Q: My doctor told me that my last blood test showed elevated liver enzymes, and I may have nonalcoholic fatty liver disease. What should my next steps be and how serious is this? -- Freddy G., Denver
A: Nonalcoholic fatty liver disease, or NAFLD, is quite common in the U.S. Around 25% of adults have NAFLD -- and about 20% of those folks have a more advanced stage called NASH (nonalcoholic steatohepatitis), in which hepatitis is causing inflammation and swelling, and even cirrhosis.
NAFLD often coexists with other health challenges -- from obesity to insulin resistance and diabetes, as well as increased alcohol use and hypogonadism in men (that's low testosterone). You don't say what the possible causes were in your case, but if you have any of those conditions, or very high blood levels of LDL cholesterol or triglycerides, you're a candidate for NAFLD. However, there are times when someone has NAFLD without being obese or having metabolic syndrome.
In any case, the next steps are to make certain lifestyle and medical changes pronto, and to get further tests to confirm the diagnosis.
Increased physical activity; improved diet (no saturated-fat foods, red or processed meats or ultraprocessed or sugary packaged foods) and taking prescribed medications to control blood glucose, blood pressure and blood lipids may slow progression of or even reverse NAFLD.
You also may need to reduce or eliminate your alcohol intake, even if you are not a problem drinker.
Next, you may get a scan -- ultrasound, CT or MRI, or a newer form of ultrasound testing called transient elastography -- to assess the amount of fat in your liver and its stiffness. You can also ask your doctor to check your testosterone levels. A new study shows that in obese guys with low levels of testosterone and Type 2 diabetes, testosterone therapy normalizes hormone levels and reduces NAFLD.
Whatever you do, don't delay. Follow up, take steps to live more healthfully, and you will be able to protect your liver -- and your life.
Q: I'm a 64-year-old woman. Do I really need to get a mammogram every year like my primary care physician says? -- Dee F., Austin, Texas
A: If you're at average risk for breast cancer, the American Cancer Society says that women ages 40 to 44 have the option to start screening with a mammogram annually. Women ages 45 to 54 should get mammograms every year. Women 55 and older can switch to a mammogram every other year or continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.
Unfortunately, cancer screening is way below where it should be -- not only for breast cancer. A new study found that in 2018, only 66% of folks age 50 and older were screened for colorectal cancer; for women age 45 and older, only 63% were screened for breast cancer; and for women ages 21 to 65, only 83% were screened for cervical cancer.
This puts all women at risk for late diagnosis -- and a riskier recovery. This is especially true for two subsets of women who have survived breast cancer, no matter for how long. A new study in the journal Cancer shows that subsequent breast cancer, acute nonlymphocytic leukemia, ovarian cancer and lung cancer are more likely to develop after a woman has had HR-negative breast cancer than after HR-positive breast cancer. Women who were first diagnosed with breast cancer before age 50 also have greater risk for subsequent cancer than women with later onset breast cancer.
Some good news on the cancer-fighting front: The combination of a new cancer vaccine and existing immunotherapy drug has been shown in mice to improve the success rate of treatments for metastatic disease from 20% to 75%, according to a study in Nature Communications. Stay tuned for clinical trials. And make sure to get all your cancer screenings as your doctor recommends.
Mehmet Oz, M.D. is host of "The Dr. Oz Show," and Mike Roizen, M.D. is Chief Wellness Officer Emeritus at Cleveland Clinic. Email your health and wellness questions to Dr. Oz and Dr. Roizen at youdocsdaily(at sign)sharecare.com.
(c)2021 Michael Roizen, M.D. and Mehmet Oz, M.D.