THE STAR, 25 JUNE 2019
HEALTHY LIVER
Taking care of your
body’s powerhouse
By NGEH CHEE YEN
LIVER health is often taken lightly,
or worse, generally overlooked.
Even when someone is diagnosed
with diseases affecting the liver
such as fatty liver, people
generally do not decide to make
lifestyle changes and only seek
medical help when the condition
has progressed to a more
advanced stage.
In a 2014 article centred on
participants in the United States
titled Knowing What’s Out There:
Awareness of Non-Alcoholic Fatty
Liver Disease published in
Frontiers of Medicine, an
overwhelming majority of the
study’s subjects were unaware of
non-alcoholic fatty liver disease
(NAFLD) and stated that their
physicians did not discuss the
disease with them.
This reveals how even patients
in a developed country are not
actively aware of liver disease,
much less patients in developing
countries, including Malaysia.
Prof Dr Lee Yeong Yeh,
professor of medicine at
Universiti Sains Malaysia and
gastroenterology and hepatology
consultant, finds
it concerning
Obtaining essential nutrients through supplementations
MARINE omega-3 fatty acids offer
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Omega-3 fish oil is important to
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being. Because omega-3 fatty
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of polyunsaturated fatty acids
and cannot be synthesised by the
human body, these essential fatty
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Opceden has responded to the
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that people often overlook their
liver health. He attributes this
reason to the fact that the liver is
a highly effective organ in healing
itself to continue looking after the
body.
“A key feature of the liver is its
ability to regenerate. The ability to
regrow allows the liver to
function indefinitely, which is not
surprising considering its vital
detoxification role. Many
symptoms of liver disease are
vague during its initial stages,
which can lead to late treatment,”
says Prof Lee.
Another concern is the fact that
there is poor general awareness
among the Malaysian public on
common liver diseases and its
complications, coupled with
rumours or misconceptions in the
community. He lists some that can
cause the liver more harm than
good:
l The misconception that
vaccinations carry health hazards,
when they actually protect the
liver from infections and diseases
such as hepatitis
l Poor awareness of the
dangers some herbs, supplements
and drugs pose to liver health
l Excessive alcohol
consumption
The spread of viral
hepatitis can be
prevented through
vaccination, as well as
improvement of
sanitation and food
safety practices.
marine essential omega-3 fatty
acids: eicosapentanoic acid (EPA)
and docosahexanoic acid (DHA),
which have been clinically tested
for heart health.
Studies show that omega-3
fatty acids are essential nutrients
that help promote health. Most
fish oil supplements in the
market are available in ethyl
ester form, while only a small
number of fish oil supplements
are found in triglyceride form.
Opceden Omega-3 Fish Oil
TG500/200 is sourced from
Norway and comes in triglyceride
form.
Triglyceride, the natural form
of dietary lipids, is a safe form of
As the liver carries out so many vital functions, it is important to ensure that it is well cared for. Some lifestyle
changes to protect your liver are maintaining a healthy weight, eating a balanced diet and exercising regularly.
The awareness for problems
such as heart disease, diabetes
and the effects of smoking are
generally higher than that of liver
disease, as symptoms of these
other diseases can be more
tangible or apparent. The
challenge is in ensuring people
truly understand the importance
of the liver and how someone
with acute liver disease would
need a liver transplant just as
much as people with certain heart
diseases would need a heart
transplant to stay alive.
Carrying its weight
Besides being the largest
internal organ and exceptionally
effective in filtering unwanted
toxins, the liver is responsible for
a range of other functions. Dr Lee
explains, “The liver performs
about 500 vital roles and
detoxification is only one of them.
Other common roles are
metabolic in nature, including
fish oil. The human digestive
system can easily absorb
triglyceride-form fish oil. Typically,
fats in most food sources are found
in natural triglyceride form.
Triglycerides are generally
associated with standard fish body
or fish liver oil.
These fats comprise three fatty
acids, such as omega-3 EPA and
DHA, and are each linked to a
molecule of glycerol. Without
glycerol, free fatty acids can oxidise
rapidly. The glycerol helps
naturally stabilise the fat molecules
and prevent breakdown and
oxidation.
To digest fatty acids, we need the
enzyme known as pancreatic
protein synthesis, carbohydrate
control and fat metabolism.”
Besides that, the liver also
produces bile, which is important
in the digestion and absorption of
fats. Because of its larger size, the
liver also has the capacity to store
vitamins and minerals.
Self-destructive habits
Looking at the many roles
played by our liver to ensure a
healthy, functional body, it would
be terrifying to imagine what
could happen should our liver
start to fail. However, knowledge
of what harms us helps us
prevent it from happening in the
first place.
A 2016 article titled Neglected
features of lifestyle: Their relevance
in non-alcoholic fatty liver disease
published in World Journal of
Hepatology shows that high body
mass index, insulin resistance
(HOMA), triglycerides, poor
adherence to a Mediterranean
Opceden Omega-3
Fish Oil TG500/200,
which is a high-
strength fish oil,
consists of 70% marine
essential omega-3
fatty acids.
lipase. Studies have found that
pancreatic lipase hydrolyses
triglyceride-form fish oil 10 to 50
times faster than it hydrolyses
diet profile, sedentary habits,
minor sun exposure and use of
“western diet” foods are common
factors in incidences of NAFLD.
What’s more, a 2018 study by the
World Health Organization
suggests that we are in for a bleak
future. In Worldwide trends in
insufficient physical activity from
2001 to 2016: a pooled analysis of
358 population-based surveys with
1·9 million participants, it was
reported that a quarter of adults
globally are not getting enough
physical activity.
With nearly two million
participants, who represent 96% of
the global population, the study
estimates that 1.4 billion adults are
at risk of developing or
exacerbating diseases linked to
inactivity. This shows that we are
the real culprits to our declining
health. Hence, action must be
taken to ensure healthy, productive
communities across the globe.
> TURN TO PAGE 2
ethyl ester-form fish oil. The
hydrolysation process needs to be
carried out in order to ensure
optimal absorption of the fish oil.
Opceden Omega-3 Fish Oil
TG500/200 contains omega-3 EPA
and DHA in triglyceride form,
which have been clinically proven
to support heart health.
Pharmaceutical triglyceride-grade
fish oil provides you with a better
outcome in reducing triglyceride
levels. Therefore, it brings
numerous health benefits,
especially to your heart.
n Look out for the advertisement
in this StarSpecial.
KKLIU No.0498/2019
2 Healthy Liver THE STAR, TUESDAY 25 JUNE 2019

