While our bodies need a small amount of fat, too much fat becomes problematic and is associated with increased risk of:

• heart attack
• stroke
• diabetes
• some cancers
• high blood pressure
• sleep problems, and
• liver disease.

How much fat is too much?

A healthy body weight is made up of between 24-30% fat in women and 18-23% in men. Women whose body weight is made up of more than 30% fat are considered obese. For men, it’s more than 25%.

The easiest way to find out if you are carrying excess body fat and if you are overweight or obese, is to calculate your Body Mass Index or BMI. Click here to calculate your BMI. You will need to know your weight, height and waist circumference. If your BMI is greater than 30, you would be considered obese.

Obesity and Liver Disease

We owe our liver a great deal of gratitude. It’s an amazing organ – the largest in our body – responsible for making bile (essential for digestion), removing toxins from our blood, making and storing glycogen (our back up fuel) and breaking down fats.

When it comes to obesity and the liver, the equation is simple: the greater the BMI, the greater the liver damage.

In people with obesity, excess fat starts to accumulate in the cells of the liver. A build up of fat in the liver cells is called non-alcoholic fatty liver disease. Most people with obesity have non-alcoholic fatty liver disease.

While you may not show symptoms, the condition is serious and can lead to inflammation (non-alcoholic steatohepatitis) and irreversible scarring of the liver tissues, known as cirrhosis. Cirrhosis cannot be treated and can be fatal.

There is some good news! While there are no drugs to treat non-alcoholic fatty liver disease and inflammation, both conditions can be reversed through adequate weight loss – exercise and a healthy diet is key.

Do I have non-alcoholic fatty liver disease?

If you are overweight or obese, a blood test can detect non-alcoholic fatty liver disease. You may also need a scan to determine the severity of the disease. A LiverScan is a non-invasive and pain-free scan (similar to an ultrasound) that can measure the amount of fat that has accumulated in the liver and whether the disease has progressed. This result will help your doctor to determine the severity of your liver disease.

Where can I have a LiverScan?

Moonee Valley Specialist Centre has the only privately owned LiverScan machine in Victoria. To find out more or book an appointment, please contact us on 03 9372 0372.

Your liver is a star organ continually working hard to ensure that your body has the nutrients it needs, while extracting harmful toxins from your blood. But how do you know whether your liver is living up to its full potential?

If your liver is damaged or diseased, its ability to perform becomes significantly impeded. People with an increased chance of liver damage and/or people showing symptoms of liver disease should check to make sure their liver is happy and healthy.

Liver function tests, or LFTs, are blood tests. The results from these tests can provide important information about your liver, and whether it is functioning correctly. Liver cells produce a number of proteins and enzymes, and these are released into the blood when the liver is damaged. LFTs measure the levels of a number of these proteins and enzymes to determine how your liver is working.

If the liver function tests are abnormal, further testing might be necessary to find the cause of the liver damage/disease.

Why would you need this test?

A liver specialist or your doctor might recommend LFTs if you have an increased chance of liver damage and/or if you have any of the following symptoms:
· Weakness or tiredness
· Jaundice
· Abdominal pain or swelling
· Dark urine
· Loss of appetite
· Nausea and vomiting

You might also be requested to have LFTs if you:

· Have liver disease or damage
· Are a heavy drinker
· Are, or might be, infected with hepatitis viruses
· Take drugs that can damage the liver
· Have a family history of liver disease.

LFTs aren’t always accurate and can be affected by conditions in the body. In some instances, LFT results can come back as abnormal when there is no problem with the liver, or normal in cases of severe liver damage. You should always discuss your results with your doctor or a liver specialist to understand their meaning.

The liver is also responsible for:

• Clearing the blood of harmful toxins including waste products and drugs
• Breaking down hormones and old blood cells
• Storing and supplying vitamins, minerals and iron to cells when needed
• Aiding digestion
• Producing essential proteins.

A healthy liver will perform its functions like clockwork. But a damaged liver will lose its ability to perform any number of its vital functions.

Damage to your liver may result from:

• Drug and alcohol use
• Poor diet
• Hepatitis viruses
• Some genetic defects and autoimmune disorders.

How can you check your liver?

It is very important to make sure your liver is performing at the best of its ability, and to do this you can check your liver with a LiverScan with a liver specialist.

What is a LiverScan?

LiverScan is a liver ultrasound, using transient elastography, that determines Fibrosis (Liver stiffness/Scarring) and steatosis (fatty change). LiverScan measures the velocity of a shearwave (vibration wave) generated on the skin by the ultrasound probe. Shear Wave Velocity measures the time the wave takes to penetrate the liver. The longer the penetration time, the higher the fibrosis score – more stiffness/scarring of the liver. The LiverScan also measures steatosis (Liver Fat Content).

What Are Liver Function Tests?

Liver function tests, or LFTs, are blood tests that test the levels of certain proteins and enzymes that are either produced by liver cells or released into the blood when liver cells are damaged. This can provide important insight into how your liver is working, however, they are not always accurate and further testing may be required. You should always discuss your results with your doctor to understand their meaning.

Do you know if your liver is healthy?
Once damaged, your liver will require extra care. Limiting alcohol consumption and following an appropriate diet (often including significant weight loss in some cases) can help decrease further liver damage. If your liver is severely damaged over a period of time, it may not recover.

It is extremely important that you know the state of your liver. We need to start the conversation early.

If you have any concerns about your liver, it is important to have it scanned to make sure everything is okay.

Other reasons for a LiverScan include:

• Diabetes
• Obesity
• Haemochromatosis
• Hepatitis
• Excess alcohol consumption
• Pain
• Abnormal LFTs
• If you have any concerns.

Dr. Nathan Connelly – Hepatologist

In this episode, I speak to Dr. Nathan Connelly, a hepatologist, about what a hepatologist does,  fatty liver disease and why it would be worth your while taking a liver with a FIBROSCAN® machine.

Nick: I’m back with Dr. Nathan Connelly. And today we’re talking about the liver. So Nathan as well as being a gastroenterologist. You’re also a hepatologist, which is a liver specialist. Do you want to, Oh, I should say hello. How are you?

Nathan: Thank you, Nick. Yes, I’m a hepatologist as well. Most gastroenterologists are, although some are more interested in the liver than others I would say.

Nick: So what does a hepatologist do?

Nathan: So hepatology is all about the study of and management of diseases of the liver. So it’s all to do with the liver, which is a very important organ indeed, you can’t live without it. And it’s a very special organ because of a number of reasons, but the diseases of the liver are very common. They commonly don’t present with symptoms until the disease is very far advanced. So in some ways, it’s quite similar to the kidneys, which again can be quite damaged before you actually start to get symptoms, whereas with other organs such as the heart and the brain, maybe, sometimes, you know, a bit earlier know that you might have a problem. The liver doesn’t have any symptoms until the disease is very advanced and usually irretrievable in terms of fixing it.

Nick: I see. We did touch on that on the last podcast we did on the liver, which was liver health and the effects of alcohol, diet and medication. So how about today we talk about liver disease. So what’s, what are some of the most common diseases of the liver?

Fatty Liver Disease

Nathan: So, the commonest disease of the liver at the moment that’s causing concern is fatty liver disease. When I was a registrar studying transplantation medicine, so I worked on the transplant unit for a couple of years, by far the commonest reasons for patients to have a liver transplant was hepatitis C. Now, hepatitis C, fortunately, we got such great drugs to treat it these days that 99% or more of people with hepatitis C are curable with treatment. And even quite advanced degrees of scarring can be reversed with the, uh, with the use of antiviral medication. So three to six months of medication will fix most hepatitis C, therefore, patients don’t need a transplant.

Likewise with hepatitis B where you have very good drugs, not to cure the disease but to at least suppress the virus, so again, it doesn’t cause problems with end stage liver failure or tumors. Alcohol is always there – there’s a smattering of patients every year who get a transplant because they drank too much. Um, obviously you have to stop drinking before you get a transplant. But even with that, some people do progress and require a transplant.

And then there’s nonalcoholic fatty liver disease, which is by far the commonest, uh, disease. These guys, which is probably gonna require transplantation in the future. Fatty liver affects anywhere between 20 and 30% of the population depending on which figures you see. And in many ways, it is a disease of Western lifestyle, uh, and the fact that we are getting fatter.

