Liver disease there are up to fifty. And they all share one insidious symptom — they remain invisible. How not to harm the precious and only one of the liver main biochemical laboratory organism? We talk with MD, Professor, head of Department of gastroenterology and Hepatology research Institute of cardiology and internal diseases, member of the European and President of the Kazakhstan Association for the study of the liver, Alexander V. Nersesova.
Of course, you remember the legend of Prometheus, who was condemned to eternal suffering for stealing fire from the gods of Olympus. Every morning the eagle flew and gradually pecked out his liver. During the night a miracle occurred: the Prometheus grows a new liver, and so repeated day by day. Say, the revival of the liver — this really is a miracle in our human understanding?
The liver is a unique organ. Almost 1/2–1/3 of the liver can regenerate in the experiment. In humans, the degree of regeneration may not be as pronounced, however, the restoration of the structure and function of the liver we sometimes observe in clinical practice. A liver disease at the initial stage of its development, if you remove the cause, may be subject to regression. If a person suffering from alcoholism, stop drinking, or if the patient with viral hepatitis receives competent antiviral therapy, the liver can to a certain extent, to recover. I can say more, it is now proven that scarring of the liver fibrosis is a reversible condition. And even the initial stage of cirrhosis with proper treatment to a certain extent can be solved. There are objective methods of evaluating the same biopsy, which allow to judge how the process, which developed in a liver subjected to reverse development.
According to medical literature, even 20% of stored liver tissue is enough for the entire body functioning normally. Maybe we should not worry about liver disease?
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— If we are talking about hepatitis, fibrosis and other pathological conditions, it is hoped that the fifth part of the liver tissue functioning smoothly and problems, we will not probably not quite right. Because most liver disease, if untreated, are progressive in nature.
What are the main reasons invariably leading to liver disease?
— Liver disease can be caused by various reasons. Most often it is the hepatitis viruses, alcohol, drugs, industrial poisons and other toxins. In addition, there are congenital disorders of metabolism, liver disease of unknown etiology, for example, autoimmune diseases, and those diseases in which the liver is involved again, for example, heart failure or diabetes.
It is well known that diseases of the liver, generally long not felt. But there are the so-called depechenode symptoms. What's it?
— Often happens so that the patient has aching joints or reveals kidney disease — glomerulonephritis, a variety of skin manifestations, the same psoriasis, lichen planus. People, consequently, turn to a dermatologist, nephrologist, district physician, and no one even thought does not arise to examine this patient for the presence of liver disease.
What are the main symptoms of chronic liver disease? That is a serious reason in order to consult a doctor?
— The range of manifestations of liver diseases is extremely broad, from no symptoms to conditions that threaten life. In many cases, the reason for the diagnosis of liver disease is a random detection of changes in biochemical tests of the liver when the patient is examined about any other diseases. It comes with the same pneumonia, and revealed that his liver function tests are not in order. Begin to pursue a more in-depth analyses and detect viral hepatitis or liver disease of other etiology. We are talking about such cases when people are not even aware of the disease. But sometimes bring the patient to the er with bleeding from esophageal varices, and he has already diagnosed with a progressive liver disease — cirrhosis or identify primary liver cancer.
Generally speaking, the manifestations of chronic liver disease malespecific. As a rule, the symptoms were General weakness, decreased performance, desire to sleep during the day, insomnia at night, irritability from time to time are in each of us. Nevertheless, such symptomatology is characteristic of disease of the liver. With regard to discomfort and pain in the right hypochondrium, to which patients are more likely to pay attention and think it's a clear sign of liver disease, I must say that these symptoms are less characteristic. Generally, the liver has no pain receptors, and she's not sick. There are pain receptors in the capsule of the liver. And she has very much stretch to cause some pain.
Does this mean that people who find themselves in these symptoms, it is necessary to address urgently to the hepatologist? According to statistics, every second person has some sort of liver disease.
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— Of course, don't go to the point of absurdity, but if the patient concerned unmotivated progressive weakness that he can't explain the overload at work, nervous exhaustion, then it is cause for a visit to the doctor. But if this is added to any local symptoms in the form of poor tolerance of fatty foods, abdominal discomfort, yellowing of the skin and urine, it is even more significant reason to investigate the state of your liver.
According to various sources, 80% of obese people, found steatosis. How is a reversible process? And what is fraught with consequences, if you do not pay attention to it?
