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RADIO SCIENCE UNIT
CHECK UP
Programme 2 - Liver Disease and Alcohol
RADIO 4
THURSDAY 16/02/06 1500-1530
PRESENTER:
BARBARA MYERS
CONTRIBUTORS:
HUMPHREY HODGSON
PRODUCER:
ERIKA WRIGHT
NOT CHECKED AS BROADCAST
MYERS
Hello. We know when we've had too much to drink, we end up sloshed, to put it politely. And when we've had too much to eat we might feel sick or get indigestion. But do we have any idea of what over indulgence might be doing sight unseen to our liver? The body's biggest internal organ and one of the hardest working is pretty resilient and has some capacity to renew itself but only up to a point. Years of excess, whether through alcohol or fatty food, can lead to permanent damage known as cirrhosis and for that there's no treatment short of a liver transplant. Not all liver disease of course is self-inflicted - viral infections and autoimmune disease take their toll. But doctors are worried that our affluent lifestyle is leading to a dramatic increase in liver disease. So what can we do to protect it?
If you're concerned that you might be harming your liver and need advice about how to assess the damage, for instance, or how to reverse it call us now: 08700 100 444 is the number or you can e-mail your questions to checkup@bbc.co.uk. And here with me to answer your questions is liver specialist and medical director of the British Liver Trust, he's Professor Humphrey Hodgson.
Humphrey, the trust refers to liver disease as the next epidemic, is that actually right?
HODGSON
It is I'm afraid, there really is an epidemic of liver disease. It's most clearly seen in alcoholic cirrhosis, the incidence of this has doubled in the last 20 years, as we drink more and more, and society - and furthermore it's not only more common but it's coming at a younger age.
MYERS
Well let's see what we can do to stop it, let's take our first call. Lara King is waiting to speak to us, she's in London, she says candidly she's approaching 40 and is a steady drinker. So is there a question Lara?
KING
Well I guess yeah you've kind of half answered it already. As somebody who's about to hit 40 I'm kind of like taking stock of my health a little more and trying to cut down on all the things that are bad for me and I'm wondering is it really - can I go back and is it - am I able to now neutralise my liver, having sort of abused it practically for the last 20 years?
HODGSON
Well it all depends Lara what you mean by abuse. First let's say not all alcohol is bad and that drinking in moderation probably even has health benefits. But we have some pretty clear guidelines of what is too much and what is safe. And the safe limits for women are 14 units a week and the safe limits for men are 21 units a week. And that comes down to three drinks a day for women, four drinks a day for men, with a couple of days in the week that you don't drink.
MYERS
So how does that fit with what you drink would you say Lara?
KING
Well obviously now a lot less than I have been drinking for some considerable time. But a lot more than I'm hoping to drink in the future. I mean I was wondering if there was any other - apart from the obvious of cutting down on alcohol - whether there's any other sort of foods or anything that aid the liver to sort of like rebuild itself after abuse.
HODGSON
You don't - the liver's got a tremendous capacity to recover and even if there's pretty severe liver disease, due to alcohol, if you stop drinking the liver can get back to being virtually pristine.
MYERS
It sounds as though you're doing exactly the right things. It's interesting taking stock at the age of 40, thinking about all your health risks, I mean it sounds extremely sensible. And if you can cut down or are already cutting down that's obviously going to be helpful. So any damage that may have been done I mean will that be reversed I suppose in any way?
HODGSON
Well there's a progression of disease in the liver. When alcohol affects the liver the first thing is you get too much fat in the liver, you then begin to get scarring around it and then you get to what we call cirrhosis of the liver, which is permanent scarring. If you haven't got as far as the permanent scarring we believe that by and large the liver can get back to complete normality and even in those people in whom it has got as far as permanent scarring it can still improve its function enormously.
MYERS
Lara, thank you very much for starting us off. Stay with us because I know there'll be more information and I'm particularly keen to know what we mean by three drinks being safe for women and four for men because there are drinks and there are drinks I think, as we all know, but we'll come to that in a moment. Let's go to another caller though who's waiting patiently. Eileen Riley's on the line. Question please Eileen?
