Another Medical Silent Killer

We hear about silent killers like hypertension (high blood pressure) and diabetes but there are others. This article is about one of which many people may not have heard.

First, lets consider the liver. It is the largest organ inside our body (the skin is the largest organ of the body). The liver has several very important functions:

*It produces bile that helps us digest the fats we eat,

*It helps to remove certain toxins (poisons) from our system,

*It helps make vital substances such as some blood clotting factors, and an important protein called albumin

*And the liver stores energy. This energy is stored as fat.

When thinking about problems of the liver, most people immediately think of alcohol. Indeed, this is not wrong because alcohol is a major cause of liver problems. In fact, regular heavy consumption of alcohol after 7-10 years can cause cirrhosis, which is the replacement of normal liver cells with scar tissue (this process is called fibrosis). Cirrhosis can lead to many severe complications and can lead to liver cancer (called Hepatocellular Carcinoma or HCC). In fact, 1/3 of people diagnosed with cirrhosis will develop HCC during their lifetime.

HCC is the most lethal cancer after pancreatic cancer. The rates of HCC have been increasing since 2007 but seem to be decreasing after 2018. It is three times more common in men than in women worldwide. In America, AUSA (Afrikans from the United States of America) are second only to Asia-Pacific Islanders in the rates of HCC. Tobacco is also a risk factor for the development of HCC (as well as cancers of the lung, esophagus, throat, bladder, kidney, pancreas, colon and rectum, larynx, cervix, mouth, stomach and certain types of leukemia).

Many people like to quibble about the type and amount of alcohol they drink by saying things like, “I only drink beer.” What they don’t realize is there is approximately the same amount of alcohol in a 12 oz. beer as there is in a 1½ oz. “shot” of 80 proof liquor, and a 7 oz. glass of 12% wine. There is even more alcohol in malt liquor and high proof wines.

Cirrhosis can also develop as a result of chronic infections with viruses, especially Hepatitis B and Hepatitis C. Many physicians recommend vaccination for Hepatitis B and treatment for those with Hepatitis C as protective.

With alcohol, even before cirrhosis develops, fat accumulates in the liver and a condition called fatty liver develops. This is the first stage in the development of severe liver disease. Interestingly, fatty liver caused by alcohol can reverse after two weeks of abstinence from alcohol. It is, however, important to realize that fatty liver is not only caused by alcohol but by other things. Those things are what this article will concentrate on.

There is a type of fatty liver called Non-Alcoholic Fatty Liver Disease (NAFLD) that occurs in people who do not drink alcohol and have not had Viral hepatitis. In fact, more than 25% of the American population has NAFLD and the incidence is increasing. It is common for ages 14 to 40 years old but very common after the age of 40 years. It is most common in Hispanics, followed by non-Hispanic whites. AUSA have the third highest incidence of NAFLD, but it is still a significant problem. Some studies suggest women are more susceptible than men, but the reasons for this are unknown.

One danger of NAFLD is it can progress to cirrhosis and all the problems cirrhosis can cause. What is most alarming to me is a significant number of people with NAFLD can progress to liver cancer (HCC) without developing cirrhosis.

As with many other illnesses, the best way to approach NAFLD is prevention. We know it is more common in people who have hypertension, obesity, heart disease, elevated cholesterol and triglycerides, and diabetes mellitus. People with those conditions should do everything they can to control these diseases. Frequently dietary modifications are necessary. Substances that should be avoided are alcohol (naturally), added sugar, fried foods, added salt, red meat and white bread, white rice and pasta. Many people who exist on the “soul food diet” would say that this list comprises “the good stuff” but as one of my older “roadies” used to say, what is good to you may not be good for you.

Unfortunately, there is no current treatment for NAFLD. A great deal of research is ongoing to find a treatment but at present, nothing takes the place of weight loss (if you are overweight), eating right and avoiding alcohol. Some studies suggest Vitamin E at 800 Units daily might help, but not completely.

My mother died from liver cancer (HCC) and never used tobacco or drank alcohol. She was never diagnosed with viral Hepatitis. She did love her fried foods and really liked the fatty part of steaks and chops. She was very much overweight and was diabetic. She died before we had access to all this information about fatty liver. Now that we know, there is no excuse.

She used to say, “A hint to the wise is sufficient.” This article is very personal for me. As one of my teachers used to say, “Govern yourselves accordingly.” Food for thought.