The deadly non-alcoholic fatty liver disease afflicts one out of three Indians. Top liver specialist, Dr. S.K. Sarin on how to protect yourself.
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00:00New research reveals an alarming finding in India.
00:04Liver disorders are reaching epidemic proportions in the country
00:08with close to 40% of adult Indians suffering from various stages of liver disease.
00:14Forty percent.
00:16And worse, 35% of our children or one out of three children in India
00:22are afflicted with some form of liver disease.
00:25Two ways, one is the journey of extra fat, surplus fat in the liver.
00:31And one is the liver which has, the fat which has spilled out.
00:35So let's divide the extra surplus fat in the liver.
00:39Now if there is extra fat more than 10% and the cells are ballooned,
00:45the body's immune cells, the white cells say this cell is not good, let us kill it.
00:51They will kill that cell.
00:52And that is a hepatitis, cell death of liver.
00:57And that is the first stage of hepatitis due to fat.
01:02We call it non-alcoholic steato means fat hepatitis.
01:08Fat induced hepatitis.
01:10More often the acidity is related to your, you know, impaired metabolic functions.
01:18So remember people who are overweight, obese or those who eat late, they have acidity, all of them.
01:24So I'll tell you 10 simple people who can self-test and diagnose without coming.
01:31And symptoms will come to later.
01:32So anybody who is overweight or obese means the waist is above 80 centimeter
01:39of a female and male above 90 centimeter or the BMI is above 23 has fertility.
01:47All diabetics should get checked up for fatty liver.
01:50Maybe majority of them will have fatty liver.
01:52Those who have high cholesterol, triglycerides, fats should check for.
01:57Now the symptoms.
02:00People, those who have extra fat in the liver generally have extra fat in their muscles.
02:06They have extra fat in their other organs and they get exhausted.
02:10I by three o'clock, I feel very tired.
02:13I don't have any energy.
02:16Get your metabolism.
02:17Get your liver checked.
02:19It should be 170 minus 170 kg.
02:23If the parents have got diabetes, blood pressure, obesity, then 170 minus 105.
02:31So the weight is 65.
02:33If you're over that, you probably may have fatty liver.
02:39Nothing but the truth.
02:40Hello, I'm Raj Chengup of India Today and your host for nothing but the truth.
02:46This is my weekly x-ray of key issues that concern you without holding back on the truth.
02:57We all tend to take our livers for granted.
03:01Yes, our livers.
03:03But you may end up paying dearly for that neglect.
03:07That's because the human liver is the largest internal organ in our bodies.
03:12Not just that, it is our largest immune gland.
03:17It weighs about one and a half kgs for adults and is slightly bigger than the palm of your hand.
03:23But it is the silent powerhouse of our body,
03:26responsible for over 500 vital functions spanning digestion,
03:31detoxification, nutrient storage, and even excretion of toxic waste.
03:36It works silently in the back office,
03:38multitasking and not letting us know how much work it really does.
03:44But new research reveals an alarming finding in India.
03:48Liver disorders are reaching epidemic proportions in the country,
03:52with close to 40% of adult Indians suffering from various stages of liver disease.
03:59Forty percent.
04:00And worse, 35% of our children or one out of three children in India
04:06are afflicted with some form of liver disease.
04:09One out of three Indian children are afflicted with some form of liver disease.
04:13Now, excess alcoholic consumption was earlier considered
04:17one of the main causes of liver disease.
04:20Not anymore.
04:22Now an affliction called as the non-alcoholic fatty liver is the main cause of the disease.
04:28Non-alcoholic fatty liver.
04:31That's the key.
04:32The surprising findings are that even if you don't consume alcohol
04:36or be overweight and obese, you can still fall prey to liver disease.
04:41And if you do not treat liver diseases early,
04:44it leads to a cascading range of serious ailments.
04:47In fact, it is now one of the leading causes of death in India,
04:51with an average 3 lakh Indians or 300,000 Indians dying every year of liver disease.
04:58This, by the way, is almost double the figure,
05:01mortality figure then of liver diseases that is reported in China.
05:06India now, in fact, has the dubious distinction of being
05:09the global epicenter of liver disease.
05:13So serious is the issue that India today has featured the threat
05:16in its latest cover story.
05:18So in this episode, we would like to look at the new danger of liver diseases,
05:24which, as I said earlier, has reached epidemic proportions in India.
05:27What are the causes?
05:29What are the symptoms?
05:30How can it be treated?
05:31And what you can do to ensure that you have a healthy liver?