RILEY
Oh hello. I was wondering how you would actually know whether or not you have liver damage. Is it tested in a routine medical check up?
HODGSON
If you ask for it to be checked in a routine medical check up it certainly will be, there are some very standard blood tests looking both at what we call liver function tests and also looking at the red cells in the bloodstream which will tell us whether or not liver damage is going on. It's not necessarily routinely done so if your doctor said oh I did a blood test and it was fine, it may not have been, but if you say I'd like a test done on my liver it's a very straightforward thing to do.
RILEY
Why would I think that I needed a test though?
HODGSON
Well firstly you might be feeling guilty that you've been drinking too much. But the symptoms of liver disease are terribly variable. Some people just feel sort of off colour, tired, some people have liver disease when they don't even know that they have it at all and are completely symptom free. And then the symptoms are fairly severe liver disease, well there then are particular symptoms which would necessarily take you to your doctor.
MYERS
Let's take another caller. Thank you for that Eileen, but stay listening again because Alan's on the line and I think is interested in symptoms. He's calling from Kent. Alan your question please for Humphrey Hodgson.
ALAN
Hello.
MYERS
Hello.
ALAN
Hello. My question basically was a bit similar to the last one. I've got two now. What would be the symptoms if you had - because you didn't mention it, although you started to - what would be the symptoms of the start of cirrhosis of the liver? And my second question is what is a unit? I mean is it one man's best bitter or another man's barley wine ...
HODGSON
I'm very pleased you....
ALAN
... half a pint of beer but there's a heck of a difference in what you get.
MYERS
Alan you said what I'm thinking and I mean Humphrey's ready to answer this but let's be entirely clear what we're talking about here, when we're talking about units and what a drink is because I have a feeling we may not have the full story.
HODGSON
Okay. A unit is a glass of wine but is a very small glass of not very strong wine, it's not Australian red plonk ...
MYERS
So your 14% volume alcohol is not ...
HODGSON
Yes, if it's 14% and you buy and you get it in a decent pub that can be two or even two and a half units in a glass of wine.
ALAN
Really?
HODGSON
Half a pint of beer is half a pint of - half a pint of not even best bitter and a strong lager can have up to two and a half to three units in half a pint.
ALAN
You've cleared it up.
MYERS
Well it's really important what you're saying because we have been led to think that a unit is a glass but the glass you get in a pub these days is very often quite a big glass and in a restaurant they're very happy to sell you actually what turns out to be 250 millilitres, which is actually - how many units is that - four, three, four?
HODGSON
Two hundred and fifty mils would be between three and four.
ALAN
But at what strength alcohol?
HODGSON
That's a 14%. So in order to get it back to being one unit you have to have wine which is probably only 10% strong and you have to be having a glass which is less than a 100 mils, which is a very mean wine glass.
ALAN
Yes I agree with you.
MYERS
So we need some sort of rather clearer renewed sort of guidelines I think perhaps being published, making it clear what we are drinking because 14 units is really two drinks a night for a woman or a day, that's not a great deal and they are small glasses, as you've just said, of moderately strong wine. That's not a lot and a lot of people were drinking more than that without realising.
ALAN
Oh yeah it's very unclear.
HODGSON
That's right, there is a campaign to get brewers and there are some responsible brewers and some supermarkets who do put the number of units per bottle on the outside, so have a look next time.
MYERS
Okay, so that's a very fair warning you've given there Humphrey but to answer Alan's question about the symptoms of cirrhosis, can you help us with that?
HODGSON
Yeah, they can be very wide ranging. Some people can have cirrhosis and be completely symptom free and it can become a complete surprise to them and even their doctors to find they've got cirrhosis. Otherwise the symptoms can be terribly non-specific, just feeling fatigued, tired, bit of discomfort over the liver which is underneath the rib cage on the right hand side. And then as conditions get more severe, the sort of things which would definitely take people to the doctor, it's gross swellings, fluid accumulates in the abdomen, swelling of the legs or going jaundiced. And those are the sort of symptoms of advanced cirrhosis which would take anybody to their doctor.
