After recovering from pneumonia in 2007, 11-year-old Megan Clermont of London, ON, remained exhausted and nauseous. Up until then, she had been generally healthy, if slightly overweight. Megan’s symptoms persisted for almost a year. Eventually, a blood test and ultrasound resulted in a diagnosis that shocked her family. Megan had non-alcoholic fatty liver disease (NAFLD).

NAFLD risk factors
Contrary to popular belief, liver disease isn’t always related to excess alcohol intake, and it is not just an affliction of the middle-aged. “The death rate from liver disease has risen by close to 30 percent over a period of only eight years,” says Gary Fagan, president of the Canadian Liver Foundation.

The most common form of liver disease in Canada is NAFLD, which is linked to obesity, a condition that affects up to 25 percent of the population, or eight million people. (Your risk of NAFLD increases with a body mass index (BMI)—a measure of body fat based on height and weight—over 30. Diabetes, resistance to insulin and increased levels of triglycerides—a type of fat—in the blood also increase your risk of liver disease.) Furthermore, increases in childhood obesity mean that more children are at risk; while estimates suggest that three to 10 percent of the general population will be afflicted with NAFLD, the risk jumps to 70 to 80 percent for obese children, says Fagan.

What does your liver do?
The second-largest organ in the body, the liver performs more than 500 functions. It filters toxins from your blood, manages hormones, doles out glucose in response to insulin, and regulates cholesterol. It also breaks down and stores fat. The liver metabolizes fat from a person’s diet; when there is more fat than the body requires, the excess can accumulate in areas like the abdomen and liver.

People with first-stage NAFLD have liver cells swollen with fat, but they don’t tend to experience adverse health effects. The second stage, which Megan Clermont was diagnosed with, is marked by swelling of the liver, which can impair its function. If left unchecked, the disease may progress to the third stage, cirrhosis (severe scarring), which will ultimately lead to liver failure.

Although the sequence of events is well known, how it progresses from one stage to the other is not yet understood. Dr. Morris Sherman, chairman of the Canadian Liver Foundation, says that NAFLD does not call attention to itself. Symptoms of advanced liver disease such as fatigue, nausea, itchy skin, sallow or yellow skin and tender or distended belly do not develop until the damage is severe.

How your weight impacts your liver
According to Dr. Elaine Chin, chief medical officer of the Executive Health Centre in Toronto, “a calorie-laden diet, particularly one high in carbohydrates, can lead to fat buildup in the liver. If you have excess weight around the middle, it is also likely in and around your organs.” Burt Lang of Howick, QC, found this out the hard way when he had a liver transplant.

Four years ago, at age 66, Burt booked a physical, which was about five years overdue. He had no real health issues, but he tipped the scales at 230 pounds and had a BMI that put him in the obese category. He left the doctor’s office with a laboratory requisition for a number of routine tests; one came back showing elevated liver enzymes in his blood. An ultrasound and a CT scan were ordered. His liver showed inflammation and scarring—cirrhosis—and Burt was told he’d require a liver transplant to survive. He was stunned. “I don’t smoke. I have been a vegetarian for 60 years. I don’t have hepatitis. I don’t do illegal drugs or have unprotected sex. And I can count only five alcoholic drinks in my life,” he says.

After the diagnosis, Burt was referred to the liver transplant unit at Montreal's Royal Victoria Hospital, where he underwent about a dozen pre-transplant evaluation tests over the next eight months. The last one was a biopsy that confirmed the diagnosis. On Dec. 3, 2011, he was placed on a waiting list. On Jan. 3, 2012, he received a liver.

Grateful for his new lease on life, Burt has cut down his portions at meals, has lost weight and now urges others to educate themselves about NAFLD. “I try to educate them on the facts, especially that most of the symptoms are silent and only show up when it is too late.”

Megan, now 17, is still experiencing symptoms due to her compromised liver. Her mom, Michelle, says they may never know if it was the family's diet, the pneumonia (and the antibiotics used to treat it) or a combination of factors that triggered the disease. But the family has taken steps to prevent further damage to Megan’s liver. They’ve dramatically improved their diet, and Megan has lost weight by exercising (when she has the energy). Michelle, for her part, has been advocating for more research on the impact of trans fats, high-fructose corn syrup and other sugars on the liver.

How to take care of your liver
Dr. Sherman, author of Liver Disease in Canada: A Crisis in the Making, says that Canadians “are suffering and dying from a preventable disease.” He recommends taking the following steps to protect your liver from NAFLD.

• If you are overweight, strive for gradual, sustained weight loss. With adequate weight loss, usually about 10 percent of your current weight, the fat will come out of the liver and much of the damage to it will recover.

• Ask your doctor to test your liver enzymes during your next blood exam. Elevated enzymes are the first indication that something may be awry.

• Watch your waistline. Excess abdominal fat is a health risk for NAFLD. A man’s waist circumference should be no more than 102 centimetres (40 inches) and a woman’s should be no more than 88 centimetres (35 inches).

• Eat a well-balanced diet. Reduce your intake of high-calorie foods, carbohydrates, trans fats and sugars. Focus on eating vegetables, fruits, fish, whole grains, and smaller amounts of meat.

For more information on NAFLD and to learn about other forms of liver disease, visit liver.ca.

We have lots more information on disease prevention, including these 5 easy tips to reduce heart disease.
                                               

This story was originally titled "Liver Disease" in the March 2014 issue.             Subscribe to Canadian Living today and never miss an issue!