05:36To help us understand the seriousness of the issue and what needs to be done,
05:40I'm delighted to welcome at this stage Dr. Shivkumar Sarin,
05:43a leading Indian physician and hepatologist who was responsible for setting up
05:48the premier institute of liver and biliary sciences in Delhi.
05:52Dr. Sarin is considered a world authority on the subject of liver disease,
05:55and we are fortunate to have him with us.
05:58So, Dr. Sarin, welcome to Nothing But The Truth.
06:03Thank you for inviting me.
06:06Thank you, Dr. Sarin, and thank you for being present here.
06:09Let's begin with talking about what we know about the liver
06:13and the vital role it plays in our bodily function.
06:16Why is it such a key organ for the body?
06:20Well, first, thanks to you for raising the issue and raising the bar
06:24for public awareness and also bringing it out
06:27in your most famous and most read India Today Weekly.
06:33And you have always brought up issues which are of national importance
06:38and of relevance to each and every person.
06:41Before I go to the fatty liver, I will recall several years ago,
06:45I wrote a piece in India Today on hepatitis B.
06:49And based on that and several others, the national programs came
06:53and everybody became aware that hepatitis B is a cause
06:57and mother to baby transmission, and many people joined hands.
07:01Hepatitis B now is a small part because it is a virus which affects the liver.
07:06But what affects and what you have raised the issue is,
07:09many percent of Indians and maybe even more have extra fat in the liver
07:15and the kids are going to have it.
07:17And this surplus fat is not good.
07:21Actually, anything surplus other than energy and muscles are, you know, not good.
07:27If you are strong, if you are surplus energy or surplus, maybe youth, it's okay.
07:34Fatty liver is a concern because of three reasons.
07:39Let me make it very clear.
07:41Those who have fatty liver, those who are predisposed to fatty liver,
07:46and how do you prevent fatty liver?
07:49Let me first handle all those who have fatty liver and they want to know why I got it.
07:55The fatty liver means if your liver has more than 5% fat,
08:01a 1500 gram liver, if more than 75 grams is fat, it's not healthy.
08:06And 10% and above certainly is a fatty liver.
08:10It's a liver which is less functional.
08:12It is occupied by fat rather than enzymes and other things.
08:17So it's not a good liver.
08:19Then those who have already got fatty liver, what are their risks?
08:25These people...
08:26Right, can I, but before we get to the risk stage, Dr. Sareed,
08:30just describe the function of the liver.
08:32We don't, we know very little about it.
08:33We just take it for granted it exists.
08:36But can you just describe, you've handled surgeries,
08:38what does the liver really do and how does it look like?
08:41Well, liver as you probably have also, I saw the beautiful India Today story.
08:49Liver does all the functions which are required to give you the food absorbed.
08:55You eat and you forget about it.
08:57Then you get up again, you eat.
08:58But from the intestine through the bacterial processing, all that food goes to,
09:05which is the first good stop to process the food into energy.
09:10Conversion of food to energy and distributing it to different body organs,
09:17brain, heart, kidney, lungs is the function of liver.
09:21But two important things people forget.
09:24One, by liver, all the extra energy goes into liver and gets converted into fat.
09:31So your fat storage is the liver.
09:34Your sugar control is the liver.
09:38And obviously detoxifies, it causes all your immunity,
09:42your color of your face is all liver.
09:45Really?
09:46Okay.
09:47And the size I would gather, Dr. Sareen, is that it's almost a little bigger than a fist.
09:52Quite a fat organ if you look at it in terms of width and depth.
09:56And it has two lobes, right?
09:58There's a large lobe and a small lobe.
10:00It's a kind of a wedge-shaped, you know, like the prehistoric stones that you have,
10:05but a much larger size that is there.
10:08So how to describe it?
10:10I mean, what is inside a liver that we never see it when, at all.
10:15Well, you're working like and talking like a doctor somewhat.
10:18Yes, liver is an organ which is beautifully made and carved.
10:24It has two lobes.
10:25The right lobe, the bigger one on your right side is the bigger lobe.
10:30It is about 60-65% of the liver weight and the left lobe.
10:35And the two lobes are joined and it carries all your bile, pit, which is called agni.
10:41All that bile is taken from the liver into the intestine and the bile is the thing which
10:48actually digests all your food and fat and then gets it absorbed.
10:52And the liver also has cells, billions and trillions of cells.
10:57And these cells regenerate by themselves.
11:00So liver is an organ which does all the functions.
11:04It is of the size about 1500 grams, one and a half kilogram.
11:09And it regenerates itself.
11:11It has the potential.
11:12It never ages.
11:13It never stops.
11:15That's remarkable.
11:17It doesn't, it gets damaged.
