THE STAR, TUESDAY 17 APRIL 2018

HEALTHY LIVER
Preventing hepatitis
THE heaviest and largest internal organ is
the liver. The liver’s main function is to
process everything you ingest and purify
your blood.
The most amazing thing about your liver
is that it can repair itself when its cells
sustain minor damage. In cases of severe
damage or inflammation, your liver stops
functioning properly and the resulting
condition can be fatal.
Inflammation of the liver is called
hepatitis, which can be caused by a virus,
alcoholism, fatty liver, autoimmunity or
prolonged use of certain drugs.
While hepatitis due to other causes is
preventable through lifestyle intervention
such as healthy eating and moderation of
alcohol intake, viral hepatitis is preventable
only by vaccination.
Gone viral
Viral hepatitis is caused by one or more
of five types of viruses.
l Hepatitis A virus – This virus is
which can be fatal.
l Hepatitis B virus – The most common
viral hepatitis in Malaysia as well as the
world, hepatitis B is preventable through
vaccination, which, according to World
Health Organization, is 95% effective against
the virus. A potentially life-threatening
disease, hepatitis B can cause a chronic liver
infection with increased risk of hepatic
cancer and cirrhosis.
Spread through contaminated bodily
fluids, chronic hepatitis B is treatable, but
there is no precise treatment for acute cases.
l Hepatitis C virus – A bloodborne virus,
hepatitis C cases can be acute (suddenly
occurring) or chronic (developing over a
long period). While recovery is usually
possible in acute cases, people with chronic
hepatitis C can develop cirrhosis or hepatic
cancer, which can be fatal. Treatment is
possible, but there is currently no
vaccination against hepatitis C.

Get a grip on
transferred through contact with infected
faecal matter and spreads through food and
water contaminated with infected human
faeces.
People usually recover from hepatitis A
without permanent liver damage and with
l Hepatitis D virus – When this virus
occurs together with the hepatitis B virus,
one develops hepatitis D. People with
chronic hepatitis B can acquire hepatitis D
from a carrier through needle-sharing,
blood and sexual contact.

clammy hands
lifelong immunity. However, hepatitis A can
turn to fulminant hepatitis in some cases, > TURN TO PAGE 2

DO you experience cold hands and feet

after sitting in the office all day long? This
often happens to women, especially among
desk-bound executives or those leading
sedentary lifestyles. Cold hands and feet
are related to blood circulation and nitric
oxide.
In 1998, Dr Louis Ignarro won a Nobel
Prize in Physiology or Medicine for his
discovery of nitric oxide’s role in the
cardiovascular system.
Since then, the popularity of dietary
supplements containing L-arginine and
L-citrulline has increased as both promote
the production of nitric oxide.
Nitric oxide has been dubbed the
“miracle molecule” as it fights off various
vascular diseases and improves wound
healing and muscle gain.
L-arginine is an amino acid involved in
the production of nitric oxide – a key
messenger molecule involved in protein
production, wound healing, erectile
function and fertility. L-citrulline is an
amino acid that plays an important role in
nitric oxide metabolism and regulation.
In our body, L-citrulline is converted to
L-arginine to support both L-arginine and
nitric oxide levels. The level of L-arginine
in the body is critical to the production of
nitric oxide.
There is a science behind nitric oxide
functions and how increasing nitric oxide
levels appropriately can help with
circulation. Nitric oxide signals the smooth
muscles of the endothelium (inner lining of
blood vessels) to relax and constrict to
facilitate blood flow.
Optimal nitric oxide production not only
improves blood circulation and vascular
health, it also assists in promoting collagen
synthesis and wound healing.
An optimal level of nitric oxide is
important for ideal vasodilation, leading to
improved blood circulation and benefiting
those who are diabetic, overweight, leading
sedentary lifestyles or used to be active
smokers.
In our body, L-citrulline
is converted to L-arginine
in the body to support
both L-arginine and nitric
oxide levels. The level of
L-arginine in the body is
critical to production of
nitric oxide.
If you fall in one of the mentioned
categories, these are some symptoms of poor
blood circulation you might be facing:
l Cold hands and feet – Our blood flows
consistently to keep our body at a healthy,
comfortable temperature. Poor circulation
causes a chill in areas of the body with many
nerve endings such as the hands and feet.
l Tingling and numbness in extremities
– It is common to experience tingling
sensations and numbness in limbs that are
inactive for too long. What differentiates
normal numbness from poor circulation is
that those with the latter condition
experience it more frequently, with
symptoms that last a few minutes.
l Slow healing of wounds among
diabetics – Good circulation ensures a good
flow of nutrients and oxygen and plays an
important role in the healing of wounds.
Diabetic patients typically have poorer
circulation, leading to a delay in wound
healing.
l Erectile dysfunction – Men with poor
circulation may experience insufficient
blood flow to their reproductive organs. It
may then eventually lead to erectile
dysfunction.
n This article is brought to you by
Vitamode Sdn Bhd.
2 Healthy Liver THE STAR, TUESDAY 17 APRIL 2018

