The normal adult liver weighs about 1.5 Kg and performs important functions like digestion, getting rid of ingested toxic substances synthesis of several important proteins including clotting factors seen in the blood.
Liver diseases could be acute or chronic. Acute hepatitis is commonly due to viruses or toxic drugs while chronic liver disease is usually due to viruses, alcohol or obesity. Hepatitis A and E viruses are transmitted by ingestion of contaminated food material while Hepatitis B and C viruses are transmitted sexually, by intravenous drug abuse or by transfusion of infected blood products. Alcohol is the most common cause of chronic liver disease. Also, it is estimated that 1 in 5 Indians suffer from Fatty Liver that may lead to significant liver disease. The prevalence of Fatty Liver is much higher in individuals with Metabolic Syndrome (Central Obesity, Diabetes Mellitus, Hypertension, increased Triglycerides and low HDL cholesterol). The prevalence of Hepatitis B and Hepatitis C, both of which lead to chronic liver disease is 4% and 1.5% respectively. According to WHO, over 200,000 individuals die of liver disease every year in India, making it the 10th leading cause of death.
Obesity in India has reached epidemic proportions. Internationally, a BMI of over 25 kg/m2is considered overweight but due to genetic tendency of Indians towards Obesity, Diabetes and Heart disease, Ministry of Health & Family Welfare along with the Indian Council of Medical Research brought out guidelines in 2012 stating that normal BMI is 18-22.9 kg/m2, Overweight 23-24.9 kg/m2and Obesity more than 25 kg/m2. The recommended calorie intake for an individual is determined by age, sex, height, weight, activity level but a baseline intake of 1200 K Cal for females and 2000 K Cal for males is recommended. A balanced diet comprises of 40% carbs, 30% fats and 30% proteins but most individuals these days prefer to have higher protein and lower fat intake. A healthy carbohydrate diet is rich in fiber (cereals and whole wheat bread, multi-grain or bran-mixed wheat flour) and low in starch (rice, potatoes) and sugar. Honey has half the calories one gets from sugar. Artificially sweetened foods like canned juice and soft drinks are rich in fructose and should be avoided. While every cell in the body can use glucose, liver is the only organ that can metabolize fructose in significant amounts. A diet rich in calories, fast food and fructose promotes development of fatty liver.
One should exercise for a minimum of 150 minutes in a week i.e. for 30 minutes 5 days a week. The routine should ideally include 4 types of exercises. Aerobics involves brisk walking, running or cycling with an aim to achieve and maintain 70% of the Target Heart Rate (220 minus age for males and 216 minus age for females). Interval training involving short bursts of jogging in the midst of a brisk walk leads to more efficient burning of fat. A set of strength training followed by exercise for the 29 core muscles in the back, abdomen and pelvis completes the package. At the end of the day though, it is good to remember that any exercise is better than no exercise. A regular work out helps in maintaining ideal weight and prevents development of fatty liver.
Consumption of more than 21 small drinks a week in males and 14 small drinks in a week in females increases the chances of developing liver disease. Accordingly, one should not exceed 2 drinks a day in men and 1 drink a day in women and it is good to have two days off in a week to allow the liver to regenerate. Once fatty liver has developed it makes sense to avoid alcohol completely. Similarly it is important to abstain from alcohol for 6 months after acute viral hepatitis to allow for complete recovery.
Numerous studies have suggested that consumption of 3 or more cups of coffee daily reduces the risk and severity of liver damage due to alcohol, Hepatitis B, Hepatitis C and non-alcoholic fatty liver disease and also lowers the risk of developing liver cancer. The mechanism is not clear but caffeine, cafestol and kahweol in coffee have anti-oxidant and hepato-protective effects.
Herbal and dietary supplements for bodybuilding and weight loss are responsible for 20% of drug induced liver injury. While protein supplements are safe it is important to check the label carefully for two common threats to the liver, viz., anabolic steroids in bodybuilding supplements and green tea extract in many weight-loss supplements.
In the absence of robust scientific data these medicines are best avoided. Unlabeled Ayurvedic medicines tend to have high levels of heavy metals and several patients with Lead poisoning have been reported from India. The only study on a common brand claiming 52 herbs was discontinued as the patients had a worse outcome on the pill as compared to the controls.
No vaccine is available for Hepatitis C and Hepatitis E. Two doses of Hepatitis A vaccine six months apart are recommended for all children above 1 year of age. By the age of 10 years 95% of our children test positive for antibody to Hepatitis A, reflecting the poor state of hygiene in the country and obviating the need for vaccination in adults. However, adults desirous of taking the vaccine may do so if negative for the antibody. The efficacy of Hepatitis A vaccine is close to 100 percent and no booster dose is required. For Hepatitis B, three doses of vaccine are recommended at 0,1 and 6 months. Adults who opt for the vaccine should do so only after testing negative for HBsAg.
Annual health checks should include a clinical examination, liver function blood test and ultrasound of abdomen. Fibroscan is a relatively new non-invasive way to study the liver. As the liver gets increasingly damaged, the stiffness increases. By directing sheer waves through the liver with an ultrasound-like probe, the liver stiffness can be determined from the velocity of wave transmission. Fibroscan is a sort of virtual liver biopsy and is recommended for individuals who have raised liver enzymes in the liver function tests and in patients with obesity, fatty liver on ultrasound, alcohol intake or those at risk of developing chronic liver disease due to conditions like Hepatitis B or Hepatitis C. One should opt for the newer versions of fibroscan with CAP (Controlled Attenuation Parameter) facility that can also quantify the fat content in liver.