Are we creating the next generation of transplant recipients?
Should we be so surprised at the epidemic of childhood and adolescent we are now facing? Were we unable to see that a diet consisting of hydrogenated and processed fats, fried foods and super-starches would not come back to haunt us? With childhood obesity already a pervasive problem we are learning about the related complications and diseases that this extreme condition is exacerbating in our children. At first the weight gain was a disturbing footnote in our modern world. But then we were introduced to childhood diabetes, heart conditions, and sky high cholesterol numbers. While serious in their impacts to a growing bodies health, their occurrence may take a back seat to what could be the greatest problem to encounter the collective declining health of our children. This emerging medical issue is known as Fatty Liver Syndrome.
What is Fatty Liver Syndrome?
Simply put conditions known as Fatty Liver Syndrome arise when the body’s liver starts accumulating fat. According to the Liver Society the statistical population numbers for Fatty Liver Syndrome are 10-20 percent. While the accumulation of fat in the liver is not normal, it in and of itself is not currently known to be harmful or cause permanent damage. One of the livers functions is producing a form of fat known as triglycerides. These are important for new cell production and are necessary to produce hormones such as estrogen, testosterone, and adrenal hormones. In the liver of a patient with Fatty Liver Syndrome, the liver cells accumulate large droplets of fat that consist of mostly triglycerides. In normal liver operation, fat from the diet is metabolized by the liver and other tissues. If the amount of fat exceeds the body's requirement, large fat accumulations may develop in the liver, which results in an increase in liver enzymes and inflammation. This inflammation can cause scarring and hardening of the liver (cirrhosis) and results in decreased liver function.
The types of Fatty Liver Syndrome
The disease popularly known as Fatty Liver Syndrome includes a range of liver conditions. There are listed here in the order of severity.
- Fatty Liver (steatosis). The most common condition. Fatty Liver Syndrome is the accumulation of fat in the liver cells. This condition typically does not result in damage to the liver and is not associated with other liver abnormalities. The scarring or inflammation of the liver typically is not present. Of the three conditions this one is asymptomatic with most patients unaware of their condition.
- Nonalcoholic steatohepatitis (NASH). The most common form of nonalcoholic fatty liver disease. Patients who have NASH typically have an inflammation of the liver as a result of its accumulation of fat. At this point the liver may not have scarring present. If left untreated NASH may lead to cirrhosis. According to the Liver Society NASH affects 2 to 5 percent of Americans
- Cirrhosis. Cirrhosis is the result of an inflammation left untreated for years. The danger occurs if it may progresses into cirrhosis of the liver. At this point the liver will more than likely have scar tissue. A liver with Cirrhosis encounters progressive and irreversible liver damage.
What causes it?
As with many liver ailments the most common cause of fatty liver syndrome is alcohol abuse. But this may soon be eclipsed by its non-alcoholic variety, steatohepatitus (NASH) In all varieties of steatohepatitis the condition is brought on or aggravated by malnutrition, obesity, diabetes mellitus, Hepatitis C virus, Wilson's disease, hyperlipidemia or endocrine disorders, and Reye's syndrome in children. There is also a rare, but serious, form of fatty liver that begins late in pregnancy which has the possibility of leading to jaundice and liver failure. In the real of non-dietary causes, Fatty Liver Syndrome may be caused by certain drug overdoses or chemical poisonings. Some of the medications and substances that can cause fatty liver include amiodarone, methotrexate, high doses of vitamin A, tetracycline, cortisone, phosphorus, prednisone and carbon tetrachloride. Carbon tetrachloride is one of the chemicals that can injure the liver in a way that makes the liver cells accumulate fat.
This sounds so familiar, where have I heard this before?
Even for those of you that are hearing about this for the first time the subject of the liver and fat seems oddly familiar. Ever hear of foie gras? That’s French right? Yes, Martha it’s French all right, French for fatty liver! (For those of you doubters translate the words “fatty liver” via the Google Translate tool into French and see what you get.) Even the beer&BBQ types know that to make foie gras you funnel a large amount of fat down some French goose’s throat! The liver grows twice the size of normal and before the goose becomes a patient in the French healthcare system he is boxed up by some French Pate house. For those of you who have connected the dots, we are basically turning ourselves in to human pate. The “fatting up” process is something of our own design and own freewill. We trade cages for lazyboys, and the quacking for the bleeps of videogames.
Most people are familiar with cirrhosis of the liver, and typically attribute this disorder to the long term effects of alcohol. The heavy use of alcohol leads to fatty liver and inflammation called alcoholic hepatitis, but known to the majority of the population as cirrhosis of the liver.
Symptoms of NASH or Fatty Liver
Most individuals diagnosed with these conditions previously exhibited little if any symptoms or complaints. Some individuals do experience symptoms and here is a brief list:
Jaundice, right-side abdominal pain, abdominal swelling, and fever overall itchiness, and small yellow skin nodules.
How is it diagnosed?
Fatty Liver Syndrome and NASH are usually detected as the result laboratory tests yielding abnormal data. In a majority of the situations the lab work was being performed for unrelated issues. In other cases the liver is tender upon examination and is found to be enlarged. The typical results from laboratory tests include the elevation of liver enzymes. These enzymes are typical AST and ALT. If your results are severe enough to warrant testing your doctor my recommend an ultrasound. Other imaging methods include magnetic resonance imaging (MRI) and/or a computerized tomography (CT) scan. Ultimately it is a physical examination (if needed) that confirms the condition of Fatty Liver Syndrome or NASH. This examination is consists of a microscopic examination of a sample of liver tissue (biopsy).
