His Best Friend, AL-

A week ago, I was in a scientific symposium on the Management of ASH, NASH and NAFLD. The speaker happened to be one of the senior residents when I was a medical clerk in UST.

What is the difference in terms of management between alcoholic steatohepatitis (ASH), non-alcoholic steatohepatitis (NASH) and non-alcoholic fatty liver disease (NAFLD)?

I see a lot of patients now with high levels of SGOT and SGPT, reflective of liver dysfunction. Some have cholesterol levels which are high. Others are currently taking or have had lipid lowering drugs in their medical history. With such levels, when is it necessary to give a drug to enhance liver function?

First, it has to be established that the liver problem is alcohol induced. How do we know that? If the SGOT:SGPT ratio is greater than 2 and the SGOT is greater than SGPT, the liver problem is probably alcohol induced. Why the fuss over alcohol?

I have a friend who seem to enjoy the company of AL (alcohol) in times of stress. He attributes his intellectual alertness and mental speed to his best friend Al. Not only him, I see a lot of male patients who ask me if it's possible for them to continue drinking alcohol despite their liver dysfunction for several reasons: they need it when closing deals, when socializing with friends and when they show- off with women. Is there such a thing as acceptable amount of intake?

What is the acceptable daily alcohol intake? Or is there really such an acceptable limit? I always tell my patients who are diabetic and hypertensive to avoid alcohol as much as possible. However, I know this is quite difficult for those who really drink a lot. But let's look at the liver.

The liver is particularly susceptible to alcohol-related injury because it is the primary site of alcohol metabolism. As alcohol is broken down in the liver, a number of potentially dangerous by-products are generated, such as acetaldehyde and highly reactive molecules called free radicals. Perhaps more so than alcohol itself, these products contribute to alcohol-induced liver damage.

The maximum safe level of alcohol intake per day is 20g. Liver damage, according to studies begin at 30g of alcohol intake per day. However, some books say, because of physiologic make-up, men can take as much as 60g/day, not without risks of course. To compute: a bottle of beer contains 10g of alcohol, 1L wine has 80g and a 30ml whiskey has 10g.

Surprisingly, ASH is more common in Asian countries rather than those countries where alcohol serves as a regular meal beverage. The main reason perhaps is exposure to poverty and lack of employment. In the Philippines, the unemployed father who belongs below poverty line is pictured as an alcoholic whose water is precisely, alcohol.

It really depends on how we control ourselves. Discipline is the key to a healthy life. Yes, it's alright to take alcohol within safe levels but we should also see if our bodies are competent. There is also a need to remember that free radicals may accumulate in the body. Its presence increase the risk of developing cancer or simply speed up the aging process. So, one may choose to make Al his best friend for as long as he doesn't abuse his cells' function.

For ASH, medication is warranted however for both NASH and NAFLD, careful observation is the only advice plus proper nutrition... and of course, infrequent meetings with Al.