It’s not just drink. Toast and pota­toes could cause liver dam­age

Re­searchers call for re­think over dis­ease that hits 20 per cent of us

Daily Mail - - Good Health - By JEROME BURNE

HOW much have you been drink­ing? was Dr David Unwin’s stan­dard ques­tion when a pa­tient’s tests showed their liver wasn’t func­tion­ing prop­erly. Your liver health can be mea­sured by a blood test for a pro­tein called gamma-glu­tamyl transpep­ti­dase (GGT) — if your lev­els are high, it sug­gests that your liver is un­der pres­sure and is usu­ally taken as a sign that you are drink­ing too much al­co­hol.

In­deed, Dr Unwin, a Gp from south­port, Mersey­side, ex­plains: ‘Like many other doc­tors, I used to as­sume pa­tients of­ten un­der­es­ti­mated the amount they drink and that al­co­hol was the main rea­son for a raised read­ing.’

But Dr Unwin doesn’t think like that any more. That’s be­cause some of his pa­tients have raised GGT lev­els, but drink very lit­tle or noth­ing at all.

In­stead their raised lev­els are due to non-al­co­holic fatty liver dis­ease, which is linked to diet. An es­ti­mated 20 per cent of Bri­tons have this con­di­tion — twice as many who have type 2 di­a­betes.

In some cases, it can progress to se­ri­ous liver dam­age and ul­ti­mately liver fail­ure. How­ever, it is not just a pre­cur­sor to liver prob­lems.

some ex­perts be­lieve it could also be a key warn­ing that the pa­tient is at higher risk of other con­di­tions such as heart dis­ease and di­a­betes.

The con­ven­tional wis­dom on non­al­co­holic fatty liver dis­ease is that eating too much is what’s caused the prob­lem, as ex­cess calo­ries are sim­ply stored as fat in the liver.

But some ex­perts, in­clud­ing Dr Unwin, be­lieve sugar and starchy food pose a par­tic­u­lar threat.

‘They cause a prob­lem be­cause they are rapidly turned into glu­cose and the body’s first port of call for stor­ing glu­cose is in the liver,’ he says.

What the liver can’t store is then stored as body fat.

The so­lu­tion, he says, is sim­ple: a low- car­bo­hy­drate diet. That means less glu­cose in the liver and so less fat.

And Dr Unwin has proven this the­ory in a study just pub­lished in the spe­cial­ist jour­nal Di­abesity in prac­tice. He se­lected 69 pa­tients in his prac­tice who had very high lev­els of GGT and put them on a low-carb diet for 13 months.

ES­SEN­TIALLY, they ate mainly green veg, lower-sugar fruit such as blue­ber­ries, nuts, fish, eggs and meat. The idea was to cut out all added sugar and re­duce starchy carbs, such as bread and pota­toes, while in­creas­ing the amount of healthy fats from olive oil or but­ter.

‘The re­sults were strik­ing,’ says Dr Unwin. ‘The first thing that hap­pened was their GGT read­ings dropped by an av­er­age 47 per cent. That makes sense be­cause the liver is the first des­ti­na­tion of new glu­cose sup­plies.’

Af­ter that came an im­prove­ment in other key health mark­ers — on av­er­age, blood sugar lev­els dropped by a re­mark­able ten points, about the same amount achieved by some di­a­betes drugs — the pa­tients’ weight fell by 11 lb, while the ra­tio of ‘good’ to ‘bad’ choles­terol went from 4.3 to 3.8, even though the pa­tients were all eating more fat.

The Bri­tish Liver Trust, which sup­ported the trial, de­scribed it as ‘ a very use­ful in­sight on how liver func­tion can im­prove’ and said it held out the hope that low-carb di­ets could help cut pre­ma­ture deaths from liver dis­ease.

But Dr Unwin’s way of look­ing at fatty liver dis­ease is at odds with the main­stream, es­pe­cially when it comes to eating fat.

The ad­vice from the NHs, for in­stance, is that a low-fat diet is the best way to pre­vent and treat fatty liver dis­ease.

And last week, re­searchers re­ported on the first pos­si­ble drug treat­ment for the con­di­tion.

Re­searchers at Birm­ing­ham Univer­sity had given a daily in­jec­tion of the di­a­betes drug li­raglu­tide to 14 pa­tients for three months — four out of ten lost their liver fat.

Their weight also dropped, they had less sign of liver dam­age and im­proved di­a­betic mark­ers.

‘ That’s in­ter­est­ing, but it’s hardly an ideal treat­ment,’ says Dr Unwin. ‘The drug needs to be in­jected daily and comes with the risk of nau­sea and di­ar­rhoea. It also costs the NHs £1,400 a year.’

