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Watch Out for…Liver Cancer

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Liver cancer has the fastest rising death rate of any cancer—but it’s very preventable.

In June, a team of scientific experts from the American Cancer Society issued a special report—about liver cancer.

Sobering statistics: Death rates from liver cancer (hepatocellular carcinoma) are rising faster than those of any other cancer—with rates doubling since the mid-1980s, said the report, published in CA: A Cancer Journal for Clinicians. This year, about 41,000 Americans will be diagnosed with the disease. The report also grimly notes that only one in five people with liver cancer are alive five years after diagnosis.

That’s the bad news. Here’s the good…

“A substantial proportion of liver cancer deaths could be averted” by prevention, early detection and treatment of the leading causes of liver cancer, the experts wrote. More good news: The main risk factors behind the rise in deadly liver cancer have been identified, and medical care and lifestyle changes usually can keep them under control.

Here’s how to protect yourself from this deadly disease…

RISK FACTORS

The three-pound liver is the largest internal organ, and for good reason—it performs a wide array of indispensable functions.

It filters and detoxifies your blood and makes proteins that help blood clot. Food would be unusable without the liver—it’s a must for the digestion of carbohydrates, protein and fat. The liver also stores glycogen, a type of carbohydrate called a polysaccharide that is used for fuel when blood sugar (glucose) is low. And the liver helps produce several crucial hormones such as angiotensin II, which regulates blood pressure.

Because the liver is involved in such a broad range of metabolic activities, it  is exposed to many factors that can weaken and damage it, increasing the likelihood of liver cancer. The two main factors are blood-borne viruses such as hepatitis C…and excess dietary fat.

Hepatitis C virus. Half of all cases of liver cancer are caused by hepatitis C, which infects liver cells. Over the decades, a chronic case of hepatitis C can first cause liver inflammation and damage and then lead to cirrhosis (liver scarring, or fibrosis) and liver cancer.

About 3.5 million Americans are infected with hepatitis C, and 81% of them are baby boomers, people born from 1945 to 1965. Not surprisingly, baby boomers have the highest death rates from liver cancer, but older and younger people get it too.

In the case of baby boomers, most with hepatitis C were probably infected in the 1960s, ’70s and ’80s by blood transfusions and organ transplants…contaminated medical equipment or procedures that exposed them to other people’s blood…sharing needles in recreational drug use…or having sex with someone who was infected. This virus was discovered in 1989 and eliminated from America’s medical blood supply in 1992.

The hidden time bomb: Most people (of any age) who have chronic hepatitis C infection don’t know that they’re infected—because the infection rarely creates symptoms until the disease has reached an advanced state.

What to do: If you’re a baby boomer, you must be tested for hepatitis C—it’s that simple. (It also is the recommendation of the Centers for Disease Control and Prevention.)

If you’re not a baby boomer, you still should be tested for the hepatitis C virus if you had a blood transfusion before 1989 or if you have a history of intravenous drug use.

The test detects antibodies to the virus. Some people infected with hepatitis C “clear” the virus and are no longer infected—but they still will test positive for antibodies that were formed at the time of the infection. That’s why positive antibody tests are followed up with liver scans that can detect cirrhosis, and if you have cirrhosis, you definitely have an active infection. A liver biopsy is the medical “gold standard” for confirming hepatitis C.

If you find out you’re infected, be happy you found out—and don’t despair. A few years ago, it was next to impossible to stop chronic hepatitis C from damaging the liver. But in the past few years, the FDA has approved daily drug regimens that can cure hepatitis C, eradicating the virus from the body in more than 90% of cases. The risk of developing liver cancer depends on the damage already done by the virus. But after successful treatment of hepatitis C, the risk decreases with time. If you’re diagnosed with hepatitis C, talk to your doctor about the drug regimen that is best for you.

Hepatitis B virus. Infection with hepatitis B is the main cause of liver cancer worldwide but is less common in the US, where it causes about 15% of cases.