11:18It's able to regenerate and rebuild itself to its original size.
11:22Yes.
11:22Right.
11:23That's why I wanted to come to that.
11:26When you talk of fatty deposits on the liver, I gather these cells are hexagonal in shape,
11:31these liver cells that are there.
11:33Now, what happens to these if these fat accumulates on it?
11:38What does it do to your liver?
11:40You said when you eat excessively or there is high glucose content or whatever it is
11:44and you're not burning it, these fats tend to deposit in your liver, not necessarily
11:49around your waist, but also in your liver.
11:52You're very right.
11:54And you're using the right term.
11:55Hexagonal is the six angles.
11:58The liver cell is a hexagonal shape, which has six angles.
12:02But consider as if you are sitting in a room and this room has air and you can breathe
12:09air.
12:10But if you pack a lot of cotton into it, you can't breathe.
12:13You will go into a corner.
12:15Maybe you'll go to the next room.
12:17If you fill the next room also with cotton, you'll go to the corridor.
12:20And if you fill that, you'll go to the road.
12:23Similarly, the liver cell has all its, you know, energy factory, mitochondria and other
12:29organelles.
12:30But if you fill it with fat, the mitochondria goes to a side, the nucleus goes to a side,
12:36the cell is not functioning well.
12:39And that is an unhealthy liver cell in which insulin will not be able to enter to do its
12:45function, to make energy and therefore fat will deposit.
12:49So a cell of liver with fat is dysfunctional.
12:54It's like a cotton-packed room where nucleus, your energy source, functioning goes away.
13:01And if this fat is extra, it will spill out into your bile, into your blood and you have
13:08a circuit fire alarm in your blood.
13:10Extra cholesterol, extra triglyceride, and this will deposit into areas and will come
13:17to the risk again.
13:18But remember, the most worrisome part of the liver fat is the insulin resistance.
13:26More and more insulin is produced to get into the liver cell, which has fat and that causes
13:32pancreas to get exhausted.
13:34And over time, it gives up to give you diabetes.
13:37So diabetes in adults is a liver disease.
13:40If you understand that, you will probably protect your liver much more.
13:45Now, you were talking about the fatty liver and the definition, there are various stages
13:50of it.
13:50The first stage, as you said, if 10% of your liver is covered with fatty material, that's
13:56seen as the first stage.
13:57Now, is that stage reversible or does it sort of progress to the next stage and more dangerous
14:03stages that is there?
14:06One of the best, you know, medically planned interview, Raj, I must compliment you.
14:11So there are two ways.
14:14One is the journey of extra fat, surplus fat in the liver.
14:19And one is the fat which has spilled out.
14:23So let's divide the extra surplus fat in the liver.
14:27Now, if there is extra fat, more than 10% and the cells are ballooned, the body's immune
14:34cells, the white cells say, this cell is not good.
14:37Let us kill it.
14:38They will kill that cell.
14:40And that is a hepatitis, cell death of liver.
14:45And that is the first stage of hepatitis due to fat.
14:50We call it non-alcoholic steato means fat hepatitis, fat induced hepatitis.
14:58And it is like burning in the liver.
15:00Liver is getting burned.
15:02And how to heal?
15:03Healing is by scarring.
15:05So this injury is healed by formation of a scar and liver gets slowly scarred.
15:11And then you have stages of fibrosis, fibrosis 1, 2, 3, 4 and stage 4 fibrosis is like cirrhosis
15:20of the liver.
15:21So how the journey starts?
15:23Extra fat, death of cells, containing fat, healing by scarring and the grade of a scar.
15:32And this journey in some people is very rapid.
15:36Maybe in 10 to 15 years, in some it may take longer.
15:39And you ask me whether it is reversible?
15:42Yes, but to a stage.
15:44If you got a deep burn, the scar is always in your whole life.
15:49But superficial burns, grade 1, grade 2 fibrosis, you can certainly reverse.
15:54So therefore, an early alarm and knowledge like what you are asking should make you aware.
16:01Now, I wanted to come to that.
16:03How do I know?
16:04See, the liver functions so well that I don't seem to really think my liver is a problem
16:09till it actually begins to collapse on me.
16:11So what are the first symptoms that you need to take cognizance of?
16:17Do you get indigestion?
16:20Do you get a bloating feeling?
16:21Do you get the most serious jaundice?
16:24Where do you begin to know?
16:25OK, there is some problem.
16:27You might have flatulence.
16:29Where do you begin to know that, look, your liver is not functioning optimally?
16:34One is symptoms and one is awareness.
16:37So, you know, people would have a little bit of acidity and they pop in a pill.
