“Biking, for me, is more than just a hobby – it’s about taking control of my life,” says 56-year-old Hemant (name changed). So, when the diagnosis of liver cirrhosis appeared as a bolt from the blue in is life, and made it difficult to continue engaging in his favourite outdoor activity, he felt shattered. But there was even more difficult news coming, as doctors thoughtfully counselled Hemant that he might soon need a liver transplant even to survive. 

For Hemant, who had never touched a drop of alcohol in his life, this diagnosis came as a terrible shock. It is commonly believed that major liver diseases only affect those who abuse alcohol. However, doctors point out that, non-alcoholic fatty liver disease (NAFLD) leading to cirrhosis, is an increasingly common occurrence among middle-class Indian men and women – even those who do not drink. “We are concerned to see data emerging in recent times from our Kauvery Group of Hospitals in south India,on younger people being affected by cirrhosis of liver. The average age of cirrhosis patients has now dropped to the forties and fifties,” says Dr. Elankumaran K, Senior Consultant Hepatobiliary Surgeon and Liver Transplant Specialist, Kauvery Hospital, Chennai. 

What is Cirrhosis of the Liver?

Cirrhosis of liver is a late-stage liver disease in which significant damage to the liver has resulted in the formation of scar tissue replacing heathy liver cells. In cirrhosis, so many healthy cells thus get damaged over time, and beyond repair, that the liver cannot function normally. The organ would eventually go into terminal failure, threatening life. 

The liver is the detox centre of the body, and also has significant regenerative abilities, says Dr. Kumaragurubaran, Hepatology consultant at Kauvery Hospital, Tiruchirapalli. “Unlike other organs in the body, given opportunity and time, the liver has a tendency to repair itself. But cirrhosis occurs when the liver is not able to repair itself anymore.”  

While excessive alcohol consumption and diseases such as hepatitis-B and hepatitis-C are common causes of cirrhosis, unhealthy lifestyles can also lead to this condition. Patients who are obese or have conditions like diabetes, insulin resistance, high blood pressure, high cholesterol, or metabolic syndrome are at risk of developing NAFLD, which can lead to cirrhosis over time in some patients. This applies universally to both men and women. 

There are no treatments that can reverse cirrhosis of liver after it occurs, but medication and lifestyle changes can halt the progression of symptoms and help manage the condition if detected early. If the cirrhosis progresses too far, however, a liver transplant is the only option available to patients. 

Why should you be concerned?

Described by friends and family as fun-loving, Hemant always had an affinity for food, loving to dig into ice-creams and the like. Though Hemant developed symptoms like bloating or discomfort around his stomach, it never seemed like a cause for concern, and was dismissed as resulting from something he ate.

Doctors are concerned that increasingly sedentary lifestyles are contributing to the growing risk of liver disease. “Yes, Hemant did have an easy-going lifestyle with a diet that contributed to his illness. But many of us today have a lifestyle like his,” says Dr Elankumaran K, the senior consultant hepatobiliary surgeon who performed Hemant’s liver transplant.

What complicates matters is that cirrhosis from NAFLD has a slow progression and is often virtually symptomless until the late stages. And even if there are symptoms, they can often be mistaken for several other common conditions. “Cirrhosis is not something that turns up overnight. The fibrosis (scarring) of liver cells builds up over years before the disease starts showing symptoms. And in most cases, patients ignore the symptoms until it reaches a critical point,” says Dr Kavya Dendukuri, Consultant Hepatologist, Kauvery Hospital, Chennai. 

Need for specialised liver care

Given the silent nature of cirrhosis and a lack of awareness among people, doctors say that patients often come in at a very late stage when transplant is the only option. However, this raises several challenges of its own. 

Hemant, for instance, spent 8 months on the waiting list for a cadaver liver donor, before finally settling for a live donation by his adult daughter. This doubled his anxiety, as he worried both about his own recovery as well as the risk his daughter had to undergo for his sake. 

Transplant procedures can be tricky because it’s important to ensure that the patient’s body does not reject the donated organ or develop an infection that could severely compromise recovery. 

That is why, for patients like Hemant, seeking care at specialist, and integrated care, units like Kauvery Hospitals’ liver transplant centres has been vital. “We provide patients with 360-degree, 24/7 liver care. Thanks to our rigorous protocols, cutting-edge technology, highly trained surgical team and equally skilled supporting staff, our success rates have been consistently high,” explains Dr. Kumaragurubaran. 

What you can do to keep liver disease at bay:

· Eat a healthy diet: Doctors recommend a balanced diet with a healthy mix of proteins, fibre, carbohydrates and lower levels of fat. In particular, higher levels of green leafy vegetables for fibre, foods that help reduce inflammation like fish and nuts, and replacing unhealthy fats and refined carbohydrates with healthy fats and more complex carbohydrates are helpful. Avoiding alcohol or keeping it to a minimum is also helpful.

· Exercise regularly: The benefits of exercise to the body are extensive even when weight loss does not occur. Doctors recommend at least 150 minutes of moderate-intensity activity each week. 

· Lose weight: Over time, losing weight is a significant contributor to reversing the deposit of fat in the liver and improving liver health in the early stages of liver disease. Maintaining a healthy Body Mass Index (BMI) and waist to hip ratio (of less than one) are very helpful in prevention. Abdominal obesity is becoming increasingly common, especially in south India, more in men than in women. Fat that you see around the abdomen is both inside and outside the abdomen and relentlessly damage intra- abdominal organs like the liver and lead to the troublesome Metabolic Syndrome, that is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels. 

· Stop smoking: Studies have found that smoking contributes to increased inflammation and scarring of the liver independent of other factors such as alcohol consumption. Stopping smoking also aids in minimising cardiovascular complications.

This article was published by TNM Brand Studio in association with Kauvery Hospital.