DEAR DR. ROACH: My husband, who is 59 years old, has been diagnosed with “fatty liver.” He is 5 feet 9 inches tall and weighs 300 pounds. He has struggled all of his life with his weight. He has pain and tenderness in his upper right side. He is scheduled for an endoscopy in two weeks. When the nurse called about the results from his ultrasound with the fatty liver, all she said to do is “diet and exercise.” I am worried that the diagnosis is more serious than they are saying. Can this lead to serious liver disease or cancer?

He does drink alcohol. Since they gave him the diagnosis, he’s been trying to cut back. He drinks four or five large mixed drinks on Friday and Saturday, and beer on Sunday. The nurse did not say anything about drinking. My husband was worried enough that he investigated the problem on the Web. I just don’t know if he can do all this on his own, without help. I’m trying to get him to see a professional, at least about the weight loss. — N.H.

ANSWER: Fatty liver disease is an increasing health problem, and a major cause of serious liver disease. Fatty liver often is divided into alcohol-related and non-alcohol-related.

Alcoholic liver disease occurs in people who drink 14 or more standard drinks per week (a “standard drink” is 14 grams of alcohol — about 12 ounces of beer, 5 ounces of wine or a mixed drink, but these can vary in alcohol content). If you really mean the amounts you said, your husband could be drinking as much as 32 standard drinks on a Friday night alone. Although only about 6 percent of people who drink as much as your husband will progress from fatty liver to alcoholic liver cirrhosis, he is at risk. Once cirrhosis has developed, the liver cannot recover. Cirrhosis, from any cause, greatly increases risk of liver cancer. Fortunately, the liver can rapidly improve from fatty liver with abstinence. It’s critical for your husband to dramatically reduce or altogether stop his alcohol intake.

Your husband is also at risk for non-alcoholic fatty liver given his BMI (body mass index) of 44.2, putting him in the “morbidly obese” level. Stopping alcohol doesn’t protect him from developing the non-alcoholic type. While I agree with the instruction to improve diet and to exercise, I am disappointed that the advice you and he received was not more explicit, both about alcohol cessation and about weight loss. You are quite right that a professional may be of great benefit.

DEAR DR. ROACH: My son is 40 years old. After a recent stress test, he ended up with five stents in his arteries, and also was diagnosed with diabetes. His doctor ordered him not to go back to work for three or four weeks, but he went back after three days. He told the doctor that he would be more stressed if he stayed home. His job is mostly sitting down. Since he didn’t follow the advice, how will this affect his health? — V.B.

ANSWER: We don’t normally have people stay home for long periods of time after placement of stents, so I was surprised to hear that he was “ordered” (I almost never “order,” only recommend, more or less strongly) to stay home.

My experience is that after receiving life-changing diagnoses, such as diabetes or coronary artery disease, it’s best to keep some habits, such as work, the same and change others. For your son, I am sure he will be recommended a proper diet for diabetes and exercise appropriate for a person with a new diagnosis of heart disease.

READERS: The booklet on restless leg syndrome and nighttime cramps offers more tips. Readers can obtain a copy by writing: Dr. Roach — No. 306, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

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