How Not to Die

  The best strategy to avoid alcoholic liver disease is to not drink so much in the first place. But if you do drink excessively, help is available. Though most people who drink may not be alcoholics,14 there is convincing evidence that twelve-step programs such as Alcoholics Anonymous can be effective for those who do suffer from alcohol dependence.15

  Isn’t Moderate Drinking Beneficial?

  Everyone agrees that heavy drinking, drinking during pregnancy, and binge drinking are bad ideas, but what about “moderate” drinking? Yes, excessive drinkers appear to significantly shorten their lives, but so can teetotalers.16 While smoking is bad for you and smoking a lot is worse, that logic may not hold for alcohol consumption. There actually appears to be a beneficial effect on overall mortality by drinking some alcohol—but only, it seems, for those who are not taking good care of themselves already.17

  Moderate drinking does appear to protect against heart disease, perhaps because of a blood-thinning effect,18 but even light drinking (less than one drink a day) has been found to increase cancer risk, as you’ll see in chapter 11. How could something that increases cancer risk still prolong life? Cancer is “only” our second-leading killer disease. Because heart disease is the leading cause of death, it explains why people who drink moderately may live longer lives than those who abstain. But this advantage may be restricted only to those who fail to practice a bare modicum of healthy behaviors.19

  To find out who might benefit from moderate alcohol consumption, researchers recruited close to ten thousand men and women and followed them for seventeen years after assessing their drinking and lifestyle habits. The results were published in a paper entitled “Who Benefits Most from the Cardioprotective Properties of Alcohol Consumption—Health Freaks or Couch Potatoes?” What constituted a “health freak”? According to the researchers’ definition, anyone who exercises thirty minutes a day, doesn’t smoke, and eats at least one serving of fruits or vegetables daily.20 (What does that say about our current diets if eating a single apple means you’re a “health freak”?)

  One to two drinks a day did lower the risk of heart disease for the “couch potatoes,” those living unhealthy lifestyles. But people who practiced even the bare minimum of healthy behaviors showed no benefit from alcohol. The lesson: Grapes, barley, and potatoes are best eaten in their nondistilled form, and Johnnie Walker is no substitute for actual walking.

  Nonalcoholic Liver Disease

  The most common cause of a fatty liver is not alcohol but nonalcoholic fatty liver disease (NAFLD). You may remember the blockbuster documentary Super Size Me, in which the film’s director, Morgan Spurlock, ate exclusively at McDonald’s for a month. Predictably, Spurlock’s weight, blood pressure, and cholesterol all went up—but so did his liver enzymes. That was a sign that his liver cells were dying and spilling their contents into his bloodstream. How was his diet causing liver damage? Let’s put it this way: He was beginning to turn his liver into human foie gras (fatty liver pâté).

  Some critics wrote off the film as overly sensational, but researchers in Sweden took it seriously enough to formally replicate Spurlock’s one-man experiment. In their study, a group of men and women agreed to eat two fast-food meals a day. At the start, their liver enzyme levels were normal, but after just one week of this diet, more than 75 percent of the volunteers’ liver function test results became pathological.21 If an unhealthy diet can cause liver damage within just seven days, it should be no surprise that NAFLD has quietly become the most common cause of chronic liver disease in the United States, afflicting an estimated seventy million people.22 That’s about one in three adults. Nearly 100 percent of those with severe obesity may be affected.23

  Like alcoholic fatty liver, NAFLD starts with a buildup of fat deposits in the liver that cause no symptoms. In rare cases, this can progress to inflammation and, over years, end up scarring the liver into a state of cirrhosis, resulting in liver cancer, liver failure, and even death—as I saw in that endoscopy suite.24

  Fast food is so effective at instigating the disease because NAFLD is associated with the intake of fizzy drinks and meat. Drinking just one can of soda a day appears to raise the odds of getting fatty liver disease by 45 percent.25 Meanwhile, those who eat the meat equivalent of fourteen chicken nuggets or more daily have nearly triple the rate of fatty liver disease compared to people who eat seven nuggets’ worth or less.26

