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It is a condition where there is too much fat deposition in the liver. Ideally the liver should have little or no fat.
In the early stages it won’t usually cause any symptoms but if continued can lead to serious liver damage like Cirrhosis (final stage of liver damage) or liver cancer.
Also, high levels of fat in liver can increase the risk of stroke, diabetes and heart attacks.

The stages of fatty liver are-
1)Simple fatty liver: Refers to accumulation of fat in liver cells which can be detected only during some blood tests. As it does not cause any symptoms, it is in most cases detected incidentally.

2)Non-Alcoholic Steatohepatitis (NASH): This happens with progression of simple fatty liver where there is inflammation of the liver and is detected by liver biopsy (A test where a small liver tissue is taken for analysis).

3)Fibrosis: With continued inflammation leads to scar tissue around the liver distorting the structure of the liver. However, in this stage, liver continues to function due to its large reserve capacity.

4)Cirrhosis:  This is the final stage of liver damage where patient starts noticing symptoms like excessive fatigue, weight loss, jaundice, leg swelling. Liver cancer can develop at this stage.

Who Are At Risk?
a)Overweight or obese whose Body Mass Index (BMI- measurement of body fat based on height and weight) is greater than 25 especially if there is lot of fat around the waist.
b)High Cholesterol
c)High Blood pressure
d)Above 50 years of age group (Though it can affect at any age. In the recent past, there is increasing incidence in younger people).
e)Smoking

Symptoms
Most cases there aren’t any symptoms in the early stage. However, some may feel a dull aching pain the upper belly, excessive tiredness, unexplained weight loss. If cirrhosis develops, one can have jaundice; skin itching, swelling in the legs, feet or in the belly.

How is fatty liver diagnosed?
a)Blood test ( Liver function test)
b)Ultrasound scan (Fibroscan)
c)In some cases liver biopsy.
Also, one would require some other blood test to rule out some other causes of liver damage which can mimic fatty liver.

Treatment
1) Lifestyle changes and diet modifications are the key treatment options which can halt the progression of fatty liver to liver failure.
2) Top 5 tips to prevent or stop progression of fatty liver disease are-

• Lose weight
• Aim for BMI of 18.5-24.9 (How to calculate BMI= Weight in KG/ Height in M2
• Healthy diet – rich in fruits, vegetables, cereals & pulses but low in fat and sugar.
• Exercise regularly. About 30 minutes of walking or cycling daily.
• Stop smoking.

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There are 2 types of viruses which can cause long standing liver damage and cancer- Hepatitis B and Hepatitis C.
Approximately 50 million people in India have Hepatitis B / C.
It is very infectious – 100 times more infectious than HIV.

Prevalence:
The World Health Organization estimates that one third of the world’s population has been infected at some time and that there are approximately 350 million who are infected long term.

Mode of spread:
From blood or body fluids( saliva, semen and vaginal fluid)of the infected person through following routes:

• An open wound, contaminated needle.
• Tattoo, body-piercing or acupuncture with unsterile needle. Improperly sterilized surgical and dental equipments.
• The virus can survive outside the body for at least a week. Hence you should take care not to share items such as a razor or toothbrush which might be contaminated.
• By having penetrative sex without a condom with an infected person.
• Mother to baby transmission can happen during delivery, if mother is already infected with Hepatitis virus.
• Small traces found in sweat, tears, breast milk and urine are generally not regarded as infectious.
• You may be at risk of hepatitis viral infection if:
  • You come in contact with other peoples blood/body fluids.
  • Sewage workers, emergency services, and contact sports
  • Foster carers and carers for severe learning disabilities.
  • Prison staff and prison inmates
  • Patients who need repeated blood transfusions and dialysis.

It doesn’t spread by shaking hands, hugging or even kissing an infected person.

Symptoms
Vast majority of infected patients may not show any symptoms early on during the disease. Only when 60-70% of liver is damaged, people may notice tiredness, swelling of the belly and legs, Jaundice, weight loss, itching and stomach pain. Hence, it is strongly recommended to get tested for Hepatitis B and take appropriate preventive measures to avoid liver disease.

Complications of viral hepatitis B & C:
Cirrhosis of liver (irreversible liver damage)
Liver failure
Liver cancer
Kidney related complications

Cirrhosis  
This is usually the result of long-term, continuous damage to the liver. Irregular bumps replace the smooth liver tissue and the liver becomes harder. This can lead to accumulation of water in the belly, weight loss, jaundice, tiredness, complete liver failure, which can be fatal without a liver transplant.