Nick: Okay. It’s, it’s mainly related to what we eat?

Nathan: It’s a complex disease. A lot of it is genetic. A lot of people who have fatty liver disease, and that doesn’t mean everyone with fatty liver disease is fat, by the way. A good 10 to 20% of people with fatty liver have a normal body mass index, which is a way of relating weight to height. So, uh, you can have a fatty liver with normal, uh, body mass index, but most people are overweight. So a lot of it’s genetic and not just the history of fatty liver disease, but a history of what we call metabolic syndrome. So that the archtypical disease of that is diabetes. So often there’s a history of type two diabetes, gout, high lipids, hypertension, all of this fits into polycystic ovarian syndrome. All fits into what we call a metabolic syndrome. And it’s due to what we call insulin resistance.

Nathan: So the body doesn’t respond as well to insulin. And sometimes the first sign of that insulin resistance is having fat in the liver. And in many ways, fatty liver as a harbing or if you like, of a type two diabetes. So the fatty liver first and the type two diabetes, but uh, very much it’s genetic and then there’s lifestyle. So it relates very much to weight, which is probably the next most important factor. The heavier you are, the more likely you are to get fatty liver disease and the more likely you are to have bad fatty liver disease. And that’s a continuum from a BMI, a above the normal range all the way up to people who are morbidly obese. In terms of what people eat, um, that probably isn’t quite as important. People would think, obviously it’s fat, it’s probably more carbohydrates to be honest – sugar than it is fat.

Nathan: Uh, certainly highly processed carbs like white bread and white pasta, they’re just like sugar. These, these, uh, are just long chains of, uh, of sugar molecules connected together and they’re broken down very quickly and act like sugar. So when you wait white bread, you basically sugar. Uh, and I was not quite as bad as sugar, but it almost is. Uh, so that’s the major dietary thing, but calories overall and weight, sedentary lifestyle, uh, all of these factors play in as well. And then, of course, you also think about co-injurious agents like alcohol causes exactly the same finding as the non alcohol, which is why we call it non alcohol. And on biopsy you actually can’t tell the difference between the two. It’s only on the patient’s history of alcohol that you can tell the difference. So people with fatty liver often say, “Well, I don’t drink doctor. Why have I got this problem? ” Well, it’s mostly genetic and lifestyle.

Nick: So, so with a scarred liver, let’s say from excessive alcohol, that’s obviously irreversible.

Nathan: No, no, it’s not irreversible.

Nick: Okay. So I guess my question is going to be the difference between a scarred liver and a fatty liver. I’ve had the impression if you, if you’re, if you scarred, you’ll liver, too greatly, you’re in serious trouble.

Nathan: So which point is it? Irreversible is what you’re asking.

Nick: Yeah, probably. And how is it different too? Or how is fat or fatty liver different to a scarred liver? Or are they both scared?

Nathan: With all forms of liver disease, um, it’s all the same things. So they’ll feed into the same pathway. It’s what’s called the fibrosis pathway. So you don’t get a scared liver from having an acute liver injury. Say, for example, you take too much Panadol and you end up with what’s called paracetamal hepatotoxicity, you will either get better or you will die. And there’s no in between. You don’t get scarring. The liver gets better or it doesn’t. You knock off vast waves of liver cells, but then they recover. Fibrosis and its end point, which is cirrhosis. And everyone would know the term cirrhosis, which everyone equates to drinking, but it’s caused by any form of liver disease. Cirrhosis is the end stage of a progressive scarring of the liver. And that scarring occurs because of ongoing damaged, chronic day in, day out inflammation. And then the scarring comes on top of that.

Nathan: We call it fibrosis, but scarring is just as good a word. And that will happen over, in most cases, years or even decades. So it doesn’t happen overnight. It takes years and decades for it to happen, but a causes absolutely no symptoms. And you might not even have much in the way of abnormal liver tests either. So if you say, well, why can’t you just do liver tests? Um, liver tests don’t tell you everything. You see people who can become cirrhotic with minimally elevated liver function tests. And you can see some people with very elevated liver function tests, who don’t have any scarring at all. So the liver function tests, which are the blood tests you get at the local pathology, are a very imperfect way of monitoring your liver health.

Getting a Liver Scan

Nick: I understand. So we’ll probably touch on this later, but it’s probably worthwhile getting a liver scan and there are two ways to do that, with an ultrasound or with a FIBROSCAN®.

Nathan: Yeah. So a routine standard ultrasound as we have done over the years, doesn’t really tell you much about liver scarring unless it’s right at the end. So at the end of the process, you end up with this shrunken knobbly, uh, abnormal looking liver, which you can be on an ultrasound, but that’s it. That’s done. If you’ve got that kind of scarring, you can’t do anything about it. So at that point, the disease has, um, has finished .

Nick: Or finished you really?

Nathan: Well. Yeah. So that, that point, the disease has run its course and you’re left with cirrhosis. You might stay clinically stable for many years, so in no way am I saying if you’re diagnosed with cirrhosis, you’re going to die tomorrow, but your liver scarring has progressed as far as it can. The question then is one, when are you going to develop signs and symptoms of chronic liver disease? And that can be you know, months, two years down the track, but you can’t actually fix that kind of scarring. Once you’ve got cirrhosis is visible on an ultrasound, you can’t fix that.

Nick: I see.

Nathan: Um, you can’t fix that with medication to, to change the disease process. Uh, you can’t fix it with white loss. Once you get that appearance on an ultrasound, the liver fibrosis problem has gone past that point. So what you want to be able to do is to pick milder forms of fibrosis. And there are a number of ways of doing that. The way we used to do it ,10 years ago is do biopsy. So if you are really worried about someone’s live about 10 years ago I’d do a biopsy, basically stick a needle in the liver and take a sample, which is obviously invasive. It hurts. And there’s a pretty significant risk of complications such as bleeding or bile leak. In more recent years, we have developed ultrasound based or sound wave based techniques to do that, one of which is a fiber scan, which is probably the best known where we bounce ultrasound waves to the liver to see how stiff deliveries.

Nathan: So when the liver stiffness goes up, it equates to scarring. So therefore you’ve got, we’ve got these tables and these ways of equating the two to each other. So for example, a liver stiffness score of over 15 kilopascals pretty much universally means you have, um, quite severe fibrosis bordering on cirrhosis even before you see a single thing on a, on a visible ultrasound. So a score under five is universally normal. Anything over 15 pretty much is universally cirrhotic already. In between there, there’s various stages of fibrosis determined by various charts and data we have. Um, but the, uh, the fiber scan over time will tell you what’s happening with the liver. So, for example, I’ve had patients with fatty liver who are found to have a score of 12 or 13 which means they’ve got it what’s called F3 fibrosis, which is just before cirrhosis and there’d been morbidly obese and we’ve gone get them to lose weight.

Nathan: And some of my patients have lost 20 or 30 kilograms, which whatever way they do it, and then you re-fiber scan them a couple of years down the track and this score is six or eight. So they’ve actually the reverse their fibrosis with weight loss.

Nick: Okay. So we need to this perception that once you’ve damaged your liver, it can’t be repaired or can’t become healthy is false.

Nathan: It’s absolutely false. So whether you do that, you just need to remove the injurious agent. So obviously it was viral hepatitis, you suppress or eradicate the virus. If it’s alcohol, you stopped drinking. And if it’s fatty liver, the only proven therapy for fatty liver is significant weight loss. And what I mean significant, I don’t mean a kilo or two. You probably need to lose maybe 20 or 30% at least of your excess weight. So you need to lose five, 10, 15, 20 kilograms to make a difference.

Nathan: But weight loss is still the only proven therapy for fatty liver disease. Um, and I know that because of studies they did with patients having gastric banding procedures. This was done about 15 years ago. So, and that was done with paired biopsies. But you can do the same thing with fiber scan and you’ll see the numbers improve. And we’ve seen the numbers improve our patients, if they lose significant amounts of weight. It might be a little bit more subtle in that may be visceral fat’s more important than weight. Uh, I have had patients recently have improved this goals with not losing much weight, maybe only two, three or five kilos, but they’ve lost a lot of visceral fat by exercising in the gym and putting on muscle and losing fat. And it might be more visceral fat that counts. But it’s hard to measure visceral fat. Um, that’s the fat inside your abdominal cavity, basically. It’s a hard thing to measure. So it might be a little bit more subtle, but basically it’s, it’s weight loss.