16:43But more often, the acidity is related to your impaired metabolic functions.
16:51So remember, people who are overweight, obese, or those who eat late, they have acidity,
16:57all of them.
16:57So I'll tell you 10 simple people who can self-test and diagnose without coming.
17:04And symptoms will come to later.
17:06So anybody who is overweight or obese means the waist is above 80 centimeters of a female
17:13and male above 90 centimeters or the BMI is above 23 has fatty liver.
17:20All diabetics should get checked up for fatty liver.
17:23Maybe majority of them will have fatty liver.
17:26Those who have high cholesterol, triglycerides, fats should check for fatty liver.
17:31Those whose parents have diabetes, blood pressure, hypertension, cancer, sudden heart disease,
17:38death, coronary or kidney disease, they all should get checked up.
17:41Those who are snoring, you may enjoy that.
17:45Those who snore may also have a fatty liver.
17:48And those who have black lines on their neck or have, you know, warts or moles on the neck,
17:55they all can, should get a screen for fatty liver.
17:59So obese people, certainly.
18:01Now the symptoms.
18:04People, those who have extra fat in the liver generally have extra fat in their muscles.
18:10They have extra fat in their other organs and they get exhausted.
18:14They say, I by three o'clock, I feel very tired.
18:17I don't have any energy.
18:19Well, get your metabolism, get your liver health checkup.
18:24People have gas.
18:25People have acidity.
18:26People have some heaviness on the upper abdomen or some people actually feel very sleepy in the day
18:35rather than in the night.
18:36You feel tired.
18:37All these people, yes, formation of gallbladder stone or people who have got high, you know,
18:43blood pressure, they all must get.
18:46So symptom wise, blood pressure is a symptom of heart having extra fat given by the liver.
18:55So diabetes, the fat is given because of liver.
19:00So liver symptoms are manifested first in the liver itself and then other organs speak for you.
19:08Interesting.
19:09And if you come to, you know, treatment of the first stage of fatty liver, okay,
19:14we get this.
19:15I go there and the doctor says, look, your stage one fatty liver.
19:18What would you advise that person to do?
19:20What are the four or five things?
19:21As you mentioned, you had 10 reasons to go and check up.
19:24What would be the 10 things that you need to do to ensure that you are before you get to the
19:29dangerous stage of liver degeneration?
19:32All the tricks, Raj, all the tricks.
19:36All right.
19:37So you assure me one thing that all the India Today and maybe all your readers,
19:42I hope by this message, everyone who listens is a doctor in oneself.
19:48You can own your body, you can get well, and I'll tell you all the tricks, no secrets,
19:54nothing is kept.
19:56So how do you, first of all, test it?
20:00I told you those who are predisposed to get rid first, get into shape.
20:07The first rule is that get in shape, do not have extra baggage on you.
20:13Like suppose somebody has 170 centimeter height, it would be 170 minus 170 kg.
20:21If the parents have got diabetes, blood pressure, obesity, then 170 minus 105.
20:28So the weight is 65.
20:30If you're over that, you probably may have fatty liver.
20:34For females, 170 minus 105.
20:37If parents have it, then 110.
20:41So if you're over that weight, you have fatty liver.
20:43So first, you can diagnose yourself.
20:45If your blood sugar is high, cholesterol, you have diagnosed.
20:48Now, how do you correct it?
20:51That is something which is tough to consider fatty liver as a fire alarm.
20:57And you have to extinguish it.
20:59So change your mindset.
21:02The first important thing is don't accept it.
21:07My friend also has, my husband.
21:10No, you have to say, I start today.
21:13And that's what message to all the India Today readers and all those who are listening.
21:19So weight, number one.
21:20Number two, you have to burn out extra.
21:23It's like a chartered accountant.
21:25Less income, more expenditure, and you're in a way healthy.
21:30So more expenditure would be by burning calories.
21:35And for that, remember, walking or anything where you have not sweat is not an exercise.
21:42It is good.
21:43It's good for heart.
21:44But after sweating, the exercise, it starts.
21:48I strongly recommend if your healthy heart is okay, then 30 to 45 minutes of sweating a day
21:55is required.
21:56On good old days, people used to do their own work, but now they are very rich.
22:00They have a PA.
22:01They have somebody who carries all your stuff.
22:03You can't even carry your bag.
22:05That's not good.
22:06Carry your bag.
22:08And there's a very famous story of London bus driver.
22:13The London bus driver vis-a-vis London conductors, they used to be double-decker buses in UK in
22:2040s.
22:21This is a story of 40s.
22:23So the conductors did not have more of heart attack, they lived longer because they were
22:30doing 30 times up and down.
