ASK THE DOCTOR: Yes, teetotallers can develop liver disease

By
Dr Martin Scurr

UPDATED:

00:48 GMT, 13 March 2012

After a recent blood test my doctor told me I had a fatty liver, but
gave little explanation. I would like to know how this came about, as I
don’t drink, smoke or eat fatty food. Can you help I am 75.

Mrs E. Goatcher, Sunbury, Surrey.

First, let me reassure you that your condition is very common —
affecting up to one-in-five adults, mostly between the ages of 40 and
60. The official term for your diagnosis is non-alcoholic fatty liver
disease, which, as the name suggests, occurs in people who drink little
or no alcohol.

This is the most common liver disorder in Western society and, in most
cases, produces no symptoms. It is caused by a build up of
trigylcerides, a type of fat, in the liver. Patients with the condition often also suffer from obesity and type-2 diabetes, but this is not always the case.

Dr Martin Scurr says as the name suggests non-alcoholic fatty liver disease occurs in people who drink little or no alcohol

Dr Martin Scurr says as the name suggests non-alcoholic fatty liver disease occurs in people who drink little or no alcohol

There is a genetic link and evidence suggests the underlying problem is
insulin resistance — this means your body has problems metabolising
glucose, the main type of sugar in the body. However, a fatty liver doesn’t pose problems unless it progresses to
non-alcoholic steatohepatosis (NASH). This is where fat builds up in the
liver, causing inflammation and scarring.

While it’s not clear what actually triggers this next stage, excess weight certainly increases the risk. Symptoms include fatigue and right-sided abdominal pain (the liver sits at the back of the abdomen, on the right).

If it’s left untreated, over time, NASH can lead to liver cirrhosis — a
more chronic scarring of the liver that affects the function of the
organ and can be life-threatening.

CONTACT DR SCURR

To
contact Dr Scurr with a health query, write to him at Good Health,
Daily Mail, 2 Derry Street, London W8 5TT or email
[email protected] – including contact details.

Dr Scurr cannot enter into personal correspondence.

His replies cannot apply to individual cases and should be taken in a general context.

Always consult your own GP with any health worries.

But all this is two steps ahead of the condition you have, and my
feeling is that, at the age of 75, you can be reassured and forget all
about this diagnosis — there should be no significant complications and
it will not shorten your life.

The only exception would be if someone with a fatty liver has diabetes
or is obese, as these might be the factors that cause progression to
NASH. You mention that you don’t eat fatty foods — in fact, this is not what
makes a liver fatty; sugar is the main culprit.

The sugar in food and
drinks is converted into fat and stored in the liver, which means
anything with added sugar or added fructose (the fruit sugar piled into
fruit juice) is a particular villain.

Note that I am not advising you to avoid eating fruit, just avoid
cartons of fruit juice. But, aside from this, please continue as you
were, and think no more of this condition.

In the past nine months, I have seen a GP nine times with chest
infections and been prescribed antibiotics. I have asked to be referred
to a specialist and been refused, on the basis of ‘guidelines for COPD’.
Who sets these guidelines Can I get round them

Mrs Winifred Curry, Withernsea, East Yorkshire.

I understand your frustration: the implication of your letter is that
your GP has diagnosed COPD (chronic obstructive pulmonary disease) as
the cause of your recurrent chest infections, but you need to know if
the diagnosis is correct. Good communication, so you can trust what you are being told, is vital
here, but this is very difficult to achieve in the ten minutes available
for GP consultations.

First,
let’s look at the possible causes of your chest infections. Certainly
COPD is one possibility — around 900,000 people in the UK have
this and it’s caused by damage and inflammation to the airways, which
restrict the flow of air into and out of the lungs. The diagnosis should be considered in anyone over the age of 35 who has a
risk factor such as smoking, and who suffers from breathlessness on
exertion, cough, and frequent bouts of infection.

