Doctors' Notes: Researchers study ways to tackle liver disease

Republished from the Toronto Star

It’s a silent disease that affects between 20 and 30 per cent of the population — but many people living with non-alcoholic fatty liver disease (NAFLD) have no idea they’ve got it.

NAFLD starts with the accumulation of excess fat in the liver. People with metabolic risk factors like obesity, type 2 diabetes, high blood pressure and high cholesterol are more prone to the condition.

Although less common, a person’s risk of developing fatty liver disease may also be increased by taking certain medications or having a family history of the disease.

In my work as a hepatologist, I see people who have both mild and serious cases of fatty liver disease. On the more advanced end of the spectrum — when the fat in the liver becomes inflamed — the condition is called non-alcoholic steatohepatitis (NASH). This can lead to progressive scarring, and eventually severe scarring called cirrhosis in some patients.

NASH represents the greatest burden of chronic liver disease today — as many as 12 per cent of people may have it. It is quickly becoming the main reason people in North America are listed for liver transplants.

Until the disease progresses to liver failure or cirrhosis and the liver begins to fail, NASH doesn’t usually cause any symptoms. That means many people go undiagnosed, which is a big problem because it affects such a large population. And for some people, the diagnosis comes too late for the damage to be reversed.

Right now, the only measures that have been shown to turn the damage back are lifestyle changes like adopting a healthier diet, reducing sugars, better managing portion sizes and getting more exercise. A weight loss of five to seven per cent can play a big role in reducing the fat and inflammation associated with NASH.

Knowing how widespread the problem is makes me passionate about finding new ways to help people. I’m fortunate to do that in my clinic, but also as a research interest, where I’m part of a team trying to identify risk factors for disease progression.

A blood test can show if your liver is mildly inflamed, and an ultrasound can show a fatty or swollen liver, but the only way to definitively diagnose NASH is through a biopsy — an unpleasant procedure associated with complications most people would want to avoid. One area my research focuses on is finding blood markers and imaging tests that could help us better diagnose the disease and see whether or not a treatment is working.

I began to specialize in this area in the early days of treatment for hepatitis C — another common liver disease. At the time, there were many people who couldn’t take the available drugs, didn’t qualify for them, or their disease was too advanced by the time it was discovered.

Today, the outlook for people with hepatitis C has changed, and we’ve got more tools than ever to control that disease. I hope that’s the direction we’re headed in when it comes to future treatment options for NAFLD.

Republished from the Toronto Star

Researchers are studying several ways to tackle these diseases, like targeting the fat, how insulin is regulated or how inflammatory processes unfold before fat even reaches the liver. Because there are so many pathways to explore, there could be just as many potential drug targets. Hopefully, some combination of them will help reduce the inflammation and prevent scarring associated with these diseases.

We could be just a few years away from new medications that could make a big difference for people living with NASH. The number of drug trials in this area has exploded recently. A number of treatments are now in phase two and three trials, which means if they work, they could be approved for use within the next few years.

• In the meantime, here are some suggestions that might help you keep your liver lean:
• Maintain a healthy weight
• If you need to lose weight, do it slowly and follow a diet that’s palatable — no-carb or high protein diets may not be sustainable in the long term
• Eat foods that are low in saturated fat and high in fibre
• Reduce your sugar intake — a great way to do this is by cutting back on pop and other sweetened drinks high in fructose
• Cook at home more often
• Get regular exercise

Dr. Keyur Patel is an associate professor of gastroenterology at the University of Toronto. He is also a staff hepatologist at Toronto Western Hospital’s Francis Family Liver Clinic. Doctors’ Notes is a weekly column by members of the U of T Faculty of Medicine. Email doctorsnotes@thestar.ca.