Liver Alert

EACH AND EVERY word in this book is based on science, not based on emotion,” says Dr Shiv Sarin, noted physi­cian and founder of Delhi’s Institute of Liver and Biliary Sciences (ILBS), about his new book which suggests 50 life-saving tips and 10 commandments to live well and live long by altering your habits and by diagnosing existing lifestyle-related or hereditary health problems before it is too late. The book also of­fers what he describes as “lifelines” that include staying lean and thin, eating right, maintaining restorative sleep and consuming medicines judiciously.

The veteran doctor has drawn examples from among his patients and others and argues in this book that people should not “outsource” their health to anyone, not even doctors, and instead, take care of their well-being on their own. Hence the title Own Your Body: A Doctor’s Life-Saving Tips. Sarin has influ­enced several health policies in the country, especially those that have to do with non-alcoholic fatty liver diseases, and he has had high-profile patients and friends; the people who have written blurbs for this book include big names from a variety of fields, including law, business, entrepreneurship, and others. Strikingly, the award-winning physician, who has also been conferred the Padma Bhushan, has put the spotlight in this book on one of the biggest public health challenges India faces. He has focused on an internal organ that often offers the first warnings about multiple debilitating ailments, and even cancer.

According to the most recent study available and conducted by AIIMS in Delhi, more than one-third (38 per cent) of Indians have fatty liver or non-alcoholic fatty liver diseases. The report notes that this phenomenon is not restricted to adults alone, but affects nearly 35 per cent of the country’s children. The study was published in the Journal of Clinical and Experimental Hepatology. In India, there is a sharp spike in non-alcoholic fatty liver dis­ease (NAFLD) and non-alcoholic steatohepatitis (NASH). While NAFLD simply means that you have a fatty liver but no damage to your liver, NASH is the condition when you have fat in your liver plus signs of inflammation and liver cell damage, according to Johns Hopkins Medicine.

Why is it a bigger health menace for India? Because it contrib­utes at least 20 per cent of the global deaths due to liver disease.

Which is why it makes enormous sense when Sarin warns that patients with fatty liver disease have a higher risk of developing cancers. New research studies have consistently proved NASH is a marker for lethal diseases. Therefore, writes Sarin, one of his life-saving tips for families with a history of cancer is to “get all members to undergo liver and metabolic health checkups. If possible, genetic testing for cancers should be undertaken.” Sample another of his 50 tips: “If they [blood lipids] are high, don’t ignore them. Consult. High lipids are generally associated with fatty liver. Get your liver fat and metabolic health checked.” He regrets that some people simply take cholesterol medication and ignore the underlying problems with the liver, much to their own anguish later on.

The liver is the largest internal organ in the hu­man body, which performs over 500 func­tions, including digestion of proteins, mineral storage, bile production and blood filtration. It weighs as much as a football, and is a window to understanding our bodies better. Liver infections are symptoms of other conditions, including diabetes, which is a health scourge in India and accounts for the largest number of patients in a single country. The fact that Indians have a genetic predisposition to developing fatty liver despite being thin compounds the problem as one too dangerous to ignore. “Nearly 20% of the people who have fatty liver are lean or have normal weight,” Sarin writes.

The reason why matters of the liver acquire greater health significance is thanks to its power to regenerate. “The liver has a unique capacity among organs to regenerate itself after damage. A liver can regrow to a normal size even after up to 90% of it has been removed,” says US’ National Institutes of Health, emphasising that understanding how this regeneration works in more detail could lead to new treatment strategies to help repair a damaged liver. Here is another tip from Dr Sarin in the book: “If you are overweight or obese, get your liver fat tested. Now.”