22:32The driver was only sitting.
22:34And that is the basis of starting the London bus driver study made people realize the importance
22:42of exercise and walking.
22:43So the first is weight.
22:45Second is your exercise.
22:47And third, very important is what you eat, when you eat and how much you eat.
22:55You want to know about it?
22:56Yes, of course.
22:57I mean, I think all of us are paying with rapt attention because it concerns our life.
23:03My problem is when I tell them, people say, no, no, no, you're too strict.
23:08They want to change my name from Sareen to this.
23:13And anyway, so my message is you must know what kind of food you are eating.
23:20You know, when you go to get the best oil for your car, your best engine, best wiring.
23:26And therefore, you must know what you should eat.
23:30People don't pay attention.
23:31They look at it.
23:32Oh, fast food, very tasty.
23:34Go in.
23:35Well, you can go in a while.
23:38So to eat, remember, if you are above 40, then you should be eat once a day.
23:46You can have small, small salads or you can have low calorie fruits and all that low sugar
23:52fruits to avoid all those things which are having high sugar content.
23:59Oats, for example, you have fructose, which is very common in all the syrup salad.
24:05I'm eating salad, but the salad dressing.
24:08So all those are those things which have a lot of fructose, all those drinks.
24:14The summer is coming and you will see tons of these being sold.
24:18I'm not against them.
24:19I'm not their enemy.
24:20But be aware that all that colas have fructose.
24:26So fructose, you have uric acid will go high, which is liver dependent.
24:32And also you add fat.
24:34So first is all the carbohydrate intake is reduced and fat.
24:38Even the prime minister has said very strongly to reduce 10 percent of oil intake.
24:44Well, oil may be sometimes reused oil.
24:47Butter is good for health.
24:49In my mind, ghee is very good.
24:50But you have to burn and you have to see that the amount you use, you should be able to
24:56burn it.
24:56In one spoon of sugar, you have five grams, which gives you about 20 calories.
25:06One gram of carbohydrate sugar is four calories.
25:09But if you take two spoons of sugar, it is equal to one spoon of ghee.
25:14One gram of ghee is nine calories.
25:17One gram of sugar is four calories.
25:20So two spoons of sugar think as if you have taken a spoon of ghee.
25:25So remember that your calories must, you must know what you are eating.
25:31That's what my message is.
25:32And decrease your carbs.
25:35You can have ghee, but a small amount.
25:38And of course, plenty of uncooked raw food.
25:4240 to 60 percent of your total food should be as natural as human beings were.
25:48Don't make a living as an artificial living.
25:51When to eat is another thing.
25:54Okay, please go ahead.
25:55No, no, no.
25:56Finish when to eat is interesting.
25:58And also remember that as far as food items are concerned, for different age groups, different
26:07age, don't you, don't you, you don't need supplements of foods.
26:11Your natural food selection should be careful.
26:14Pregnant mothers or those who are doing, they should actually have more different calcium
26:19and others.
26:20But I would say don't take pills.
26:22Just have food.
26:23Good choices.
26:24And one thing which people will not like on your birthday, avoid having, you know, cakes
26:3020 gram.
26:31Oh, he's 50 years old.
26:3250 kg cake.
26:33No, no, no.
26:35I would say get 50 kg of things which have less calories.
26:38Change the mindset of giving children and adults all these high calorie content.
26:45Now, what about alcohol one and second beverages like coffee and tea?
26:52Yeah, that's a gorilla in the house.
26:54You already have a problem and then you have a gorilla in the house in the form of alcohol
27:00and beverages.
27:01Well, the, the country and a lot of governments earn a lot of revenue because of alcohol.
27:11So my saying may not be light, but if you as an individual want to be healthy, remember
27:19alcohol is a socially accepted poison and try to avoid it.
27:25It causes injury to the liver and all other organs.
27:28It has no added advantage except you feel, oh, I'm an elite person.
27:33I am moving in the circle where everyone drinks and if I don't drink, I'll be an outcast.
27:39You can have a wine glass or something, a bottle, maybe on your birthday, your wife's
27:45or maybe very close friends, but I would say avoid alcohol in any form, especially alcohol
27:52is not to be used if you are obese or you have diabetes or if you have a family history
28:00because in them, the alcohol causes extra damage.
28:03Nowadays, we have people in their twenties and thirties, girls also coming for liver
28:10transplant.
28:11You really start crying.
28:12The guy has not even married and he's transplanted.
28:17Which is a very good point.
28:18I wanted to check with you.
28:19Of course, finish with this beverages.
28:21Are you okay to have coffee, tea?