The unsung hero

YOUR liver is one of the most hard-working
organs in your body. Unfortunately, very few
people think about their liver when they eat
junk food. Your liver is your friend and junk
food can be an enemy.
Some may argue that your brain is the
supreme ruler of your body, but if that is
true, your liver is surely the main
administrator. If you want a long, healthy
life, keep your liver happy.

Ways to detect liver damage Main causes of liver damage

Jaundice
The most prominent
symptom of liver damage.
This symptom is caused by
the accumulation of bilirubin
in the body.
Bruising and bleeding
When the liver is
compromised, it stops
producing certain proteins that
enable blood clotting. Easy
bruising and bleeding could be
a sign of liver damage.
Dark urine
Caused by build-up of
bilirubin (an indication of
poor liver function).
Alcohol abuse
Over time, the
inflammatory effect that
alcohol has on the liver
can cause a build-up of
scar tissue (cirrhosis).
Heredity Diabetes
Liver diseases such as Unchecked diabetes can
haemochromatosis are inherited slowly damage the liver or
from one or both parents. Having worsen fatty liver disease.
one or both parents with
hereditary liver disease
increases your chances of
developing it.

Swollen ankles
Your body retains water
when your liver is not
functioning properly. The
excess fluid pool in your
lower extremities and make
your ankles appear swollen.
Abdominal pain
Liver damage can cause
a sporadic throbbing or
stabbing pain under the right
side of the ribcage or the
upper right abdomen.
Nausea Unhealthy eating habits
If you are constantly Eating too much fatty food
nauseous or vomiting can cause liver damage
frequently, it could due to fatty liver, hepatitis
indicate liver damage. or a combination of both
(steatohepatitis).
Infection
The most common infections
that cause liver damage are
due to hepatitis viruses,
which spread through bodily
fluids, food and water, or
close contact.
Autoimmunity
Diseases such as primary biliary
cirrhosis and autoimmune
hepatitis stress the liver and
cause scarring.

