In 1980 a group of patients were admitted into the prestigious Mayo Clinic in the United States. They reported vague symptoms of fatigue and pain under their right rib. Upon testing, doctors found inflammation in their liver. They found scarring in and around the liver. There was inflammation that stopped the liver working properly. There was severe liver damage, and there was a build-up of fat in the liver. This was the first time doctors had seen a damaged, fatty liver in people that was not caused by alcohol. The presentation of these patients was so rare that the doctors had no name for this new disease. When one of the lead physicians published his findings he called the condition a “hitherto unnamed disease.” This was a brand-new disease that had not been seen in people before 1980.
At the time, only twenty people were known to have this new disease. Now, just thirty-eight years later, several hundred million people have the same disease. Clearly something has happened over the last forty years. The disease is called non-alcoholic fatty liver disease. It starts with a build-up of fat in the liver. The liver becomes slightly enlarged, people become fatigued, they are overweight, and they feel some discomfort under their right ribs. As fat builds up in the liver, there is a huge surge of inflammation. This inflammation causes scarred tissue in the liver and surrounding blood vessels, meaning the liver cannot fully work. As the fat levels rise, and as inflammation continues, the liver then starts to shrink. It reaches a point where it cannot be repaired. At this point, damage to the liver is permanent. There is liver failure. Often people get liver cancer. The only solution is a liver transplant. Sadly, many millions of people die.
This would be bad enough, yet liver disease doesn’t quite sound like a major issue like cancer, diabetes, or heart disease. It sounds obscure, not so important, and quite rare. It sounds like something other people get. This is plain wrong. In Pakistan it’s estimated that over thirty million people have non-alcoholic fatty liver disease, about 20% of all adults. Pakistanis who are over forty and overweight almost certainly have the start of fatty liver disease. Around 50–75% of overweight Pakistanis, of any age, have fatty liver disease. If you’re a Pakistani female then the chances that you have the disease are even higher. Many people in this room will have fatty liver disease without even realising.
Unfortunately, fatty liver disease causes damage to the body far beyond the liver. About 30% of sufferers will have diabetes. About 50% will also have heart disease. There is a hugely increased risk of dying from a stroke or heart attack. Many will get cancer. All people with fatty liver disease have massive inflammation, which is linked to many diseases, from arthritis to Alzheimer’s disease. All will have high cholesterol and high triglycerides. For some, the volume of their brain will shrink, causing them memory problems. This is a disease that causes death, that affects hundreds of millions of people across the world, and, more pertinently, affects about thirty million Pakistanis. It’s also becoming more common with every year that passes.
So, what has caused this epidemic? The first candidate is sugar, especially the sugar found in junk food and sugary drinks, like Coke and 7-Up. Since 1996, the average Pakistani is now eating 14 kg more sugar per year. Next year, Pakistan will overtake America in sugar consumption. When sugar is eaten the liver converts the sugar into fat. Some of this fat lines the belly making a person look fat. But some of it stays in the liver, causing inflammation and the start of fatty liver disease.
The second candidate is eating food and oils rich in omega-6 fatty acid. This includes fried food, vegetable oils, vegetable ghee, sunflower oil, and margarine. All of these cause inflammation and contribute towards fatty liver disease. In 1961, the average Pakistani ate 1.86 kg of vegetable oils per year. This year, the figure stands at 19 kg. That’s a lot of inflammatory calories.
Sugar and vegetable oils are two general causes of fatty liver disease. However, thanks to Punjabi scientists and clinicians we now know precisely what is damaging Pakistani livers—and you’re probably not going to enjoy hearing this.
The last few decades have seen a change in Pakistani eating habits. Eating out has become popular, as has fast food, and eating late into the night, especially for Lahoris. The amount of time spent eating has increased, as has portion sizes. Food quality has decreased in favor of low-quality food, even if it seems to taste delicious. Time spent sitting indoors, especially for ladies, or sitting during work, has increased. There is a corresponding lack of exercise, less work outdoors, and less domestic work around the house. Put these factors together with increased sugar and vegetable oil and it explains why thirty million Pakistanis have some degree of liver disease. But there’s more. We haven’t considered a crucial factor explaining why liver disease is on the rise. That factor is obesity.
In Pakistan, obesity is increasing at an alarming rate. There are now more fat people than malnourished people in Pakistan, making Pakistan the ninth most obese nation on earth. Unfortunately, all that delicious Lahori food means that Punjabis are the most likely to be overweight. If we measure obesity by waist size, then we find about 57% of Punjabis are carrying too much weight. It is obesity, especially fat around the stomach, that is driving fatty liver disease, and other diseases, among urban Pakistanis. Whether in Lahore, Islamabad, Birmingham, or Toronto the result is always the same: urban living, too much food and late-night eating, lack of exercise, lots of sitting, little outdoor or domestic activity, plus sugar and vegetable oils equals obesity, disease, then sadly an early death.
Yet death is not sudden from these diseases. There is a period of many years where there is poor quality of life. Fatigue sets in, going out is a burden, playing with children or grandchildren is difficult, and there is shortness of breath. As the liver becomes more inflamed, mental and emotional health starts to worsen. Recent research has shown that there is a clear link between anxiety and depression and fatty liver disease. There is decreased motivation to do things. This leads to less socializing, as sufferers stay in their home more, further reducing vitality and activity. It’s a viscous, downward spiral that is no way to live. People with liver disease are also more prone to anger. As they get angry, whether at other people or at their lot in life, they produce more inflammation. This inflammatory state worsens the liver, leading to a state whereby anger is driving liver inflammation, further shutting down liver function and worsening health.