What are the diagnostic tests?

1. Blood tests to detect the infection and liver damage
2. Ultrasound scan
3. Liver biopsy in some cases

Prevention:
     Vaccination
If you are negative for hepatitis B, you can get vaccinated. This has got more than 95% protection rate in healthy individuals. This will effectively prevent the hepatitis B infection. Vaccineconsists of ‘inactivated’ form of hepatitis B. It is generally a safe vaccine. It is also the first vaccine against a human cancer (hepatocellular cancer).
3 injections are required at 0, 1 & 6 months interval.
Booster injection should be given five years after the initial injection. Sometimes need to check the response to vaccination.

Who should have the hepatitis B vaccination?

• Babies born to infected mothers
• Close contacts of infected people.
• Regular receivers of blood transfusion or blood products and dialysis.
• People with any form of liver disease
• People traveling to countries with high prevalence of hepatitis B
• Injecting drug users
• Sex workers

Risky occupations mentioned above

After exposure to the virus (before vaccination):
Anyone who has been exposed to the virus should see doctor and usually be given an injection of antibodies called immunoglobulin (HBIG) immediately, as well as the vaccine.
Babies born to infected mothers also receive the same treatment, which will prevent hepatitis B.

HEPATITIS C:
Mode of spread and complications are similar to Hepatitis B. There is no vaccination for Hepatitis C.
Now there is cure available for Hepatitis C viral infection which can permanently clear the Hepatitis C virus from the blood and prevent Liver damage. Treatment is usually in the form of a single tablet taken daily for about 3 months.

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This refers to any break in the inner lining of stomach/intestines. It can happen in any part of the digestive tract.

What are the symptoms?
Stomach pain, weight loss, black stools, low haemoglobin, loose stools, blood in stools etc.

What causes ulcer?
Smoking, excess alcohol, infections, dietary imbalance, hereditary, drugs and in some cases there may not be any specific cause.

How to detect?
By careful examination and evaluation with appropriate tests, the root cause can be found. It can be blood test, X-ray, endoscopies etc.
Yes, in many cases. It depends on the underlying cause. Treatment can be a course of medicines in the majority of cases to surgery rarely

How can I prevent ulcer?
Avoid any form of tobacco and excess alcohol. Stop self medication. Regular balanced and hygienic diet, regular exercise, recreation, stress-free lifestyle, yoga and meditation etc can help

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Jaundice

What is Jaundice?
It is yellowish discoloration of the eyes, skin and urine. Usually due to liver diseases and rarely due to blood related disorder. It can cause itching.

What causes it?
Anything which cause Liver disease (Liver is a vital digestive organ located on the right side of your belly), can cause jaundice. For example: Hepatitis, alcohol, liver cancer, drugs etc.

Is there any cure?
Yes and it depends on the cause. Your doctor can assess and advice treatment depending on the cause of Jaundice.

Any specific diet:
Depends on the cause of jaundice. For example: if it is due to viral Hepatitis-normal balanced diet should be fine. Your doctor could advice specific diet for you depending on individual condition.

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It is a term generally referred to stomach pain/fullness/bloating/burping/excess passage of wind from anus (flatulence), incomplete stool clearance etc. It can be quite troublesome affecting your life, work, mental peace and academic performance. It can vary from simple indigestion from over indulgence with your favorite food, to serious illnesses like ulcers and cancers.

How to detect the cause?
After listening to your complaints and thorough physical examination, the doctor can narrow down the possible cause. This can be confirmed with some tests.

Can it be cured?
It depends on the cause and in most cases, yes. Treatment can be as simple as following the right diet and lifestyle.

How to prevent it?
Hygienic and timely intake of balanced food. Avoid self medication. If you have any recurring stomach pain, low blood count, weight loss/excess weight gain, passing blood in stools, loose motions, especially disturbing sleep, you should consult gastro specialist at the earliest.

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What is fatty liver?
When you have too much fat in liver. This happens when you accumulate too much of triglycerides ( a type of lipids) in your liver.

What cause fatty liver?

