By Paula Goodyer
How do you get people to care about a disease with no symptoms? That’s the challenge for doctors worried about the silent march of non-alcoholic fatty liver disease which, at its nastiest, can lead to liver cancer and liver failure – often with little warning.
Your liver’s worst enemies used to be too many drinks or infection by hepatitis B or C. Now that honour goes to belly fat which in turn can cause fat to build up in liver cells, increasing the risk of serious liver damage.
“By 2020 more people will have liver cirrhosis caused by non-alcoholic fatty liver disease than with hepatitis C and hepatitis B combined,” says Dr Alex Hodge, a consultant gastroenterologist with Melbourne’s Monash Medical Centre and Monash University. “The disease is a spectrum – at one end there’s a bit of fat accumulating in your liver cells but at the other is scarring of the liver – cirrhosis – which can change the liver’s structure, causing irreversible damage.”
Unless we can turn the tide, over seven million Australians will have non-alcoholic fatty liver disease by 2030 and around five per cent of them will have developed cirrhosis, according to the Gastroenterological Society of Australia.
“That’s 400,000 people with liver cirrhosis that could be avoided,” says Hodge, who’ll be raising awareness of NAFLD at the International Conference of Lifestyle Medicine this coming weekend.
“People with non-alcoholic fatty liver disease – now almost one in three adult Australians – also have a threefold risk of type 2 diabetes and double the risk of heart disease,” he says.
How can something so potentially scary not grab our attention?
Because it’s invisible – there may be no symptoms until it’s advanced and no simple test that can spot the early signs.
“Although ultrasound can detect fatty liver, it can miss up to 40 per cent of cases. Conventional ultrasound is also poor at detecting scarring on the liver,” he explains. A more accurate scan called FibroScan can detect fatty liver and scarring but it’s not available in all areas and there’s no Medicare rebate. ”
There’s no Australia-wide health campaign warning about the disease either. However, Western Australia’s Live Lighter campaign struck a blow earlier this year with a graphic TV ad showing the ‘toxic’ abdominal fat that lurks behind a bulging waistline and linking it to fatty liver disease. It was a move prompted partly by concerns from liver specialists about NAFLD’s potential to become a major problem, says Steve Pratt, the nutrition and physical activity manager for the Live Lighter campaign.
With no pill to stop fatty liver in its tracks, losing weight around the middle and eating healthier food is the only way to reverse or reduce it, says Hodge.
“Too many refined carbohydrates and sugars in the diet are helping drive non-alcoholic fatty liver disease – they can be converted to fat in the liver and induce inflammation and insulin resistance, which is the precursor to diabetes. We live in a society driven by the dollar – we need to make it easier and more affordable to buy healthier food and harder to buy junk food.
“People also need to understand the implications of non-alcoholic fatty liver disease and recognise that our lifestyles have consequences. If we can stave off fatty liver disease not only will our livers thank us, but we also reduce the risk of developing diabetes and heart disease.”
Hodge’s own research last year found evidence that fasting might improve fatty liver disease. A study of patients at Monash Medical Centre found that restricting eating (but not kilojoules) to just an eight-hour period between noon and 8pm improved markers of fatty liver disease and reduced abdominal fat.
What is it about fasting that might do the liver some good?
“It might have something to do with reducing the amount of snacking throughout the day. Eating causes us to release inflammatory chemicals into the blood stream so it may be that grazing causes low-grade inflammation – or it may be that when people snack they often eat refined carbohydrates,” he says.