The continuing national conversation about Americans' overconsumption of sugar -- particularly New York Mayor Michael Bloomberg's current war on supersized sodas -- brings up a good point about liver health.
If you consume too much sugar, you are putting your liver at risk. Add that to all the other health problems associated with diets high in sugar.
It's not always a simple "A leads to B" statement, but it is known that overconsumption of sugar is sometimes the precursor to fatty liver disease. Doctors often want to test for fatty liver disease when they see overweight or obese patients.
Fatty liver disease is not actually a disease but a condition -- usually showing no symptoms -- that can lead to cirrhosis (scarring) and liver failure.
This abnormal accumulation of fat on the liver is called nonalcoholic fatty liver disease (NAFLD) when it is diagnosed in someone who drinks little or no alcohol.
A more serious step up from NAFLD is nonalcoholic steatohepatitis, also called NASH. It means fat in the liver is causing inflammation or other damage.
According to the National Digestive Diseases Information Clearinghouse, NASH affects 2 to 5 percent of Americans, while an additional 10 to 20 percent of Americans have fat in their liver, although it is not necessarily doing any harm.
The NDDIC says there is no one cause of NASH, but it is often seen in obese patients and/or those with diabetes. So not surprisingly, the recommendation to patients is to take weight off, eat a balanced diet, increase physical activity, manage medications and avoid alcohol.
Keep in mind, though, NASH can also show up in those who are not obese, do not have diabetes and do not have elevated blood cholesterol.
Why take care of your liver? It's considered the most complex organ in the body, with the tasks of regulating blood sugar levels, producing enzymes, breaking down toxins and filtering food components, among other things.
The book "Digestive Wellness" by Elizabeth Lipski notes that high fructose corn syrup has been linked to fatty liver disease in several studies. In addition, when nutritionists look at sources of refined sugar in American diets, the finger always points to soft drinks, which are commonly sweetened with high fructose corn syrup.
Also contributing to fatty liver, however, are environmental toxins, junk food and high-fat diets, Lipski wrote.
Chances are, a fatty liver condition will not show any symptoms, but you should be on the lookout for fatigue, unexplained weight loss and weakness. In that case a doctor will conduct a blood test or liver scan, to be followed possibly by a diagnosis using a liver biopsy.
A recent column by Dr. Anthony Komaroff of the Harvard Medical School, who writes the series "Ask Doctor K," addressed the question, "Is fructose bad for you?"
"The short answer is yes," Komaroff said, surveying changes in our diet over the last several decades that have led to too-high levels of fructose.
The problem is not only nonalcoholic fatty liver disease, but also elevated triglycerides, elevated LDL cholesterol, the buildup of fat around organs, increased blood pressure and the creation of insulin-resistant tissues.
Experts are careful to say, though, that there is no proof that high fructose corn syrup is the sole cause of liver problems or other medical conditions.
"Still, it’s worth cutting back on fructose," Komaroff writes. "That’s what I tell my patients, and what I have done myself."
He suggests cutting back on refined sugar in sweetened drinks, pastries and cereals, yet continuing to eat fruit, as it is only a minor source of fructose.
Lipski, Elizabeth. "Digestive Wellness." New York: McGraw Hill, 2012. pps. 233-4.
Komaroff, Anthony. "Is fructose bad for you?" Ask Doctor K., Harvard Health Publications. Web. 11 June 2012.
"Nonalcoholic Steatohepatitis." National Digestive Diseases Information Clearinghouse. Web. 11 June 2012. http://digestive.niddk.nih.gov/ddiseases/pubs/nash
Reviewed June 12, 2012
by Michele Blacksberg RN
Edited by Jody Smith