Arm yourself with knowledge

> FROM PAGE 1
Building the fortress
Trying to improve your overall health can
be tough, but your organs will thank you in
the long run. According to the American
Liver Foundation, some lifestyle changes
you can adopt to protect your liver are:
l Maintain a healthy weight – Obesity
can cause fatty liver, which can lead to
NAFLD – one of the fastest growing forms of
liver disease.
l Eat a balanced diet – Avoid high-
calorie meals with saturated fats and
refined carbohydrates, and opt for more
fibre, lean protein and adequate hydration.
l Exercise regularly – Consistent
exercise can burn triglycerides and reduce
liver fat.
l Avoid the use of illicit drugs – As the
liver detoxifies the body, subjecting it to
harmful substances can damage it.
l Use alcohol responsibly – Excessive
consumption of alcohol can damage or
destroy liver cells and scar your liver.
l Wash your hands – Use soap and
warm water before and after handling
anything that can contaminate your
surroundings, such as changing a dirty
diaper or preparing food.
l Follow directions on all medications
– Your liver can be harmed when ingesting
medications incorrectly, such as consuming
more than your recommended dosage or
mixing your medications with alcohol.
l Get vaccinated – While there are no
vaccines for hepatitis C yet, you can get
vaccinated against hepatitis A and B.
Armed with this knowledge, it is time for
each of us to start appreciating our liver’s
hard work and take its well-being into our
own hands by cooperating with it to
ensure a strong, healthy liver for a hale
and hearty body.