Nick: I believe you’re only clinic in Victoria to have one of theseFIBROSCAN® machines.

Nathan: It’s he only private clinic.

Nick: Private clinic.

Nathan: Most public hospitals have one. Um, it’s the question is when you should have a fiber scan. I’ve got some rules for my patients. I think, I think any diabetic should have one. 97% of diabetics have a fatty liver. If you’re a young diabeteic and you’ve got type two diabetic, and you’ve just been diagnosed as highly likely to go to fatty liver. You almost certainly got a fatty liver. Um, and if you have a fiber scan it will tell you, um, what stage that fatty liver is that. If you have a fatty liver with a minimal fibrosis score, then it’s okay to keep doing what you’re doing and to sort of gradually lose some weight and be healthy, but you don’t have to panic. If you have a fiber scan, and the scores 15, you’ve got a problem. And that happens not infrequently.

Nathan: The estimate is that probably five to 10% of people with a fatty liver will develop significant fibrosis. and cirrhosis, but that might not seem like a lot, but when you’re talking about five to 10% of 20 to 30% of the population, it’s a huge number of people, which is what’s got everyone worried about this epidemic of obesity. It tends to not be a problem that you see commonly in people under the age of 50, but over the age of 50, you start to see this landslide of people who turn up with cirrhosis, uh, on the background of either having diabetes or being significantly overweight. So I think if you are diabetic, um, you should think about it. I think if you have abnormal liver tests, um, you should definitely think about it. Uh, and I think if you’ve got a body mass index over 35, you, you’d think about it. Um, and they’re the sort of groups I would recommend having one, having normal liver function test is no guarantee either, by the way.

Nick: Well, that’s, that’s what happened to me. Um, I had to live a function test. I just had a regular blood test, I think. And then there were elevated levels in the results related to the, I guess the function of my liver

Nathan: What they tell you, they don’t tell you liver function at all. I must say, sorry to cut in, liver function tests for the vast majority of them are a misnomer. They’re actually live that enzyme tests. They don’t tell you how the liver functions. They tell you whether you might have a problem with your liver, particularly inflammation, the inflammation of the liver cells or inflammation of the bile ducts that carry the bile away from the liver or blockage of the bile ducts will present as abnormal liver tests, but they don’t tell you anything about the function. The albumin test does. The Billy Reuben does, the coagulation studies do, but not the other liver function tests.
Nick: I mean, it was quite, it was quite a frustrating process me because my GP recommended I take a an ultrasound and that didn’t reveal any problem, but the, the levels in my function tests was so high. There was some concern and then I went to see you guys and had theFIBROSCAN® and that sort of revealed no problem.

Nick: Yeah, it’s very important in people who have that process. So the standard approach for an abnormal liver test is pretty simple. Um, if you kind of me with abnormal liver tests and you’re otherwise, well I would take a history of how much you drink, how, how much you weigh, medical problems, medications you take. I would then wait at least a month and repeat them because sometimes a one off liver test abnormality can be due to a virus or some other intercurrent illness that just goes away. So I don’t panic after the first one. If they’re repeatedly abnormal, then I would do an ultrasound and you’re doing an ultrasound predominantly to make sure that you don’t have a blocked bile duct because that will make you liver test abnormal and that you don’t have any focal lesions in your liver like a tumor or something that could make your liver tests go up and that you’re not obviously got cirrhosis.

Nathan: The next thing we do with that, it’s not the case. So you liver a test is normal. We do what’s called a liver screen. So we test you for liver viruses, uh, on overload, copper overload, those kinds of things to see whether there’s an obvious reason for why you got abnormal liver tests. And if we don’t find any reason for it, then a fiber scan is useful in that setting to make sure you don’t need to do a biopsy. So if you do a fiber scan on someone with slightly abnormal liver test, no cause found, um, one the fibroscan might say, well hang on, this is fatty liver cause you’ve got a high what’s called attenuator parameter school, but more so it will say, okay, you got slightly abnormal liver tests but your fibrosis score is normal. Therefore you can afford to wait, repeat the liver tests in six or 12 months and not panic. If on the other hand the score comes back as a 15, then really you’ve got significant liver disease and you probably should have a biopsy. So cause that’s the end in game. That’s the sort of last thing we do is liver biopsy and some people need to have that. So that’s the other situation where it’s as useful as people with abnormal liver tests and no idea why because that’s not an uncommon problem.

Nick: So with a Livescan if, if someone is listening and they are a diabetic or they are concerned with their weight or that they just would like to get a scan, they don’t require a referral, do they?

Nathan: No. So fiber scans and non-Medicare rebated, um, the, we, there have been several attempts to get a Medicare rebate for patients with diabetes, patients with hepatitis C, but no, no, no luck. So, uh, it’s got nothing to do with Medicare therefore you don’t need a referral. Might be a good idea to let your GP know that you need a fibroscan. But, um, we would always send a copy to the GP if the patient was happy. But generally speaking, you don’t need to refer. He’s walking and have one.

Nick: Okay. So if you have been drinking for let’s say 20 years and maybe having a typical Australian diet with lots of meat and let’s say you binge drink occasionally on the weekends and you don’t want to go to GP just to get a referral or recommendation, someone could just call you guys and say, Hey look, I’m interested in getting aFIBROSCAN®.

Nathan: Yeah, you can just book in and have it. Very interesting about alcohol. Um, we do get those people coming. They come in and say, listen, I’ve been drinking a bottle of red wine a day for the last 30 years. Um, I want to keep drinking my bottle of wine a day for the next 30 years. Um, I say to those patients, first point. Um, if I tell you your liver is quite bad, will you stop drinking? If they say yes, then I think a FIBROSCAN®is very reasonable. Um, I also tell them if their FIBROSCAN® is a, okay, I have one of these recently, a guy who drinks bottle and a half to two bowls of red a day , he has done so for 40 years and he’s FIBROSCAN® score was six, which is barely above normal. And I said to him, listen, you can keep drinking for your liver but the rest of you is not going to be very happy.

Nathan: So you know, alcohol does more than just affect the liver, it causes heart failure it causes, it causes atrial fibrillation, which is an abnormal rhythm of the heart. It causes lots of problems, increases risk of multiple forms of cancer. So it’s not just about the liver, but I did say you specifically asked me about your liver and your liver is fine and it probably will continue to be fine giving you 75 years old and you’ve been doing this for the last 30 years. Um, but the rest of you really should significantly reduce your alcohol intake for those reasons. What he did. I don’t know, but that’s not an uncommon scenario for people to come in and ask, you know, a might be a patient who’s overweight and their parent had, you know, a severe fatty liver disease and died from it or had um, or needed a liver transplant and they might come in and says I’m overweight as well.

Nathan: Um, I’ve got bad genetics. You know, I want to know what my liver is doing. You know, we’ve had that situation multiple times, sometimes the results good. And I tell him to go and lose weight cause I should lose weight cause it’d be good for them to lose weight. Other times, it’s really bad. And I said, listen, you really, really need to lose weight. Sometimes that can be the difference between opting for ongoing attempts at diet and exercise versus suggesting more extreme forms of the weight loss like bariatric surgery, which I have sent multiple patients for because of their very bad fatty liver. In the end their fatty liver aren’t going to be helped by losing weight. There are drugs in development but they’re still in phase two and three study. So, and they’re probably not gonna be as effective as weight loss. Anyway, by the looks of it.

Nick: I see. So, so with the liver, and this might sound like a stupid question, obviously the, there’s preventative care, just, just don’t drink too much and be careful with your diet. And then if you have, you’ve killed your liver, basically your only chance is replacement and it’s obviously it’s not an organ where you can do any sort of surgery on.

Nathan: No. So there’s no, there’s no, what you have to do with the liver, you have to stop the injury to the liver before you have irreversible fibrosis. So identify and stop before irreversible fibrosis and therefore cirrhosis occurs. The next phase if it has already happened, is to support the patient. So to look out for the complications of cirrhosis and the ultimate treatment is an orthotopic liver transplant or a liver transplant, which um, is needed because there’s no dialysis for the liver. They’ve been attempts that things, Mars machines and stuff, but they don’t really work very well. So really it’s a liver transplant or you die in the end. And it’s basically two ways how people die with liver disease. I either develop jaundice and liver failure and bleeding and all those kind of problems. Or they get a tumor in their liver, what’s called a hepatocellular carcinoma or a hepatoma, uh, and that, that kills a, a good proportion of patients who have, um, who have end stage liver disease.