Good liver,
good health
THE largest internal organ of the the liver. Regularly
human body, the liver is a
multitasker that works constantly
The liver helps taking whole grains or
other forms of complex
and silently. control blood sugar carbohydrate may help

levels. When sugar

It helps clean the blood by
detoxifying toxic and harmful
substances into safe materials. It
plays a major role in fat
metabolism, secreting bile that
breaks down fat and lipids.
prevent fatty liver disease.
Coffee – Drinking coffee can
level in the blood help protect your liver. Studies
show that drinking coffee can have
drops, the liver beneficial outcomes for liver

The liver is also responsible for
regulating blood supply. It does so
by storing blood, producing
proteins that are important in
blood clotting, and breaking down
old or damaged blood cells so they
immediately breaks
disease patients and individuals at
risk of liver disease.
down glycogen and Turmeric – The active
compound found in turmeric,
releases sugar into known as curcumin, has anti-
inflammatory effects and
the blood. antioxidant properties, which help

The danger signs

can be removed from the body.
In addition, the liver helps
control blood sugar levels. When
sugar level in the blood drops, the
liver immediately breaks down
glycogen and releases sugar into
the blood.
The liver converts ammonia,
a toxic byproduct of protein
metabolism, into harmless urea,
which is then transported to the
kidneys and excreted in urine.
The health of our liver is affected
by various factors, such as toxins,
obesity, an inactive lifestyle,
viruses, type II diabetes, genetic
factors, drug abuse and heavy
alcohol consumption.
Non-alcoholic fatty liver disease,
hepatitis, liver cancer and alcohol-
related liver disease are the most
common types of liver disease
around the world.
There are many foods that can
help keep your liver healthy.
Oatmeal or whole grains –
Fatty liver is the result of fat build-
up in the organ, which may
obstruct the normal functioning of
keep the liver healthy.
Other foods such as almonds,
blueberries, spinach, broccoli and
green tea are also good for your
liver.
In addition to having a healthy,
balanced diet, you should exercise
regularly and drink plenty of water
instead of sweet drinks. Limit
alcohol consumption and avoid
foods that are processed or high in
sugar and salt.
n This article is brought to you by
21st Century Products (M) Sdn Bhd.
> FROM PREVIOUS PAGE
What makes hepatitis D
dangerous is that its
co-existence with hepatitis B
makes it difficult to treat.
However, if it is not treated,
both conditions can cause
cirrhosis, which can lead to liver
failure.
The best way to prevent
hepatitis D is to be vaccinated
against hepatitis B.
l Hepatitis E virus – Similar
to the hepatitis A virus, this
virus spreads through food and
water contaminated with
infected human faeces.
Most hepatitis E cases are
uncomplicated and full recovery
is possible without permanent
liver damage.
Possible indicators
It is very likely that if you
have hepatitis, you may not
have any apparent symptoms,
which makes this disease even
more dangerous. Initial
symptoms of hepatitis mirror
symptoms of the common flu
and can interfere with
diagnosis.
However, it is imperative that
you schedule a check-up if you
notice any of the symptoms as
an early diagnosis can save your
life. It is, after all, better to be
safe than sorry.
Look out for these symptoms
that can be early indicators of
hepatitis.
l Mild fever
l Prolonged loss of appetite
l Vomiting and nausea
l Prolonged fatigue
l Abdominal pain
l Joint and muscular
pain
whites of the eyes, commonly
known as jaundice
l Dark-coloured urine
l Light-coloured stools
l Piercing abdominal pain
Viral hepatitis can affect
anyone, but people who are
not vaccinated face a higher
risk of getting infected.
Such individuals should
be extra careful around people
with hepatitis and when
visiting a country that has a
high prevalence of viral
hepatitis.
Since chronic hepatitis B can
be passed on to foetuses by
mothers, it is important for
infected mothers to undergo
regular check-ups.
A preventative measure is
to have newborn babies
vaccinated against the virus.
On the non-viral hepatitis
front, people who lead
unhealthy lifestyles including
those who are alcoholic, get little
to no exercise and practise
unhealthy eating habits are
more likely to develop the
disease.
The best way to fight this
deadly liver disease is through
awareness. Educate yourself
about hepatitis and its
symptoms, causes, treatment
procedures and prevention
methods to keep yourself and
your loved ones safe.