28:22Or you're saying that also is?
28:24No, no, no, no, no, no.
28:27Coffee is good for liver.
28:28It actually clears all the fat from the liver.
28:31It prevents liver cancer, liver cirrhosis.
28:34It is scientifically one of the best, but that doesn't mean that you have alcohol and
28:40you have good food and then you have coffee and say, well, I can have coffee and also
28:46coffee can increase blood pressure, but it is a good thing and you can have tea, but
28:52all these should be with low or less sugar.
28:56Right.
28:57You were talking about this young girl that came with the liver replacement.
29:00Now, one of the issues in India is that children seem to be having a high percentage, one out
29:05of three children.
29:05They said 35% of our children have fatty liver problems.
29:09Why is that happening?
29:10Normally, children burn their energies pretty, I mean, all their calories pretty well.
29:15What's the reason in India?
29:18It's a very, very good and important question close to my heart.
29:22So I told you those who have fatty liver.
29:24Now, the second part is those who are not aware that they have fatty liver and these
29:30are kids.
29:32For them and for the rest of the people who do not have children, the message is, suppose
29:39you want to set up a factory, you will have preparation, there will be ground survey,
29:45there will be engineering, structure and everything you prepare and it takes months or years
29:51sometimes, even for a house.
29:54But has anybody thought how we prepare ourselves, me or my partner for having a child?
30:02You never think about it.
30:03You say, oh, we should have a child this year and you plan, but not knowing that the child
30:10is made from you or your spouse.
30:13So the original manufacturer are you and if you are defective, you will have a child who
30:20is unlikely to be healthy.
30:22And this has been proven by a recent study, which was published in one of the most prestigious
30:28journal of American Medical Association, JAMA, 7 million children, 7 million people were
30:35screened.
30:36Those where parents were obese.
30:39The children, 87% of the children were overweight and obese.
30:44The parents are unhealthy.
30:46The child is bound to become obese or bound to have.
30:50So why the obesity is increasing in the young kids is because the elderly, I mean, the parents
30:57were not healthy and they were not aware.
30:59Nobody told them to prepare themselves to have a child, to be healthy for having a child.
31:06And the better part of it is those children who were born to lean and thin parents in
31:14that American study, only 3% had obesity.
31:19See how beautiful message is that if you're healthy, your child is going to be healthy
31:25unless it's spoiled.
31:26But if you're unhealthy, you have made a mistake.
31:29You have prepared a manufacturing defective child.
31:34Well, that's a good point.
31:35And, you know, I think that's very good for young couples to think about so that they
31:39maintain their health before they have the child.
31:41But I just wanted to come to one more aspect before we come to the final part of our show
31:46is that is there like we have in our heart, you know, heart problems, heart disease, we
31:53seem to have what is called, you know, X gene or whatever it is that makes us more susceptible
31:59to heart disease than other people across the world.
32:02Is there an X factor in India that makes us susceptible to liver disease?
32:08In our genes for some reason.
32:10I'll come, but first, the remaining part of your talk, why the Indian children and
32:14obesity is there, because firstly, the kids are not doing as much as effort.
32:20And we did a study in Delhi under a project called Smiles to let you know, between 18
32:26and 25 years of age, only about 32% of the boys and girls were walking for 40 minutes,
32:36not to talk of exercising.
32:38And any of them have high cholesterol and blood pressure in the age of 18 to 25.
32:45So the message is, if this generation is unhealthy, the next generation, their children will be
32:52more unhealthy.
32:53This is a walking gene.
32:55We do not want an India of this kind.
32:57We want an India where youngsters are smarter, healthier than their parents are.
33:03So the movement must start from today.
33:05Those who are listening, please get in shape.
33:08If you're 18 and you want to have a child at 30, you have to have 10 years of pooling
33:14of your genes to become non-transmitting that bad habit to your newborn child.
33:21Coming to genes, partly I told you these are walking genes.
33:27If your parents are obese or have diabetes or have cancers, then the chances are that
33:35you will have some of it.
33:37So in my book, Own Your Body, I have set 10 commandments.
33:41And the first commandment is that you should have a Virasat.
33:48I'll just show you the book if I have.
33:51This is where I want to show you the book, not for any publicity or for anything, but
33:57just to tell you that there are 10 commandments in this book.
34:03And the commandment number one is, please draw your family tree.
34:09Page 290 says, draw your family tree.
34:13We always ask, oh, I got this land from my father and this much from my mother and this
34:18jewelry I got.
34:20But please draw, I got from my father diabetes, my mother had blood pressure and somebody
34:27had cancer.
