no symptoms until the condition progresses to liver cirrhosis or failure. So never miss your routine check ups if you are a regular consumer of alcohol, are overweight, have diabetes and high level of cholesterol.

There is no medication to treat a fatty liver. Early fatty liver is usually easily reversed through dietary changes, weight loss, exercise and control of risk factors such as diabetes.  Obese patients may benefit from weight loss (bariatric) surgery.

Prevention

*Lose weight if you are overweight, but avoid rapid weight loss.
*Exercise at least 30 minutes per day.
*Reduce the amount of fat in your diet.
*Avoid a carbohydrate-rich diet (potatoes, white bread, white rice). These get absorbed quickly by the intestines and get converted to fat in the liver. Food items that get absorbed slowly (such as unprocessed fruit, nuts, pulses and grains, apples and oranges) are beneficial.
*Be cautious of eating too many fruits, juices and carbonated drinks rich in fructose.
*Antioxidants such as silymarin, Vitamins C and E may have some benefit.
*Never miss your annual health checkups.
*If you have diabetes and hypertension, treat it effectively.
*Even if you are a light alcohol drinker, it is ideal to stop alcohol consumption completely.

(The author is a consultant in liver diseases and transplantation at BGS.)