FATTY LIVER disease is a condition that used to occur almost exclusively in people who drink excessively. Not anymore. The epidemics of obesity and diabetes are to blame. Fatty liver affects between 70 per cent and 90 per cent of people with those conditions, so as obesity and diabetes have become more common, so has fatty liver disease. Fatty liver disease isn't confined to any one group, and there don't seem to be pronounced gender differences. It's primarily a condition of middle age, although children may get it too. Fatty liver disease is rapidly becoming more common in Asia, and some research suggests that men in India may be especially susceptible. Plumped-up Liver Cells The prevailing theory is that the condition gets started because of insulin resistance, which is, in turn, frequently a consequence of obesity and excess fat tissue in the abdomen. When people are insulin resistant, their muscle, fat, and liver cells don't respond normally to insulin, so levels of the hormone—and the blood sugar it ushers into cells—build up in the blood. As a result, the risk of developing diabetes and heart disease increases. But insulin resistance is a complicated metabolic state that also includes an increase in the amount of free fatty acids circulating in the blood. Fatty liver disease occurs when some of those fat molecules accumulate inside liver cells. The presence of those fattened cells can then lead to inflammation in the liver and damage to the surrounding liver tissue. Once that happens, if excess alcOhol is not involved, the condition is called nonalcoholic steatohepatitis (steato for fat and hepatitis because the liver is inflamed). Fortunately, that unwieldy name boils down to a handier acronym, NASH. Estimates vary quite a bit, but it seems that five per cent to 10 per cent of people with fatty liver disease go on to develop NASH. NASH is often a relatively stable, low-grade condition that people live with for years, with few if any symptoms. But it can also start a cascade of serious damage to the liver and attempts by the organ to regenerate itself that culminate in an abundance of scar tissue and impaired liver .

MEN IN INDIA SUSCEPTIBLE TO FATTY LIVER

Function—a condition called cirrhosis. Cirrhosis is i and can lead to total failure of the liver. It also is with an increased risk for developing liver cancer. Some studies have shown as few as three per cerr with NASH developing cirrhosis, while others have many as 26 per cent doing so. There's no test or risk predicts who will develop cirrhosis and who won'i one study did find that people who are older or liver biopsies showed more inflammation were at g It's clear, though, that the prognosis for NASH is far it is for steatohepatitis which is the result of hea consumption. Perhaps, as many as half of all I alcoholic steatohepatitis (which lacks a handy acror to develop cirrhosis. It's just a theory at this point, but people with disease and NASH may need to be more worried disease and stroke than about serious liver prc article published in The New England Journal oi in late 2009 argued that the inflammatory and ot pumped out by a fat-afflicted liver promote the atilt process that damages the insides of arteries and m more likely to clot, a combination that can lead to I or stroke. The evidence the authors cited is in circumstantial. They pointed to a study showing t with NASH is twice as likely to die from heart mac as people without it. And NASH seems to add to th come with excess weight. Overweight men with I higher levels of C-reactive protein, an inflamtriatory fibrinogen, a clotting factor, than overweight m, NASH. Moreover, the levels of those and other fac as NASH gets more severe. Diagnosis Requires a Biopsy Most people with fatty liver disease don't have sym that's true even if it has developed into NASH. Only c do people feel run-down, or they have an achy fe upper right side of the abdomen, where the liver So, more often than not, fatty liver diseke and discovered incidentally, starting with higher than nk of liver enzymes on a routine blood test. Ultrasout the same technology used to get pictures of develoc can be informative: the liver looks bright because th up as white on the image. But neither an ultrasour or MM scan is completely reliable for making a dia fat in the liver is visible, but not the NASH-related ml Some researchers have developed formulas that,

The fatty liver: How it starts and what it can lead to: Abdominal obesity and metabolic syndrome cause insulin resistance Insulin resistance increases fatty acid levels in the blood Fat accumulates in liver cells • Usually there are no symptoms
• Weight loss can make the liver less fatty
• Excessive alcohol also make the liver fatty Fat in liver cells causes inflammation and damage to liver tissue• The medical term is steatohepatitis (steato-for fat and-hepatitis for liver inflammation)
• Steatohepatitis that's not related to alcohol is called nonalcoholic steatohepatitis, or NASH A liver biopsy is the only way to definitely diagnose NASH blood test and measurements of various hormones, inflammatory factors, and liver enzymes to arrive at a diagnosis, but this work is at a preliminary stage. Currently, a liver biopsy is the only way to make a definitive diagnosis of fatty liver or NASH. Liver biopsies involve insetting a long needle into the right side of the abdomen and eKtracting a small piece of liver tissue that can be examined '.cr a microscope. Liver biopsies are an invasive procedure, 'iey aren't entirely free of risk and complications, but
• le also fairly routine these days and can be done on an outpatient basis. Whether a doctor will order a biopsy to nail down a diagnosis depends on many factors, including whether the person is obese or has diabetes or shows other signs of liver trouble. Weight Loss is the Treatment hercs been a fair amount of research into using diabetes lings to treat NASH, even in people who don't have diabetes. vitamin E is a possibility: a trial showed some improvement in the livers of people who took large doses (800 IU daily) of the vitamin. fht, many doctors are wary about prescribing large doses of vitamin E because they've been associated with a increased risk of bleeding. Besides, die improvements in the liver were limited. Fish oil has produced some favourable results, and clinical trials

