Thursday, September 5, 2013

Potential complications from obesity and type 2 diabetes: Liver Cirrhosis and Liver Cancer

Until recently, hepatocellular carcinoma, a primary malignancy of the liver, was a very rare cancer in North America and most developed countries. However, the recent escalation in the number of overweight, obese and type 2 diabetic individuals has contributed to a corresponding rise in cases of liver cirrhosis and related hepatocellular carcinoma cases.

Being overweight, obese and/or developing type 2 diabetes promotes the deposition of fat into liver cells, primarily due to high circulating insulin levels. As liver cells fill up with fat (triglycerides) it leads to fatty liver degeneration, which later involves inflammation. This condition is known as NASH (non-alcoholic steatohepatitis). As NASH progresses, liver tissue often degenerates into cirrhosis (an irreversible liver condition), whereby liver cells are no longer able to function normally.

With cirrhosis, a host of signs and symptoms occur due to malfunctioning of liver cells, some of which include failure of the liver, swelling of the legs (edema), accumulation of fluid in the abdomen (ascites), bleeding from veins in the esophagus (varices) and mental confusion (hepatic encephalopathy). Cirrhosis also increases the chances that hepatocellular carcinoma will develop. Thus, hepatocellular carcinoma is on the increase in our society, directly as a result of overweight, obese and type 2 diabetes problems.

It should be noted that heavy chronic alcohol consumption can also cause fatty liver problems with associated liver inflammation (steatohepatitis), which resembles NASH upon blood lab investigation, imaging and biopsy findings.

Non-alcoholic fatty liver disease is currently the most common liver disease in the U.S. and worldwide, affecting an estimated 10-24 percent of the global population. In the U.S., the Centers for Disease Control and Prevention reports that currently, approximately one-half of the U.S. adult population is overweight (BMI >25) and one quarter of the U.S. adult population is obese (BMI >30). That means upwards of 29 million Americans have non-alcoholic fatty liver disease, 6.4 million of whom have non-alcoholic steatohepatitis (NASH). Even more alarming than these statistics is the fact that non-alcoholic fatty liver disease is occurring among children in the U.S.

How do we know if a person's overweight problem, obesity status, or type 2 diabetes condition is causing fatty liver changes? The first evidence is a slight rise in serum liver enzymes, especially ALT and AST. Thus, it is a good idea to get these tests done. This also applies to children if they are overweight.

In the early stages, one of the solution is to start eating a low saturated fat / cholesterol / trans fat diet, which should also exclude deep-fried and pan-fried foods. A lower glycemic diet is also helpful, as is the inclusion of regular endurance exercise, all of which pave the way to weight loss, improved blood sugar regulation and lower circulating insulin levels, even in type 2 diabetics. Applying these simple lifestyle modifications often reduces ALT and AST into the normal range within 3-6 months as body fat declines.

In many cases, the family doctor does not emphasize sufficiently the importance of lifestyle changes to help the patient decrease their risk of premature morbidity and mortality associated with NASH. As we know, being diagnosed with hepatocellular carcinoma or even cirrhosis, for that matter, is no walk in the park. Hepatocellular carcinoma is a cancer that is highly preventable. It is a lifestyle-based cancer in our modern society, and thus we should consider overweight problems as a serious health concern.

Apart from lifestyle changes, we can also go for alternative medicines such as Kamalahar if we have already developed fatty liver disease.


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