Nathan: So, unlike the kidneys, you can live on dialysis, uh, for many years, the washing machine as they call it. You can even have an artificial heart put in, but there’s no artificial liver. It’s someone else’s or, or that’s it. The good news is, the liver has an amazing capacity to regenerate and if the liver disease is recognized early enough. It is reversible. So things like FIBROSCAN® are there to go right You’ve got abnormal liver tests, but not only do you have abnormal liver tests, you have evidence of progressive liver damage and fibrosis. Therefore we need to find out what’s causing it and we need to stop it. That’s the point. 90% of people with fatty liver have fat, but they have no scarring or insignificant scarring. Therefore we don’t have to worry about them so much. Yeah, they need to lose weight for their diabetic risk and other reasons, but it’s not specifically for their liver they need to do that which marks them is a different group of patients.

Nick: I see. Well I actually, as I mentioned before, I had a liverscan with you guys and it was um, pretty much like taking an ultrasound, um, and it only took about five, five minutes and the good thing you get the results immediately and then there’s your elf to explain what they mean.

Nick: Did we give you a diagnosis?

Nick: Oh no, not a diagnosis. You just said, okay, you’ve got a score of 4.3, so you’re fine or something.

Nathan: then I diagnosis, but you don’t need a biopsy. That’s not uncommon. I mean the liver tests, the liver tests are interesting. They, they go up and down with the seasons. Sometimes they go up and down for reasons we don’t understand. And that’s all fine. As long as you don’t have progressive scarring. So not everyone who has abnormal liver test absolutely requires a reason as to why. And we do see quite often no reason. And that’s fine. We just repeat the fiber scan every five years. So otherwise you need a biopsy and, and it’s amazing how often the biopsy itself doesn’t provide an answer. So you really, you really want to avoid biopsing people if you don’t have to. That’s why it’s a great test.

Nick: Well, I recommend it. I also recommend you guys – professional, very caring, and I know you care for your patients. So on that note, I guess we’ll, we’ll end this podcast episode. Thank you for your time.

Nathan: Okay, thanks. Thanks, Nick.

Liver Health

Welcome to episode five of the Holy Gut podcast. In this episode, we discuss the liver and liver health with gastroenterologist and liver specialist Dr. Nathan Connelly.

Nick: We’re back with Nathan to talk about the liver and liver health. So, welcome back, Nathan.

Nathan: Oh, thank you, Nick.

Nick: So, let’s begin with the function or functions of the liver. What does this amazing organ do?

Nathan: It is truly amazing. The liver, where it’s situated, is very important for helping you digest your food. Indeed, the food comes into the liver from the gut and very raw, full of toxins and very difficult to process. So, the liver processes at all into more useful food substances, which then gets distributed to the body.

Any toxins and other unwanted parts get excluded out evenly in either the kidneys or in the bile. So, it a very significant detoxifying effect and a very important metabolic function. It also makes lots of proteins for things like blood clotting and albumin, which is the major protein in your body. So, it is absolutely vital to human health.

Nick: Okay. And so we probably need to think that anything we digest be it’s food, drink, drugs, they all ended up going through the liver. Is that right?

Nathan: That is absolutely correct.

Nick: Okay. So we should really respect this organ or think about how we treat it; but, I guess most of us don’t because it’s probably a large percentage of the population, don’t really know what it does, but we now have established that I guess we should discuss how we look after it, and maybe look at how diet, and maybe how things like alcohol affect the liver. So do we want to begin with alcohol?

Nathan: First of all, I’d say, Nick, the reason why people don’t think about the liver is because liver disease doesn’t cause any symptoms until the liver disease is very advanced. So, it’s not like heart disease, where people start to feel short of breath or get chest pain.Or, skin disease where you notice straight away. The liver can get very, very scarred, what we call fibrosis or cirrhosis, until people and people don’t feel any symptoms from it. So, it’s not only often when it’s too late that people will notice they have a liver problem at all.

That’s why it’s important to want to look after to your liver and two, if you suspect there’s a problem, have a test that will tell you whether the liver that has a problem or not. And that’s not easy.

Nick: I see. Okay. So if you go to your GP and he has some concerns about your liver, and then you get some blood tests done and you see a specialist, and they say, “Well look, your liver is severely scarred. It’s too late and there’s nothing much you can do.”

Nathan: Well, to the point where you really sick and you’re turning yellow and losing weight, then it’s too late, ut before then, generally, most forms of liver disease are reversible up to a certain point.

So, to just say that the people listening to the podcast understand, that liver disease, if you’re waiting for to get symptoms before you do something about your liver, you are waiting too long.

Nick: Okay. So we need to be proactive in how we think about the liver and how to treat it, and if we have any concerns, we should get it checked. And there are a number of ways to do that, which we’ll sort of discuss. Okay. I guess there are maybe three areas we can think about. There’s food, there’s probably alcohol, and then this probably medication, which I imagine also can damage the liver.

Nathan: Yes.

Alcohol and the Liver

Nick: I guess with Australians, we do drink a lot. We have a sort of a laid back attitude to things. And yeah, we have this culture where we go out and drink often or we drink at home and we don’t really, most of us probably don’t think about what alcohol does to our liver. So, do we want to discuss that?

Nathan: Yeah. So, alcohol’s probably the common toxin, or certainly be the commonest toxin that affects the liver. There is no safe level of drinking for the liver. The general guidelines from the National Health and Medical Research Council for healthy drinking are widely known and widely available.

For me, that would stay two standard drinks of alcohol a day with two alcohol free days a week. Now, undoubtedly from a liver perspective, some people get away with drinking a lot more than that. The consequences of drinking too much are hardly individual, that is true.

Nick: Yes.

Nathan: But, it’s pretty much a continual increase in risks beyond that. So, if you drink five standard drinks, that might increase your risk above two and if you drink 10, that’s above five. So, it’s a continual risk. There’s no cutoff.

Some people drink extraordinarily amounts about high amounts of alcohol and never develop liver disease. That is true, and people always went to that and they’ll, say “Aw, Uncle Dave, he drank, slab a day his whole life and he died at 95,” or something else.

And there are cases like that, but there are also cases of people who drink relatively modest amounts of alcohol and develop significant liver disease. So, there’s genetic factors, there’s other medications people take and they are other liver conditions that may coexist. That means that they’re drinking their level of alcohol, consumption is dangerous.

Nick: Yeah. I just personally, myself, I have looked at my drinking and I do remind myself that alcohol is a toxin. So, it’s probably important to think of alcohol. You read articles where maybe a glass of red’s healthy and all these things, but at its core, alcohol is toxic.

Nathan: Yes. The actually alcohol component, the benefit of drinking red wine probably relates to some of the other volatile chemicals within it, not the alcohol.

Nick: As you have mentioned, depending on maybe on your body type, your age, your health, and some other factors, alcohol will affect your liver differently, depending on each person.

Nathan: Yeah.

Diet and the Liver

Nick: What about a food? I guess with food, we’re probably talking about aspects of what we eat, maybe how much we weigh, and if we’re developing a fatty liver?

Nathan: Yeah. So, the fatty liver I think is very important. If you had to discuss diet in the liver, you really are talking about fatty liver predominantly. There’s a lot of things out there about detoxifying diets and all this kind of stuff. But from a Western medical perspective, there’s no real evidence for someone with a healthy liver that any sort of dietary intervention is going to make any difference, whether that liver stays healthy or not.
Nathan: If you’ve got a fatty liver, however, it’s different. Because, a fatty live affects 20% of the population. It affects every diabetic. And I mean, just about every diabetic will have fatty liver.

Nick: Okay.

Nathan: It’s what we call an insulin resistance problem. And for most people with fatty liver, the major significance of it is that they have an increased risk compared to the average person developing diabetes. But beyond that, approximately 5-10% of people with fatty liver do develop liver disease. It’s called nonalcoholic steatohepatitis, or NASH.

Diet treatments are very important for trying to reduce the risk of disease progression in people with fatty liver disease. Predominantly, calorie restriction on weight loss, which is by far the most important factor. There were lots of trials being done on medications at the moment to treat fatty liver.

