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Couch potato alert too much television and too little exercise can be bad for your liver.
In fact scientists now know long periods of inactivity, as well as too many beers in front of the box, are a significant risk factor for cirrhosis.
The reason is that lack of exercise, as well as overweight, contributes to fatty deposits in the liver, one of the most common causes of liver disease.
"Lifestyle factors are extremely important in the prevention and treatment of cirrhosis," says Professor Geoff Farrell, Director of the Storr Liver Unit at Westmead Millennium Institute in NSW.
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"Too much sitting in front of the tv or computer won't do your liver any favours because it needs exercise to help insulin work better as well as to mobilise hormones that break down fat in the tissues rather than leaving it all the load.
"At the same time, two thirds of people who are significantly overweight (a BMI of 0+) have abnormal liver function tests.
"That's a red flag saying you could have a serious medical problem involving liver inflammation, damaged cells and fatty deposits, or get diabetes or have a heart attack."
Yet getting as little as 0 minutes exercise a day can dramatically change that bleak picture, says Farrell.
"Go for a walk, or a swim, and get your pulse rate up.
"Unfortunately gardening or housework won't reverse insulin resistance. But a bit of sweat, even climbing a couple of flights of stairs, will really benefit your liver."
Of course, being a couch potato isn't the only liver danger.
Excess alcohol (more than two standard drinks a day for women and three for men) is the best publicised villain but the link between diabetes and liver disease has been widely underplayed.
Currently the seventh major cause of death in Australia, non-insulin dependent diabetes mellitus is expected to affect 1.6 million people in the next 10 years.
It's an insidious disease that can result in longterm complications such as blindness, kidney failure, amputation and impotence, as well heart attack and stroke.
But it's not well known that people with a family history of diabetes may develop liver disease before they develop diabetes, says Farrell.
"The same genes that lead to diabetes when people gain too much weight can also lead to liver disease.
"At the other end of the equation, diabetes can cause cirrhosis because of fatty deposition and scarring related to secondary hormonal changes."
In Australia, notified cases of hepatitis C another major focus of liver research - now amount to more than 160,000 with the cost of this epidemic estimated to be $107.5 million up to 17, rising by around $1000 for each new infection.
Farrell says these viruses dispose the liver to disease because they live and divide in liver cells where they are attacked by immune cells trying to rid the body of viral infection.
"This immune attack is the inflammation we call hepatitis and it leads to scarring of the liver, made worse if the person drinks too much alcohol or is overweight."
In 00, however, the future for hepatitis sufferers has never looked brighter.
Drug treatments that, in most people, can control viruses such as hepatitis B and C and, in 50 per cent of cases, cure them, have become more widely available.
"The drawback is they are expensive and there are a lot of side effects.
"But treatments are improving about every two years."
Whatever shape your liver is in now, Farrell says the good news is "Fatty deposits can go and liver tests can improve with lifestyle changes. A lot of liver damage that we thought was permanent can heal. And, in the case of hepatitis B and C, if we get rid of the virus, the liver can go back to normal."
Exercise daily, stick to healthy fats such as olive oil and fish rather than too much meat, learn to deal with stress (it affects blood sugar levels), and take a hard look at your general lifestyle.
"Combining things like heavy drinking, a family history of diabetes, a hepatitis C infection, or obesity, doubles your risk of cirrhosis.
"Anyone who has a risk factor for liver disease should reduce alcohol usage by half the recommended maximum."
You may also want to explore alternative therapies.
Naturopathy looks at foods, vitamins and even tissue salts that can assist liver function (see case history) while Chinese medicine uses both herbs and acupuncture to help restore liver health.
"Chinese medicine doesn't see the liver as a detoxifier, which is quite different from the Western idea of it," says Shona Barker, of Sydney's Wholistic Medical Centre in Surry Hills.
"The liver stores blood, is responsible for the smooth flow of chi, controls the sinews and houses the ethereal soul.
"It is also seen as the seat of emotions, so healthy emotions equal a healthy liver."