Shockingly, there are concerns that liver diseases unrelated to alcohol consumption can affect our rural population, too. Several studies, including the one by Kovai Medical Center and Hospital, Coimbatore, and co-authored by Dr Arulraj Ramakrishnan, show that liver inflammations are not an urban phenomenon. The study, published in The Lancet, titled ‘Prevalence of abnormal liver tests and liver fibrosis among rural adults in low and middle-income country: A cross-sectional study’, shows that liver infections are rising among hardworking rural Indians too. Similarly, Open had reported earlier about a survey of Delhi students conducted by Apollo Hospitals and the INCLEN Trust which said that of the 961 children aged 5 to 10 examined, from across 13 private schools, over 22 per cent of the children in the nor­mal weight range had non-alcoholic fatty liver disease. Of the overweight children, 45.6 per cent had NAFLD. Other known disorders of the liver include hepatitis, liver cancer and cirrhosis.

Besides alcohol consumption, fatty liver is caused by increased intake of un­healthy food, reduction in consumption of fruit and vegetables, sedentary lifestyle and other factors. In fact, doctors typically aver that fatty liver is the “liver counter­part” of metabolic diseases, such as dia­betes, hypertension and heart disease. But luckily, in most cases, the condition is reversible with strict lifestyle changes. As Sarin says, one has to bear in mind that the liver swells and works less efficiently as fat accumulates in the organ. It is impera­tive that we understand the functions of the liver. Dr Jake Liang, a US-based liver expert, writes, “The liver transforms the foods you eat into energy and nutrients your body can use, and it regulates how nutrients flow to different parts of the body when needed.” Any damage to the liver therefore proves costly.

Sarin goes on to state in his book that diabetes in adults is a liver disease. “The surplus fat in the liver cells restricts insulin from reaching these cells. As a result, the body needs more insulin to achieve the same degree of glucose utilisation to produce energy and fulfil the requirements of bodily functioning. In very simple terms, this constant, increased need for insulin to carry out glucose metabolism in the cells and tissues of the body is the basis of insulin resistance in the body,” he writes. Mayo Clinic’s website explains what insulin resistance is: “Insulin is a hormone released by the pancreas that tells your cells to open up to that sugar and convert it into energy. With insulin resistance, the cells don’t react, and don’t open up, resulting in excessive sugar in the blood.”

Like others, Sarin notes that the texture of the skin is an indica­tor of the presence of insulin resistance in a person. High insulin levels affect the skin and make cells proliferate more, he says. Which is why another of his life-saving tips goes like this: “Get up and see the front, sides and back of your neck in the mirror. Look for skin tags, moles and black velvety lines, and remember them as well.” Next to it in the book are two images of a person’s neck, displaying the velvety line and skin tags that the author says sug­gest metabolic syndrome. This is also the reason why the doctor insists that those with hypertension get themselves tested for liver and metabolic health—in order to make changes that improve the condition of the liver and overall health. He also gives simi­lar advice for those suffering from hypothyroidism (when your thyroid gland doesn’t make enough thyroid hormones to meet the body’s needs): get tests for liver and metabolic health. He also dwells on how fatty liver can overburden the heart and result in health complications.

One of the interesting tips from the doctor is not to plan a child if one of the parents is in poor health because, he argues citing science journalists and studies, that the health of the parents de­termines the health of the baby. He also says that obese parents should lose weight before contemplating conceiving. His argu­ment is that by losing weight, a mother can reverse fatty liver and early liver fibrosis, and that the benefits will be passed on to the child. Sarin compares parents to an original equipment manu­facturer (OEM) of a car. While we know that certain brands are trustworthy, there are others that aren’t, and therefore produce defective automobiles. His logic is that even a human child is born healthy or defective depending on the health of the parents. But that is not the end of the road, he concedes. Good health manage­ment can bring the child back on track.

Sarin, who has seen a number of his patients spring back to normal health thanks to them heeding instructions and living well, has many more tips to offer, including for sexual wellness. By writing this book, Sarin has placed before our health policymak­ers as well as individuals, as Mukesh Ambani writes in his blurb for the book, “rich medical wisdom acquired through years of successful practice”.

The bottomline here is that you can reboot yourself, but a bit of discipline is in order.

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