Dr. Roach: Fatty liver can progress to cirrhosis

Dear Dr. Roach: My husband, who is 59 years old, has been diagnosed with “fatty liver.” He is 5 feet 9 inches tall and weighs 300 pounds. He has struggled all of his life with his weight. He has pain and tenderness in his upper right side. He is scheduled for an endoscopy in two weeks. When the nurse called about the results from his ultrasound with the fatty liver, all she said to do is “diet and exercise.” I am worried that the diagnosis is more serious than they are saying. Can this lead to serious liver disease or cancer?

He drinks alcohol. Since they gave him the diagnosis, he’s been trying to cut back. He drinks four or five large mixed drinks on Friday and Saturday, and beer on Sunday. The nurse did not say anything about drinking. My husband was worried enough that he investigated the problem on the Web. I just don’t know if he can do all this on his own, without help. I’m trying to get him to see a professional, at least about the weight loss.

N.H.

Dear N.H.: Fatty liver disease is an increasing health problem, and a major cause of serious liver disease. Fatty liver often is divided into alcohol-related and nonalcohol-related.

Alcoholic liver disease occurs in people who drink 14 or more standard drinks per week (a “standard drink” is 14 grams of alcohol — about 12 ounces of beer, 5 ounces of wine or a mixed drink, but these can vary in alcohol content). If you really mean the amounts you said, your husband could be drinking as much as 32 standard drinks on a Friday night alone. Although only about 6 percent of people who drink as much as your husband will progress from fatty liver to alcoholic liver cirrhosis, he is at risk. Once cirrhosis has developed, the liver can’t recover. Cirrhosis, of any cause, greatly increases risk of liver cancer. Fortunately, the liver can rapidly improve from fatty liver with abstinence. It’s critical for him to cut or stop his alcohol intake.

Your husband is also at risk for nonalcoholic fatty liver given his BMI (body mass index) of 44.2, putting him in the “morbidly obese” level. Stopping alcohol doesn’t protect him from developing the nonalcoholic type. While I agree with the instruction to improve diet and to exercise, I am disappointed that the advice you and he received was not more explicit, both about alcohol cessation and about weight loss. You are quite right that a professional may be of great benefit.

Dear Dr. Roach: You recently mentioned that apples are high in sugar. I am a man, 74, with borderline diabetes and an A1c level of 5.7 percent. I have been eating an apple a day for a long time and worry that I might be making my diabetes worse.

L.T.

Dear L.T.: The best data I can find on this still show that whole fruit, such as apples, do not adversely affect blood-sugar control if eaten in reasonable quantities (i.e., up to four a day). An apple a day is still good advice. Please don’t stay away from the doctor, though.

Email questions to ToYourGoodHealth@med.cornell.edu.