But in the end, the only proven therapy forward is weight loss. It’s an insignificant amounts of weight loss. It’s proven that if a patient loses a significant amount of their excess weight, that their liver disease doesn’t progress, and indeed. It actually regresses.

So, you can have quite a large degree of scarring and it can actually get better if you lose your excess weight. That overall is about calorie reduction. There might be some added benefit to maybe eating more protein, maybe over carbohydrates and fat, although that’s still a bit controversial.

Generally, we just advise people calorie restriction, and course alcohol striction as well. But beyond that, and just the usual general advice, and eating lots of fruit and vegetables and, lean meats, and avoiding processed food, takeaway food, excessive amounts of salt.

Generally, the advice is fairly generic in that it’s advice you give to anyone to live healthily. Calorie reduction is vital for fatty liver.

Nick: I guess we can make it like an educated guess that if someone’s overweight or obese and, they’ve been that way for a significant number of years, it’s likely they have a fatty liver.

Nathan: Yes.

Nick: Are there cases where people look healthy, they have good health, they’re at a reasonable weight, but they may have a fatty liver for some dietary reason they haven’t discovered or they don’t know about?

Nathan: You do see fatty liver in people with a normal body weight. Of course, it’s mostly suspected in people who are overweight, but approximately 5%, maybe a fatty liver patients have a body mass index less than 25. Body mass index is a way of relating weight to height. So, yeah. There are what we call skinny fatty liver patients, and they often often have a family history of type two diabetes. So, it’s a genetic thing, it’s predominant.

Sometimes, they have other conditions and other medications that predispose into fatty liver. But just because you have a normal body mass index, it doesn’t mean that you are completely immune from getting fatty liver disease.

The other thing to say, Nick, is if you’re told you have fatty liver because you have abnormal liver test in an ultrasound, which show fat, which is usually have diagnosed, that fat can also be seen in a number of other liver conditions.

For example, Hepatitis C, a virus that affects the liver commonly causes a fatty liver on ultrasound. There are a couple of other liver diseases that do the same. Also, to mention that alcohol does the same thing.

So, to tell the difference in a person between their alcoholic fatty liver disease and nonalcoholic fatty liver disease is all a matter just of questioning the patient. So, just because you’ve got fat doesn’t mean it’s just nonalcoholic fatty liver disease.

Medication and the Liver

Nick: Okay. Alright. So we’ve touched on alcohol and on diet. What about medication? If you’re taking antibiotics or other medication, that’s obviously going to affect the liver too.

Nathan: So, drugs in the liver is a fascinating area. The vast majority of drugs that cause liver tests to be abnormal probably are pretty harmless. They’re doing what’s called enzyme induction. So, lots of drugs make the liver make enzymes. A lot of antiepileptic drugs do that. Some of the cholesterol pills do that. Alcohol does that.

So ,there’s lots of medications that make the liver tests go up, but there are also some medications that can cause severe liver damage; mostly acute, meaning that it all happens suddenly. There’s a number of antibiotics out there that can cause that.

We see that commonly. People rarely die from it. I haven’t, I’ve seen cases but, I was involved with the transplant unit. So, you kind of do see those cases; but generally, most people recover from a drug induced liver injury. But, some drugs can also cause chronic liver damage as well.

So, that has to be taken into account when having patients on these medications. It’s quite a specialized area. It’s certainly worthwhile; if you’re worried about your medications and your liver talking to, initially a local doctor or maybe a specialist about whether the medications you take might be affecting your liver.

Liver Cleanse?

Nick: Okay. I know a lot of people do Google things like, when I did my research for this podcast, you’ll see things like liver cleanse or kombucha. So, can people treat unhealthy liver or a scarred limit with kombucha or can they do a liver cleanse?

Is that sort of just nonsense?

Nathan: I’m very careful, Nick, with this topic, not to use the word ‘nonsense.’

Nick: Okay.

Nathan: I would rather use the word ‘unproven.’

Nick: Okay.

Nathan: Yeah. Has been some alternative/herbal/naturopathic, whichever way you want to use them. Preparations that had been tested in treating liver diseases. For example, they are in China; there’s a number of herbal preparations. If they’ve actually tested to see whether they work, they don’t seem to, based on the studies they’ve done. Neither did that cause harm.

All the other things, I think a lot of it, because it’s untestable, you can get away with saying a lot of things about it and you can’t disprove it. Therefore, they hide behind that and say they were of benefit. So, I’d say unproven is a kind word to use.

But, do I think they work? No, I don’t.

Liver Health

Nick: Alright. I think the general idea, I now believe, that the liver, you either have a healthy one or an unhealthy one. It’s going to be pretty hard to live with an unhealthy liver.

Nathan: Not really. I mean the liver, you talk about the natural age of organs, like how old you have to get for your heart gives out, and your kidneys give out, and you brain gives out. The liver is actually quite robust.

It does quite well with acute injury, it recovers nearly always, unless you really, really push it too far. Even with degrees of scarring and fibrosis, if you stop the injury, whether it be alcohol or a virus, or fat or whatever is injuring the liver, it will generally bounce back.

The other point is, is that most people, as I said previously, don’t know that they’ve got a problem with the liver. Therefore, it’s all just a case of not being picked up quick enough. So, I think it’s more accurate to say that most people do have a healthy liver.

Most people who have an unhealthy liver, if they attend to their unhealthy liver, they will get better. That’s not like kidney disease, where if you push the kidneys a little bit too far, they will gradually deteriorate, regardless of what you do.

To some degree, the heart, it’s similar liver. The liver tends to be a little bit more tolerance of being abused to some degree.

Nick: I see.

Nathan: Whatever that process might be. So, it’s never too late. What people really need to know, I guess, is whether they got a problem with the liver at all, and that isn’t as easy as it sounds to know that.

Liver Tests

Nick: Now that you’ve said that, there’s talk about liver testing. So, I think there are four ways to test that. The liver, obviously, can get a blood test. You could do an ultrasound, do a FIBROSCAN®, or a needle biopsy.

Nathan: It’s a pretty good way of putting it there. The main tests we do.

Nick: Okay. So, let’s discuss each of those and maybe the accuracy of each, or what they reveal.

Liver Fuction Test

Nathan: Yes. Starting with liver tests. The liver function tests are interesting. They’re not really tests of liver function. They’re actually tests of liver enzymes, and that’s different.

So, the test of liver function or actually things like the aluminum level in your blood, the bilirubin level, which is a toxin, and the way your clotting works in your blood, they’re true liver tests.

The liver test that most people get done at their local doctor are actually liver enzyme tests. And all All they do is indicate whether there may be a liver disease or not. They’re very poor at telling us how bad the liver disease is.

They are prone to false negatives and positives, which means sometimes liver tests can be completely normal and there is a problem and sometimes a little bit test quite abnormal and there’s actually no problem at all. So they suffer a lot from accuracy problems. So, they’re only really an initial test and a screening tests, if you like.

Nick: So, this is a blood test you’re talking about?

Nathan: Yes, these are the liver enzyme tests of the liver. They’re commonly called liver function test, but that’s a misnomer.

Nick: Okay.

Nathan: A very unfortunate one that we’re trying to get rid of. It’s just a blood test. It can be repeated several occasions, and often the trend of what they’re doing is more important than the absolute numbers.

Ultrasound

The ultrasound has positives and negatives. The ultrasound is an imaging test of the liver, there’s no radiation involved. So, it’s very safe.

It will tell you if you have a very diseased liver. So if you have a liver which has got cirrhosis and has shrunken and irregular, it will tell you that. It will tell you if you have a fatty liver, most of the time if it’s significant. It will tell you whether, usually there’s any problem with the gallbladder or the bile ducts, which can cause liver disease as well.

So, it’s a very useful initial test. And I think anyone who has persistently abnormal liver function tests, should have an ultrasound as the next test. Most people would agree with that.

Nick: Well that’s what happened to myself, which we might discuss after you explain each test as a case study. Okay. So, normally you’d probably get a blood test and if there are elevated results, and your GP saying, “Okay, the next step is to get an ultrasound.” Then, if that doesn’t reveal anything, but you still have concern or there’s still evidence to say there’s something wrong with the liver.

I guess the next step could be a needle biopsy or a FIBROSCAN®?