The discovery by clinicians that the health of the liver is directly linked to the health of brain, and that anger can worsen inflammation in the liver is impressive. What’s more impressive is that traditional Chinese doctors knew this two thousand years ago.
Every good traditional Chinese doctor knows that anger impairs the health of the liver. That grudge you have against a family member impacts your liver. The road rage you experience impacts your liver. The resentment you have against your boss, or husband, or wife hurts your liver. Always getting angry at your children damages your liver. Five hundred years ago, physicians to the Ming dynasty counselled that avoiding anger was of the utmost importance for nourishing the liver and the maintenance of overall good health. They wrote how the liver controlled the circulation of internal energy to produce vitality. That it influenced social relationships and emotional health, and is involved in how a person thinks, or whether a person has anxiety. In short, poor liver health leads to poor quality of life, depression, and poor emotional health. The very things researchers in our time are only just starting to discover. The Chinese even knew that the liver weighs 1.084 kg. This is remarkably accurate considering they didn’t operate or perform autopsies. They determined this from touch and feel.
One of the traditional Chinese remedies for liver health is sleep. In the Chinese system the best time to rejuvenate the health of the liver is between 1:00–3:00 a. m. During this time a person must be asleep. They counsel that going to bed by 11:00 p. m. is a must to allow for deep sleep by 1:00 a. m. During these hours internal energy enters the liver to replenish it, allowing for healing.
Internal energy, sleep, and tradition might seem fanciful to modernist adherents of scientism. But then we learn from allopathic studies that sleep deprivation causes oxidative stress in the liver, leading to inflammation, then disease. We learn that sleep deprivation is linked to the progression and development of fatty liver disease. We learn that people who have less than six hours sleep are significantly more likely to have fatty liver disease. We also learn that the liver has its own internal clock. It keeps its own hours that are controlled by clock genes within the liver. This internal liver clock regulates the elimination of harmful substances such as pesticides, pollutants, and drugs. There is a clear day and night rhythm to how the liver works, and if this internal clock is disrupted through lack of sleep, then these harmful pollutants build up, leading to a range of liver diseases. The Chinese were right about sleep and liver health. Sadly, it also means that strolling up a Food Street in Lahore late at night is bad for your liver.
When you start to develop fatty liver disease your doctor cannot help you. To be sure, in the last stages of the disease before death he might be able to arrange a transplant or chemotherapy if you have cancer. He might be able to arrange a heart bypass or help with a heart attack too. But as fatty liver disease develops, as the body becomes more inflamed, and fatigue sets in, there is little he can do. There is no pharmaceutical drug for fatty liver disease. He cannot give you a magic pill that enables you to carry on eating. This should be seen as an opportunity as it means you can do things for yourself to prevent and reverse the disease.
The first, as we have seen, is from the Sunna. Do not get angry. Do not get angry. Do not get angry. Get rid of all grudges, hurt, and resentment from your heart. The second therapy for the liver is also from the Sunna, and is cheaply available to everyone here. Thanks to scientists at the Sheikh Zayed Hospital in the Punjab city of Rahim Yar Khan we now know that black seed (Urdu: kal - lun - ji) has a profound effect upon liver health. This research team bought black seed from the local market, then gave two grams per day to patients with confirmed fatty liver disease for three months. These were not expensive, pharmaceutical grade herbs. They were bought from the local market. At the end of three months there was a significant reduction in body weight. Some patients lost as much as 13 kg. This was because black seed suppresses hunger hormones, meaning that people who take it eat less. Then, there was a remarkable reduction in liver enzymes. These liver enzymes are produced when the liver is damaged causing them to spill into the blood. A reduction in liver enzymes indicates a healthy, functioning liver. The black seed also lowered inflammation, reduced blood pressure, and improved cholesterol.
Now, unfortunately, we come to the crux of the matter. Modern Pakistani food is delicious. It’s addictive. But it’s killing you. It is not what your ancestors ate. They ate less rich food, less meat, and less rice. Their portion sizes were smaller. Your ancestors ate virtually no fried food, no take-out food, no sugar, no white flour, and no vegetable oil. These need to be cut out. Their diet was not inflammatory. It did not lead to obesity. One of the few proven ways to improve the health of your liver is to lose weight, or not get fat in the first place. Even losing just 10% of your weight dramatically improves liver health, reducing your risk of heart disease, diabetes, and cancer. While losing weight you need to emphasize vegetables, pulses, and legumes all of which help the liver. The bacteria in local yogurt lowers liver enzymes, indicating that it rejuvenates the liver. Turmeric in food helps, as do eggs. To reiterate: lots of vegetables, legumes, pulses, some meat, some butter ghee, yoghurt and buttermilk, occasional small portions of rice, eggs, some fruit, and high-quality barley or wholegrain wheat. This is nearer the diet of your ancestors.
Your ancestors also sat less, moved more, probably had more chores, and may have worked in villages or on fields. This raises the question of exercise. Exercise is another proven benefit for the liver, and it doesn’t matter what type of exercise. Strength training is beneficial, as is bodyweight training, and aerobic exercise. For people overweight, even walking is helpful. Anything that gets you moving and slightly out of breath. You don’t need to exercise hard. But you must do it often, several days a week.
Finally, sugar has to go. Around the world sugary drinks and snacks have been shown to damage the liver. It should be seen as a poison. Among Hispanic communities, obesity, diabetes, and fatty liver disease are reaching unprecedented levels due to sugar and a junk food diet. There are very real warning signs that Pakistanis, wherever they are in the world, are heading for the same fate. So, ditch the sugar and save the falooda for Eid.