34:28So I am made up of genes which were given to me by my parents.
34:35My wife has got these genes, they got it from their parents and the baby that is going to
34:41be produced is likely will have all these traits.
34:46So today in the era of personalized medicine, precision medicine, the genes play a huge
34:56role.
34:56For example, some people you must have come across.
34:59Sir, I try very hard, but I can't wait.
35:02These people who need support, they actually are made up of something, the genes where
35:09the fat does not disappear, we have to work hard.
35:12So every fat person is not a bad person.
35:15You look at somebody and say, oh, this guy must be eating every time.
35:21On the other hand, some people who are very lean and thin, but they still have at the
35:25age of 20-25, blood pressure, heart disease and they are unfortunate because they got
35:33the genes from their parents.
35:35So genes have a huge role to play and fatty liver is the beginning of the problems of
35:43a human body.
35:44Nearly all cancers, prostate, breast, colon, esophagus, all of them start with a base of
35:54extra inflammation in the body and the extra inflammation is swelling.
36:00The chronic irritation is obesity, fatty liver.
36:03My friends, I would like to convey that if you want to prevent all these diseases, non
36:09communicable diseases, try and get rid of fatty liver and there is a need for a national
36:15initiative on reduction of fatty liver.
36:20This is a good point that you talked about because in 2020, India declared fatty liver
36:26as a non communicable disease.
36:28Now, what does that mean?
36:29I mean, by declaring it, what does it what does happen?
36:35I'm very happy you raised this point.
36:37India leads the world and we were very happy that the then health minister, Dr.
36:42Harshvardhan, when we presented the accepted 21st of February 2021, India was the first
36:51country in the world to start a screening for fatty liver and it was a bottom of approach.
36:57Means the village workers would just ask those 10 questions.
37:01They will start referring people for the next level and the impact is after four years,
37:07people are aware of it.
37:09The government of India, salutations to them have taken this to a higher level.
37:14Mr. Mansukh Mandavia himself lost weight and said, look, I was having fatty liver and now
37:19I'm rid of fatty liver, he told in parliament.
37:23Same is true of the current honourable Srinidhar Das and many, many others that and they lead
37:30by example.
37:31The prime minister has certainly led by example by saying lose fat and obesity.
37:38So I think the impact of India going and still India is numero uno, is still number
37:43one in the world in the preparation for fatty liver.
37:47But the movement must start from you, all listeners, movement must start all readers
37:53of India Today, this story and do not stop there.
37:57Teach other 10 and teach other 10 and the change should start and I'm sure that if
38:03you are aware, your children will thank you.
38:05Oh, I am born to a healthy parent.
38:09Well, coming to the final part of our program on this, we talked about the early stages
38:15of fatty liver and how you can prevent it and reverse the process that's happening.
38:21And of course, to test it pretty simple, a blood test will reveal whether your liver
38:25is dysfunctional or not.
38:27You proceed to an ultrasound which will tell you whether you're on stage one fatty liver
38:31and then comes the other issue that if you now diagnose beyond stage one and you have
38:37got into a serious problem with the liver, what are the options available to a patient
38:44or what would a doctor advise you to do if your liver is reached beyond stage one, gone
38:49into stage two and as progressing towards cirrhosis or complete damage of the liver?
38:55Thank you, bringing the points for suffering of those who have stage two or stage three
39:01fatty liver, many of them, a simple blood test that includes liver function test and
39:08your ALT or SGPT.
39:10If SGPT is high, I would say normal try and keep it around 20, upper limit should be 30.
39:17If the SGPT is high, it is a marker of cell death.
39:20STP, what did you say?
39:25SGPT or ALT is a simple blood test.
39:29It's a liver enzyme like hemoglobin.
39:32Everyone knows hemoglobin.
39:34I would like everyone to know about SGPT or ALT.
39:38This test tells you if it is high, suppose yours is 60, 70, it's a real cause of worry.
39:45So try to have it around 20 or upper limit of 30 SGPT.
39:51Ultrasound, which tells you the grade of fatty liver, if the grade is two or three, but ultrasound
39:57picks up only 30 to 40% of people unless they are advanced fat in the liver.
40:02So there are other tests, high blood sugar, high serum insulin, or if you can do elastography
40:09tests like Fibroscate, FibroTouch.
40:13These are the ones which tells you about fat and the fibrosis in the liver.
40:18If you have stage two or three fatty liver, please try, get it out.
40:24And you can come down in a year's time, certainly to grade one or even no fatty liver.
40:30Weight loss.
40:30Again, this is without surgery.
40:33Am I right?
40:33You're saying you can bring it down without surgery.