A word of caution before you embark on your healthy liver programme take it slowly, especially if that involves getting out from in front of the box.
"One of the worst things you can do for your liver is lose too much weight too quickly because that mobilises the fat in the bloodstream the liver has to deal with."
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SURVIVING LIVER DISEASE
Fourteen years ago, Jeff, a 5-year-old security guard, was shocked to discover he had hepatitis C. Today, after changing his lifestyle and taking part in three drug trials, he's free of the disease.
"I'd have never known I had hep C except for a routine blood test after I complained to my GP of chest pains," he says.
"I felt quite well - I was even playing competitive squash."
Symptoms of liver dysfunction usually include tiredness, aching muscles, loss of appetite, nausea, jaundice, diarrhoea, dark-coloured urine, abdominal pain, light-coloured stools, irritability, itching and flu-like symptoms.
Yet a liver biopsy showed Hep C had been present for 10 years and scans revealed Jeff's liver was inflamed.
"They were never sure how I'd got it (hep C is only transmitted by blood) but it may have been during a short stay in hospital. Whatever, the consensus was it would take 0 years off my life.
"I was told to lay off alcohol, reduce fat in my diet and deal with stress."
All are critical to restoring healthy liver function, says naturopath Deborah Cooper, author of Womens Health in Womens Hands ($7.45, Random House.)
In treating patients with hepatitis as well as lupus and liver cancer, she also recommends reducing salicylate foods (oranges, tomatoes, capsicum, eggplant) and amine foods (anything pickled, smoked, fermented, aged, or fortified including smoked salmon, soy sauce, anchovies and even vintage wine); taking St Marys Thistle to regulate liver enzymes; reducing exposure to chemicals such as tobacco, marijuana, pesticides, petrol fumes and even household sprays; and stress reduction.
"Anger aggravates the liver," says Cooper, who adds that most people can assist their liver by taking simple measures to reduce toxicity in their food, environment and emotions.
Adding natural natural liver tonics such as dandelion root tea, spirulina, green tea and goldenseal and
foods such as radish, pineapple, lemon, grapefruit, grapes, cucumber, beetroot, bitter salad greens and garlic may also be helpful.
For Jeff, an improved diet and lifestyle was his only recovery tool until 10, when the liver drug Interferon became available.
"I was given a six-month course to inject myself with three times a week.
"While I was taking it my liver function tests were normal then, when I stopped, the readings shot up again."
In 11, doctors tried again, this time with a two year treatment, without success.
In June 1, Jeff took part in a nine-month trial in which Interferon was combined with a new drug, Ribavirin.
"Bingo! My blood tests stayed normal.
"Once a year I have CT scans and ultrasounds but my lifestyle is better than before.
"Sure, I don't overdo it and I stick to a healthy low fat, low alcohol programme. But I'm one of the lucky ones."
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THE FUTURE
Scientists at Westmead Millennium Institute in NSW have had a longterm interest in how hepatitis C affects the liver, with 10 per cent of worldwide drug trials for treatment coming out of Australia.
"We have been able to determine how long treatment for this virus should be, a world first for our scientists," says Farrell.
WMI is also a world leader in understanding how enzymes in the liver break down drugs, from panadol to heroin.
"They are oxidised by an enzyme called cytochrome P450 but this reaction can vary 0 to 0 fold in individuals.
"When levels of this enzyme are very high, for example because someone is taking a prescription drug, and then they take a painkiller, they may get liver damage.
"Similarly, if someone drinks to excess and combines this with the use of painkillers, the combination may seriously affect the liver."
In this line, WMI is trying to gain a better understanding of how antibiotics affect the liver and identify the risk of complications such as severe drug reactions and liver damage.
"This is a rare but serious complication and we're trying to find out what makes some people susceptible."
Additional research centres on the biochemical process by which scarring is deposited in the liver, leading to cirrhosis.
"Cirrhosis causes liver cells to divide too rapidly and this may lead to liver cancer.
"Our research has identified the controlling signals inside cells which makes them divide or die. "Working out how to turn on or off key signals will prevent or cure liver cancer."
ends
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