Busting Myths with the ‘Liver Doc’

In a world filled with misinformation, a fresh wave of science
He goes by the name The Liver Doc on Twitter, his primary medium for advocacy and engagement.
He goes by the name The Liver Doc on Twitter, his primary medium for advocacy and engagement.Special arrangement

Dr. Cyriac Abby Philips (AP) is a renowned expert in liver health, acclaimed for his scientific talks, videos, and engagements on various social media platforms. He goes by the name The Liver Doc on Twitter, his primary medium for advocacy and engagement. 

With a strong commitment to combating pseudoscience’s detrimental impact on healthcare, he tirelessly bats for for evidence-based practices and patient empowerment. 

As a respected member of the Clinical and Translational Hepatology and Monarch Liver Laboratory, The Liver Institute, Rajagiri Hospital in Kerala, India, Dr. Philips also holds a significant role as a faculty member for the Guidelines Committee on Drug Induced Liver Injury under the Asia-Pacific Association for Study of Liver (APASL). Moreover, his expertise extends to serving as an expert member at the Center of Excellence in Microbiome Studies, collaborating with the Kerala Development and Innovation Strategic Council and the Ministry of Health and Family Welfare. 

Through his multifaceted roles, Dr. Philips  has gained recognition for his unwavering dedication to promoting evidence-based healthcare practices and empowering individuals to make informed decisions. His contributions play a vital role in advancing liver health and fostering a rational approach to healthcare and medical practice free from the shadows of quackery. 

In an exclusive interview with Greater Kashmir Correspondent Zehru Nissa (ZN), he talks about the liver health, diabetes management, protein supplements and meat consumption.

ZN: How common is Non-alcoholic Fatty Liver Diseases? Is it as serious as Alcohol related Liver Disease? 

AP: Non-alcoholic fatty liver disease, also called NAFLD, recently renamed as MALFD or metabolic-dysfunction related fatty liver disease (to remove the stigma associated with the word alcohol in the title and to encompass various metabolic causes of fatty liver) is one among the causes for liver disease.

Data from a recent systematic review and meta analysis from India showed that approximately one in three adults or children have NAFLD. This is a huge number. The severe form of NAFLD is called NASH or non-alcoholic steatohepatitis in which there is fat deposition, inflammation as well as scarring in the liver.

This condition has the highest risk for progression to cirrhosis and is also a risk factor for development of liver cancer in the absence of cirrhosis. The recent large State-wide review of liver cancer in Kerala showed that the most common cause for cirrhosis leading to liver cancer was due to NAFLD. Alcohol-related liver disease is also a serious illness with its own set of progressive stages and complications.

The natural history of alcohol-related liver disease and NAFLD is different and hence they cannot be compared head-on with respect to which is more serious, but both conditions are equally important causes for severe liver disease and liver cancer and has modifiable aspects - meaning we can prevent progression and reduce disease burden with preventive measures. 

ZN: Is NAFLD related to meat consumption?

AP: There is no conclusive evidence to suggest that recommended levels of meat consumption can increase risk of NAFLD. Studies have shown that high red meat and mostly processed meat consumption leads to increased risk of developing fatty liver disease, but this was also dependent on consumption of sugar-sweetened beverages, presence of diabetes and obesity.

A direct causation with meat consumption and NAFLD occurrence has not been proven in good quality prospective population based studies. For example, a recent study in the journal, Clinical Nutrition (2022) showed that red meat consumption, including both unprocessed and processed red meat, was associated with significantly increased risk of developing NAFLD, but this association was mediated largely by obesity.

Hence red meat and processed meat consumption could increase risk of NAFLD in those who are already at risk of developing it and when such risks are probably controlled, the risk with meat consumption could also be reduced. 

ZN: What other dietary and lifestyle factors lead to Liver Disease? 

AP: Consumption of sugar-sweetened beverages including sodas and processed fruit juice, increased consumption of fruit (> 4 portions/day), sedentary life, lack of proper sleep, use of ultra processed foods, presence of diabetes, high blood pressure, a high waist to hip ratio, heart diseases and high lipids also predispose the person to NAFLD. NAFLD can also progress and significantly worsen in the presence of mild to moderate alcohol use also.

Certain medications such as corticosteroids, anti-arthritis drugs like methotrexate, certain chemotherapy agents, tetracycline antibiotics and certain rarely used anti-seizure medicines can also promote NAFLD development.

An important upcoming cause for fatty liver disease is use of complementary and alternative medications including those with high sugar content herbal supplements such as Chyavanprash, and certain herbal products contaminated, adulterated or prepared with heavy metals and alcohol such as arishtams (in Ayurveda) and mother tinctures and alcohol based Homeopathy formulations. 

ZN: A growing number of people is getting diagnosed with Fatty-Liver of various grades. Is it reversible? 

