Q: I saw my GP recently because for a couple of months I’d had discomfort in my right side under my rib cage. I wondered if it was my gall bladder – particularly because I carry weight around my middle. An ultrasound scan showed that my gall bladder is normal, but I have slightly raised liver enzymes and a ‘fatty liver’. My doctor didn’t seem too concerned about this, but when asked how much alcohol I drink (a couple of glasses a week) he was surprised that it wasn’t more. Should I be concerned?
Having a fatty liver is exactly what it sounds like: too much fat infiltrating your liver. If this is allowed to continue it can become serious. Until recently most cases were actually caused by heavy drinking, which is why your GP would have seemed surprised that you don’t drink more.
Previously, when a scan showed a fatty liver I used to have conversations along the lines of, ‘So are you really only drinking one or two glasses of wine at the weekend?’ We are used to patients under-reporting alcohol consumption, but it turns out that our scepticism may be unfair because alcohol is no longer the commonest cause for liver damage. It’s more likely to be poor diet that has fed the surge in damage to this poor organ. Storing excess fat around the tummy, where it wraps around and infiltrates important organs such as the liver and pancreas, causes inflammation and a rise in liver enzymes. This may be the cause of your discomfort.
Given that you are not a big drinker, you may have an early stage of a condition called non-alcoholic fatty liver disease (NAFLD). If this persists, the liver can become scarred and damaged. NAFLD has even overtaken alcoholic liver disease as one of the most common causes for liver transplant.
But don’t despair. Although there is little evidence for effective medication, we know that by changing to a low-carbohydrate, Mediterranean-style diet, cutting calories (for some people reducing alcohol) and making lifestyle changes, you can reverse the damage, draining away the excess fat. The liver should recover fully, allowing enzymes to revert to normal. What’s even more encouraging is that by doing this you also reduce your chance of getting diabetes, cardiovascular disease, high blood pressure and kidney disease.
Most people who have NAFLD are not aware of it, but one of the best, and incredibly easy, tests is to measure your waist circumference. Do this with a tape by measuring all the way around your middle, level with your belly button. Your waist measurement should be less than half your height. If your liver continues to show signs of inflammation, your GP may refer you to a gastroenterologist for tests such as ultrasound elastography or even a liver biopsy. In the meantime, you might want to lose those excess inches – and rid the liver of that troublesome fat.
The magic mineral our bodies love
It’s zinc: used by up to 300 enzymes, affecting everything from immune function to wound healing, cell growth and digestion to inflammation and blood sugars. We need to consume small amounts daily, though, as it can’t be stored.
It’s best to get your daily quota through zinc-rich foods, including red meat, poultry, fish, as well as beans, wheatgerm, legumes, nuts, seeds and wholegrains. Vegetarians may be at higher risk of deficiency.
Pharmacist and nutritional therapist Richa Puri (ifm.org) advises speaking to a GP first. ‘Zinc acetate or gluconate taken for a few days may reduce the length of colds. I tend to take a zinc supplement at this time of year. Zinc of up to 15mg can be taken daily. Higher doses may be needed for conditions such as diarrhoea, acne and age-related vision loss, though may have side effects. Avoid taking alongside medications such as diuretics and certain antibiotics.’
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