For millions of years, humans adapted and evolved to survive in conditions where food was scarce. We are biologically prepared so that at any time we eat just a tiny bit more than we need; we keep it, because perhaps tomorrow or the day after, we will not find food again. Our ancestors persisted this way, by storing enough fat to keep searching for the next meal. That is what the human body does naturally, and that’s why we get sick if we eat too much and don’t exercise.
The liver reacts badly to overfeeding, which fills cells that should be empty most of the time with gelatinous chunks of sticky fat. Then enzymes are released to deal with this problem, and — just like maintenance workers in real life — most of the time they manage to break everything around them while they work. So, the liver develops scarring, and in time your liver becomes so engorged with scars — a condition known as cirrhosis — that it looks the same as if you’ve been drinking a litre of wine every day.
Cirrhosis is a serious problem that has been with us for a long time. Now it is understood that fatty liver disease is the leading cause of cirrhosis, which often leads to liver transplantation.
Unfortunately, there is no chance of getting a liver transplantation in Vietnam because it is unavailable here, and so people with end-stage fatty liver generally die. The risk factors for fatty liver are the same as they are for cardiovascular diseases — being overweight or obese, diabetes, high cholesterol, clogged arteries, all from excessive amounts of stored fat.
Dealing with Viral Hepatitis
Prior to research done in the 1970s and 80s, it was thought that the chief causes of cirrhosis were alcoholism and hepatitis. One of the main reasons why viral hepatitis has become far less of a causal factor is due to the discovery of a cure for hepatitis C — and that may result in the same for hepatitis B. Left unchecked, these viruses cause liver inflammation that leads to cirrhosis or liver cancer in patients, often leading to a choice between transplantation or death.
There was a time when, with a very strong treatment and injections, a cure for hepatitis C would be achieved in about 13% of cases. Through the careful application of science, treatments became easier yet more effective. Success rate leapt to 50%, and through more astonishing advances, to 75%.
This medicine has now been refined even further to the point where we are now down to just one tablet per day for only 12 weeks, no side effects, and a 98% chance of success. Doctors like me who are old enough to have been witness to all of this, can only shake our heads and say wow. It is not magic, it’s science. And these medicines are now available in Vietnam.
The key point is the cost. A liver transplant, if there are not many complications, is around US$250,000. The 12-week treatment, or 84-day cost for taking the tablet is US$84,000. That’s a very good deal. You’re cured, there are no side effects, and you save the US$250,000 for the transplantation.
These advances, and similar research to beat hepatitis B have greatly reduced the incidence of cirrhosis and liver transplantation. In the case of fatty liver, however, besides diet, exercise and taking omega-3, the big issue around treatment is teaching. We doctors need to teach patients that even if they feel nothing, they may die because of the build-up of fat in their liver.
I always push all my patients to do what I like to do — to run. It’s very hard to succeed — it’s difficult to change a habit. Sometimes, however, your life depends on it.