To Your Good Health
DEAR DR. ROACH: My doctor said that an ultrasound and blood tests show that I have fatty liver. I drink wine and a beer occasionally. What is fatty liver? How did I get it, and what can I do about it? — E.M.
ANSWER: Fatty liver is a catchall term for abnormal fat depositions in the liver. These can come about in people with heavy alcohol use: Only about 1% of people who have two to four drinks per day will develop alcoholic fatty liver disease, but 6% of those who have eight drinks per day will.
For nondrinkers, or people who drink only occasionally, the major risks are older age, diabetes, being male and being overweight or obese, especially when the weight is predominantly around the abdomen. Nonalcoholic fatty liver disease is extremely prevalent in the United States: 10% to 46% of people have it. It is now among the leading causes of cirrhosis in the U.S.
The major treatments for nonalcoholic fatty liver disease are lifestyle changes. Alcohol abstinence is recommended, even modest alcohol use like you. If you are overweight, weight loss is the primary treatment. One authority recommends a goal of 5% to 7% of body weight (so, 10-14 pounds if you weigh 200 pounds, for example). Regular physical activity was found to reduce overall mortality rates in people with NAFLD as well, independent of the effect on body weight.
Because viral hepatitis can be much more severe in a person with fatty liver, you should be sure you are immune to hepatitis A and hepatitis B (your doctor can do blood tests to be certain, and can give the appropriate vaccines if you are not immune). If you have diabetes, careful control of diabetes is essential. Because people with NAFLD are at increased risk of heart disease, other risk factors, especially blood pressure and cholesterol levels, should be more aggressively treated, including with medication therapy if lifestyle changes are not enough.
DEAR DR. ROACH: This is a general question about vaccine reactions. My husband and I both recently had influenza vaccines and shingles second vaccine. Neither of us had a reaction other than a red spot where the injections were done. Does this mean that they weren’t effective? We’re both over 75 and wonder how strong our immune systems are. Should there have been some reaction? — J.D.
ANSWER: Both the flu vaccine and the shingles vaccine are effective at reducing risk of developing their respective diseases, although neither of them is perfect. Last year, the flu vaccine was about 45% effective overall, while Shingrix (the new two-shot vaccine) has greater than 90% effectiveness in protecting against shingles, even in people in their 70s.
A vaccine reaction within the first 24 hours often relates to the body’s response to the preservatives and stabilizers in the vaccine. A lack of reaction to the vaccine does not mean that your body isn’t responding to the key portion of the vaccine, the part that gives immunity to the virus. You should still be protected.