• Weight loss is the main treatment. Vitamin E has shown some promise Further liver damage results in liver fibrosis and cirrhosis Fibrosis is a buildup of fibrous tissue; cirrhosis is a buildup of scar tissue Between three per cent and 26 per cent of NASH patients develop cirrhosis A small number of people with cirrhosis develop liver cancer NASH has been linked to an increased risk of heart attack and stroke A liver affected by NASH may produce inflammatory factors that promote the atherosclerotic process that narrows blood vessels NASH may be just another aspect of metabolic syndrome The cause of NASH, not NASH itself, may increase heart attack and stroke risk

are under way, but it can't be endorsed yet. These setbacks and uncertainties have left weight loss (ideally from changes in diet and an increase in physical activity) as the only recommended treatment for most cases of fatty liver disease and NASH. Crash dieting is a bad idea, though, because rapid weight loss can wind up damaging the liver, In addition to encouraging people to lose weight, doctors will often advise people with diabetes who have fatty liver disease or NASH to be vigilant about controlling their blood sugar. The Bottom Line Many parts of the body come to grief once people become obese or develop diabetes. It's not surprising that our livers do too, given how central they are to a whole suite of metabolic processes. There's some evidence that a fatty liver may add to the already high risk of heart disease among people who are obese or have diabetes. Fatty livers can also develop into cirrhotic ones if the inflammatory processes take off. But, there are two bright spots in the take-home message about fatty livers, First, most cases stay relatively stable and don't result in serious liver disease. Second, the treatment is not an expensive drug with side effects, but losing weight—and that will benefit many other parts of the body besides the liver.

UNLEASH A NEW FITNESS ROUTINE
IF YOU need to lose weight and get more exercise, look no further than man's best friend. According to Marty Becker, DVM, and Robert Kushner, MD, authors of Fitness Unleashed: A Dog Owner's Guide to Losing Weight and Gaining Health Together, taking daily walks with your dog can be an excellent way to manage your weight and reach government-recommended goals for physical activity. A study conducted at the Northwestern University found that people who went on a diet and fitness plan with their clog lost weight and kept it off better than people who dieted and exercised on their own. Most recently, Mars Petcare, which makes dog food and sponsors research on human-pet interactions, surveyed 1,000 dog owners and found that 39 per cent felt that making sure their pooch gets walked helps them be more active. Over half of pet owners also say their pets are good company while exercising, and they'd prefer to walk with them than walk alone. Another Mars Petcare study found that people who got a new dog walked 30 minutes more a week than they did before they had a dog. To encourage people to exercise with their pets, Mars Petcare has been teaming up with the YMCAs in Washington

DC, New York, Nashville, Chicago, and Portland, (introduce The Power of" Pets programme. Physical and Mental Benefits Having a dog c many health benefits: People with pets have loy,, pressure and cholesterol levels, suffer from chronic frequently, and visit the doctor less often. Pet ownei has mental perks: Getting outdoors for regular canit puts you in touch with nature, exposes you to mood. sunlight and fresh air, and allows for social discoui are irresistible to many people and provide conversation starter). What's more, research shows that older people when pet stay healthier than non-pet owners, probably they're more physically active, and because the comp pet staves off feelings of loneliness and isolation. L kids with pets tend to be more active too. On the other side of the leash, regular walks make y very, very happy (witness the tail wagging when you the word 'walk). "The fringe benefit of a workout prcl that includes your dog is a big one: as any experiencec can tell you, a well-exercised, tired dog is a well-h dog," according to Drs Kushner and Becker. Barking, cl digging and other problems often go by the wayside dog is being walked frequently and well. The regular activity also helps your canine companic his bones and joints strong and control his weight, when add years to a dog's life. Approximately, 40 per American clogs are overweight, putting them at risk ft problems, diabetes, arthritis, breathing issues, and a just like overweight humans. The authors advice was daily minimum of two blocks for every 10 lbs of you body weight. Your dog will also love it if you establis walking time—and may even bring you the leash to you it's time to go out! In turn, that can help you stick I exercise plan.

Recommended Activity Levels for Humar, For kids: 60 minutes of physical activity a day, inch aerobic activity and muscle-strengthening exercise su, gymnastics or calisthenics For adults: 150 minutes of moderate-intensity ae activity per week plus strength training twice a week Recommended Activity Level for Dogs A daily walk of at least two blocks for every 10 lbs dog's body weight.