  NAFLD has been characterized as a “tale of fat and sugar,”27 but not all fat affects the liver similarly. People suffering from fatty liver inflammation were found to be consuming more animal fat (and cholesterol) but less plant fat (and fibre and antioxidants).28 This may explain why adherence to a Mediterranean-style diet with plenty of fruits, vegetables, whole grains, and beans has been associated with less severe fatty liver disease even though it is not typically a low-fat diet.29

  NAFLD may also be caused by cholesterol overload.30 The dietary cholesterol found in eggs, meat, and dairy can become oxidized and then set off a chain reaction that results in excess fat in the liver.31 When the concentration of cholesterol in your liver cells gets too high, it can crystallize like a stick of rock and result in inflammation. This process is similar to the way uric acid crystals cause gout (as we’ll see in chapter 10).32 Your white blood cells try to engulf the cholesterol crystals but then die in the process, spilling out inflammatory compounds. This may explain how benign fatty liver cases can turn into serious hepatitis.33

  To explore the relationship between diet and serious liver disease, about nine thousand American adults were studied for thirteen years. The researchers noted that their most important finding may be that cholesterol consumption was a strong predictor of cirrhosis and liver cancer. Those consuming the amount of cholesterol found in two Egg McMuffins34 or more each day appeared to double their risk of hospitalization or death.35

  Your best bet for avoiding NAFLD, the most common cause of liver disease, may be to avoid excess calories, cholesterol, saturated fat, and sugar.

  Viral Hepatitis

  Another common cause of liver disease is viral hepatitis, which is triggered by one or more of five different viruses: hepatitis A, B, C, D, or E. The mode of transmission and prognosis differs for each of these viruses. Hepatitis A is spread primarily through food or water that is tainted with contaminated feces. It can be prevented through vaccination, avoiding raw and undercooked shellfish, and trying to ensure that everyone who handles your food washes their hands after changing nappies or using the toilet.

  While hepatitis A virus is foodborne, hepatitis B virus is blood-borne and is transmitted sexually. As with hepatitis A, an effective vaccine is available against hepatitis B that every child should get. Hepatitis D virus infection can only occur in someone who is already infected with hepatitis B and so can be prevented by preventing hepatitis B. So get vaccinated and refrain from intravenous drug use and unsafe sex.

  Unfortunately, there is currently no vaccine for the hepatitis C virus, the most dreaded of liver viruses. Exposure can lead to a chronic infection that, over decades, can lead to cirrhosis and liver failure. Hepatitis C is now the leading cause of liver transplants.36

  Chlorella and Hepatitis C

  The green algae chlorella looks promising for the treatment of hepatitis C. A randomized, double-blind, placebo-controlled study found that about two teaspoons a day of chlorella boosted the activity of natural killer cells in participants’ bodies, which can naturally kill hepatitis C-infected cells.37 A clinical study of hepatitis-C patients found that chlorella supplementation may lower the level of liver inflammation, but the study was small and uncontrolled.38

  There is a desperate need for alternative treatments for hepatitis C, as older, less expensive therapies frequently fail due to their unbearable side effects, whereas newer, more tolerable drugs cost as much as $1,000 (£650) per pill.39 Chlorella may help as an adjunct (additional) therapy or for those who can’t tolerate or afford conventional antiviral therapy but may not be without risk
(see here).

  Hepatitis C is transmitted via blood, usually through sharing needles rather than via blood transfusions, now that the blood supply is screened for the virus. However, sharing personal-care items that can be contaminated with trace amounts of blood, such as toothbrushes and razors, may also present a risk.40

  Although a case was once reported involving a woman who contracted hepatitis C from sharing a supermarket meat slicer with an infected coworker,41 the virus would not naturally be present in the meat itself, as humans and chimpanzees are the only animals who appear susceptible to it.

  The same cannot be said for hepatitis E virus.