The liver can take on quite a heavy workload, but you shouldn't take it for granted as being
unaware of your liver health could be fatal.
THE STAR, TUESDAY 25 JUNE 2019 3
4 Healthy Liver
A lesser-known danger
“WHAT if you had a potentially life-
threatening disease and didn’t know it? Fatty
liver disease is one such disease. Often, no
symptoms whatsoever appear in the
beginning, only becoming apparent when
significant and sometimes irreversible
damage to the liver has already occurred.
“Symptoms include abdominal pain and
distension, vomiting blood and jaundice.
This silent progression is what makes this
disease all the more dangerous,” says Dr
Prabhjot Singh Sidhu, gastroenterology and
hepatology consultant at Ara Damansara
Medical Centre.
Fatty liver occurs when there is excessive
fat deposition in the liver. Its causes are
many – excessive alcohol consumption, viral
hepatitis, autoimmune conditions and
metabolic syndrome.
The extremely high rates of obesity,
diabetes mellitus and hypertension all
contribute to metabolic syndrome, which,
according to Dr Prabhjot, is the most
common culprit of fatty liver disease in the
country.
“The risk of having a fatty liver, or in this
case, non-alcoholic fatty liver disease
(NAFLD), by way of metabolic syndrome is
increased by risk factors such as weight gain,
significant weight loss, diabetes mellitus,
raised lipid levels, hypertension and
hypothyroidism. You only need two of these
factors to be at increased risk of developing
NAFLD.”
Many people, including doctors, used to
think that fatty liver disease is nothing
serious because it’s just fat and we all have a
little. However, Dr Prabhjot warns, “This fat
deposit causes inflammation over time,
which can lead to fibrosis, cirrhosis and even
liver cancer. Yes, it can take years at times
for the condition to progress from one stage
to the next, but the progression can be more
rapid and even skip a stage in some people.
“It is important to remember that the top
two killers in people with fatty liver disease
are heart disease and cancer, not liver
failure, as previously assumed. Having a
fatty liver also significantly increases your
risk of heart disease, diabetes mellitus (by up
to five times), colorectal cancer (by up to
three times) and colonic polyps (by 1.5
times).”
“The severity varies between individuals,
but the risk factors are there, so it is essential
to diagnose fatty liver as early as possible to
address its causes.”
Lack of proper awareness
“There is a common misconception that
only obese people are susceptible to NAFLD.
People with obesity are at risk, but people
with centripetal obesity (fat accumulation
around the stomach region) are more at risk.
Let’s not forget that between 7% and 20% of
patients with fatty liver disease are
considered slim or of normal weight.”
Many people misjudge their fat
Proper awareness can save lives
While it is true that, thanks to the
Internet, people are more informed
today about their health then they were
a few decades ago, there is still a dire
lack of proper awareness.
Dr Prabhjot Singh Sidhu,
gastroenterology and hepatology
consultant at Ara Damansara Medical
Centre, says, “It is good that people read
up about diseases and ailments and take
a keen interest in their health, but it is
important to remember that there is a
lot of misinformation on the Internet. I
recommend that patients at least discuss
their concerns or queries with a
healthcare professional before
embarking on self-medication
endeavours.”
An example of such endeavours would
be taking supplements and medicine
that claim to be able to detoxify your
liver. Dr Prabhjot questions: “Why would
an organ that is responsible for cleansing
your entire system need external
Many people used to think that fatty liver disease is nothing serious, but doctors now caution that fat deposits in the liver can lead to fibrosis,
cirrhosis and even liver cancer.
Dr Prabhjot Singh Sidhu.
accumulation because they depend on body
mass index, which is not an accurate
measure since it doesn’t consider muscle
weight. A better way is to find out your body
fat percentage.
“Since there are no symptoms in the early
stages of fatty liver disease, it is best to go for
a screening if you have the risk factors or
are worried. However, for those with
diabetes mellitus or obesity, screening is a
must,” stresses Dr Prabhjot.
assistance to detoxify itself?”
Similarly, many people take probiotics,
thinking it will help improve their gut
health. According to Dr Prabhjot, with so
many options available, people are often
at best just guessing when selecting one.
“Probiotics can be helpful in specific
situations such as in the treatment of
antibiotic-related diarrhoea, irritable
bowel syndrome, bloating pains and
ulcerative colitis, but you have to know
which strain of bacteria at what dosage
would be most beneficial in treating that
symptom based on prior studies for any
chance of efficacy. Randomly taking just
any probiotic of the shelf is certainly not
a recommended approach.”
By taking such supplements and
medications without proper guidance,
you risk damaging your liver even more
instead of making yourself healthier, so
make sure you are not just aware of the
dangers, but also have the right
information.
“Diagnosis of fatty liver is fairly easy since
it can be detected with a simple ultrasound
and blood test. The treatment can be simple
if the right approach – addressing the root
cause – is taken. For instance, if obesity is the
cause, the treatment is to lose weight. If
drinking alcohol excessively is the cause,
then quitting alcohol is the remedy. As for
NAFLD, aside from exceptional cases, the
only recognised treatment is weight loss.
There are no recommended drugs as a form
of treatment as of today.”
Beware of randomly popping pills
“When faced with a serious disease, and
the treatment course requires some effort,
we often see people look for shortcuts and
reach for supplements and/or herbal
remedies. This practice can be very
dangerous.”
Dr Prabhjot has a word of warning for
such people, “Medicines must pass stringent
tests by an appropriate governing body to be
classified safe and effective, but when it
comes to herbal remedies and supplements,
the rules are different. The requirements are
much more relaxed.
“There is often little evidence that these
remedies work. Drug-induced liver injury
(DILI), although rare, is serious, with
anabolic steroids, weight-loss supplements,
herbs and green tea extracts topping the list
of its causes.
Seek the advice of medical professionals before beginning self-medication. Drug-induced liver
injury (DILI) can be life-threatening and between 20% and 70% of DILI can be attributed to
herbal remedies.
THE STAR, TUESDAY 25 JUNE 2019
“Between 20% and 70% of DILI can be
attributed to herbal remedies. Even though
it’s rare, we should still worry because
treatment is limited and outcomes can be
poor. Aside from mislabelling, many
ingredients in these products are often not
listed. It is important to remember that
something ‘natural’ does not automatically
mean it is safe. Do the research and make
educated, informed decisions. If unsure, see
your doctor.”
The ignored powerhouse
While he is all for people wanting to be
healthy and taking care of themselves, Dr
Prabhjot stresses that there is no shortcut to
achieving it.
“Keeping healthy is a continuous process
that takes dedication and hard work through
eating well, exercising regularly and
maintaining a healthy lifestyle. Unless you
have conditions that require medication, you
can never achieve good health by just
popping a pill because, for the moment at
least, there is no such thing, especially for
liver health,” he says.
Dr Prabhjot emphasises that the liver is
one of the most neglected and often abused
organs in our bodies, and people must put in
more effort in being aware of and
preserving their liver health.
n For more information, call 03-5639 1212.