When Leigh Fischer was 24, he was like a lot of university students: preoccupied with doing assignments and practising with his band. He was also overweight, carrying 340 lb. on his six-foot-three frame. “It wasn’t to the point where I was morbidly obese; I was still mobile and functional. Everything was kind of normal,” he recalls from Winnipeg—except for a pain in his side. His doctor ordered blood tests, and Fischer soon learned that his liver was engorged with fat; he had non-alcoholic fatty liver disease. “It was scary,” he says. “It wasn’t anything I’d ever heard of.”
Fatty liver disease used to affect mostly heavy drinkers in old age. But as obesity rates have risen, so, too, has the incidence of non-alcoholic fatty liver disease (NAFLD), which occurs when fat accumulates inside the liver cells. It is now the most common liver disease among Canadians and Americans alike, affecting at least one-third of adults, and 10 per cent of children. But because NAFLD is often asymptomatic or goes undiagnosed, some experts say the disease is probably even more common than that. (It is usually detected while investigating other medical problems.)
“The statistics are staggering,” says Dr. Eric Yoshida, a Vancouver gastroenterologist and chair of the Canadian Liver Foundation’s medical advisory committee. Caught early, NAFLD can be reversed through diet and exercise. In the worst cases, untreated NAFLD, combined with genetic and environmental factors, is associated with liver scarring and failure, cancer, diabetes, heart attack, stroke and aneurysm. “The bottom line is that NAFLD is a marker for bad health,” says Yoshida.
Nowhere is that more obvious than in the transplant world. Over the last decade, NAFLD is the only medical condition requiring a liver transplant that has been increasing, says Dr. Leslie Lilly, a transplant physician at Toronto’s University Health Network. It used to be “the sixth- or seventh-most common cause for a liver transplant,” he says, far behind diseases such as hepatitis B and C or excess alcohol consumption. “Now it’s No. 3. And in another 10 or 15 years, it’s probably going to be No. 1.”
That has created high demand for liver donations, but many donors themselves have undiagnosed NAFLD. As a result, “we are discarding more and more [livers] from deceased donors because they are too fatty for us to use,” says Lilly, “so we’re really feeling squeezed.” Over time, he warns, “we’re going to see more and more patients waiting longer and longer for their transplants.”
Liver failure may be a devastating consequence of NAFLD, but it’s not the most prevalent threat, says Dr. Marie Laryea, a Dalhousie University professor and one of only two liver-transplant specialists serving Atlantic Canada. Far worse is the disease’s association with heart and blood vessel problems. “I try to emphasize with patients that, if you have fatty liver disease, the risk of you dying of it is increased, but not as much as the risk of you dying of cardiovascular disease,” she says. “That’s the No. 1 cause of mortality in that patient population.”
In fact, NAFLD is considered part of metabolic syndrome, says Yoshida, the cluster of conditions including high blood pressure, high cholesterol and belly fat linked to heart attack, stroke and diabetes. The good news is that, in the same way that these conditions can be improved or reversed through lifestyle changes, so, too, can NAFLD. “A little over four hours [of exercise] per week, which almost works out to half an hour a day—that’s all it takes,” says Yoshida, a professor at the University of British Columbia.
That is a key theme at the Fatty Liver Forum info-sessions co-hosted by Laryea for newly diagnosed NAFLD patients every two months in Halifax. The meetings have been a creative way to educate individuals about the disease while they wait a year or more to see a liver specialist. “Then we see them in clinic and usually, they’ve already lost a little bit of weight,” says Laryea, “so we’re a step ahead.”
For Fischer, a lot has changed since he was diagnosed with NAFLD in 2010. He replaced carbohydrate-laden meals with salad and fruit. He also began working out three times a week using Xbox Kinect as part of a study at the University of Manitoba of practical solutions for NAFLD patients. “I slowly graduated from doing that to actually heading to a gym,” Fischer recalls. “It can be a very frustrating process. For a while, I was down on [exercise] because I was a scale watcher.”
Eventually, he focused on the activities he enjoyed most: running, swimming and biking. Today, Fischer is a triathlete. At his leanest, he weighs 215 lb. Along with all that extra weight, Fischer has shed NAFLD by committing to a lifestyle change. “If you’re looking for a quick fix, it isn’t really out there,” he says. On the other hand, he says, “Working on something for three years is going to look like a quick fix when it’s 20 years [later] and you’re still healthy and alive.”