  Preventing Hepatitis E Through Diet

  As one of the CDC’s Division of Viral Hepatitis laboratory chiefs explained in a paper entitled “Much Meat, Much Malady: Changing Perceptions of the Epidemiology of Hepatitis E,” hepatitis E virus is now considered a zoonotic disease, able to spread from animals to humans, and pigs may be the primary viral reservoir.42

  The shift in thinking began in 2003, when researchers in Japan linked the hepatitis E virus (HEV) with the consumption of grilled pork liver. After testing pig livers from Japanese supermarkets, the researchers determined that nearly 2 percent of the meat tested positive for HEV.43 In the United States, it was even worse: 11 percent of commercial pig livers purchased from supermarkets were contaminated with HEV.44

  That’s alarming, but how many people really eat pig livers? What about plain old pork?

  Unfortunately, pork may harbor HEV as well. Experts suspect that much of the American population has been exposed to this virus, as there is known to be a relatively high prevalence of HEV antibodies among U.S. blood donors. This exposure may be a result of individuals consuming HEV-contaminated pork.45

  So do more people die of liver disease in countries where pork is more popular? It appears so. The relationship between national per capita pork consumption and deaths from liver disease correlates as tightly as per capita alcohol consumption and liver fatalities. Each pork chop consumed per capita may be associated with about two beers’ worth of increased liver mortality risk on a countrywide scale.46

  Aren’t viruses deactivated by cooking? Usually, but there’s always the problem of cross-contaminating your hands or kitchen surfaces while handling raw meat. Once meat is in the oven, most foodborne pathogens can be destroyed by cooking the meat to proper internal cooking temperatures, with an emphasis on proper. Researchers at the National Institute of Health subjected the hepatitis E virus to various levels of heat and found that HEV can survive the internal temperature of meat cooked rare.47 So if you cook pork, invest in a meat thermometer and make sure to follow proper handling techniques, including washing kitchen surfaces with a bleach solution.48

  Though most people who develop hepatitis E recover completely, it can be deadly for pregnant women: The risk of death during the third trimester can reach as high as 30 percent.49 If you are pregnant, please be especially careful about pork preparation. And if there are people in the household who like their pork pink in the middle, they should be sure to wash their hands thoroughly after using the bathroom.

  Weight-Loss Supplements and Liver Disease

  We’ve all seen those marketing schemes involving products espousing all sorts of health claims. And given the pyramid-like multilevel structure of those types of distribution programs—you earn money by selling products and also for recruiting others to sell—word can spread pretty fast, which is particularly troubling when PR outruns the truth.

  Indeed, while the vast majority of drug-induced liver injuries are caused by conventional medications, liver damage caused by certain classes of dietary supplements can be even more serious and may lead to higher rates of liver transplants and death.50 Multilevel marketers of products later linked to toxic reactions (such as noni juice51 and Herbalife52) have pointed to scientific studies to support their health claims. However, a public health review found that such studies often seemed “deliberately created for marketing purposes” and were presented in such a way as to appear “designed to mislead potential consumers.” Often, multilevel marketing study researchers didn’t disclose their funding sources, but a little detective work can expose a web of financial conflicts of interest.53

  These suspect studies were the same ones cited to provide proof of safety for their products. For example, a multilevel marketing company that sells mangosteen juice cited a study they paid for to support its assertion that their product is “safe for everyone.” The study involved exposing just thirty people to their product with another ten people given a placebo. With so few people tested, the stuff could literally kill 1 or 2 percent of users and you wouldn’t know.54

  A study that the multilevel marketing company behind a supplement called Metabolife cited for safety placed thirty-five people on the stuff.55 Metabolife has since been withdrawn from the market after being linked to heart attacks, strokes, seizures, and deaths.56 Hydroxycitric acid, a component of such products as Hydroxycut, was studied on forty people.57 No serious adverse effects were found, but the story ended the same way: Hydroxycut was withdrawn after dozens of verified cases of organ damage were brought to light—including massive liver failure requiring transplantation and even death.58 Until the multibillion-dollar herbal supplement industry is better regulated, you’re better off saving your money—and your health—by sticking to real food.