But not only does he ar­gue that diet and cut­ting carbs hold the key to treat­ing non-al­co­holic fatty liver dis­ease, Dr Unwin and oth­ers say the con­di­tion is more im­por­tant than it is of­ten re­garded, with raised GGT act­ing like a ca­nary in a coal mine — an early warn­ing — that the glu­cose lev­els are up and the fat stores in the liver are bulging, with di­a­betes and heart dis­ease down the line. ‘Non-al­co­holic fatty liver is the third great epi­demic of mod­ern times, join­ing di­a­betes and obe­sity as ma­jor threats to health,’ says Dr Unwin.

‘And sugar and carbs look like the cul­prits. It’s tempt­ing to hope that hav­ing eaten our way into all three epi­demics, we can eat our way out again by cut­ting back on sugar and starch.’

Roy Tay­lor, a pro­fes­sor of medicine and me­tab­o­lism at the Univer­sity of New­cas­tle, has shown how blood tests for GGT can pick up signs of fatty liver years be­fore a pa­tient then goes on to de­velop di­a­betes.

As he has said: ‘Be­fore di­ag­no­sis of type 2 di­a­betes there is a long, silent scream from the liver.’ Non­al­co­holic fatty liver dis­ease also pushes up the heart dis­ease risk.

‘The long-run­ning Fram­ing­ham heart dis­ease trial found a high GGT in­creased car­dio­vas­cu­lar dis­ease risk by 65 per cent,’ says Dr Unwin. ‘Now it looks as if we have a way to bring it down.’

Alan Threlfall is one of the pa­tients who took part in Dr Unwin’s fatty liver trial. Aged 43 and weigh­ing 19 st — he is 5 ft 8 in — he’s had type 2 di­a­betes for more than 12 years and de­scribed his life as ‘hor­ren­dous’.

ALAN and his wife Katy have three young chil­dren, but he says he’s had no real life with them. ‘I was sleep­ing 18 hours a day. I was so tired ev­ery step was like walk­ing though wet con­crete,’ he says.

‘I’d run a mar­ket­ing busi­ness with Katy, but I had to stop that two years ago. I was ready to throw my­self off a build­ing.’

At the start of the trial, Alan’s GGT level was ex­tremely high at 223 — when the healthy range is from zero to 50 — and his blood sugar level was of­ten three times the nor­mal level.

Four months later, his GGT has dropped to 78 and his blood sugar lev­els had gone from 90 (a sign of out of con­trol di­a­betes) to 43.

He’s grad­u­ally com­ing off med­i­ca­tion, has lost 2 st and his weight is still drop­ping.

Alan de­scribes it as a mir­a­cle. ‘Within a week, I felt the fog of fa­tigue start to ebb away. Just be­ing able to play with the chil­dren is won­der­ful,’ he says.

Crit­ics have claimed that the dra­matic im­prove­ments re­ported by pa­tients such as Alan aren’t to do with cut­ting back on carbs, but are due to weight loss; the ex­tra fat in a low-carb diet makes you feel fuller, so you eat less.

But ‘ this doesn’t fit with what the trial found’, says Richard David Fein­man, a pro­fes­sor of cell bi­ol­ogy at the state Univer­sity of New York Downstate Med­i­cal Cen­ter in Brooklyn.

He co-au­thored the pa­per Dr Unwin wrote on his study and is an in­ter­na­tional ex­pert on car­bo­hy­drate me­tab­o­lism.

‘If the drop in GGT was a di­rect re­sult of weight loss, you would ex­pect to see the two drop­ping to­gether,’ he says. ‘But that isn’t what hap­pens.

‘In­stead the im­prove­ments in GGT come re­ally quickly, within a few weeks at the be­gin­ning, be­fore sig­nif­i­cant weight loss has even started.’

The chal­lenge, of course, with all di­ets is whether you can keep it up. But Dr Unwin is op­ti­mistic.

‘On the trial, they fol­lowed it for an av­er­age 13 months, but my wife and I, along with many of the pa­tients, have been on it now for nearly three years.

‘I’m 57 and have just run a 10km (six-mile) race in 52 min­utes as my body has adapted to us­ing fat, rather than carbs, for fuel.

‘It’s cer­tainly not the Atkins diet, which has too much pro­tein and not enough greens.

‘Feel­ing health­ier and hav­ing enough en­ergy to play with your grand­chil­dren is mo­ti­vat­ing. It feels like good medicine when peo­ple im­prove their lives through life­style changes and with­out tak­ing med­i­ca­tion.

‘so, surely this is worth some fur­ther in­ves­ti­ga­tion?’

Pic­ture: ALAMY

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