MYERS
Alan, I hope we've helped you with your two very good questions. Let's take a call from Mike in North Wales who I think will help us further with the answer, I think Mike's also concerned about liver damage and the symptoms. Mike, is this a personal story or a friend?
MIKE
No it's myself. From the age of 20, I'm now 54, I don't think I've been sober for more than a handful of nights. And I'm now on 12 units a night. It never really varies. I don't drink during the day because I work all day. But every single night I have 12 units - I have three strong cans of lager - and this has gone on now for years.
MYERS
So you know you're a heavy drinker?
MIKE
Yeah. I have five children and I'd like now to see them grow up a little bit more and I'm worried that the symptoms I have may be an indication of damage.
MYERS
And what symptoms are you getting?
MIKE
I'm getting a feeling of warmth, as if I'm seeping fluid in my abdomen. I'm also getting symptoms of spots and lesions on my skin - on the back of my hands and on my upper cheek bones on my face. And I'm also getting a rather puzzling one, which I hope the doctor could help me with, in that sometimes - well most often - when I have a heavy meal I find there's a rush to go to the toilet quite soon afterwards, I was wondering if that - I'm quite mystified by that one.
MYERS
Okay Mike thanks for that. What would you say Professor?
HODGSON
It's always difficult Mike giving advice not even over the phone. The symptoms that you talk about could reflect the liver beginning to work not incorrectly - losing its function. But on the other hand they could be quite coincidental. There's nothing from what you're saying that would make me say gosh you'd better get yourself off to hospital or you'd better get yourself off to your GP about that.
MYERS
What even the fact that he's drinking 12 units ...
HODGSON
But - that's about the symptoms. But I'm really saying is if you are drinking at that rate and have been drinking for that period of time you really at risk. You're at risk of - the chances of having cirrhosis or developing cirrhosis in the next few years must be of the order of 20-30% in you. And it is the time to grapple with the problem and that's going to take all what your family can help, your GP can help and there are agencies can help.
MIKE
I find it is such a common - I find it is such a common problem. I mean I have contacts with two or three hundred people a week in my business and two bottles of wine, three bottles of wine, half a case of lager is more normal than not...
MYERS
You're not wrong, we live in quite a heavy drinking culture and this is what I think is changing, is it not Professor?
HODGSON
That's absolutely right. The incidents of cirrhosis is going up absolutely parallel to the consumption of alcohol in this country and it is going up and up.
MYERS
What should Mike's first step be if he does as he says and tries to grapple with this?
HODGSON
I think it would be really helpful to go to your GP ...
MIKE
I have been twice - I have been twice and I've had two blood tests, the last one a year and a half ago and that was negative.
HODGSON
Right.
MIKE
But I'm aware now that I have feelings of - it's hard to explain, as you say, they're non-specific but I know - I think I will go again.
HODGSON
I think two points is - you should go again because you want to know what the situation is now. But even if the tests come back normal, I hope they do, that's not - you shouldn't then say right well that's fine it's not affecting me, I needn't bother, you should say thank goodness, I'm really going to take this seriously in time and I must just cut progressively down.
MYERS
Mike good luck with that, thanks very much for coming on and talking to us and obviously there's fair warning there that over drinking can and does lead to problems and we hope you get that sorted out. Can I just put a question - I mean one of the things that people tend to think, perhaps it's my way of thinking, that you would know that you were drinking too much if you were an alcoholic, if you were dependent on alcohol. Do you have to be dependent on alcohol to be drinking enough to damage your liver?
HODGSON
No you don't. Clearly people who are dependent are more likely to but people who don't regard themselves as dependent, whose family don't regard themselves as dependent, can still be drinking heavily to a state which can damage their liver.
MYERS
And they do not need to be in their 50s for that damage to start to come through.
HODGSON
That's right we are now seeing people coming into hospital with cirrhosis, even dying of liver failure, when they're in their 30s.
