By Dr C.S. FOO
Wednesday June 29, 2011
The liver is a workhorse of an organ that exceeds even the heart in terms of sheer workload. Unfortunately, with modern day lifestyles, it has become prone to becoming ‘fat’.
IN an exercise of gratitude, let us place our left hand just over the lower ribs, on the right chest wall, and whisper, “Thank you, liver ... for all the things you have done in the past, is doing in the present, and will do in the future ... and I will not abuse you again.”
This reddish brown triangular organ may not pulsate nor gyrate, but it works harder than the heart, carrying out more than 500 known functions, and perhaps thousands more yet to be discovered.
Some of the more important roles include handling the nourishment and garbage that comes in from the mouth, neutralising drugs, toxins and poisons, replenishing enzymes and hormones, producing bile for digestion, storing ready energy (glycogen) for any sudden need, ensuring we do not bleed to death, etc ... the list is exhaustive.
Architecturally intricate, the liver cells are arranged in compartments, with blood vessels and bile channels crisscrossing like flyovers and underpasses that can be a model for townplanning.
A diseased delicacy
The Spy Who Loved Me chased after the bad hats and birds in skirts in his heyday. Today, Sir Roger Moore is still chasing birds (of a different kind), and screaming “fowl” over the mistreatment of ducks and geese harvested for foie gras.
In a documentary, he narrated the story of the depths of cruelty that these animals endured in captivity, the graphic nature of which is beyond the scope of this discussion (google foie gras/PETA/Roger Moore ... bon appétit).
In the final stages of fattening the liver, the birds are caged tightly and forcefed via a long tube that is inserted into the oesophagus, where a ball of high-starch feed is pumped into the stomach. The liver gradually and painfully balloons up with fat, enlarging to many times its normal size. Eventually, it ends up on a plate, a gourmet offering that literally melts like butter on the palate. This expensive delicacy is biologically an abnormal and diseased organ, called fatty liver.
Some members of the homo sapien family do have some similarities to our incarcerated feathered cousins, with one or two exceptions. Although not caged, a sedentary lifestyle sets the stage for obesity. Food of high caloric value and in excess amounts finds its way down the gullet without much compulsion. Foie gras of the human liver has become a fashionable and popular addition to the menu of chronic diseases of modern man.
The popular trend of undergoing annual medical check-ups is undoubtedly a wise move. In the minds of most, the purpose is to seek out trouble that may need rectification. Obviously, if a pressing problem is found, urgent and decisive treatment is warranted.
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| Cruel delicacy: Foie gras is actually the diseased, fatty liver of a duck ... Foie gras of the human liver has become a fashionable and popular addition to the menu of chronic diseases of modern man. |
Cruel delicacy: Foie gras is actually the diseased, fatty liver of a duck ... Foie gras of the human liver has become a fashionable and popular addition to the menu of chronic diseases of modern man.
What if parameters like blood pressure, cholesterol, fats (triglyceride), blood sugar, etc, are only marginally above the upper limit (referred to as borderline)? What does one make of the instance of mildly elevated liver enzymes (AST, ALT and GGT)? What about that ultrasound report that is “normal”, except for the fine print that mentions a fatty liver?
Apart from a slight protuberance at the belly, there are no detectable signs or symptoms of the disease. Jokes abound about expanding waistlines, but this is no laughing matter as it is certainly a bag of trouble.
Interestingly, many a time, the medical report is forgotten, spawning complacency. Come the next and following years, the diligent process of “screening” is repeated, and the same findings are presented, with a sense of satisfaction that “everything is still ok”.
What is generally not appreciated is that the earlier medical test results that first implicated fatty liver is a harbinger of a family of chronic diseases like diabetes, hypertension, obesity, high cholesterol, heart disease, stroke and liver failure, if left unattended.
The fatty liver
One of the major functions of the liver is to process the oils that we imbibe. As an in-house refinery, it transforms the fats into useful components (yes, like cholesterol) to be distributed to various tissues in the body for usage or storage.
If the fat content in the liver exceeds 10% of its weight, then fatty liver takes centre stage. It is then not only a factory, but a warehouse for fats as well. Alcohol, by its injurious effects, causes fatty liver (alcoholic fatty liver disease), but many teetotalers also harbor a similar condition. Non-drinkers with butter livers are said to have “non-alcoholic fatty liver disease”, or NAFLD for short.
