The biggest solid internal organ that we have is our liver. On the occasion of World Liver Day which falls in the month of April, Medicircle is conducting an exclusive series featuring eminent hepatologists and gastroenterologists to raise awareness about the significance of the liver to our overall health and to educate people to take care of it to lead a healthy life.

Dr. Sachet Chandak is a Consultant Gastroenterologist and Hepatologist with a demonstrated history of working in the hospital and health care industry. He is skilled in Diagnostic and Therapeutic Endoscopy, General Gastroenterology, Hepatology, Gastrointestinal and related cancer diseases.

You need a liver test even if you are healthy

Dr. Chandak mentions, “With the World Liver Day coming up shortly, it's a good time to discuss the problems faced by people in relation to liver diseases. If the question is, should I get my liver tested even if I am healthy? The answer is “yes”. So now the question is, why do we have to do that? So, the problem with liver diseases in a majority of the time, they are asymptomatic, to begin with, and when they become symptomatic, we have already reached the advanced liver disease stage. So we can say we miss the bus if we wait for the symptoms to begin."

Who is at risk of developing liver diseases?

Dr. Chandak points out:

• “Alcohol Consumption - People who are consuming a significant amount of alcohol which is more than a drink per day
• Obesity - It has taken the shape of an epidemic now. It began in the west initially, and now we get to see a lot of this problem in India also. Due to lifestyle, people are gaining more and more weight and becoming obese.
• Diabetes – It goes hand in hand with obese patients,” says Dr. Chandak.

Infrequent but important causes of liver disease

Dr. Chandak further points out:

• “People who are IV drug abusers or who have multiple sexual partners are at high risk for developing hepatitis B and hepatitis C which leads to liver disease
• Patients who have a family history of hepatitis B, or hepatocellular cancer 
• One more important thing that we come across in regular practice is people who have had blood transfusions in the 80s and 90s. At that time, the hepatitis C virus was yet to be discovered and the blood products were not screened at that time and that is why we get to see a lot of hepatitis C cases nowadays so, basically, these are the high-risk groups who should undergo liver screening. 
• Another important factor is age. Generally, what we see is people who are about 30 years of age with these risk factors should get themselves tested for liver diseases. 

So, basically, these are the high-risk groups who should undergo liver screening,” says Dr. Chandak.

We define health by symptoms but asymptomatic people can suffer from the liver problem too

Dr. Chandak emphasizes, “Being healthy does not mean that the liver is healthy because we define the term “healthy” by symptoms of an organ. So, in the case of liver diseases, till they reach their advanced stage, they won't cause any symptoms, apart from some amount of fatigue. And when it has reached the advanced stage, then you can see symptoms like jaundice, fluid in the abdomen, swelling on the legs, excess fatigue, and all these things. So yes, we see a lot of asymptomatic patients who are detected to have liver diseases. So even “Healthy People” should get screened for liver diseases,” advises Dr. Chandak.

Non-alcoholic fatty liver disease is on the rise

Dr. Chandak mentions, “Non-alcoholic fatty liver disease is on a rise nowadays mainly in the urban population. People who are not consuming alcohol still have fatty liver. This population is mainly who are obese or diabetic having a sedentary lifestyle. So, the best and definitive treatment for non-alcoholic fatty liver is diet control and exercise. These are the two main pillars,” he says.

Those who have non-alcoholic fatty liver should lose 5% of their body weight

Dr. Chandak mentions, “It is advisable for people with non-alcoholic fatty liver to lose 5% of their body weight. for example, if a patient is weighing 100 kilos, so, based on his height-weight ratio, which is known as the body mass index or the BMI, 100 kilos would be an excess for him. So, for him to get rid of fatty liver or to reduce the fat in the liver, the most important way is to lose 5% of his body weight over a period of six months.”