  Protecting the Liver at Breakfast

  Specific plant foods have been found to be protective of the liver. For instance, starting out the day with a bowl of oatmeal and (surprisingly) coffee may help safeguard our liver function.

  Oatmeal

  In numerous population studies, consumption of whole grains has been associated with reduced risk for a range of chronic diseases,59 but it’s hard to tease out whether eating whole grains may just be a marker for a healthier lifestyle in general. For example, people who eat whole grains, such as oatmeal, whole wheat, and brown rice, also tend to be more physically active, smoke less, and eat more fruits, vegetables, and dietary fibre60 than those who might prefer a breakfast of a high-sugar cereal such as Froot Loops, for example. No wonder the former group may have lower disease risk. Fortunately, researchers can control for these factors, effectively comparing nonsmokers only to nonsmokers with similar diet and exercise habits. When that’s done, whole grains still appear to be protective.61

  In other words, the evidence seems clear that oatmeal eaters may have lower rates of disease, but that’s not the same as showing that if you start eating more oatmeal, your risk will drop. To prove cause and effect, we need to put it to the test by performing an interventional trial: Change people’s diets and see what happens. Ideally, researchers would randomly split people into two groups and give half of them oatmeal and the other half a placebo—a fake, similar-tasting and -looking oatmeal. Neither the study subjects nor the researchers themselves can know who’s in which group until the end. This robust, double-blind method is easy to use when studying drugs, as you just give people a sugar pill that looks like the drug in question. As we’ve discussed, it’s not as easy to make placebo food.

  But in 2013, a group of researchers published the first double-blinded, randomized, placebo-controlled trial of oatmeal in overweight men and women.62 They found a significant reduction in liver inflammation in the real oatmeal group, but that may have been because they lost so much more weight than the controls (that is, the placebo-oatmeal eaters). Nearly 90 percent of the real-oatmeal-treated subjects had lost weight, compared with no weight loss, on average, among the control group. So it may be that the benefits of whole grains on liver function are indirect.63 A follow-up study in 2014 helped confirm the findings of a protective role for whole grains in nonalcoholic fatty liver patients in reducing the risk of liver inflammation. In this study, refined grain consumption was associated with increased risk of the disease.64 So lay off the Wonder Bread and stick to truly wonderful whole-grain foods, including oatmeal.

  Making
Your Own Whole-Cranberry Cocktail

  A specific class of plant compounds called anthocyanins—the purple, red, and blue pigments in such plants as berries, grapes, plums, red cabbage, and red onions—have been found to prevent fat accumulation in human liver cells in in vitro studies.65 A single confirmatory clinical (human) trial has been published in which a purple sweet potato concoction successfully dampened liver inflammation better than a placebo.66

  When it came to suppressing the growth of human liver cancer cells in a petri dish,67 cranberries beat the other most common fruits in the United States: apples, bananas, grapefruits, grapes, lemons, oranges, peaches, pears, pineapples, and strawberries. Other studies have found that cranberries are also effective in vitro against additional cancers, including those of the brain,68 breast,69 colon,70 lung,71 mouth,72 ovary,73 prostate,74 and stomach.75 Unfortunately, there have yet to be clinical studies of the effects of cranberries on cancer patients that confirm these findings.

  Moreover, to the drug industry’s chagrin, scientists have been unable to pin down the active ingredients involved in cranberries’ special effects. Extracts concentrating individual components fail to match the anticancer effects of the cranberry as a whole,76 which of course can’t be patented. More proof that it’s nearly always best to give preference to whole foods.

  How do you do that with cranberries, though, since they’re so tart?

  It’s not easy at the supermarket. Ninety-five percent of cranberries are sold in the form of processed products, such as juices and sauces.77 In fact, to get the same amount of anthocyanins found in a single cup of fresh or frozen cranberries, you’d have to drink four liters of cranberry juice, eat 840 grams of dried cranberries, or make your way through twenty-six tins of cranberry sauce.78 The ruby-red phytonutrient found in cranberries is a powerful antioxidant, but the high-fructose corn syrup added to cranberry cocktail acts as a pro-oxidant, canceling out some of the benefit.79