Nathan: It’d be fast for both of those. Basically, the next thing one would do- So, first of all, the first thing to say is, you’d have a one-off, which is normal. Don’t panic, get another test a month or two later and see what it’s doing.

That’s the first point because often it’s transient; so, lots of viruses in it will give you a transitly abnormal liver function test.

Nick: Okay.

Nathan: So, what we do is repeat them in a month or two. The ultrasound I would usually combined with a whole bunch of blood tests to look for the reason why the liver tests are abnormal. So, a number of liver diseases give you a specific blood test markers.

For example, Hepatitis C and Hepatitis B, you can do a blood test for them. You can do a blood test for iron overload, which is another cause of abnormal liver function tests.

So, that will be combined with the ultrasound. If your ultrasound was normal and your blood tests didn’t reveal a cause for your liver, the test being abnormal, and you still didn’t know what’s going on, and the liver tests were getting worse, then yes. You would want to do another test to both either diagnosed the cause of liver function test abnormality, or at least to tell you how bad it is in terms of scarring.

Liver Biopsy

A liver biopsy is definitely an option. It is commonly used in people who are very worried about their liver. The problem with the liver biopsies is, it’s invasive. You have to stick a needle in your liver, you have often have some sedation for it. It can be painful.

There can be complications such as bleeding. Now, that’s not to say if your doctor says you should have one, you shouldn’t have one because you almost certainly need one.

It just means that there’s a useful to have other options available when trying to assess how bad the liver disease is. That’s where FIBROSCAN® comes in.

FIBROSCAN® TEST

So, a FIBROSCAN® is a relatively new test, has been around for about 10 years, and the FIBROSCAN® uses ultrasound waves, which will bounce through the liver to test how stiff the liver is. So, the stiffer the liver, the more scarring there is. We come up with what’s called the liver stiffness score.

That correlates with most liver diseases to a degree of scarring or fibrosis. That’s a good aid to diagnosis because of the person that has fairly, mildly abnormal liver test and you don’t know why, but they’re FIBROSCAN® score is low, then you can afford to take a wait and see approach.

Maybe assess a bit more carefully for fatty liver, advise them to lose weight and to do some exercise, and hope or liver function tests down.

If, however, the FIBROSCAN® score is very bad, then that is a patient you could recommend these as a biopsy or some other further evaluation. So, the FIBROSCAN®’s very good at what’s called stratifying patients risk.

So, low FIBROSCAN® score, you can take a relaxed approach. High FIBROSCAN® score, you need to be a little bit more concerned. That’s particularly important with common liver diseases like fatty liver; because, Nick, fatty liver affects 20% of the population.

You can’t biopsy them all to figure out which of the hundreds of thousands of people in Australia with fatty liver have bad liver disease, and which ones have fairly mild liver disease; because most of them, actually, are going to be alright.

It’s not only a relatively small percentage, 5-10%; they might run into trouble. So, it’s important to try and find those cases and to concentrate your efforts at weight loss and other therapies on that group.

Nick: I understand. With these tests, as you know, towards the end of, I think the middle of last year, I just went and had some blood work done just to check up on my health. I came back with all these elevated levels for ALT, and AST, and ALP, and GGT. I really still don’t understand all that, but my GP couldn’t really explain anything other than “Okay, they’re high and it means it could be something wrong with your liver.”

And then, he recommended that I take an ultrasound and that didn’t really reveal anything. Like, it sort of revealed there’s nothing wrong with your liver; but then I decided to take a FIBROSCAN® with you guys. So, I sort of have one question.

Could you skip the ultrasound? Because, what I understand is, the FIBROSCAN® seems to be a more advanced version than an ultrasound, and it goes deeper and, provides sort of better data. Does that make sense?

Nathan: It does, it does. The only issue, I guess, your particular liver test abnormalities, what we call a mixed liver test abnormality. Looking at your liver tests that you tell me, basically the ALT and the AST, tests that measure liver cell damage themselves. The other two, the alkaline phosphatase and the gamma GT, or gamma-glutamyl transferase, generally our enzymes involved with the bile ducts.

They look for what’s called, cholestatic liver disease. So, disease that affects the bile ducts and the liver. When both are elevated, either problem could be going on, or both.

Therefore, sometimes the FibroScan can give you a lot more information than the ultrasound does, but it doesn’t give you one piece of information, which is sometimes important, which is are the bile ducts and the gallbladder normal?

So, that’s why they kind of go together. But, a FibroScan- if you know, for example, you’ve got a fatty liver, the FIBROSCAN® will actually tell you whether you have any scouring or not.
Nathan: Whereas, the ultrasound won’t, not unless you’ve got very, very, very severe scarring or cirrhosis. So, you’re true, yet you sort of right in one way and not right in the other.

Nick: Okay. Let’s say someone doesn’t like their blood being taken or, they’re only concerned about their liver. Let’s say I think they’re healthy in general, and I know they drink a lot. Can they just take a liver, a FibroScan?

Nathan: Yeah. Snapshot FibroScan, at a point in time, is a pretty good test for exclusion of significant liver disease. So, if you drink too much or you have a fatty liver, or you have whatever the cause of your liver problem is, and you have a FirboScan, which suggests that your scarring level is normal, then a FibroScan is very reassuring.

That doesn’t mean you should go off and drink more. Alcohol can affect other organs and it’s not good for you. So don’t get me wrong, but if you’re specifically worried about “Is my liver scarred, is my liver damaged?” A FibroScan is a pretty good test for reassuring the patient that it’s not that. That is absolutely true.

Nick: Okay. And how often would you recommend someone get a liver scan?

Nathan: It depends on what their result is, Nick. If they have a very, very normal score and I have no reason to have ongoing liver damage, you might just do one. If on the other hand, they have ongoing risk, like a fatty liver, or the use of certain drugs, which we know affect liver function, then we might do them every two or three years.

For example, there’s a drug called- as an example if I can use, there’s a drug called methotrexate, which is commonly used in rheumatology to treat rheumatoid arthritis and those kinds of conditions. We commonly do FirbroScans every two or three years in patients from methotrexate to see whether it’s safe for them to continue taking the medication.

Nathan: So, that’s a situation where serial FibroScans can be useful in preventing the patients in the liver biopsies because it used to be, that it was protocol; these patients had a biopsy every five years. Patients don’t want to have-

You can get patients to have one liver biopsy, but getting them to have more than one is difficult because they’re not very enjoyable. Basically, it can be repeated.

For someone with fatty liver, we often will say, depending on their score. If they had a borderline score of like an 8 or a 10, we might say, “Come back in three years and have one.” If they’ve got a score of 5 or 6, we might say, “5 years,” that kind of thing, depending on the form of liver disease and how bad their initial score is.

Nick: I understand. Okay. Well we’ve been going for almost half an hour, so let’s maybe wrap things up. So, I think we’ve established that the liver is, obviously, it’s an amazing and vital organ. We probably don’t appreciate it and treat it with the care that we should.

And so, we need to factor in what we eat and perhaps our level of health or how much we weigh. And if we are overweight, we probably want to think about reducing our calories, and obviously eat a healthy diet.

If we are drinking, we really want to monitor out drinking and maybe cut back. And if we have some concerns about if we’ve damaged our liver, let’s say due to alcohol, or if we think we have a fatty liver, be worthwhile getting a FIBROSCAN®.

Nathan: Yeah, just a little point. There are FibroScan machine test available. We have one here in Moonee Valley Specialist Centre. It’s a point of care test, Nick.

Patients can walk in, we’ll do the FibroScan. Only thing they need to do is fast. And, we’ll give them an answer on the day, as well as an explanation. A basic explanation and what it all means.

Nick: Yes. And since you know I went through one. So, into it, it was just peace of mind because I was pretty sure there wasn’t anything wrong; but at the same time when you have a blood test and you see all these elevated levels, then you thinking, “Ah, I think I had these elevated levels eight years ago and I’m not sure why.”

Nathan: Are they still on that level?

Nick: No. I dropped down a little on the blood test I had after that. But, I’m probably due for another test..

Nathan: Some people, the reasons we don’t understand, and I’ve seen this a lot of times, will have a very quite abnormal liver test and no cause. Of course, eventually, a lot of them do end up having a biopsy, even with a relatively benign FibroScan.

