Give your liver some love

This story first appeared in Healthy You - July 2024, The Gazette’s quarterly health publication.

The liver is more than just a simple filtration system. It performs over 500 bodily functions, including temperature regulation, processing food, fighting infection and more. Dr. Barakat Aburajab Altamimi, gastroenterologist and chair of Internal Medicine at Mercy Medical Center, shares how to keep the liver healthy.

“It’s important for good health and a long life,” he said.

One of the most common liver problems in the United States is fatty liver disease — a colloquial name for metabolic dysfunction-associated steatohepatitis (MASH). Approximately 24 percent of U.S. adults have this condition, defined as having intrahepatic fat of at least 5 percent of the liver’s weight. It’s treatable if caught early, but catching it can be challenging. Many people don’t know they have the condition.

“It’s often asymptomatic,” Altamimi said.

People with this problem might have livers that look enlarged on ultrasound and may have changes in the thickness of the liver as measured on a FibroScan, according to Altamimi. A primary care provider might notice a problem when they perform an ultrasound for an unrelated reason or when they do bloodwork.

“If people do experience symptoms, they might include loss of appetite, right-sided pain and fatigue,” Altamimi said.

This condition used to be referred to as non-alcoholic steatohepatitis (NASH). Altamimi said the new term helps clarify what causes the disease (metabolic dysfunction). He also said it can be trickier to catch than fatty liver disease related to alcohol (called alcoholic steatohepatitis) for a simple reason: those who consume alcohol in excess have reason to think they might have liver problems. Those who don’t might never suspect they are at risk.

Although there are two distinct causes of excess fat on the liver — alcohol or metabolic dysfunction — cirrhosis can result from either. Cirrhosis, which means scarring of the liver, is a serious illness.

“Cirrhosis has prominent symptoms: yellow discoloration of the eyes, dark urine, mental confusion and possibly swelling of the legs, ankles or belly,” Altamimi said.

But there are plenty of ways to prevent MASH — and even to reverse it before it progresses to cirrhosis. The best prevention tool is a healthy diet, according to Altamimi.

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“The American diet isn’t very rich in fiber,” he said. He recommends eating whole grains, fruits and vegetables, along with limiting refined sugar. Too much simple sugar, such as what’s found in regular pop, gets turned into fat.

Altamimi also recommended adhering to the Center for Disease Control and Prevention’s recommended limit for alcohol, which is two drinks per day for men and one per day for women. Because he has first-hand experience with the health issues that can be caused by alcohol, his advice would be to limit those amounts even further.

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

If someone already has MASH, Altamimi said there are additional measures that can be added to try to reverse the damage. He recommends at least a 10 percent weight loss for those patients. For those who also have diabetes, GLP-1 agonists — medications to manage blood sugar levels that may also lead to weight loss — are approved by the Federal Drug Administration. (They aren’t currently approved for those who have MASH without diabetes.)

He also makes sure MASH patients are up to date on hepatitis vaccines to prevent any potential further injury to the liver. Additionally, regular vaccines are important for those folks because of the liver’s role in fighting infections. Finally, avoiding drugs that are known to potentially harm the liver is important.

As of March 2024, a drug called Resmetirom was approved for the treatment of MASH. Resmetirom is a thyroid hormone receptor beta agnostic that targets the underlying causes of metabolic dysfunction associated with the disease. Altamimi said there’s a catch: It can’t be used in someone who already has cirrhosis.

Treating the condition can become a little tricker for patients who are already slim. Altamimi said one misconception about the illness is that it only happens in those who are obese. It can occur in thinner people who have problems with cholesterol or high triglycerides. In those cases, the patients might be referred to a cardiologist to manage those issues, which in turn could help reverse MASH.

Altamimi said the liver is a uniquely resilient organ.

“Even if we remove two-thirds of it, it can re-grow. That’s how capable it is.” Still, the one thing it can’t overcome is scarring. Scarring can prevent it from re-growing and limit its function, which could result in the need for a transplant. Altamimi said liver transplants are difficult surgeries that can come with long waiting lists and complications.

It’s far preferable to treat your liver well today through a healthy lifestyle and modest alcohol consumption.

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