Nonalcoholics can and do develop serious liver diseases
Heavy drinking is a known cause of liver failure. But much of the increase in serious liver disease these days is found among those who rarely or never drink.
According to public information published online by the National Institute of Diabetes and Digestive and Kidney Diseases (part of the National Institutes of Health), a serious form of liver disease called nonalcoholic steatohepatitis (NASH) occurs in 2 percent to 5 percent of Americans — and these are people who drink little or no alcohol.
The effects resemble those caused by alcohol abuse — inflammation and scarring that can lead to liver failure.
“Most people with NASH feel well and are not aware that they have a liver problem,” the institute’s article says. “Nevertheless, NASH can be severe and can lead to cirrhosis, in which the liver is permanently damaged and scarred and no longer able to work properly.”
Having excess fat in the liver is even more common, but is it harmful?
“An additional 10 to 20 percent of Americans have fat in their liver, but no inflammation or liver damage, a condition called ‘fatty liver.’ Although having fat in the liver is not normal, by itself it probably causes little harm or permanent damage.
“If fat is suspected based on blood test results or scans of the liver, this problem is called nonalcoholic fatty liver disease (NAFLD). If a liver biopsy is performed in this case, it will show that some people have NASH while others have simple fatty liver.”
People who are overweight, obese, have sleep apnea or have Type 2 diabetes or any of several other conditions increase the risk of nonalcoholic fatty liver disease.
“Patients usually come to the clinic because their liver blood tests are elevated or fatty liver has shown up” on imaging scans, said Rohit Loomba, a professor at the University of California at San Diego School of Medicine who is an expert on the disease. Several possible causes of liver disease have to be ruled out before a diagnosis is made.
The liver is the body’s largest internal organ, about the size of a football and located in the upper right portion of the abdomen, above the stomach. It processes everything eaten or drunk, and it removes toxic substances from the body.
As obesity rises, so does the incidence of fatty liver disease, says Rohit Satoskar, medical director of liver transplantation at MedStar Georgetown University Hospital Transplant Institute.
About a fifth of those diagnosed will eventually develop the most serious, progressive form of the disease (nonalcoholic steatohepatitis), which can cause cirrhosis and liver failure and is now one of the leading reasons for liver transplantation. Loomba says there are approximately 6,000 liver transplants a year in this country, and as many as 2,000 of them are related to nonalcoholic fatty liver disease or a cirrhosis related to it.
People with this most severe form generally show few symptoms until very late in the disease’s progression, when fatigue, weakness, abdominal pain, weight loss, jaundice and mental confusion can appear.
IN THE FAMILY
Jay H. Hoofnagle, director of the liver disease research branch at the National Institute of Diabetes, Digestive and Kidney Diseases, believes that while obesity appears to be a risk factor, there is probably a genetic component that makes obesity more harmful to some people’s livers than to others. He said Asians, Hispanics and American Indians appear to be more prone to developing the more severe form of the disease, whites less so and blacks the least.
Washington resident Ben Goodman, 25, has a family history that suggests he is at risk for fatty liver disease. When he was a teenager, his father, who never drank alcohol, died of liver disease. His father’s father also died of liver disease. Goodman’s doctor advised him when he was 15 to get a liver biopsy despite his apparent good health. That biopsy showed elevated levels of liver enzymes, a condition that can precede disease.
Goodman, a former congressional staff member who works for the public policy advocacy organization Mission: Readiness, says he was shocked when he got the results and has been determined to stay as healthy as he can in an effort to keep the disease at bay.
The only therapies known to stave off or reverse liver damage caused by early-stage nonalcoholic fatty liver disease are weight loss, eating a healthful diet and getting exercise. Although the disease is not caused by alcohol consumption, drinking does stress the liver, and doctors often recommend that those with a fatty liver avoid alcohol, along with drugs that can stress the liver. It is also important to keep cholesterol and diabetes under control.
“We have to deal with the underlying problems, which are lack of physical exercise and poor eating habits,” Hoofnagle says.
SCREENING UNREALISTIC
Satoskar said the biggest problem is that the disease is “under-recognized, even among primary care doctors.” Yet screening the population isn’t realistic, he adds, because the only way to diagnose nonalcoholic steatohepatitis is with a liver biopsy. But a biopsy is an invasive procedure “and usually only considered if someone is at high risk,” as was the case with Goodman.
Goodman, who is 5-foot-6 and weighs 160 pounds, makes sure to exercise at least three times a week, stays away from fried foods and foods with too much sugar, and eats a lot of fruit, vegetables and lean meat. He has lost 30 pounds over the past three years. “It’s a constant battle to stay healthy,” he says. “But my father died at the age of 50. I just turned 25, and that weighs on me.”