What to do: As with hepatitis C, most people who are infected with hepatitis B don’t know it. You should be tested for hepatitis B if you were born in Asia or Africa, where it is more common…you were never vaccinated for hepatitis B (a standard vaccination in the US)…you had sex with a person known to be infected with hepatitis B…you have an HIV infection…you’re on hemodialysis for kidney failure…you are on chemotherapy or another immunosuppressive treatment…or you have ever used recreational drugs intravenously.

If you are infected with hepatitis B, treatment will depend on whether the infection is acute or chronic and the degree of liver damage. Talk to your doctor about the liver-protecting regimen that’s right for you.

Obesity and diabetes. The twin US epidemics of obesity and diabetes have led to a third epidemic—nonalcoholic fatty liver disease (NAFLD)—and NAFLD can lead to liver cancer. Obesity, of course, includes excess fat…and in diabetes, excess blood sugar eventually gets stored as excess fat. Fatty liver afflicts an estimated 20% to 30% of American adults, including more than 60% of those who are obese. What happens: Between 10% and 20% of people with NAFLD develop an even more serious form of fatty liver disease called nonalcoholic steatohepatitis (NASH). In NASH, liver cells are inflamed and swollen, and there often is cirrhosis. Warning: NASH puts you at the same risk for liver cancer as someone with hepatitis C.

What to do: There are no long-term medical therapies that successfully control NASH. But lifestyle changes are proved to both prevent and reverse the condition.

HEALTHY LIVER LIFESTYLE

If you’re obese or have diabetes, you probably have NAFLD, and it’s possible that you have NASH. Either way, your risk for liver cancer is elevated. Make the following lifestyle changes—starting today. Note: The same lifestyle changes also are effective for strengthening the liver in people diagnosed with hepatitis C or hepatitis B.

Eat a Mediterranean diet. It’s the best dietary approach for managing NAFLD and NASH. Latest development: A scientific paper in the July 2017 issue of the medical journal Liver International declared the Mediterranean diet “the diet of choice” for NAFLD. The paper’s authors point out that the diet can reduce fat in the liver even without weight loss…reduces liver inflammation and liver scarring (cirrhosis)…can prevent or treat diabetes…and is better than a low-fat diet for weight loss. (Losing as little as 7% to 10% of your total body weight can reverse NASH.)

Bottom line: Eat more fruits, vegetables, beans, whole grains, olive oil, nuts and seeds, and fish. Eat less saturated fat from red meat and dairy products, less sugar and less processed food, and drink fewer or no sodas, including diet sodas (which, research shows, increases the craving for sugar).

Don’t fail to exercise. The more physically active you are, the less likely it is that you will develop NAFLD. My recommendation: Go for a brisk walk of 30 minutes at least five days a week—a study shows this regimen reduces liver fat by up to 43%.

If you’re drinking coffee, don’t stop. Many studies link coffee intake to a healthier liver. Standout scientific research: Coffee drinkers have a 40% lower risk of liver cancer than people who don’t drink coffee according to a study published in Clinical Gastroenterology and Hepatology. Those who drank the most coffee—three or more cups a day—had a 56% lower risk. The beverage is proved to reduce liver enzymes (a sign of inflammation) and to slow the progression of fibrosis.

Consider taking liver-supporting nutritional and herbal supplements. Scientific studies show that certain nutritional and herbal supplements can decrease liver fat and fibrosis and improve liver function. Check with your doctor about taking these top three…

  • Omega-3 fatty acids. Typical dose: 500 milligrams (mg) to 2,000 mg daily.
  • Vitamin E. Typical dose: 400 IU, twice daily.
  • Silymarin (active ingredient in milk thistle). Typical dose: 250 mg, three times daily.
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Source: Pankaj Vashi, MD, AAF, FASPEN, chair of the department of medicine and the chief of the department of gastroenterology/nutrition at Cancer Treatment Centers of America at Midwestern Regional Medical Center, Zion, Illinois. A member of the Society of Integrative Oncology, Dr. Vashi’s scientific papers have appeared in The American Journal of Clinical Nutrition, BMC Cancer, European Journal of Clinical Nutrition, Nutrition Journal, and many other leading medical journals. Date: August 28, 2017
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