South Asians Prone to Fatty Liver Disease
“This is your wake up call. What’s happening in your liver is probably happening in your heart, too.” I tell this to a significant portion of my patients every day, and it is a growing problem worldwide. Fatty Liver Disease (FLD) is one of the leading causes of chronic liver disease in the US. FLD indicates a spectrum of abnormal fat accumulation in the liver, with or without inflammation. In a small percentage of patients inflammation can cause progressive liver scarring resulting in liver failure. Once liver failure sets in, most patients die without a liver transplant. In addition, studies indicate that patient with FLD have higher risk of death from heart disease, which is the leading cause of death in the US.
In recent years, FLD is increasingly identified in children, and the statistics have been very concerning to the medical community. About 10% of children in the US have FLD, and prevalence in obese children can be as high as 30-35%. Disturbing reports show FLD in kids as young as two years old. Viral infections are the most common cause of liver transplantation in the US at this time—but in the next decade, liver failure from FLD is predicted to be the leading cause of liver transplantation, which emphasizes the magnitude of this problem.
There is no routine screening available for FLD at this time. So how do you know if you are at risk? FLD is frequently associated with obesity (especially central type), high blood sugar, high LDL and triglycerides, low HDL (good cholesterol) levels, sedentary lifestyle, and strong family history of heart disease and diabetes. In addition South Asians are at higher risk due to genetic makeup, which predisposes them to abnormal fat metabolism, Add to this a high carbohydrate and low protein diet, and the risk for FLD escalates.
There are no significant symptoms associated with FLD. When symptoms appear it is mostly due to liver failure and unfortunately valuable time was lost in preventing the consequences of this silent disease. Most of my patients are identified with FLD when they have abnormal liver enzymes or evidence of FLD on their ultrasound. We still have to rule out other causes associated with these findings including infections; this can be accomplished with examination and blood work at a doctor’s office.
For patients who have FLD, this diagnosis has to be heeded as a warning sign to make longterm lifestyle changes. Weight loss is most effective way to remove accumulated fat in the liver. To do this, aim for losing about 5-10% of your current body weight over 6 months. Make small changes in daily routine such as taking stairs instead of elevators, running 30 minutes a day, using a pedometer, cutting TV or computer time and engaging in more physical activities. Focus on dietary changes, increasing protein and fiber content in meals, avoiding refined sugars and substituting whole grain products. Avoid butter and ghee, replacing them with healthier alternatives like olive oil and nuts (in small portions, as these are also calorie dense). Eat small portions more frequently and consistently add fresh fruits and vegetables to your meals. Avoid or limit alcohol consumption. Check your blood sugar and cholesterol levels with your doctor and make sure they are adequately controlled. In select individuals medications are available for FLD, but these are only a second line of treatment and have to be discussed with your doctor.
Set realistic goals and follow them meticulously. Get your family members involved and increase awareness. This is a call from your body to change habits that have a negative consequence on your health. Talk to your doctor about your risk factors and how to control them. Information is available today. Seek it for yourself and your family, and make changes today for a healthier future.
[Dr. Kavitha Gopal is a board certified gastroenterologist with special interest in liver diseases, acid reflux disorders, and colon cancer screening.]
[Gulshan Harjee, M.D., is a board certified internist in private practice with an emphasis on prevention. Please email your health and medical questions for consideration in this column to: gharjee@comcast.net. The material in this column is of a general nature, and must not be construed as specific medical advice. This column rotates monthly along with the Fitness Lifestyle column by Aarti Patel.]
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