Look after your liver

I read an alarming article this week about liver disease.  For decades, liver disease was associated with heavy drinkers.  Too much alcohol means that fat becomes deposited in the liver which damages liver cells, but at this stage it's often symptomless.  However, if this process continues over years, the constant repeated damage to the liver cells can lead to scar tissue - severe scarring is known as liver cirrhosis.  This scar tissue makes the liver hard and lumpy and as a result it becomes unable to function properly.

New information has arisen that says that a fatty liver does not necessarily happen only due to heavy drinking, but also has a lot to do with over eating.  Being overweight encourages the progression of liver disease, as high levels of visceral fat becomes stored around the organs.  Visceral fat releases fatty acids and other inflammatory substances that further damage the liver cells, according to Professor Massimo Pinzani, a liver specialist and director of the Institute for Liver and Digestive Health at University College London.

One of the biggest problems is that liver disease is difficult to spot before it is at an advanced stage.  Andrew Langford, chief executive of the British Liver Trust explains;

"There are very few symptoms.  The liver doesn't have any nerve endings - so when it's damaged, you don't always feel it."

The first signs of a problem are:

• Extreme fatigue
• Dark urine
• Pale stools
• Jaundice - this is caused by a build-up of the waste product bilirubin, which the malfunctioning liver can no longer remove.

"If someone says 'Oh you look well, have you been on holiday?' and you haven't, it could be that you've got a very mild form of jaundice," says Mr. Langford.

Other complications of the advanced stages of the disease are episodes of confusion, memory loss and even hallucinations.  This has a clinical name of hepatic encephalopathy and is due to the build-up of toxins in the body that affect the brain, this can often cause a dementia type state.

Liver disease is the fifth biggest killer in the UK, and the number of deaths has soared by 25% in the last decade - in part because of heavy drinking, but also due to our expanding waistlines.  Not only is liver disease killing more of us, but it is doing so more quickly.  The average age of someone dying from liver disease is now 57, but just two years ago it was 59, and in the mid-eighties it was 63.

With two-thirds of Britons officially overweight, and 30% classed as obese, Dr Jude Oben, a liver expert at the Royal Free Hospital and St. Thomas' Hospital in London says:

"Over-eating and being overweight are by far the most significant risk factors for liver diseases now."

Dr Oben, who helped found the charity Obesity Action Campaign, thinks non-alcoholic fatty liver, as the condition is known where the patient is not a drinker, should be re-labelled as obesity-induced liver disease.  However, the truth is that you don't need to be obese to suffer from non-alcoholic fatty liver.  Professor Pinzani warns that anyone with a BMI over 25 is at risk of developing fatty liver disease.  One strong indicator of the risk is your waist circumference because this can more accurately reflect how much fat is stored around your organs.  Measuring around your belly button, anything above 80cms for a woman and 94cms for a man is a cause for concern, says Dr. Oben.

Liver disease also has a strong link to cancer;

"A significant percentage of patients with cirrhosis will develop liver cancer," says Professor Pinzani.  This could be as many as 45 out of 100 patients.

However, there is another cause of cirrhosis which is also diet related and has nothing to do with being obese or alcohol.  Lots of people have too much iron in their body, and not many people know about it - even lots of doctors don't include it in standard blood tests.

Iron is essential to good health in the human body, but too much can have the opposite effect.  Hemochromatosis is more common in men than in women.  Women, during their fertile years, use up their iron reserves every month during menstruation.  Men obviously don't.  Women can develop hemochromatosis after menopause when their menstrual cycle has stopped.  The build up of iron in the body means that the protein Ferritin, stores the iron where it can, usually around the soft organs such as the liver, for future use.  However, depending on your diet and your lifestyle, you may not use up those stores and more is being constantly added.  These iron deposits can oxidize and cause damage to the liver and other organs.  Particularly, it can cause cirrhosis of the liver, you may have heard of a young man dying from cirrhosis at the age of 35 and how people comment that he "never drank".

I say this is diet related because lots of the foods we eat contain iron: red meat, egg yolks, green leafy vegetables such as spinach, broccoli,  sea food, iron enriched cereals, turkey giblets, chicken livers, dried fruits, etc.

The good news is that the problem is easy to detect.  The next time you go for a check-up and have a blood test, ask them to check your ferritin levels too.  If they are high, then you need to watch what you are eating, cut out as much iron as possible from your diet (only if you have high levels of ferritin), for a period of time and then get another test done to see if the ferritin level as come down.  If not, the easy solution is to donate blood once a month, that will kick start your body into using up it's deposits.

So, I encourage you - as always, to eat healthily, watch your weight, take regular exercise and get a yearly blood test, just to keep an eye on things.

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