How is it treated?
As of this moment treatment for fatty liver syndrome consists of eliminating or treating the cause of the condition. It is believed that most cases of fatty liver syndrome are reversible. As with many curable diseases and disorders fatty liver syndrome is reversible if caught early in its development stages. Regardless of the background cause it should be the goal of the patient to develop a healthy diet. Since there are no miracle drugs associated with NASH or Fatty Liver Syndrome, people are looking to vitamin and mineral supplements as components in healing. If left untreated, NASH and Fatty Liver Syndrome can result in severe liver damage. In cases like these, the patient may eventually require the extreme measure of a liver transplant.
How can Fatty Liver Syndrome be avoided?
To avoid fatty liver adopt and follow these guidelines:
Follow a low-fat and low-cholesterol diet
Exercise regularly to maintain an ideal weight
Establish a regimen to insure your body is receiving the necessary and essential vitamins and minerals
Review medications to ensure that they aren't toxic to your liver
Have blood sugar, cholesterol and triglyceride levels checked regularly
Nutritional causes are treated by impacting the availability of fat and modifying how it enters the liver. As many nutritional causes tend to be rooted in diet deficiencies this can be accomplished by providing available carbohydrates or by adding protein to overcome complete or large deficiencies. ( See South Beach Diet)
Proteins are used to make lipoproteins to carry cholesterol and fats. (Also see South Beach Diet) Doses of L-carnitine, Lecithin, Zinc, and Choline are also increasingly being recommended for patients.
Vitamins, Herbs, and Minerals
There are many well known and traditional vitamins, herbs, and minerals that may help the body deal with liver issues. The following is a list of items that are increasingly being studied in regards to fatty liver syndrome. Always talk with your doctor regarding your supplement and vitamin intakes.
Choline - Choline is an essential nutrient that is found in foods, principally in the form of phosphatidylcholine but also as free choline. An association between a low-choline diet and fatty infiltration of the liver in rats has been documented for quite some time. Choline is a lipotrope, which is a substance that prevents deposition of fat in the liver.
Inositol - Inositol is primarily used in the treatment of liver problems. It also aids in the breakdown of fats and helps in the reduction of blood cholesterol. It is necessary for the formation of lecithin and functions closely with Choline, folacin, Vitamins B-6 & B-12, betaine, and methionine to prevent the accumulation of fats in the liver.
Lecithin - Lecithin is largely composed of choline, plus linoleic acid and inositol. It acts as an emulsifying agent, enabling fats and other lipids to be dispersed in water.
L-carnitine - L-Carnitine is a water-soluble, B-vitamin-like nutrient that the body uses to turn fat into energy.
Milk Thistle (Silymarin) -Composed of three flavonoids: primarily Silybin and minor amounts of Silydianin and Silychristin, which support liver function by raising protective glutathione levels. Milk Thistle is one of the more well known herbs to benefit the liver.
SAMe - It has been suggested that SAMe acts as an "intracellular control switch" which regulates hepatic cellular regeneration, differentiation, protects against oxidative stress, and hepatotoxin exposure. (1) Lowered SAMe levels are suspected to lead to steatosis and steatohepatitis. (2)
Zinc - Zinc is necessary for the metabolism of selenium. Both selenium and zinc found to be reduced in patients with Hepatitis C.
Household chemicals and Fatty Liver
If you have been diagnosed with Fatty Liver syndrome it is extremely important that you limit exposure to everyday chemicals that are already noted for their toxicity to the liver. It is important to use gloves or adequate protection when utilizing these chemicals in order to limit absorption. The following is a brief list of household chemicals that you should exercise care around:
Chlorinated aliphatic and aromatic hydrocarbons
Found in: Paint Thinner
Can cause liver and kidney damage.
Naphthalene Also Known As: 1-methylnapthalene, and 2-methylnapthalene
May be Found in: Mothballs, Moth Flakes, Toilet Bowl Cleaners, Deodorant Blocks for toilets and diaper pails
Para-Dichlorobenzene also known as: para-DCB, p-DCB, 1,4-Dichlorobenzene
Para-Dichlorobenzene is a probable carcinogen that can also harm the central nervous system, liver and kidneys.
Also Known As: tetrachloroethylene, tetrachloroethane, 1-1-1 trichloroethane solvents, PCE
Found in: Dry Cleaning Fluid, Spot Removers, and Carpet Cleaners
Can cause liver and kidney damage if ingested. Can accumulate and persist in human fatty tissues and breast milk.
Phenol and cresol
Found in: Disinfectants
May cause diarrhea, fainting, dizziness, and kidney and liver damage
Also Known As: methylbenzene
Found in: Adhesives, Nail Polish, Cosmetics, Rubber Cement, Paints, Paint Thinners, Lacquers, Stain Removers, Dyes and Inks.
toluene in highly toxic, may cause skin, kidney, liver, central nervous system damage; may damage reproductive system.
(1) Matt JM, Corrales FJ, Lu SC, Avila MA. S-adenosylmethionine: a control switch that regulates liver function. FASEB J 2002; 16:15-26.
(2) Rozenthal P, Biava C, Spencer H, et al. Liver morphology and function tests in obesity and during total starvation. Am J Dig Dis 1967; 12:198-208.