If you have most

of the above
symptoms, it is
advisable to also
keep an eye
out for the
following ones,
which indicate
advanced
hepatitis.
Immediate
medical
attention is
required if you
display these
symptoms.
l Yellowing of
skin, nails and
THE STAR, TUESDAY 17 APRIL 2018 3
4 Healthy Liver
FATTY livers in geese are prized,
but in humans, they can cause
serious health complications.
A whopping 30% of the Asia-
Pacific population is affected by
non-alcoholic fatty liver disease
(NAFLD) and the numbers are
only getting bigger, according to a
2012 study published in
Hepatology International.
The same study reported an
NAFLD prevalence in Malaysia of
22.7% among individuals
attending a health check at a
suburban medical facility and
observed an inordinately high
prevalence of NAFLD among
Malays and Indians compared to
that of other races.
Most people with fatty liver
have simple steatosis or simple
fatty liver in which case the fat
does not cause inflammation in
the liver. People with NAFLD do
not consume significant amounts
of alcohol.
However, up to 25% of people
with NAFLD experience non-
alcoholic steatohepatitis (NASH),
characterised by inflammation
that can lead to fibrosis (scarring),
cirrhosis (severely scarred,
hardened and shrunken liver),
and eventual liver failure, whose
only mode of treatment is liver
transplantation.
“There is an increasing number
of patients with NAFLD who
develop liver cancer or require
liver transplants. In fact, NASH is
now the second most common
cause for liver transplants in the
United States and will likely
overtake hepatitis as the number
one cause for liver transplantation
in the future, as more hepatitis C
patients today are being treated
with curative antiviral drugs,”
says Dr Ganesalingam
Kanagasabai, consultant
gastroenterologist at Subang Jaya
Medical Centre.
Only a small percentage of
NAFLD cases progress to cirrhosis,
but it still makes a significant
impact on the regional disease
burden.
A subtle disease
NAFLD across the board is
typically asymptomatic. In rare
cases, patients complain of
discomfort, but by the time
symptoms are noticeable, it is
usually too late and the liver has
begun failing.
Tangible symptoms include
swollen ankles due to fluid
retention, jaundice, confusion and
internal bleeding.
“The most common way that
people find out they have fatty
liver is when they undergo an
ultrasound scan of the liver or
routine blood test that reveals an
abnormal reading of liver
enzymes,” says Dr Ganesalingam.
According to him, most people
with fatty liver have metabolic
syndrome – a cluster of conditions
that includes hypertension,
obesity, diabetes and elevated
cholesterol levels.
The danger zone
“People with fatty liver don’t
often die from liver disease. The
majority instead succumb to
cardiovascular complications or
stroke caused by metabolic
syndrome, which is associated
with fatty liver,” says Dr
Ganesalingam.
“Cancer-related deaths are
among the top three causes of
death in people with NAFLD.”
He states that for the average
person, liver disease is the 12th
most likely cause of death. For
someone with fatty liver,
Dealing with fatty liver
however, the likelihood of liver
disease killing him goes up to third
place.
Detecting the culprit
A fatty liver is any liver with
more than 5% fat. Currently,
only livers with a significant
amount of fat can be picked up
through ultrasounds.
The drawback with ultrasounds
is that if the scarring is not severe,
the radiologist will be unable to tell
if the liver is damaged.
“The difficult part is detecting
which patient with fatty liver has
