Fatty liver – a disease not only drinkers

Proven content

Transaminases (liver tests) and ultrasound are the main tests for the diagnosis of fatty liver. The specialist explains how to take care of the liver.

Fatty liver has long been associated with alcoholism. For some time, doctors have also diagnosed this condition in people who drink moderately or even in abstainers. We are talking about the causes of this phenomenon with prof. dr. hab. med. Janusz Ciancia, head of the Department of Liver Diseases at the Medical University of Warsaw.

Live longer: What exactly is fatty liver?

Prof. dr hab. med. Janusz Cianciara: This is the excessive accumulation of fatty compounds in liver cells – hepatocytes. A significant degree of steatosis can adversely affect the function of the liver. Steatosis is often accompanied by hepatitis. Its next stage may be fibrosis and, consequently, after a few or several years, a serious disease, and sometimes even cirrhosis of the liver. Since fatty liver is more and more often detected also in people who do not abuse alcohol, the term: non-alcoholic fatty liver was introduced. The causes of this abnormality may be at least several: overweight, especially obesity, type 2 diabetes, dyslipidemia (disorders in fat metabolism), a diet high in animal fat and high in carbohydrates, sedentary lifestyle, widespread use of drugs and drugs. Fatty liver disease can also occur in hepatitis C.

Ż.d .: You mentioned obesity as the first cause of fatty liver. Are all obese people doomed to this disease?

JC: Statistics show that every third or fourth inhabitant of our country is obese or overweight. Of these, 60%, or about 6 million, have nonalcoholic fatty liver disease. Other countries are also not very well. In the United States, every third person can be classified as obese, and in Germany every second person exceeds the correct weight. Most of them develop fatty liver sooner or later. In addition, obese people are often diagnosed with arterial hypertension, coronary artery disease, they develop type 2 diabetes and disturbances in the metabolism of fats and carbohydrates. All of these conditions, including fatty liver, make up the metabolic syndrome. If fatty liver is detected early enough, the occurrence of the metabolic syndrome can be prevented by proper prophylaxis. This is not always completely successful, because fatty liver and metabolic syndrome are to a large extent genetically determined.

Ż.d .: How does medicine explain the formation of a “defective” genetic record?

JC: I believe we were endowed with a good genetic record that provided for a different lifestyle and diet. We were supposed to run a lot, hunt a lot, use our muscles, and at the moment we drive cars, move little, so we burn little, of course in a metabolic sense. In addition, we eat poorly, which results, among others, from from too easy access to food, not always well prepared (fast food). As a consequence, metabolic disorders lead to excess weight. It is an increasingly common phenomenon, also affecting children and adolescents. Although fatty liver sometimes also occurs in lean people, it is much less common than in obese people.

J.D .: Do we have any clear symptoms with fatty liver: pain, indigestion?

JC: The liver does not hurt because it is not innervated. However, if it greatly increases its volume and overfills the bag around it, then you feel pressure, discomfort, sometimes not too strong pains under the ribs on the right side. However, these are not clear and unequivocal symptoms indicating liver ailments. People with fatty liver may feel great and not have any digestive problems. Of course, until the first signs that the liver is no longer “coping” with fatty liver appear. It’s not uncommon for people with fatty liver or metabolic syndrome to experience weakness, fatigue, insomnia and even depression. These symptoms often resolve when you change your lifestyle without taking any medications.

Ż.d .: What diagnostic tests are used when fatty liver is suspected?

JC: First of all, ultrasound of the abdominal cavity. The liver with steatosis has a characteristic appearance on the monitor – it appears white. It is necessary to test the level of sugar, triglycerides and cholesterol levels, with HDL and LDL fractions, and the so-called liver tests, i.e. transaminase and gamma glutamyltranspeptidase (GGTP). Typical of fatty liver and metabolic syndrome is that overall cholesterol levels may be normal, while HDL levels (the preferred fraction of cholesterol) are too low and triglycerides are sometimes elevated. GGTP values ​​are usually elevated.

Ż.d .: It seems to laymen that the most information about the condition of the liver comes from liver tests (transaminases). When can we observe an elevated level of transaminase score?

JC: Transaminases, or liver tests, are a valuable clue about the problem. The level of transaminases may be elevated not only as a result of the disease process in the liver, but also, for example, after strenuous exercise or in diseases of the bile ducts and gall bladder. The increase in these enzymes, usually transient, has also been seen after taking some medications, e.g. statins. Successfully used in cardiovascular disease and the prevention of atherosclerosis, these drugs are potentially toxic to the liver. In contrast, chronic viral hepatitis and fatty liver disease may run with normal transaminase activity results. Therefore, this test is not sufficient to assess the degree of liver damage. More detailed analyzes are needed – the ability of the liver to synthesize proteins, mainly coagulation factors and albumin, should be assessed. Only the results of these studies inform about the functioning of the liver as an organ as a whole. Elevated results of transaminase only tests are not a contraindication to the use of essential drugs (e.g. statins), even if the package leaflet mentions potential hepatotoxicity.

Z.d .: Can fatty liver be cured?

JC: Yes, to a large extent, and the treatment is quite simple – just go on a proper diet (if the previous diet was unhealthy), lose a few kilos if you are overweight and take care of physical activity. After a healthy lifestyle for a while, the fatty liver will decrease, but usually not completely. The genetic program cannot be changed – the predispositions will remain. However, it is better to have 5% fatty cells than 80. Vitamins that have antioxidant properties, C and E, and phospholipids are useful in fighting the disease. These compounds are present in all cell membranes in the human body. When administered in the form of a drug (eg Syliflex – silymarin-phospholipid complex, Essentiale Forte, Esseliv), they help regenerate and renew liver cells. Therefore, they are a desirable dietary supplement for people with fatty liver.

Ż.d .: What about other drugs, also of plant origin, that are considered to protect the liver? How do you assess their usefulness?

JC: These must be proven and tested products, e.g. a preparation based on milk thistle, incl. Silimarol is a drug with proven effects if it is administered in the right doses and for many months. Heparegen or Liv 52 preparations may also have a beneficial protective effect on the hepatic cell. The most important drugs, however, are adequate nutrition and physical activity.

Ż.d .: What are the basic elements of a diet beneficial for the liver?

JC: Maintaining the correct proportions of fats, proteins and carbohydrates. Vegetable fats and marine fats should prevail, and animal butter in small amounts. Butter, accused for years by nutritionists, has been restored to favor. Carbohydrates served in the right amounts are also a beneficial component of the diet. Obese or overweight people should avoid honey, jam and sugar. The liver “likes” a balanced and varied diet. We have no influence on the genetic record, but with the appropriate lifestyle and diet we can “fix” 20-30% of disorders resulting from metabolic abnormalities.

1. Use HepaDr for fatty liver. And in tablets, available on Medonet Market.

Prof. dr hab. med. Janusz Cianciara, interviewed by Barbara Skrzypińska

Source: Let’s live longer