In our own backyard, we are facing an escalating weight problem, with the incidence of overweight (BMI 25 to 30) in adults doubling over the last 20 years (it now hovers around 30%). At this alarming rate, one can estimate the incidence of fatty liver to be at least one in 10 adults.
The root cause of NAFLD is overindulgence in the wrong kind of carbohydrates and fatty foods. Foods that spike the blood sugar (known as high glycaemic index items) are the kind of choices we make repeatedly on a daily basis, such as rice (especially Jasmine rice), white bread, potatoes, etc.
What goes up comes down even faster, as the blood sugar crashes. This is the result of an outpouring of insulin from the pancreas in a hurried attempt to normalise blood sugar.
However, due to a sedentary lifestyle, the blood sugar is not utilised and converts to fat, distributed to the middle (known as visceral or “hidden fat”). The fat cells in the tummy become so overfilled that excess literally drips out into the circulation to lodge at the next port of call, namely the liver.
Hence, fat begins to accumulate in the liver cells (steatosis), interfering with the many functions it has to perform.
Bashed by NASH
Of course, we can choose not to make a change to the recipe for better health. Sticking to the old ingredients is the perfect plan for undesired outcomes.
Fatty liver is relatively harmless in the early stages, but storing highly combustible material in the wrong place is hazardous over prolonged periods. The liver cells are not fat cells and are not meant to keep the excess fat. Forcing them to accumulate the fuel against their will eventually make them unhappy. They soon start a fire.
Fat in the right places can be burned for energy, but in a depot like the liver, the unstable fat stores undergo oxidation (peroxidation) and generate toxic chemicals that injure the surrounding tissues, setting up an inflammatory reaction.
The presence of fatty liver with inflammation is called NASH (non-alcoholic steatohepatitis). The blood test results are now not so okay, with the liver enzymes beginning to climb. The organ swells up, and now there might be a slight discomfort, over where the palm of gratitude was previously placed (refer to the opening sentence).
In the presence of repeated and prolonged inflammation, the liver structure loses its architecture, and normal tissue is replaced by fibrous strands. Eventually, the liver shrinks and hardens as cirrhosis sets in.
The organ is now unable to cope with all the demands placed on it, and begins to malfunction, a state known as liver failure. The outlook appears bleak, with a host of nasty complications waiting to explode.
Non-alcoholic fatty liver disease (NAFLD) is a spectrum ranging from mild fatty change to liver inflammation (NASH), eventually culminating into cirrhosis.
In the early and mild fatty liver stages, there is nothing much the medical caregiver can offer, except healthy lifestyle advice and good information. Throwing the switch for change is a personal choice. Unfortunately, many eventually contribute to statistics of modern disease because doing the right things can be difficult for some.
Although there are no specific medications, lifestyle change must be instituted so that early fatty liver can be reversed.
The ideal pattern of behaviour to ameliorate fatty liver involves a triad of:
> Exercise, at least 30 minutes daily.
> Select low glycaemic foods, keeping to good fats below 30% of caloric value.
> Supplementation based on scientific evidence (beware of poorly standardised herbal extracts and products with purity concerns, as these can potentially add to the toxic burden on the liver).
Taking smaller, frequent meals is better than large feasts as this places less demands on insulin, thereby avoiding large swings in sugar levels. Empty calories (eg carbonated beverages) and calorie-dense foods (eg muffins) just pile on the numbers, but do not contribute any significant nutritional value.
Choice of supplements should include broad spectrum antioxidants, vitamins and minerals. Glutathione is an important antioxidant enzyme (especially in liver cells), which require selenium, N-acetyl cysteine and other members of the antioxidant team to be replenished.
A bioflavanoid extracted from the seed of the milk thistle plant has shown promising results.
Alpha-lipoic acid works in concert with the other members of the antioxidant orchestra, enhancing the defences and recycling vitamin C, E, glutathione and co-enzyme Q10.
The danger of misreading information like this may spur the reader to trot off to the nearest pharmacy and fill up the shopping basket. The dosage, balance and ratios of nutrients must be safe and effective.
Seek advice from a nutritionally interested professional, rather than a DIY jigsaw puzzle.
Modern day livers are as stressed as the owners. The poor organ is working overtime, but we relentlessly choke it with processed foods, fake foods, drugs, alcohol, and what not. If ducks in the foie gras farm could talk, they would quack, “Stop the torture!”
http://thestar.com.my/health/story.asp?file=/2011/6/29/health/8962949&sec=health