NASH with ongoing inflammation
and scarring in the liver. A patient
can have normal liver test results
yet have significant inflammation
and scarring,” says Dr
Ganesalingam.
According to him, the most
accurate way to test for NASH is to
A transient elastography is used to diagnose liver trouble.
do a liver biopsy – an invasive
procedure with potential risks.
The diagnostic timeline
“When a patient is diagnosed
with NAFLD, the next course of
action is to examine his risk
potential and determine
contributing factors such as
diabetes, high blood pressure,
obesity, high cholesterol, smoking
and lack of exercise. After that,
we have to assess whether the fat
is causing the liver harm,” says
Dr Ganesalingam.
A non-invasive, quick and simple
way of assessing whether or not
the fatty liver is harmful is with a
transient elastography of the liver
that can determine the degree of
fibrosis and the amount of fat in
the liver. A transient elastography
is performed with a Fibroscan
machine.
“The Fibroscan uses shear waves
that are projected at the liver. The
rate at which they travel through
the liver is measured.
“If there is significant scarring
within the liver due to fat-induced
inflammation, the waves travel
faster through the denser tissue
and results in a higher reading,”
says Dr Ganesalingam.
A Fibroscan is useful in assessing
the seriousness of fatty liver cases,
but is unfortunately not widely
available in Malaysia.
A low transient elastography
reading indicates simple fatty liver
with no scarring. A high reading is
cause for concern as these patients
probably have NASH and an
increased risk of cirrhosis, liver
failure or liver cancer.
Patients with high readings need
to be monitored for potential
complications due to their fatty
liver. It is believed today that
THE STAR, TUESDAY 17 APRIL 2018
patients previously thought to have
cirrhosis of unknown cause (called
cryptogenic cirrhosis) probably
had NASH.
Treatment and prevention
Lifestyle intervention consisting
of diet adjustments, exercise and
weight loss is the cornerstone of
treatment for fatty livers. It is
advisable to aim for at least 5%
weight loss, but the recommended
rate is around 7% to 10%.
According to Dr Ganesalingam, it
is generally believed that a 10%
weight loss leads to as much as
80% reduction of liver fat, which in
turn reduces inflammation and
can reverse scarring in the liver.
If a patient loses more than 5%
of his total weight, a significant
amount of fat, inflammation and
scarring in the liver is reduced.
Equal emphasis should be given to
proper control of diabetes, blood
pressure and cholesterol levels.
Other strategies involve drug
treatment. Non-diabetic NASH
patients with significant liver
scarring are prescribed vitamin E,
while diabetic NASH patients are
prescribed pioglitazone.
More new drugs emerge every
day, but even promising ones such
as the glucagon-like peptide-1
receptor agonist are still in testing
or trial stages, which means the
only treatment for NAFLD is still
lifestyle intervention. In patients
who are morbidly obese where
lifestyle intervention has failed,
bariatric surgery is an option.
“A medical consultation for
NAFLD should emphasise lifestyle
intervention consisting of diet
change, exercise and weight loss. It
is important to remember that
most patients with NAFLD die from
heart disease and stroke, not liver
disease.
“It is futile to take a liver
supplement diligently without
watching your diet, exercising
and quitting smoking. Liver
supplements should not be used
as the cure-all for NAFLD,” adds
Dr Ganesalingam.
n For more information, call
03-5639 1212.