'I had slight swelling in my belly': fat in the liver does not usually show signs

‘I had slight swelling in my belly’: fat in the liver does not usually show signs

Retired Heides Paulo Pinto, 67, has always taken care of his health. But, in the pandemic, he left the check-up for later, especially at the most critical moment, with an increase in cases and deaths from covid-19, and still without a vaccine against the disease.

When things got better last year, he looked for doctors who were already part of his routine, a urologist and a cardiologist. One of the specialists passed the abdominal ultrasound exam, which identified a liver disorder, a mild non-alcoholic fatty liver disease – the disease is also known as “fatty liver” or “fat in the liver”.

“I was surprised because I didn’t feel anything. Sometimes I had a certain swelling in my belly, I thought it was normal, from the diet, that I had eaten too much, but it didn’t go away”, recalls the retiree, who lives in Rio de Janeiro. With the result, the cardiologist suggested that he look for a hepatologist, a specialist in diseases that affect the liver, to investigate further.

When the doctor passed another test, elastography, which assesses the consistency of the liver, the result showed that the disease was, in fact, advanced.

“During the pandemic, I was very anxious and ate more. Living in Rio, I used to ride a bike and go to the gym, but during this period, I stopped”, says Heides.

Treatment involves healthier habits

According to Andreia Evangelista, hepatologist at the Advanced Hepatobiliary Center at HSVP-RJ (São Vicente de Paulo Hospital in Rio de Janeiro), there is no specific remedy that will solve the problem. “Studies show benefits of some drugs that help steatosis: improving inflammation, but without removing fat from the liver”, explains the doctor who even treated Heides.

Heides returned to the gym and gained muscle mass

Image: Personal archive

What happens, in most cases, is the treatment of obesity or diabetes with drugs that, consequently, also help to reduce excess fat present in liver cells.

Therefore, the main way to treat the disease is with lifestyle changes: balanced diet and frequent physical activity. So, the retiree also started to be attended by a nutritionist — at which point he resumed healthier eating habits.

“I learned to read better the labels of the foods I bought. I changed completely, and it wasn’t anything radical”, he says.

Heides’ dietary changes involved the following measures:

  • It significantly reduced the consumption of processed foods, especially ultra-processed foods, such as boxed juices, ready-made sauces and ham;
  • Include more fruits and vegetables in the diet;
  • Added more cereals and grains;
  • Reduced alcohol consumption — which was already low.

In almost 4 months, Heides already managed to control the problem, also counting on the constant practice of physical activity. It even went from 75 kg to 66 kg. “I’ve already lost 9 kg and gained muscle mass. With the help of a personal trainer, I started doing physical activity”, says the retiree, who has resumed the habit of riding a bicycle.

It’s that balance thing. I was very unbalanced. Now I’m fine, we don’t realize that exercising and having a good diet are such essential things. Heides Paulo Pinto, 67

“Of course, sometimes, when I feel like eating something, I buy it, without exaggerating like I used to. But today, I eat more fruits and cereals, for example, and I have reduced a lot of fatty food.”

Heides Paulo Pinto, 67 - Personal archive - Personal archive

Heides treated problem without radical changes

Image: Personal archive

Heides says that the doctors congratulated him on his effort from the beginning. “Looking at old photos, I realize how much better I am today.”

Silent, disease can be dangerous if left untreated

Hepatic steatosis is when liver cells (hepatocytes) become filled with fat inside. That’s why the disease is known as “fat in the liver” or “fatty liver”. The main causes involve excess weight (overweight and obesity), sedentary lifestyle, diabetes and high cholesterol and triglycerides.

As the disease usually has no symptoms, the diagnosis is more difficult to make. “The screening test is the abdominal ultrasound, which is part of the routine of people with overweight, obesity, diabetes or pre-diabetes, in addition to those who have high cholesterol”, explains the doctor from Hospital São Vicente de Paulo.

According to the hepatologist, most cases are benign, being “only” a risk marker for the patient. However, you need to be very careful with the diagnosis, as an untreated fatty liver can increase the risk of other diseases, such as steatohepatitis, an inflammation of the organ that results in the process of fibrosis (scarring).

Heides Paulo Pinto, 67 - Personal archive - Personal archive

Retired during training with personal

Image: Personal archive

“Everything that inflames in the body, it repairs with scarring. And the liver does the same thing. But in some cases, this evolution can result in liver cirrhosis, which is a risk factor for liver cancer”, highlights Evangelista.

To treat the problem, the two main pillars, according to the doctor, are diet and physical activity – as stated above. “Patients need to change their lifestyle. And that doesn’t mean ‘shutting up’ for food, but relearning how to eat well,” she says.

The importance of food

It is essential to avoid processed foods —as Heides did—, especially ultra-processed foods, which are products produced by industry that should be avoided. Some examples are: boxed juices, instant noodles and soups, cookies, packaged snacks and ice cream.

“A healthy and balanced diet, according to the needs of each patient, is the basis for the prevention and management of non-alcoholic hepatic steatosis, as well as for several other health conditions”, explains nutritionist Jamile Tahim, master at UECE (Ceara state University). “In this particular case, a diet of real food is essential.”

According to tahim, it is important to include fiber, vitamins and minerals, proteins, polyunsaturated and monounsaturated fats and complex carbohydrates. The specialist gave tips and food suggestions that are important to include in the diet.

  • Fruits: apple, banana, melon, papaya, grape, kiwi, watermelon;
  • Vegetables and greens: broccoli, chayote, lettuce, carrots and kale;
  • Carbohydrates in their full versions: breads, rice and pasta;
  • Fibers, grains and seeds: oat, chia, linseed, sesame and sunflower;
  • Tubers: potatoes and cassava;
  • Legumes: beans, peas, chickpeas and lentils.

According to the nutritionist, it is essential to restrict alcohol intake, as it has an inflammatory potential, intensifying the overload of liver functions by generating substances that increase the risk of toxicity that are metabolized in the liver.

Finally, she reinforces that the practice of physical exercise is essential for the management of the disease, as it improves the functional capacity of our body and increases the sensitivity of the action of insulin, a hormone that regulates the metabolism of glucose absorption after ingestion. of food, avoiding blood glucose spikes.

“This action is important to prevent the metabolism from transforming excess glucose into a form of fat that, among other places, is deposited in the liver, worsening the severity of the disease”, he says. Tahim.

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