MYERS
And is that because they've started as teenagers and have been heavy drinkers throughout their early adulthood?
HODGSON
Yes, yes.
MYERS
Okay we'll go to another call because it's not just about abuse of the liver with alcohol, there are other ways that we can inflict some damage on ourselves. Lisa Mellar in York wants to talk about this issue. Lisa, your question please for the Professor.
MELLAR
Hello.
MYERS
Hello.
MELLAR
A friend of mine has recently been diagnosed with a fatty liver. When she asked what had caused it the doctor said it's a symptom of a Western diet, no further advice was given. My friend's really concerned and what she'd like to know is, is it reversible, would a low fat diet help and in the long term could it be life threatening?
HODGSON
Your friend's doctor is absolutely right. Fat in the liver is very common. We talk - alcohol starts off with fat in the liver but even in people who don't drink at all fat in the liver is common and it's common in Europe, it's common in the United States, it's not common in Sub-Saharan Africa where people are very skinny. And so it is due to a - the high fat, high carbohydrate diet we have and the fact that as a population we are getting progressively heavier. It is probably up to 20% of people walking around in the streets in London at the moment have some excess fat in their liver, so it's very common and therefore quite obviously it needn't be serious. The risk of it - it gets associated with people having high cholesterol, people having a tendency to get what we call maturity onset diabetes - diabetes in later life - a tendency to have a high blood pressure. And actually in a way it's quite a good thing to have found out when you're relatively young because really it's a wake up call about your lifestyle, it reminds you that if you do take exercise, if you keep your weight down you're actually in 20, 30 years time much less likely to be suffering from a heart attack, from a stroke. And so there's nothing terribly worrying about being found to have a fatty liver but it is a wake up call to do the lifestyle things we all know that we ought to do.
MYERS
So when you're asking about treatments and so on I mean there aren't any magic medications for this?
HODGSON
No, it's - it's losing weight and taking exercise. And I give this advice to a lot of people and of course not everybody takes it. But the people who do - who come back and they've shed a stone, a stone and a half, over the course of three to four months - not rapidly but slowly - they come back and they say I feel so much better.
MYERS
You raise this on behalf of a colleague ...
MELLAR
That's right.
MYERS
And is this information that they haven't been able to get from other sources, so you're trying to help out or is there something else you're hoping to do?
MELLAR
Well yes, I mean she's been blindly reading everything she can about the liver and then she's been frightening herself. Since she was diagnosed she just been eating a low fat diet and she has lost over a stone thus far but really I mean she's coming up to retirement and she was just worried really if this was going to have any long term consequences.
HODGSON
There are a few people in whom the fat in the liver does go on to cause scarring and can indeed cause cirrhosis. It is much, much less common than merely having the fat in the liver. And if she's managing to lose weight, she may even by now have got most of the fat out of the liver and it tends to be the really very obese people in whom the progressive liver damage takes place.
MELLAR
So you can actually get the fat out of the liver?
HODGSON
Yes.
MELLAR
Oh that's good news.
MYERS
Good. Well pass that on because that is encouraging. We've had an e-mail - thank you very much for that call - we've got an e-mail from Gill Lyons who's saying that she's been advised she has fatty liver. She looked it up on the internet but wasn't able to find much information as to what to do. Is this another of those conditions where the information is not really very clear to people, I'm sure the British Liver Trust does what it can to give information but is it something that we need to be better educated about, the risks that we may be running, not just if we are an affluent lifestyle, the damage we might be doing to our cardiovascular system, which we're reasonably well aware of, but the possible risk of the damage to the liver as well. Would you like to see more information about this?
HODGSON
I would like to see more information about it for a number of reasons. Firstly, that if people are aware of the whole variety of things that can affect the liver taking those seriously will allow us to identify other things that may affect the liver. In terms of - but fatty liver of the sort that we're talking about is really just yet another wake up call to try and take your lifestyle seriously and on the whole taking it seriously is much more likely to reap benefits in years to come in terms of reducing those cardiovascular risks because those are numerically much greater than those of the liver disease getting progressively worse.
