Give your liver some love

This article first appeared in The Gazette's quarterly health magazine, Healthy You – July 2024.

The liver is more than just a filtering system. It performs more than 500 bodily functions, including regulating body temperature, processing food, and fighting infection. Dr. Barakat Abramjab Altamimi, gastroenterologist and chief of internal medicine at Mercy Medical Center, shares how to keep your liver healthy.

“It's important for health and longevity,” he said.

One of the most common liver diseases in the United States is fatty liver disease, also known as metabolic dysfunction-associated steatohepatitis (MASH). Approximately 24% of American adults have the disease, which is defined as having fat in the liver that makes up 5% or more of the liver's weight. It is treatable if caught early, but can be difficult to detect. Many people are unaware that they have the disease.

“It's often asymptomatic,” Altamimi said.

People with the problem may have what appears to be an enlarged liver on an ultrasound or a change in liver thickness as measured by a FibroScan, Altamimi said. Sometimes your doctor will notice the problem when they order an ultrasound or run blood tests for an unrelated reason.

“If symptoms do occur, they may include loss of appetite, pain on the right side and fatigue,” Altamimi said.

The disease was previously called nonalcoholic steatohepatitis (NASH). Altamimi said the new term helps clarify the cause of the disease — metabolic dysfunction. He also said it may be harder to spot than alcohol-related fatty liver disease, called alcoholic steatohepatitis. The reason is simple: People who drink too much alcohol have reason to think they have liver problems. Those who don't may not think they're at risk.

Excessive accumulation of fat in the liver can be caused by two things: alcohol and metabolic dysfunction, but either can lead to cirrhosis, which is scarring of the liver and is a serious disease.

“Cirrhosis has noticeable symptoms such as yellowing of the eyes, dark urine, mental confusion and possibly swelling of the legs, ankles and abdomen,” Altamimi said.

But there are many ways to prevent MASH and even reverse it before it progresses to cirrhosis, and Altamimi says the most effective prevention is a healthy diet.

“The American diet isn't very rich in fiber,” he says, and he recommends eating whole grains, fruits, and vegetables, and cutting down on refined sugars. Too much simple sugar, like the kind found in most sodas, turns to fat.

Altamimi also recommends sticking to the Centers for Disease Control and Prevention recommended alcohol limits of two drinks per day for men and one drink per day for women, but advises limiting the amount even further, having experienced firsthand the health problems alcohol can cause.

“I think it should be less than that,” he said.

For people who already have MASH, Altamimi says there are additional measures they can take to reverse the damage. He recommends a weight loss of at least 10 percent for these patients. For people with diabetes, GLP-1 agonists have been approved by the Federal Drug Administration to help manage blood sugar levels and potentially lead to weight loss (they are not currently approved for MASH patients who don't have diabetes).

We also make sure that MASH patients keep their hepatitis vaccines up to date to prevent further damage to the liver. Additionally, because of the liver's role in fighting infections, regular vaccinations are important for MASH patients. Finally, it is also important to avoid medications that are known to have the potential to harm the liver.

As of March 2024, a drug called resmetirom has been approved to treat MASH. Resmetirom does not rely on thyroid hormone receptor beta and targets the underlying metabolic dysfunction associated with the disease. However, Altamimi said, one drawback is that it cannot be used in people who already have cirrhosis of the liver.

For patients who are already thin, the disease can be a bit trickier to treat. One misconception about the disease is that it only happens to obese people, Altamimi said. It can also happen to people who are thin but have cholesterol or high triglyceride issues. In those cases, patients may be referred to a cardiologist to address those issues, which could help reverse MASH.

Altamimi said the liver is a uniquely resilient organ.

“If you remove two-thirds of the liver, it can still regrow. It has that ability.” But one insurmountable challenge is scarring, which can prevent the liver from regrowing, limiting its function and requiring a transplant, which Altamimi said is a difficult operation with long waiting lists and potential complications.

It is far better to start looking after your liver today through a healthy lifestyle and moderate alcohol consumption.

“There's no liver better than your own,” Altamimi said.