Just because we just don’t want to miss anything, and if you’re running ALT and IST is 200 or 300, and it’s quite odd and you don’t know why. There’s no fat and there’s no drugs involved, and the screens are negative, when you biopsy people with that, often you don’t find much.

So, there are some people who have quite abnormal liver tests, but no apparent reason. And it’s a benign process. You do see that from time to time. So, just because the doctor in the end, even when the biopsy can’t work out why the liver tests are abnormal, it doesn’t necessarily mean that you have a massive problem.

Nick: I understand, but it’s obviously it’s worth the peace of mind of getting your liver checked.

Nathan: Absolutely.

Nick: And making sure that at least there’s no scarring.

Nathan: That’s the people who have all the tests done. I’m not talking about your average person who just walks into the GP, does a test and they’re abnormal. Most people like that will have a problem.

Nick: Yeah. Okay. Which was my case. They were sort of triple, sort of a standard rating. So there’s a bit of a concern. But, that was worthwhile for me getting the test. It sort of gave me some peace of mind and I knew there was nothing sort of really wrong.

Then I think that the following blood test levels had come down significantly. I think we discussed a few things when we were doing the test. I think it was one of those things where I was pretty stressed at the time where I took the first blood test, and maybe that was the problem.

I was probably thinking, “Oh man, I’m really stressed. I should go and get my health checked.” Which might’ve had some, I mean I have no idea if that influences blood work, but, yeah. I’m certainly glad I came in. I had the test and sort of view. “Okay. Yeah. I don’t have a scarred liver.”

Nathan: Yeah. It’s certainly true that people worry a lot when that first test comes back abnormal. So, the FibroScan is good in providing that reassurance that you’re not developing scarring of the liver; because, that’s what it’s all about in the end, in terms of your liver.

Nick: I agree. All right. Well let’s wrap up this podcast. Thank you very much for your time, Nathan.

Nathan: Thanks, Nick.

Nick: This episode was brought to you by the Moonee Valley and Specialist Centre and LiverScan Australia. To learn more about the liver FibroScan or to make a booking, please visit liverscanaustralia.com.au.

Moonee Valley Specialist Centre is Victoria’s only private LiverScan facility. There is no waiting list and no referral required. Go to liverscanaustralia.com.au to book your liver scan.

At least, this is what I believed until a friend of mine ended up in the hospital with liver failure. Turns out drinking just two cans of beer or two glasses of wine a day can cause irreversible damage to the liver and what’s worse, we may never know we have liver damage until it’s too late.

How serious is the problem?

According to the 2018 FARE (Foundation for Alcohol Research & Education) report, 82 percent of Australians surveyed drink regularly while at least five million people drink to get drunk. The report also says alcohol leads to 5,500 deaths while causing 157,000 hospitalizations each year, not to mention the burden of about $36 billion annually on the society.

The good news is that most of us are concerned about alcohol abuse. The bad news is that very few Aussies – like me- are aware of the link between liver problems and alcohol abuse.

What does the liver do?

As the largest organ in the upper right abdomen, the liver’s main task is to get rid of toxins and store nutrients. From helping the body to make and store energy to breaking down fats, this fantastic organ has multiple roles to play.

After we eat or drink, the nutrients, as well as unwanted toxins such as chemicals, drugs or alcohol, are absorbed into the blood in the intestine and taken to the liver. Once blood reaches the liver, anything that can potentially harm our body including drugs, alcohol, chemicals such as pesticides, pollutants, preservatives or food coloring are removed.

The buck stops here

Excess alcohol can slowly but surely damage liver cells to the point where the cells can no longer grow. Instead of healthy liver tissue, fat begins to accumulate. When more than 5 percent of the liver is replaced by fat, the condition is called Fatty Liver Disease (FLD).

Continuous damage from toxins such as alcohol cause scars to form in the liver even as the cells try to repair themselves in a process called fibrosis. With more such scars being formed over time, the liver loses its ability to improve itself and function normally. Extensive scars in the liver lead to chronic conditions such as liver cirrhosis, liver cancer, and liver failure.

Like me, most people do not realize in time that they have fatty liver or fibrosis because there are are no symptoms at this stage. Signs such as fatigue, appetite loss, nausea, confusion, swelling of legs and abdomen, yellowing of skin only appear in the later stages of fibrosis. If you wait until these symptoms to appear to get blood tests or ultrasound done, the damage to your liver could be beyond repair.

Preventing liver damage with FIBROSCAN® 502 TOUCH

The only way to stay safe is to get a liver scan with the FIBROSCAN® 502 TOUCH test every six months so that minor damage can be diagnosed before it becomes extensive.

Just like an ultrasound, the liver scan is a painless procedure that can be completed between five to 30 minutes. Also called transient elastography, the state-of-the-art technique uses “shear waves” to accurately measure fatty liver changes and the extent of scarring. Unlike a liver biopsy which involves taking a small sample of liver cells in one location, the FIBROSCAN® 502 TOUCH studies the entire liver.

The FIBROSCAN® 502 TOUCH test helped me understand that I can stop liver damage in its tracks by cutting out alcohol, exercising and eating healthy.

I now raise a glass to health. Schedule your scan now to protect your liver.

As one of the most vital organs in the human body, we need to make sure that among the good times, we give the liver a break from alcohol and take good care of it.

Here are 10 things you can do to look after your liver:

1. Water, water, water

Our bodies love water – after all, we’re made up of around 60 percent water. So make sure you drink plenty of it every day! Add a dash of lemon or lime if you find it hard to drink plain water.

2. Manage your meds

Many medications can harm your liver, especially if you don’t take them as directed. Make sure your GP or medical specialist is aware of all of the medications you are taking and the dose. Other prescriptions, food intake and your genes are all factors that need to be considered when taking medication. If you start any new medication and notice that you are becoming nauseous, tired, itchy or jaundice (yellowing of the skin and whites of the eye), contact your medical professional.

3. Safe sex

Make sure you practice safe sex to protect yourself and your partner. There are a number of diseases transmitted during sex that can harm your liver. Hepatitis C is just one example.

4. Don’t overdo the drinks

When you consume excessive amounts of alcohol (more than six drinks for men and four for women), your liver begins to struggle processing other vital nutrients as it’s too busy removing the toxins. Excessive drinking overtime causes fat to build up in the liver, which can lead to inflammation and fatty liver disease. Doesn’t sound very nice and it’s not.

5. Eat the colour wheel

Eat a colourful diet full of fruits and vegetables. Not only does a colourful salad look good but it’s packed with nutrients and fibre – your liver will thank you! Keep the ‘beige’ foods (think bread, doughnuts etc) to a minimum.

6. Keep an eye on your BMI

Have you checked your body mass index (BMI) lately? If you are overweight or obese, your liver is at risk of developing fatty liver disease and this means that over time your liver could be damaged, along with other complications. The good news is that fatty liver disease can be reversed with weight loss and a healthy diet. Click here to check your BMI

Supplied by BMI Calculator Australia

7. Move your body

Exercise has so many benefits for your body and mind. It helps you to maintain a healthy BMI and lose weight, which helps to prevent liver disease. Choose an exercise that you enjoy and get started – even if it’s a walk around the block. Anything is better than nothing. Try different forms of exercise until you find something you enjoy and then it won’t even feel like exercise and you’ll still get to enjoy the benefits!

8. Be wise and sanitise

Did you wash your hands after you last went to the bathroom? Washing your hands after using the bathroom, before and after preparing and eating food is an easy way to stay safe from infectious germs that can harm your liver. Carry a hand sanitiser with you if possible and sanitise your hands after touching public surfaces too, including shopping trolleys, handrails and especially money.

9. Navigate needle risks

If you’ve ever injected illegal drugs seek out a hepatitis C test, as the disease can spread through your body and cause intense liver damage. The same test is valid if a needle has ever accidentally pricked you. Don’t share needles.

10. Don’t wait, vaccinate

If your liver already shows some form of damage or you have a weak immune system, be sure to check whether your vaccinations are up to date. Most children are vaccinated against hepatitis A and hepatitis B, however, many adults haven’t been immunised. There is no vaccine for Hepatitis C.

Looking after your liver is essential for you to live well. A diseased liver just can’t do its job and that means you will become sick. If you have a history of heavy drinking, drug use, or you are overweight or obese, it’s a good idea to have your liver checked for disease, as often there are no symptoms in the early stages.