— Fatty liver may develop for several reasons. And we at the clinic conditional share it on the alcohol, when it is associated with alcohol consumption, and, consequently, to non-alcoholic. To distinguish them according to the survey, including the morphological character, it is often difficult. For this reason there are many scientific recommendations. I can say that, according to the American Association for the study of liver, the toxic dose of alcohol can cause liver disease is 25-30 ml of ethanol — pure alcohol — per day, i.e. affected by any alcohol — strong, and weak. According to the European recommendations, the dose for women and men, respectively, is divided into 20 and 40 ml of ethanol per day. So if the person is your weekly allowance will be divided by days, he may know how that the dose that he usually consumes toxic to his body.
If we are talking about fatty liver or fatty hepatitis in people who do not drink alcohol, it is a distinct disease, called alcoholic hepatitis. It often develops in overweight people with diabetes. It can also develop when a sudden weight loss and several other conditions.
With regard to the flow of fatty liver and fatty hepatitis, this process may be reversible, and recommendations in this plan are simple: good nutrition, getting rid of excess weight and dosed physical loads. These recommendations are included in the clinical standards of treatment of such patients. There is no magic drug that would have removed the fat from the liver in people who do not observe these recommendations, does not exist. Although today there are a number of drugs, for example, the same essential phospholipids and other medications that we use in complex therapy of fatty liver disease.
As I understand it, You have a negative attitude towards fast weight loss? Why?
— Rapid weight loss is extremely harmful to humans. Usually recommended to lose no more than 1-1. 5 kg per week, 3-4 kg per month. The fact is that if a person loses weight quickly, he deprives himself of a sufficient amount required for metabolism. And there may come a situation when the body is not to be missed specialized proteins that transporterowych fat. In these cases, the fat will just accumulate in the liver. A paradox, a man like losing weight, but he is progressing steatosis. Because rapid weight loss is a dangerous thing.
What forever have to forget the diet, that our liver has always been healthy?
— Of course, I could say: do not drink alcohol, do not eat foods, do not fry in the pan, on the grill... But we all live in the real world, and I understand that none of us will follow these guidelines 100%. I think everything needs moderation. However, I repeat, the most harmful substance to our liver is alcohol.
How do you feel about the fact that people on their own, without consulting a doctor, use medications to prevent?
— Now the market has a huge Arsenal of so-called hepatoprotectors. I can say that very few of them are officially endorsed by the international medical community, and their effectiveness is proven in clinical practice. Ie really works, not such a large number of drugs. Most of those that the market offers to the liver, as a rule, is irrelevant. In the Arsenal of gastroenterology, there are only 4-5 drugs of this series that we used in diseases of the liver, and each of them has its own clear testimony.
Probably from your patients, You have heard the expression — it is time to clean the liver. Anyone can do it and how often?
— This question always upsets me. The liver is not a drain, and cleaned it with some regularity. As a rule, cleaning implies the reception of certain choleretic funds. Before the clinic we have used the techniques a blind sensing where it is indicated for stagnation of bile. But did it according to indications and not as often. Now we methods of sensing away, the medicine was another. And what people call a liver flush and how they do it, just plunges into shock. And well, if it makes people healthy, and if he has cholelithiasis? Indeed, many believe that using these procedures you can display the stones. It often ends up on the operating table, as calculus can simply clog the bile duct, because its diameter is only 2-4 millimeters!
But look in the Internet, specialized Newspapers and magazines crammed with wonderful recipes liver cleanse: a glass of olive oil, lemon juice... And people are doing it.
We live in an age of evidence-based medicine. The effectiveness of any technology used should be proven through research performed according to a certain methodology, and the technology subsequently approved. No studies in the literature on so-called cleansing of the liver does not exist, and such advice is usually advocating people not related to medicine.
We talk a lot about the dangers of Smoking. How the liver reacts to nicotine?
— Of course, nicotine refers to the risk factors of progression of liver disease and is a poor predictor of their treatment.
And if You have your own secret of health? Can you share that?
— Special secrets I have. The only thing I do is observe moderation in all my habits, including diet. This also applies to the actual diet, and alcohol. What else I do? Drink coffee. Coffee is the most powerful hepatoprotector. Drinking 2 cups of coffee per day is included in the international standards for the treatment of patients with liver disease. Studied gepatoprotektory properties of green tea. Generally a day should be consumed at least six liters of fluid, which I also follow. And to sooner or later earn steatosis, go to the gym, the pool, trying to swim not less than one kilometer.