Exercise can help get rid of fatty liver

Dr. Chandak mentions, “what I usually advise to my patients is to walk daily, about 30 to 45 minutes, at least six days a week. It is considered to be a very good form of exercise to keep your muscles active as well as to lose weight. At the same time avoid a sedentary lifestyle, like most of us are working in offices sitting in front of our computers or laptops for 10 - 12 hours a day. There is hardly any exercise. That is why exercise regularly is very important.”

The diet helps in getting rid of fatty liver

Dr. Chandak mentions, “Diet control is equally important for the treatment of fatty liver. One should have low fat, protein-rich and mild to moderate amounts of carbohydrate in the diet. We should consume fewer calories in the diet. For an average Indian male, or a female, about 2000 to 2500 kilocalories per day is the recommended diet, but patients who are obese or Suffering from fatty liver should reduce this total calorie intake to about 1500 to 1800 kilocalories per day, which is known as a hypo calorie diet.” 

Alcohol consumption should be controlled

Dr. Chandak mentions, “those who are consuming alcohol have to reduce their amount of alcohol to moderate intake. So consuming alcohol a couple of days a week in small amounts is okay. But those who are consuming excessive alcohol and are obese are prone to both alcoholics as well as non-alcoholic fatty liver disease. So, such patients are at high risk of progressing their liver disease from fatty liver to developing steatohepatitis that later on progresses into liver fibrosis. 

No health supplements are required to improve your liver function

Dr. Chandak emphasizes, “We are living in a world of social media right now. We are exposed to a lot of videos, advertisements, banners, and all forms of therapy are prevailing in our country. Right from allopathy, homeopathy, herbal medicines, and so on. So, the direct answer to your question is no, I would not advise any health supplements to improve your liver function. Because there are a lot of them available in the market. But none of them have been approved or in studies, none of them have been shown to produce a statistically significant improvement for which they are advised,” says Dr. Chandak.

Foods high in antioxidants should be taken to antagonize toxins in our body

Dr. Chandak mentions, “We come across a lot of videos on social media where a lot of people talk about detoxifying the liver. If you as such ask the specialist in this field, the hepatologists, none of them would tell you to go for detoxifying the liver. At the same time, there are a few important foodstuffs that you can include in your diet. So, as we know liver is a very important organ of our body, it is the metabolic factory of our body. So whatever toxins we are ingesting in any form has to go through the liver. So, foods that are high in antioxidants will antagonize these toxins. So, the liver has a lot of metabolic and oxidative stress. Foods which are rich in antioxidants help you keep your liver healthy,” says Dr. Chandak.

He lists down following food items rich in antioxidants: 

• One of them is garlic - garlic is very rich in antioxidant substance is and it is also known to be good for the heart. It improves your blood circulation as well. 
• Secondly, green leafy vegetables like spinach – are very rich in natural green color. It has that color because of its high antioxidant content.
• Certain fruits are also helpful - especially dried fruits like walnuts. Also, lemon has a high antioxidant content. 
• Green tea is also high in antioxidant properties.”

What to avoid to keep liver healthy

Dr. Chandak advises not to have a high fructose diet. He says, “we come across a lot of high fructose substances in the market mainly they are the soft drinks, canned fruit juices, etc. which are high in fructose content. Bread contains a lot of sugars. Along with these, processed food or processed meat also puts a burden on your liver and promotes fatty liver. Those who have diabetes should avoid eating excess fruits especially mangoes, watermelons, apples, etc. They can have these in small quantities. One should also reduce the intake of alcohol.”

Avoid anabolic steroids

Dr. Chandak points out, “there are certain products available in the market for people who are working out, who are bodybuilders and doing a lot of gyms. They are advised by some people to take anabolic steroids to increase their muscle mass. These anabolic steroids are very harmful to the liver. In fact, we have seen cases of liver failure happening because of anabolic steroids. They are given in the name of health supplements, or, substances to increase your muscular build. One should be very careful with the supplements because they are easily available over the counter and they are preached and publicized by many non-experts in the field,” says Dr. Chandak.

(Edited by Amrita Priya)