TO YOUR GOOD HEALTH By Keith Roach, M.D.
DEAR DR. ROACH: I am 59 years old and am having problems with my lower abdomen. After colonoscopy and ultrasound, my doctor called to say I have a fatty liver. When asked what that means, I was told to lose weight. I weigh 170 pounds, and am 5 feet 6 inches tall.
Research online suggests that alcohol is an issue, but I don’t drink. I may have a drink or a beer when I go out, but most times I am the designated driver, so I don’t drink. The only medication I take is estradiol-norethindrone 0.5-0.1; I take one daily. Diabetes does not run in my family, and I have not been tested for it.
Can you give me information on “fatty liver” and treatment? – J.A.
ANSWER: Non-alcoholic fatty liver disease is an increasingly common problem; in fact, it is the most common liver disorder in industrialized countries. Recent studies have suggested that 30 to 46 percent of people in the U.S. have NAFLD. Most people are diagnosed in their 40s or 50s.
Obesity, particularly abdominal obesity (as opposed to fat around the hips and thighs) is common in fatty liver disease. People with suspected NAFLD should have other possible causes evaluated, especially viral hepatitis (types B and C), hemochromatosis and autoimmune hepatitis.
Simple fatty liver is a benign condition; however, some people will develop the more serious condition non-alcoholic steatohepatitis (NASH). Seventy percent of people with NASH are obese, and up to 75 percent have Type 2 diabetes. NASH without treatment can lead to fibrosis and even cirrhosis of the liver.
Your body mass index is 27, so you are considered overweight, not obese. Still, I would recommend gradually losing 10 pounds or so. I also would recommend that you continue to drink very moderately or not at all. Exercise also can help.
DEAR DR. ROACH: I am 77, female and in great health except for being diagnosed with achalasia. I know it is rare, and I was happy to find out why my digestive system had discomfort. Do yoga twists or shoulder stands worsen this? It seems worse when I do these. – E.H.
ANSWER: Achalasia is a disease of abnormal movement in the esophagus, the muscular tube that carries food from the back of your throat to the stomach. It is caused by damage to the nerves in the esophagus, possibly from destruction by the body’s immune system. Because of the nerve damage, the food gets stuck in the esophagus, leading to difficulty swallowing and vomiting of undigested food. Both solids and liquids are affected, as opposed to esophageal cancer, in which the problem is mostly solids.
Gravity helps us swallow, so being upside down will make gravity work against you, and I would expect the condition to worsen with yoga positions that turn the esophagus upside down. I wouldn’t recommend those types of positions, especially since they may cause or worsen vomiting.
Treatment of achalasia should be done by an expert in the condition, and may include dilation of the esophagus, injection with Botox into the muscle or surgery.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to P.O. Box 536475, Orlando, FL 32853-6475.
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