AP: Fatty liver disease is reversible. In fact, the most important aspect is to treat and control the cause of fatty liver. There are no approved drug treatments for the management of NAFLD.

The mainstay of treatment includes weight loss, a calorie deficit diet, daily physical activity (aerobic exercises), avoiding alcohol, treating and controlling diabetes, low functioning thyroid disease, high lipids and high blood pressure.

The treatment is not a single approach, but a multi-pronged wholesome approach whereby all relevant risk factors are addressed and taken care of - this helps people reverse NAFLD. The grades of fatty liver on ultrasound have no bearing with the disease severity. The presence of abnormal liver tests along with increased scarring (or significant fibrosis) of the liver (NASH) stage is more important and needs treatment. 

ZN: Many youngsters are pumping iron and pumping all sorts of ‘protein’ along with that . What are the risks? 

AP: Protein supplements that are purely protein based - such as whey based (concentrate, isolate or hydrolysate) or pure plant based (such as pea based) or other pure animal protein basd (such as egg-based) are safe to use. Blended proteins that contain various herbal ingredients or other dietary supplements such as ashwagandha, turmeric or green tea extracts are the ones that have the potential to harm.

The best biological protein is egg and the most digestible protein is whey (dairy based). There are no risks associated with specific pure protein-based supplements when used within recommended doses for age, activity and in men and women.

Caution should be taken for proteins that are marketed as mass-gainers as most may contain adulterants such as anabolic steroids. Hence such supplements should be purchased from well known and validated brands and from trusted sources. 

ZN: Diabetes in all communities is growing. And many people start with ‘herbal and natural’ drugs to treat it. What is your advice to them? 

AP: A new study published in Lancet estimates that 101 million people in India - 11.4% of the country’s population - are living with diabetes and also found that 136 million people - or 15.3% of the people - could be living with pre-diabetes.

Diabetes is one of the commonest associations with NAFLD and its treatment, control or reversal through scientific methods, based on empirical evidence is utmost important.

In this context, use of herbal supplements, multi-herbal drugs, traditional beliefs such as use of methi (fenugreek) water, consuming Gymnema (gurmar) herb and other naturopathic methods invite more harm.

An expert viewpoint in the Lancet a few years ago opined that herbal drugs for diabetes were “maximum hype and minimum science.” Herbal drugs industry is unregulated and hence the supplements are contaminated, adulterated with other drugs and contain toxic herbs that can cause liver or kidney injury, interact negatively with standard medicines and reduce their effectiveness or interact synergistically to increase side effects. There is no role of herbal drugs or natural therapies in the management of diabetes. It is a waste of money and can lead to loss of life. 

ZN: ‘Liver tonics, liver detoxification and body detox treatments’ are everywhere. Are these beneficial? 

AP: “Detox” or “Detox Therapy” are big words used by the wellness industry to deceive people into believing that certain drugs, supplements, practices or interventions can help them maintain overall health.

The word detox, in the context of medical science and healthcare is a quackery term used by the wellness industry to detox people off their hard earned money. These practices are wasteful, expensive, detrimental and have no role in realistic healthcare.

Some detox therapies that include the use of herbal drugs or supplements can also potentially cause severe organ injury leading to death. This has been reported far too many times in published literature. It is high time that people wake up from their misinformation riddled slumber and embrace critical thinking. 

ZN: Kashmiri weddings are all about meat, meat cooked in fats mostly. This is the wedding season here, what is your advice? 

AP: A meat-based diet is not an inferior one. A balanced diet from an omnivore point of view has significant nutritive value. The inclusion of meat in the human diet is driven by evolutionary aspects and grounded on nutritional value.

Inclusion of freshly sourced animal-proteins such as meat in diet improves nutritive quality of food intake. The Indian Council for Medical Research (ICMR) recommends for Indians consumers to reach 10.5 kilos of poultry meat and 180 eggs per annum.

The ICMR also recommends meat consumption at 10.8 kg per year per. Roughly, among meat-eaters, if one consumes freshly sourced, unprocessed lean red meat less than 90g per day, it is considered safe limits and impacts health quality positively. One must bear this in mind while feasting. 

ZN: What is the secret to a healthy liver? 

AP: The secret to a healthy liver is to have a healthy body. Many times, people tend to inaccurately focus on “organ health” rather than “holistic health.” Holistic in this context means that “the parts of something are interconnected and can be explained only by reference to the whole.” In this regard, there is no liver health or gut health or brain health - it is a healthy body that encompasses healthy organ systems.

This aspect can be achieved by healthy living - well balanced diet, daily physical activity, taking care of one’s mental health, adequate sleep, healthy work hours, work satisfaction, healthy and positive social interactions and ultimately, avoiding misinformation and disinformation with regards to healthcare and embracing an evidence-based, realistic, rational and logical health-seeking behaviour. 

DISCLAIMER: The views and opinions expressed in this article are the personal opinions of the author.

The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.

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