— Barbara, Canada Fatty liver has become a major cause of liver disease in the United States. It is closely associated with obesity, diabetes, and “metabolic syndrome,” a major risk factor for heart attacks and strokes. Fortunately, non-alcoholic fatty liver disease, which is projected to become the most common liver disorder in the United States in the next 10 to 15 years, is also the most reversible form of liver disease. Unless the fatty liver has progressed to cirrhosis (scarring of the liver), weight loss can reverse the condition. People with fatty liver disease who lose more than 5 percent of their body weight have lower rates of fat accumulation in the liver, while those who lose more than 9 percent have shown reversal of their liver disease. In addition to weight loss through diet and exercise, diets high in refined carbohydrates (those with a high glycemic index) are associated with fatty liver more than complex carbohydrates. Examples of high-glycemic carbohydrates include white bread, many commercial breakfast cereals, and white rice. Complex carbohydrates that may protect against fatty liver disease include whole-grain breads and brown rice. Q2. During an insurance screening, it was brought to my attention that some of my liver enzymes were elevated. What could this mean? — Karen, Texas Elevated liver enzymes can be a sign of many things — including a completely normal person. It’s difficult to answer this question, because there are different kinds of liver enzymes that can be tested for, each of which may indicate a different potential problem. Generally speaking, elevated liver enzymes may be caused by alcohol, prescription drugs such as statins (used to lower cholesterol), infections such as hepatitis, gallbladder disease, and many other conditions, some of which are not even related to the liver. While we may call some of these enzymes “liver” enzymes, some of them occur in other parts of the body, such as the heart and bones. A variety of blood tests or, if indicated, a liver biopsy can help determine the cause of the elevated enzymes. In your case, it’s important to know which test results were elevated and to repeat these tests when you are fasting to double-check the results. If the repeat results concern you, you may also want to see a hepatologist — a doctor who specializes in diagnosing and treating diseases of the liver. Q3. Is it possible to pass the H. pylori bacterium through sexual contact or kissing? Helicobacter pylori (H. pylori), a bacterium found in the stomach and duodenum (part of the intestine), has been shown to play a major role in causing peptic ulcers. Most cases of H. pylori infection occur without any symptoms during childhood and are most commonly associated with poor sanitary hygiene — that is, not washing your hands thoroughly after using the toilet. While this bacterium could theoretically be passed by any oral contact — such as kissing — from one person to another, no such transmission has ever been reported. In fact, adults who were not infected during childhood rarely are infected later in life. There is no evidence that any other sexual contact can transmit H. pylori. Q4. My mother was just told she has functional dyspepsia. I’ve never even heard of that. What is it, and what treatments are available? Dyspepsia or indigestion (the word “dyspepsia” is derived from the Greek roots for “bad digestion”) is defined as persistent or recurrent pain or discomfort centered in the upper abdomen, otherwise known as indigestion. Functional dyspepsia (also sometimes called non-ulcer dyspepsia) is the diagnosis we give to a person who has symptoms but for whom no identifiable cause can be found upon a routine diagnostic workup. We find that 60 percent of patients with dyspeptic symptoms do not have an established diagnosis after a number of medical tests, including upper endoscopy or barium studies of the esophagus and stomach to rule out ulcer disease, malignancy, and gastroesophageal reflux disease; gastric motility studies to rule out gastroparesis and other motility disorders; and right upper quadrant ultrasound to rule out gallstones. We now subdivide the patients into groups according to their main symptom in order to create a rationale for treatment options. In this manner, patients with predominant ulcer-like or heartburn-like symptoms are treated with acid blockers. Patients with dysmotility-like symptoms are treated with prokinetic agents that help the stomach empty. To date, it’s not clear whether these subclassifications have resulted in improved outcomes for patients with functional dyspepsia. It’s of note that some patients respond to counseling or antidepressants in addition to acid blockers and prokinetic agents. Learn more in the Everyday Health Digestive Health Center.