When you do start experiencing systems of liver disease, they can include: loss of appetite, diarrhoea, abdominal pain, feeling ill, tiredness fatigue, or more advanced symptoms like pain in the upper right side and an increased sensitivity to alcohol and drugs.

11. See a Liver Specialist To Take Liver Scan

A liver scan is a non-invasive, pain-free procedure that is similar to having an ultrasound. A liver scan measures the amount of scar tissue and fatty change (Steatosis) of the liver, allowing a liver specialist to determine if your liver is damaged and to what extent.

For more information on the LiverScan, click here. Remember, you only have one liver, so look after it this festive season and all year round!

Recent research by the Foundation for Alcohol Research and Education found that 82% of Australians drink and almost 50% (5.7 million) drink to get drunk. While it can be harmless fun, more often than not excessive drinking leads to harm.

In the short term, there’s the hangover to deal with – the headache, dehydration, nausea, vomiting, the hazy memories of the night before and an empty wallet.

Long-term or chronic excessive heavy drinking can have devastating effects on our social, mental and physical health.

Alcohol abuse is associated with depression, increased physical violence, throat and mouth cancers, breast cancer, kidney and pancreatic problems, heart disease and stroke, and liver disease.

Alcohol and Liver Disease From Heavy Drinking

In short, alcohol and the liver don’t mix. Like all organs in our body, the liver functions best when we look after it with a healthy balanced diet (including plenty of water) and exercise. Drink too much alcohol and your liver will struggle to do its job (i.e., remove harmful toxins from the body, protect against disease, store energy and make protein).

Excessive alcohol can cause fat to build up in the liver leading to a condition called fatty liver disease or steatosis. This is the most common liver disorder resulting from excessive heavy drinking.

Too much fat in the liver can cause the liver cells to become enlarged and inflamed. An inflamed liver from alcohol is known as alcoholic hepatitis – a potentially fatal disease.

If you continue to drink alcohol the inflammation can eventually lead to cirrhosis. Cirrhosis occurs when scar tissue starts to replace the healthy liver tissue. Because there is no cure for cirrhosis, treatment aims to slow progress.

Fatty liver disease and alcoholic hepatitis can be cured if you stop drinking. However, even after you stop drinking, cirrhosis can still develop.

Symptoms of liver disease can include jaundice (yellowing of the skin and whites of the eye), dark urine, nausea and vomiting, weight loss and pain in the upper right side.

LiverScan – Alcohol Liver Test

If you are concerned about your liver, an alcohol liver test with LiverScan can provide answers.

A liver scan is a pain-free, non-invasive procedure used to measure the scar tissue in the liver and fatty liver (steatosis). The results are immediate and can help doctors decide whether treatment is required and what treatment is best.

Moonee Valley Specialist Centre has the only privately owned liver scan machine in Victoria. To find out more or book an appointment, please contact us on 03 9372 0372.

How much alcohol is safe to drink?

If you are concerned about alcohol and liver disease, to help you make an informed decision about how much you drink, the National Health and Medical Research Council has developed the Australian Guidelines to Reduce Health Risks from drinking alcohol.

Love your liver … it’s the only one you’ve got.

What is binge drinking?

Binge drinking can ultimately be defined as the consumption of an excessive amount of alcohol within a short period of time or in one sitting. More specifically, for women, any more than four standard drinks in one sitting is considered to be binge drinking. For men, any more than six drinks in one sitting is classed as binge drinking.

Who is at risk?

People aged 18 to 24 are most likely to report risky drinking behavior, according to recent research from the Australian Institute of Health and Welfare. However, that doesn’t mean that others aren’t at risk, anyone who binge drinks is at risk of some form of liver damage or disease.

What is binge drinking liver damage?

In short, when a person binge drinks or drinks excessively over a period of time their liver starts to replace its own healthy tissue with scar tissue. As this process progresses over time the liver loses its ability to properly function. Liver damage can include but is not limited to, steatosis (fatty liver disease), fibrosis (liver stiffness /scarring), cirrhosis (process of the scaring of liver tissue), and alcohol hepatitis (inflamed liver).

What are the symptoms of alcohol liver damage?

Early symptoms include things such as; tiredness, abdominal pain, feeling ill and loss of appetite, fatigue or even diarrhea. Advanced symptoms of alcohol liver damage however, are more identifiable; jaundice (yellowing of the skin and whites of the eye), dark urine, nausea and vomiting, weight loss, pain in the upper right side and an increased sensitivity to alcohol and drugs (as the liver is not functioning properly and is unable to process them).

What can I do to confirm if I have alcohol liver damage?

If you notice any symptoms of alcohol liver damage that tie in with your tendency to binge drink, it is recommended that you see your doctor. Your doctor may recommend that you have alcohol liver functioning tests such as a LiverScan.

What is a FibroScan?

A FibroScan® is a pain free, non-invasive procedure used to measure the scar tissue in the liver and fatty change (Steatosis). The results are immediate and can help doctors decide whether treatment is required and if so what treatment is best. Moonee Valley Specialist Centre is the only private practice in Victoria to have a FibroScan® 502 Touch device. To find out more information or book an appointment with liver specialist Dr. Nathan Connelly, please contact us on 03 9372 0372.

According to a recent (2015-2016) survey conducted by the Australian Government’s Sports Commission, 5.8% of Australian adults participate in football – that’s 1,141,027 people.

That same survey suggests that our top motivation for playing sport is to increase our physical health and fitness. Ironically, so many of our sporting activities – win, loss, training – are followed with a few too many drinks at the pub or a mates’ house.

Drinking won’t matter if I’m exercising, right?

Wrong! It’s easy to assume that regularly playing sport and putting in the hard work to achieve your peak health and fitness would cancel out the Friday night binge drinking session. What this doesn’t take into account are the long-term repercussions of indulging in risky drinking patterns. A harmful or risky drinking pattern can be defined as excessive drinking or binging in one sitting. For men, it’s any more than six drinks and for women, it’s any more than four standard drinks.

How will it affect my training and health levels?

Each gram of alcohol contains approximately seven calories, adding up to 70 calories for a standard drink containing 10 grams of alcohol. Extra calories equal extra body weight.

Alcohol also affects our body’s ability to absorb nutrients and apart from making you more prone to illness and longer recovery times, your body needs to be able to absorb the right nutrients to perform at its best.

Excessive alcohol does no favours to our liver either. Excessive alcohol can cause fat to build up in the liver leading to a condition called fatty liver disease or steatosis. This is the most common liver disorder resulting from excessive heavy drinking.

Too much fat in the liver can cause the liver cells to become enlarged and inflamed. An inflamed liver from alcohol is known as alcoholic hepatitis – a potentially fatal disease.

If you continue to drink alcohol the inflammation can eventually lead to cirrhosis. Cirrhosis occurs when scar tissue starts to replace the healthy liver tissue. Because there is no cure for cirrhosis, treatment aims to slow progress.

Fatty liver disease and alcoholic hepatitis can be cured if you stop drinking. However, even after you stop drinking, cirrhosis can still develop.

How do I know if my liver has been affected?

There are early symptoms of alcohol-based liver pain that you can be on the lookout for such as: loss of appetite, diarrhoea, abdominal pain, feeling ill, tiredness or even fatigue.

However, if you know you’ve been drinking excessively for a while, advanced symptoms of alcohol- based liver damage are more serious and noticeable. For example, pain in the upper right side and an increased sensitivity to alcohol and drugs, because your liver is not functioning properly and can’t process these substances. Other advanced symptoms include weight loss, nausea and vomiting, dark urine and jaundice (yellowing of the skin and whites of the eye).

What do I do if I am experiencing any of these symptoms?

The first thing you need to do is see your doctor as soon as possible. Your doctor may recommend you to see a liver specialist to have a liver scan to determine whether your liver is damaged, and to what extent. A LiverScan measures the amount of scar tissue and fatty change (Steatosis) to the liver. The procedure is non- invasive and completely pain-free.

The results are immediate and will allow your doctor to determine if your liver is damaged and what treatment is required.

Take a liver alcohol test

LiverScan Australia is the only private practice in Victoria to have a FibroScan® 502 Touch device that can perform a liver alcohol test. To find out more or book an appointment, please contact us on 03 9372 0372.