You may not have heard of fatty liver disease. Experts say you need to know | CBC Radio

It’s a disease many have never heard of — yet it affects about 25 per cent of Canadians. 

Non-alcoholic fatty liver disease happens when fat builds up in the liver. Experts say it’s hard to say what exactly causes it, but it’s associated with poor diet and not enough exercise. 

Most people experience no symptoms of fatty liver disease — so you may not know you have it. 

If left untreated, it can lead to more serious liver disease, such as cancer, and land you on a liver transplant wait-list. 

“Your liver has tremendous reserve. Until you’re down to about less than 20 per cent, you don’t feel anything,” said Dr. Eric Yoshida, a professor of medicine at UBC and a hepatologist, a doctor who specializes in the liver.

Dr. Alnoor Ramji, a hepatologist and clinical associate professor at UBC, said some patients will complain of a vague sense of discomfort or bloating in the area of the liver, which is just under the right breast. 

“It’s not going to be a sharp pain. It doesn’t keep them from doing things or activities in any way whatsoever,” said Ramji. 

Does it have anything to do with alcohol? 

There are two kinds of fatty liver disease: alcoholic and non-alcoholic. The non-alcoholic type affects more people in Canada than the kind associated with alcohol. 

Ramji said many people diagnosed with fatty liver disease are surprised because they don’t drink much. 

“They go, ‘How can I possibly have anything wrong with the liver?’ It’s almost a disbelief that they have a liver disease because they don’t consume any significant amount of alcohol,” he said. 

Do more of us have fatty liver disease than in the past? 

Experts say the rates of fatty liver disease are going up in Canada. 

“Fatty liver disease is now one of the most common indications for a liver transplant, whereas, say, 10 to 20 years ago it was things like hepatitis C,” said Yoshida. 

There are now medications to help cure hepatitis C, so Yoshida said he no longer sees many patients for that disease. 

Ramji co-authored a modelling study in 2020 that suggested the incidence of fatty liver disease will increase by 20 per cent by 2030. 

“That’s driven in the context of Type 2 diabetes as well as obesity, because as those two conditions increase, you expect the fatty liver disease will increase,” said Ramji. 

The modelling study — published in the Canadian Medical Association Journal — also suggested that the number of patients with complications from fatty liver, including cirrhosis, which is scarring and damage of the liver, will double between now and 2030, said Ramji. 

That means the number of people in Canada with extreme liver damage will go from about 100,000 in 2019 to 200,000 in 2030, he said. 

There is a lack of national data in Canada on fatty liver, said Ramji, which means most of the data he and other researchers rely on comes from the U.S. or other countries. 

“When we did the modelling data in Canada, we used obesity and diabetes rates available to drive the burden of fatty liver disease and its complications,” said Ramji. 

“Hopefully with more interest in this area and thus support, we can better understand the Canadian landscape.” 

WATCH | Dr. Eric Yoshida on the impact of alcohol and liver disease among young people

Dr. Eric Yoshida on the devastating impact of alcohol and liver disease among young people

Dr. Eric Yoshida, a professor of medicine at the University of British Columbia and chair of the Canadian Liver Foundation’s Medical Advisory Committee, says patients – particularly younger ones – often express shock and disbelief that alcohol has caused them serious illness.

So how do you know if you have fatty liver disease? 

Experts say most people are diagnosed through blood tests or an ultrasound, often ordered because of an unrelated symptom. 

In many cases, a family doctor will notice that liver enzymes are higher than normal and will then order an ultrasound, which can confirm the diagnosis, said Dr. Natasha Chandok, a hepatologist at the William Osler Health System in Brampton and an adjunct clinical professor of medicine at McMaster University. 

“What I would tell patients is that if they have risk factors for fatty liver disease that they should see their family doctors to get screening,” said Chandok. 

Experts say the biggest risk factors are Type 2 diabetes and obesity. 

“Almost 60 per cent of patients who have diabetes can have fatty liver disease,” said Ramji. 

Studies have shown that certain ethnic groups may be at higher risk for fatty liver disease, said Chandok. 

In some studies done in South Asia, three out of four adults have fatty liver disease, she said. 

“So undoubtedly there may be environmental or genetic risk factors in certain ethnic groups, like South Asians, that may predispose to this disease as well,” said Chandok. 

Ramji agrees more screening could help diagnose people earlier. 

“If we were trying to be proactive, which is where we should be, we should probably think of those persons who are at higher risk and try and case-find or screen these persons,” he said. 

How can I prevent fatty liver? 

Hepatologists say they work with their patients to reduce the amount of carbohydrates and sugar in their diets and encourage exercise. 

Many of her patients don’t have a good understanding of a healthy diet and the importance of exercise, said Chandok. 

“A lot of patients are struggling with day-to-day life. They have very busy jobs, they don’t have a lot of time for exercise, they’re looking after their children,” she said. 

“The message that I try to give patients is at least give yourself 20 minutes [of exercise] a day, and anything you’re putting into your body in terms of nutrition, try to optimize it.” 

Ramji said the price of healthy food can be a barrier to some patients, as can cultural aspects, such as diets that are traditionally high in starches like rice or noodles.

“We have to think about what the family is consuming as well, not just the patient,” said Ramji. 

It’s all about moderation, he said. 

“You can still continue to have the rice and noodles; it’s the amount that you have and the proportion of green vegetables that you put into there.” 

For coffee drinkers, the good news is that coffee has been shown to help the liver, experts say. 

“If patients do enjoy coffee, I tell them to have a couple of cups a day — without sugar, of course,” said Chandok. 

Liver is the ‘smartest organ’ 

Through improved diet and exercise, fat in the liver can decrease, as can scar tissue, said Ramji. 

“I say the liver is the smartest organ,” he said. “It’s one of the few places where you can actually reverse damage … and that’s phenomenal.” 

Experts say both primary care providers and patients need to become more aware of the risks of fatty liver disease. 

“Why have you not heard of this? People hear about diabetes, high blood pressure, heart attacks and all that. Why have you not heard about it?” said Ramji. 

He said it’s important for primary care providers to let their patients who have Type 2 diabetes or obesity know about the risks of fatty liver disease. 

“I know it’s been very busy for primary care and they’re dealing with so many things, but the way to think about this is more preventative.” 

It comes down to education, experts say. 

“I think it starts with children and young people who have to have a healthy lifestyle,” said Yoshida. 

“A lot of it is simply going to have to be just basic public education.”