The first technique for diagnosing COPD is a spirometry — where the patient blows into a device that records lung function. But to be certain there are no abnormalities in the lungs, which might
account for the infections, patients should undergo a chest X-ray, too.
It’s also worth having a blood test to check for anaemia, as this could
be a cause for the breathlessness and recurrent infections.

COPD (chronic obstructive pulmonary disease) is caused by damage and inflammation to the airways, which restrict the flow of air into and out of the lungs

COPD (chronic obstructive pulmonary disease) is caused by damage and inflammation to the airways, which restrict the flow of air into and out of the lungs

A CT scan of the lungs may also be needed to seek out or exclude the
condition of bronchiectasis, an important cause of frequent chest
infections, and completely different from COPD. This disorder can be silent, but slowly progresses for many years from childhood onwards.

It often follows on from childhood whooping cough, which causes the
initial damage, and the main feature is irreversible widening of the
airways in the lungs. But to the guidelines. These are laid down by the government health
watchdog, the National Institute for Health and Clinical Excellence
(NICE).

This body develops treatment recommendations by examining
medical evidence, and using the views of experts, patients and industry. If you are diagnosed with COPD, under the guidelines you are meant to be helped to give up smoking.

You should also be offered an inhaler called a bronchodilator (a muscle
relaxing medicine to relieve spasm in the airways), along with a
corticosteroid to help reduce inflammation. Finally, your GP should
offer a physical exercise programme and advice on lung health and coping
with breathlessness.

None of these is a cure — there isn’t one for COPD — but they may well help you feel better. In short, the guidelines are not so much a list of rules to avoid, but
should be considered more as a recipe for leaving no stone unturned in
helping you avoid future infections, and minimising any further
deterioration in your lung function.

But my concern — like yours — is whether the diagnosis is correct.

If, for example, you are not a smoker, and never have been, I would question the label of COPD. You do, however, need the support of your GP: if referral to a chest
clinic is not forthcoming, why not ask for a list of the NICE
guidelines If this does not help your situation, then it’s time for a
second opinion.

By the way… Diabetics are at greater risk from lethal clots

I recently spent a week back at school on my annual course of ‘refresher’ lectures at the Royal College of Physicians. I cannot be sure if it is just me, but every year the science seems to get more difficult to comprehend, and more and more of the lectures incorporate such complex immunology, genetics and other molecular detail that I wonder if I am still fit for purpose.

But once or twice each year there is a moment when the intellectual sun comes out, and I hear things that are clearly great advances — details that will profoundly influence the way I think in my daily care of patients. One such moment was in a talk from a cardiologist from Newcastle upon Tyne about heart disease and diabetes.

He reminded the audience that the prevalence of diabetes has increased by 42 per cent in the developed world, quadrupling in some countries.
One third of humans born after 2000 will be diabetic, eventually. Diabetes also triples the risk of heart disease. Dr Azfar Zaman explained that, for some reason, the blood of people with diabetes seems to clot more easily. They have something called vulnerable blood.

Not only does the blood in these patients clot too easily but, when it does, it is a tough sort of clot that doesn’t clear — making it extra lethal and so putting the patient at greater risk of stroke or heart attack, and less likely to recover if they suffer one. So the next task is to seek out ways of reducing the ravages of this vulnerable blood.

There have been large studies where patients with diabetes have had their blood sugar levels controlled obsessively, but, disappointingly, this didn’t work. Even though patients suffered fewer heart attacks, there was, for some reason, an increase in mortality, meaning that when an attack did occur, it was more likely to be fatal.

There were also studies of careful blood pressure control, keeping the level down to 120mmHg with great diligence. But this also did not help reduce the risks of vulnerable blood, and neither did carefully controlling cholesterol.

But guess what Nothing works as well as losing weight. Effective dietary calorie control — producing weight loss sufficient to push the diabetes into the background — is the only approach that works to tackle vulnerable blood. The message is obvious: don’t get heavy. And if you are, get lighter. It’s in your hands.