MYERS
It sounds as though Gill is trying to take things in hand. She says her GP has told her not to eat too many takeaways. But she does say that she drinks very little alcohol, so I think she's perhaps feeling that it would be the alcohol that might be causing the problem. What's the connection between fatty liver and alcohol consumption?
HODGSON
Well there may or may not be a connection. For those who are drinking excessively fatty liver can be the first sign of the alcohol affecting the liver. For people who are a little bit overweight, have fat in the liver because of that, the alcohol is probably more or less irrelevant and there isn't really a reason to become - give up and become tea total except to remember that of course alcoholic drinks often have quite a lot of carbohydrate and quite a lot of sugar in, but I wouldn't advise her that she had to go off and become tea total, just drink safely.
MYERS
Okay thank you for that. To Bristol now. David Hunt has a question for us. David your turn.
HUNT
Oh hello. What can the expert tell me about Gilbert's Syndrome, which I was told I had back in August 2004?
HUDGSON
Well the first thing is that it's really a completely different topic, it's got nothing to do with alcohol or fatty liver and most importantly it's got nothing whatever to do with serious liver disease or cirrhosis.
HUNT
Would it be born with or acquired?
HODGSON
Yes, you were born with it and you may well - your mother or father may well have had it and all that it means is that one of the tests of the liver when it's looked at is slightly abnormal and the yellow pigment that everybody has in their blood, which if the liver's damaged rises up to a very high level and people know then they have a liver disease, in Gilbert's Syndrome, which is a not a disease, just the liver is lazy in getting that pigment out of the blood and so it rises up to a slightly higher level. So it's a biochemical abnormality found in a blood test, really of no concern at all, except to know about it, it's not a disease.
HUNT
So it doesn't impact on any particular ...
HODGSON
No, no. It doesn't impact on anything else, it's in the two term a medical curiosity.
MYERS
I hope that's reassuring David, that sounds very straightforward and it's nothing you've been doing clearly. So unlike some of the other problems that we've encountered today that particular condition has nothing to do with self-inflicted damage. Let's go to an e-mail and this is about the use of statins, this is Gordon who's e-mailed us from Wokingham and asking about the risk of liver damage from the use of statins. His doctor says that he, Gordon, is okay but he, Gordon, is still concerned. Now what is the possible connection between drugs for - to bring down cholesterol - statins - and the possibility of liver damage?
HODGSON
When - any form of drug that affects the metabolism has the potentiality to affect the liver and the liver function tests, those tests that we're looking at to see if the liver is disturbed. And so routinely now general practitioners will check patients' blood to make sure that it's not having any adverse effect on the liver. If that's been done and your doctor's happy and you've been on this now for some years there really isn't a problem. The vast majority of people have no problems with statins at all and they're very good for bringing the cholesterol down.
MYERS
Okay very clear, thank you very much. Let's take a final quick call from John, John Weston in Poole.
WESTON
Yes hello there. This actually follows on from the statins actually. I was diagnosed with high blood pressure and a high cholesterol level of 8 actually. I started taking the statins but because the blood pressure tablets I took in the morning, the statins I took in the evening, I quite often forgot to take the statins and I had also been taking a natural product - milk thistle - I don't know whether you know anything about that but it seems to be a natural remedy to aid with liver ...
HODGSON
Yes it's - this - quite a lot of people take it, it doesn't really have much effect I think one way or another, if you think it's doing you good I don't think anybody would worry about you taking it but I'm not sure it's necessarily worth the money.
MYERS
Okay fair enough, thank you very much indeed. There we will have to leave it, thanks to all who rang and to those who got through and to those who didn't. I hope that at least the answers have been helpful to all who've been listening. And thank you very much to my expert today Professor Humphrey Hodgson. There is more information on our website at www.bbc.co.uk follow the leads to Check Up and you can listen to the programme again. You can also call our helpline which is 0800 044 044. And next week we'll be back with the ageing eye.
ENDS
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