FREE RADICALS VS ANTIOXIDANTS

IF YOU'RE at all interested in nutrition, then you're familiar with the terms antioxidant and free radical. Have we got it all wrong about free radicals and antioxidants? Are free radicals actually good for us? Can you get too many antioxidants? Do Free Radicals Cause Aging? Free radicals, of course, are molecules with an unpaired citron, which makes them electrically unstable. In an effort to , abilise themselves, they recruit electrons from other molecules, which often creates more free 'Icals. If it gets out of hand, this .tron-robbing free-for-all can N.. a lot of damage, disrupting function and DNA. Tay back in the middle of the last century, a scientist named Denny Hannon first introduced the notion that free radicals were a primary cause of aging and disease—and that quelling these free radicals with antioxidants could help us live longer and keep us from getting sick. cr since, it's as if we've been in some sort of race in which whoever consumes the most antioxidants wins—which explains why antioxidant supplements are a multi-billion dollar industry. Weirdly, however, it has turned out that taking all these supplements doesn't actually make anyone any healthier. In a he studies, people taking antioxidant supplements were actually worse off than those who didn't. Should You Take Antioxidants? It appears that taking high dose antioxidants may reduce the Inefit you get from exercise. In the past couple of years, we've been learning that free radicals may actually have some benefits—and that overloading ourselves with antioxidants may be getting in the way of the body's normal healthy way of functioning. For example, we know that vigorous exercise creates a lot of free radicals in the body. And because we've been taught that free radicals are harmful, many people reasoned that athletes should take high-dose antioxidants to counter-act the damaging effects of 11 those free radicals. But, it turns out that this may do more damage than good. Call You Get Too Many Antioxidants? Ibis see, it turns out that the production of free radicals in the body triggers the body's own antioxidant defenses—and also helps the body adapt to the stress of exercise. That ability to adapt in turn enhances the effects and benefits of exercise. Flooding the body with antioxidants, on the other hand, prevents that adaptation from occurring. It appears that taking high dose antioxidants may reduce the benefit you get from exercise.

Other studies in nematodes, which are a type of worm, show that big doses of antioxidants actually shorten their lifespan. Are Free Radicals Good for Us? At the very least, it appears that in viewing free radicals as the enemy of health, we greatly over simplified the situation. And then, as we so often do, we over-reacted by taking huge amounts of antioxidants. It seems as if we have to learn this lesson again and again: Just because something is good doesn't mean that more is necessarily better. We need to aim for a healthy balance. Apparently, free radicals serve a helpful function in the body. So it's not surprising that wholesome activities like exercising (and breathing) create them. On the other hand, too many free radicals can he damaging, which is why it's a good idea to avoid second hand smoke, deep-fried foods, sunburns, and other things that create excessive exposure to free radicals. Likewise, antioxidants serve a valuable function, so it's not surprising that diets featuring antioxidant-rich foods like fruits, vegetables, nuts, and legumes are linked with good health and reduced disease. On the other hand, overwhelming the body with artificially concentrated doses of antioxidants appears to be of little benefit and may even be harmful.

Spend your money on nutritious whole foods instead of supplements, stay active, avoid excessive stress, and keep your sense of humour.

CUTTING EDGE SURGERY WITH iPOD

FOR THE first time in Asia, an Indian surgeon used an iPod to perform a joint replacement surgery, thanks to DASH, a new technology that aids the surgeon perform the procedure with greater accuracy and precision. World renowned orthopaedic surgeon Dr Arun Mullaji who is a specialist and world-renowned pioneer in computer-aided knee replacement surgery and has performed nearly 3,000 computer-assisted knee replacement operations, performed a knee replacement surgery at Breach Candy hospital in Mumbai recently using a brand new iPod Touch. Unlike the rest of the world that uses the portable media .

Player to rock to its favourite tunes, Dr Mullaji uses the iPod Touch to assist with the surgery while the patient was under the knife. This is the first time in Asia that a surgeon performed a commercial non-experimental orthopaedic surgery with the aid of an iPod. Gulab Sanghvi, aged 75 years, opted for this revolutionary and pioneering technique for her knee replacement surgery. The surgery was completed successfully and the patient was able to walk the same day. A piece of clever engineering and innovative technology from the orthopaedic implant company Smith & Nephew Inc, known as DASH Smart Instrument system, which is compatible With the iPod, enables the iPod to connect wirele fi) to a camera that emits an infrared beam. The iF is attached to miniature instruments. The surgeon positins these instruments by reading the data on the ipod’s high resolution screen to accurately cut the bone to ph joint. The surgeon can thus determine the exact al the leg and the new joint on the screen of the iPc the iPod literally gives the surgeon accuracy at DASH is a sophisticated, portable surgical navigation system designed to assist orthopaedic surgeons in making one of the most technically difficult operations(joint replacement) simple.

Studies have also shown that when computer technology is used for replacement, the patient experiences less pain,loses less blood, and has a low risk of needig a blood transfusion. Which is why computer navigated systems are very popular in operating theatres. But DASH is a unique evolution in the field of orthopaedic knee replacement. While these old systems can be as large as a washing cumbersome to use since the ipod is a handheld device, it reduces the length of the operation and is more affordable.

"Accuracy in positioning the new joint is what decides how well the patient walks, how much the knee bends,and even how long it lasts," said Dr Mullaji, explaininig the DASH-enabled iPod not only makes the surgeons job easy, but also ensures that the surgery is a success for the patient.

"The iPod, a compact and portable device, is slated to transform the way surgery is performed, and will even replace the latest computer navigation imaging systems that are a rage in operation theatres across hospitals currently,”predicts Dr Mullaji.