40:36Yeah, as I told you, get back to the point of normal weight, reduce your weight and work
40:49out for your exercise, with sweating and all that, change your time of eating.
40:55And instead of a dinner plate, use a desert plate, half the plate, keep your stomach a
41:00little bit, you know, empty.
41:03And if you change the timing of food and the quantity of food, you lose weight and the
41:11restorative sleep.
41:12So I would say majority of the people can, fatty liver can be reduced.
41:18But if the fibrosis has set in, means stage three or four fibrosis, you certainly need
41:24specific drugs.
41:26Many good drugs are available.
41:29Some of them are available in India, Saraglitazar or even Vitamin E or maybe Pentoxyphilin.
41:37There are several drugs and in the US a new approved drug is Arismeterone for 30 days
41:43is like $5,300.
41:45So you actually become thin by buying the drug.
41:50But all these and the weight losing new, you know, hype, or you take an injection and you
41:56lose weight.
41:56All these GLP-1, GIP-1 agonists, very expensive.
42:01My suggestion is these are meant for people who cannot move, who have no desire to exercise
42:07or change their life.
42:09And for them, there may be 5-10% weight loss with this.
42:12They are effective drugs, but you stop them, again, the weight will come back.
42:17Again, the liver will have fat and fibrosis.
42:20And thirdly, you might actually lose some of your muscles.
42:24So these are people who are inactive or cannot or do not want to do any activity.
42:30So avoid them as much as make your life different.
42:34And it can reverse even stage 3 fibrosis, stage 4 fibrosis can reverse.
42:40Do not get disappointed.
42:42Yeah, if you have got jaundice, then if the liver has failed, you have food in the abdomen,
42:49then certainly you require a specialist.
42:51You can manage yourself by losing weight, changing diet and others.
42:56For advanced disease, you certainly need a specialist.
43:00But for everyone who is listening, consider fatty liver as an important thing in your
43:04life.
43:05You and your family and your children should be aware of it.
43:10Own your body, make yourself the owner that I will not let things go wrong with me.
43:16Very good advice, Dr. Singh.
43:18Just one final point.
43:19When you scroll the Instagram these days, you get a lot of these fatty liver cures.
43:25There's a tablet.
43:26You take this for 20 days and you're fine.
43:29How reliable all these tablets are?
43:32Is there really anything that can clean up fatty liver like this?
43:37Well, fortunately, I don't read them and I'm not aware.
43:41And also, I don't have any Instagram or any such thing.
43:44But I will tell you, the liver does not.
43:48There is nothing like a detox.
43:50There is nothing like you take this and your liver gets better.
43:54I wish there were something like this.
43:56But it is your metabolism.
43:59And metabolism has to be corrected by effort.
44:02You have to, you know, earn your health.
44:05People can't give you health by, you can't buy your health.
44:09So you have to earn your health.
44:11Yes, if you have disease, certainly doctors will give you
44:15drugs which will decrease fibrosis, which will decrease fat.
44:19So my suggestion is, I'm sure those who are saying must be having a lot of science behind it.
44:24But if there is no science, there is no publication, there is no evidence-based medicine,
44:31I would say, avoid these medicines and go to science.
44:36But remember, health is not given, health is earned.
44:42Earn your health, earn health for your kids, for your families,
44:47and be owner of a chiseled, sharp, smart, thin, and strong body.
44:54Dr. Sareen, brilliant advice.
44:57All of us need to follow that.
44:59And particularly, as you said, own your body, earn your health.
45:03And you can reverse the positions that you are there.
45:06You can take the decision now, get into a proper diet that brings your fat down.
45:12Make sure that you are testing regularly to see that your
45:15fatty liver isn't getting out of hand and take care of your liver.
45:18Because if you take care of your liver, you're going to be well.
45:21Am I right?
45:21That's the big message that's there.
45:23Absolutely.
45:24And I do hope after a year, you have again a session and we will see the impact.
45:29And you can have viewers' point of view.
45:31What do they say?
45:32Do they agree or they don't like me because I'm a little strict?
45:36Let us be.
45:36Your title is Truth.
45:39And this is the truth.
45:41That is the series, Raj, you carry.
45:43And this is the truth.
45:44And accept the truth.
45:45Accept science.
45:46Accept where you are.
45:49Thank you so much, Dr. Sareen, for taking time out to speak to us.
45:53And for more details, you can read the in-depth cover story on the subject
45:57done by my colleague Sonali Archaji in The Latest India Today.
46:01And thank you for being with me in this episode of Nothing But The Truth.
46:04I look forward to having you with me next week.
46:09Nothing But The Truth.