Myth 1: Fatty liver is nothing to worry about
A: Fact: Most people with fatty liver don’t get any symptoms.In a proportion of patients, fatty liver can progress to significant liver damage in the form of steatohepatitis, fibrosis, cirrhosis (scarring of the liver) andliver cancer. This happens because prolonged fat deposition in the liver cells causes inflammation and then scarring. The scar tissue builds up, causing fibrosis which may progress to cirrhosis. In rare cases it may cause liver cancer also. Presence of fatty liver is associated with increased risk of heart disease, different cancers in the body, diabetes, hypertension, obstructive sleep apnea syndrome etc. Therefore, diagnosis of fatty liver should not be ignored and thorough evaluation for liver and non-liver related complications should be done.
Myth 2: “there’s nothing that can be done for treatment NAFLD”
A: Fact : Many treatment options are available today for management of NAFLD. Lifestyle modifications like (proper diet and weight loss) and various medical and surgical treatments are effective in the management of NAFLD. All patients with NAFLD should be try to lose weight. Even a 5-7% weight loss can have beneficial effects. In addition, appropriate management of co-morbid metabolic conditions like dyslipidemia and diabetes is of paramount importance.
Myth 3: “The patients of NAFLD don’t need to see a liver specialist?”
A: Fact: A consultation with a liver specialist is an important step in the management of NAFLD. The liver specialist will first distinguish patients with simple steatosis (who have a good liver related prognosis but needs close monitoring for other organs) from those who have NASH and are at risk for progressive liver injury. He will also ensure that there is no alternative / additional disease in the liver. Based upon the staging of NAFLD he will be able to provide valuable prognostic information and suggest appropriate line of treatment.
This staging is often done by a combination of blood tests, imaging and elastography based (like MR Elastography, ARFI, Fibroscan etc) methods. Although liver biopsy remains the gold standard for NAFLD diagnosis and staging, determining which patient requires liver biopsy is another important aspect of specialist evaluation of NAFLD.
Myth 4: “There are no drugs for patients with NAFLD”
Fact: There are several drugs which have shown benefits in patients with NAFLD. The most commonly used medicine is Vitamin E. Recently, newer drugs like saroglitazar and obeticholic acid have shown improvement in liver biopsies of patients with NAFLD. There are many drugs like pioglitazone, GLP-1 inhibitors like liraglutide, SGLT 2 inhibitors (gliflozins) which when given for diabetes treatment, help improve the liver also. It should be noted that these drugs are more effective when combine with life-style modification, diet and exercise.
Myth 5: Fatty liver disease cannot be reversed Fact: In the early stages of the disease, fatty liver can be reversed completely. This can be achieved by the following measures:
- Avoid alcohol
- Reduce sugar intake
- Cut out saturated fats in diet
- Exercise regularly (Aerobic and Isometric)
- Maintain a healthy weight
- Control blood sugar levels
- Eating a healthy diet with plenty of fresh fruits, vegetables, whole grains and lean meats like chicken and fish
Even in those patients who have fibrosis, there is some hope of halting the disease and possibly reversing the damage with appropriate management.
Myth 6: Fatty liver disease is only seen in the rich and those who are obese
Fact: NAFLD is common across all socio-economic strata and in rural as well as urban population. While, it is more common in the obese, it may also be seen even in a proportion of people with normal BMI and is referred to as ‘lean NASH’. This is likely to be due to excessive visceral fat without significant increase in body weight. Lean NASH appears to be more common in India as compared to the west.
Myth 7: If the liver function tests (LFT) are normal, the liver does not have disease Fact: Most people with fatty liver will have a normal or near normal LFT. Often, the LFT remain normal till the liver disease becomes very advanced. A normal LFT does not rule out significant liver disease. A combination of blood tests, imaging and elastography-based (like MR Elastography, ARFI, Fibroscan etc) tests and sometimes liver biopsy is used for assessment of liver status.