• Excess of alcohol
• Over weight
• Lack of exercise
• Smoking
• Diabetes
• Hypertension
• High Cholesterol
• Polycystic ovary
• Hepatitis B & C
• Drugs

What effects it will have on liver?
It can progress in some cases over a period of time, in stages, to cirrhosis.

What are the symptoms?
Fatty liver does not cause any symptoms in early stages. If it progresses to liver cirrhosis, it may cause jaundice, stomach pain, swelling of the belly.

Can it be cured?
It can be reversed, depending on the stage, with appropriate diet, lifestyle and medicines.

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If you’re extrinsically motivated, you’re driven to do things by external pressures or the incentive of external rewards.
When it comes to physical activity, intrinsic and extrinsic motivations both play a part. Extrinsic motivation helps you to start being active, whilst intrinsic motivation helps you to stick with it!
What motivates you at any given time can depend on different things such as your age and gender. It’s thought that men are often more influenced by intrinsic motivational factors, such as challenge, competition or mastering a new skill, whereas women tend to be more extrinsically driven by things like appearance. Your motivation can also change as you get older. Fewer people want to take part in physical activity as they get older. For those who do, their motivations are often based around looking after things like health and stress levels.

So why does this matter?
Motivation can change from one individual to another. But understanding motivation as a whole and your own motivational needs at any given time could help you to choose a type of activity that’s best for you.
Outlined below are some different types of physical activities and the most common motives people identify for taking part. So, before you jump in first and commit to a rigorous gym routine, have a think about your motivational needs and see if you can find an activity that matches your motives.

Team sports
It’s been found that people often take part in team sports because they enjoy being part/affiliation of a team. Affiliation is an extrinsic motivator, and can help motivate you to sign up to a team in the first place.
Being part of a team, and having other people to exercise with, can also increase your motivation due to something called social comparison. If your teammates are slightly more capable than you are, it’s likely you’ll be more motivated to try to keep up. Avoiding letting other people down is also a huge motivating factor when it comes to team sports – far more so than not letting yourself down. It brings back the sweet memories of childhood at times!
The interest to learn a new skill is another reason why people take part in team sports. Learning a new skill or improving your technique is known as a process goal. It’s not focused on a particular result, such as losing a certain amount of weight, but learning and developing instead. Research has found that people who work towards process goals keep their motivation and feel greater levels of enjoyment than those who focus on outcome goals, so bear this in mind when choosing how to keep active. This also keeps your mind fit.

Individual sports
When it comes to individual sports like cycling or bowling, the enjoyment factor comes out on top. This is a good example of intrinsic motivation. If you enjoy individual sports this could be a good option for you.

Racket sports
In racket sports your motivation for taking part may change depending on your level of expertise. If you’re a novice, enhancing your skills can be enough of an incentive to keep participating. But if you’re experienced, you may be more driven by competing and external rewards such as winning a competition. External motives are great to give you the push you need to start being active, but aren’t as helpful when it comes to keeping it up. So if you feel like you’re losing your motivation, you could try picking a racket sport you’re unfamiliar with to develop your skill set.

Planned exercise
Improving general wellbeing is seen as a popular motivator for people who pursue lower-intensity exercise such as jogging or dancing. However, more intense forms of aerobic exercise and weight training are often pursued by people who are motivated by extrinsic rewards for example improving their physical appearance. Before bolting for the bench press, reflect for a moment and see if this is the best option for you.
If this is the best option for you but you struggle to workout consistently, one technique that has been shown to increase motivation is to combine it with something you find pleasurable. For example, only allowing yourself to listen to your favourite play list while at the gym could make you more likely to go regularly.

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Sensible drinking

Many of us enjoy a drink or two and find it helps us to relax and socialise. While this shouldn’t do you too much harm, regularly overdoing it is associated with various health risks. Sensible drinking means knowing what your limits are and being aware of how much you’re drinking. It’s key to understand how to enjoy alcohol in moderation as part of a healthy lifestyle

How much is too much?

Proposed new guidelines recommend that you should not regularly drink more than 14 units over the course of a week. If you do drink as much as 14 units, you should spread it over three days or more, rather than having all at once. Also minimum of three alcohol free days a week.

An easy way to cut back on your intake is to have several drink-free days each week.

How many units in your drink?

Alcohol levels in a drink are expressed as ‘percentage alcohol by volume’ . Some brands also give the number of units of alcohol the drink contains on the packaging.

