Silent killer: Doctors battling liver disease that threatens one-fifth of adults

MURRAY — For five years, Wayne Eskridge carried the same photo.

It wasn't a picture of a loved one. It was a picture of his liver.

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Back in 2010, a surgeon went in to remove Eskridge's gallbladder and came out with bad news: He was sure Eskridge had stage 4 liver disease.

This came as a shock. Eskridge, 73, didn't drink. He had no symptoms of liver disease. In fact, the semiretired Boise engineer had hardly ever been sick.

In the weeks and months to pass, doctors performed blood tests, genetic tests and two liver biopsies, which provided conflicting information. One suggested his liver was healthy. Another said his liver was severely scarred. The bloodwork indicated that nothing was wrong, but then a hematologist diagnosed him hemochromatosis — too much iron in his blood.

"For the next couple of years, every time I went to the doctor I'd take my picture and I'd ask about my liver," Eskridge said.

Eskridge didn't know it then, but he didn't have hemochromatosis. He was, however, very sick — suffering from one of the most common diseases in the U.S.

It's an illness that is growing fast, strongly linked to the rise of the obesity epidemic. The medical term is nonalcoholic fatty liver disease. Doctors sometimes call it the silent killer.

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Researchers have known for decades about the effects of cholesterol on the heart. But only in the past 10 years have they started realizing that diet also affects liver health.

In the past 20 years, the prevalence of nonalcoholic fatty liver has doubled in adults. Now the disease affects between 20 and 30 percent of adults in the U.S.

"It's a hard number to believe," said Michael Charlton, the director of hepatology and the liver transplant program at Intermountain Medical Center.

The disease causes fat to build up in the normally soft liver. Eventually, the liver becomes scarred and inflamed. That's known as nonalcoholic steatohepatitis, or NASH.

For years, hepatitis C has been the leading cause of liver transplants. NASH is projected to overtake it by 2020.

"We're seeing a kind of shift where fatty liver disease is becoming the biggest problem in our country," said Jake Krong, who coordinates clinical research at Intermountain Medical Center's liver disease and transplant program.

Nonalcoholic fatty liver is also becoming rampant among children. An estimated 1 in 10 children have nonalcoholic fatty liver, a number that has more than doubled over the past 20 years.

By his own admission, Eskridge was a farm kid who grew up on meat and potatoes.

"We liked red meat and we liked half-and-half in our coffee, and we liked ice cream," he said. "We liked all of the packaged foods and sausage and cheese."

He didn't know that his diet, typical of so many Americans, was dangerously high in cholesterol and saturated fats.

Few people do, Charlton said.

He recalled one study where researchers fed mice a typical fast-food diet to see what would happen to their livers. Within six months, they all developed NASH with progressive fibrosis.

"They loved it. They got really big," Charlton said. "But their livers got really sick."

Physicians have to overcome another problem in the battle against fatty liver: The disease can be tricky to diagnose.

Liver disease typically doesn't cause pain or other symptoms until it's too late. That's why doctors call it the silent liver disease.

And liver biopsies — long considered the gold standard for a diagnosis — are prone to error. Because biopsies provide a snapshot of about 1/50,000th of the liver, they can lead to conflicting results if the patient's liver has a lot of variation.

That's what happened to Eskridge, and it's why he remained undiagnosed for five years.

In recent years, new technology has emerged that uses ultrasound waves to probe the liver. These elastography machines are one of the only ways physicians can get an accurate measurement of the stiffness of the liver. The technology is so new that Intermountain Medical Center is the only hospital in the Intermountain West that offers it.

So Eskridge drove from Boise to Murray to go through one of these machines.

It didn't take long for Charlton to come back to Eskridge with a diagnosis.

The machine "confirmed what the surgeon had seen at the beginning," Charlton said. Eskridge had nonalcoholic fatty liver disease, for which there is no cure.

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To prevent further scarring and loss of liver function, Charlton prescribed Eskridge vitamin E and 60 milliliters of extra virgin olive oil every day. Both are antioxidants that have been found to improve NASH symptoms.

He also put Eskridge on the Mediterranean diet, which is high in fish, fruits, vegetables, whole grains, nuts and healthy fats like olive oil. A large study published in The New England Journal of Medicine showed the diet was powerful in reducing the risk of heart attack, stroke and death from heart disease.

Eskridge admits it "takes some getting used to." But he was sick of hauling around that picture of his liver. And he was tired of seeing his wife sitting by his hospital bed and crying.

So he buys low-sugar tomato sauce, eats lots of vegetables and swallows his olive oil, every day, like the medicine that it is.

"If every patient took on board medical advice to the degree Mr. Eskridge does, there'd be a lot less work in medicine," Charlton said.

Nobody knows yet if the damage done to Eskridge's liver can be reversed, but there are some promising signs: Blood tests indicate that fewer of his liver cells are dying.

"In the back of your mind, you can look at that beautiful prime rib and say, 'That sucker will hurt me,'" Eskridge said. "You've got to develop a little scale in your mind that lets you feel OK about not having that pleasure."

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