One unit is equal to 10ml by volume or 8g by weight, of pure alcohol. This is the amount of alcohol an average adult can process in one hour.

The number of units of alcohol in different drinks varies. It’s also rare that the usual measure your drink comes in will contain just one unit. Here are some common drinks you might order at the bar and how many units they contain.

Each of the follwing units have about one unit of alcohol

Champagne/wine 100ml 13% Alcohol

Regular Beer 285ml 5% Alcohol

Fortified wine 60ml 20% Alcohol

Hard liquor/spirits 30ml 40% Alcohol

Something else to bear in mind is that the same type of drink can vary in strength between different brands. For example, some wines and lagers contain more alcohol than others. What’s more, bars and restaurants offer a variety of measures. Here are some examples.

If you drink three 250ml glasses of wine, you’re drinking a whole bottle of wine and three times the recommended daily units. It can be easy to do without even realising it !

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Here are some tips to maintain your energy:
Always have breakfast
Overnight your body is in a state of fasting, which leaves your brain depleted of its main energy source glucose .Kickstart your metabolism in the morning with a slow-releasing carbohydrate breakfast like cereals/musseli. This will slowly release glucose into your body, keeping you fuller for longer without causing a spike in your energy levels.

Avoid skipping meals
We are creatures of habit and by eating three meals a day, your body can learn to manage feelings of hunger. Dont wait until hunger fills your mind completely. Having timely meals helps to sustain your energy levels by keeping blood sugar levels within a healthy range. It could also lead to better portion control at meal times by preventing you from over eating and help you to make healthier choices.

5 portions of fruit-a-day
Fruit and vegetables are packed full of vitamins, minerals, antioxidants and fibre – all of which are essential for your body to function the way it should. Fibre may also help keep you feeling fuller for longer. This means you might snack less in between meals.

On average, a portion of fruit or veg is equivalent to 80g. Below are some examples of what counts as one portion:

1 apple, banana, pear, orange or other similar sized fruit
2 plums, satsumas, kiwi fruit or other similar sized fruit
1⁄2 a grapefruit or avocado
1 large slice of melon or fresh pineapple
3 heaped tablespoons of vegetables, beans or pulses
3 heaped tablespoons of fruit salad or stewed fruit
1 heaped tablespoon of raisins or sultanas
3 dried apricots
1 cupful of grapes, cherries or berries
1 dessert bowl of salad
1 small glass (150ml) of pure fruit juice

Make sure you get enough iron
Iron is an essential mineral and one of the main components in red blood cells. It transports oxygen around your body, so getting the right amount through your diet is important. Eating foods rich in iron can help to prevent iron deficiency anaemia and its associated symptoms, which include feeling tired and weak. Foods like red meat and beans, leafy green vegetables and fortified foods such as high fibre breakfast cereals are all high in iron. So try to make sure you get enough of these into your diet.

More water, less alcohol
Alcohol increases the amount of urine your body produces. It can leave you dehydrated if you drink too much of it. Drinking six to eight glasses of water a day should be enough to keep you hydrated. But you may need more if you’re doing regular exercise or if it’s hot outside. Take a look at our alcohol and liver disease for more information on this.

Watch out for added sugar
Sugary food and drinks cause a spike in your blood sugar which can then lead to a drop shortly afterwards. This rollercoaster effect plays havoc on your energy levels and leads to more cravings of sugary foods to keep you going throughout the day. These sugary foods are converted into glucose and fructose in the body and any excess that isn’t used up as energy may be stored as fat. This isn’t great if you want to keep to a steady weight. If you need something to keep you going, snack on foods low in refined sugar.

Eat foods rich in B vitamins, zinc and magnesium
These vitamins and minerals are essential for energy functions in the body. You need B vitamins such as thiamine, niacin and riboflavin are to help break down energy from the foods you eat. They also help to maintain muscle tissue and keep skin and eyes healthy. Make sure you eat a variety of different foods to maintain optimum levels of these vitamins and minerals. Include lean meats and fish, wholegrains, yeast extract(dosa, idli etc) lentils, sprouted grams, milk, eggs and unsalted nuts in your diet where you can.

Tip: Don’t forget that it’s also important to keep moving. At least a 30-minute brisk walk, five times a week alongside getting enough sleep and drinking enough water should help you to avoid those energy slumps.

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