Q: I am 39 years old weighing 81 kg and 176 cm tall. I was diagnosed with fatty liver and my LFT results are serum bilirubin total - 1.690 mg/dl, serum bilirubin direct - 0.454 mg/dl, serum bilirubin indirect - 1.236 mg/dl, SGOT - 62.77 IU/L , SGPT - 159 IU/L, serum alkaline phosphatase - 111 U/I, serum total proteins - 6.9 gm %, serum albumin 4.368 gm % and glycosylated haemoglobin - 6.9%, fasting blood sugar - 119 mg, total cholesterol - 186.0 mg/dl, triglycerides - 349.0 mg/dl, HDL - 24.06 mg/dl, LDL - 92.11 mg/dl, VLDL - 69.80 mg/dl. I don't take alcohol and am a non-smoker. The doctor prescribed Udiliv 150, Hepamerz and Lipanthil 300 mg. Please suggest if the above medicines are suitable for curing the fatty liver problem?

A:Some of your LFTs (Liver Function Tests) are not within normal range such as bilirubin, SGOT, SGPT and Alkaline phosphatase. Even though your fasting blood sugar is slightly higher (at 119 mg), there is no cause for worry since glycosylated Hb is normal (this test indicates the level of blood sugar in the past two months). Despite this, I would suggest a repeat blood glucose be done: once fasting and again 2 hours after normal meal to rule out diabetes. Triglycerides are on the high side at 349 (ideally below 200) but it is not clear if the test was done after 12 hour fasting and no alcohol intake in the previous 72 hours. Udiliv (ursodeoxycholic acid) is indicated in chronic cholestatic liver disease. Since there is a certain amount of cholestasis in the form of high bilirubin, I think one should take this medicine for about 4 weeks and do the bilirubin test again. However, the recommended dose is at least 300 mg twice daily for a person of your weight. A very low sub-therapeutic dose may give no benefit. In some rare cases, instead of decreasing cholestasis, ursodeoxycholic acid can actually increase the problem; hence on must repeat the bilirubin test after four weeks. Hepamerz is indicated as a supportive and maintenance treatment of chronic liver disorders. The correct dose in your case will be a minimum of one tablet 3 times daily for several weeks. It does not have any side effect. Fenofibrate (sold under the brand name of Lipanthil abroad and hence quite expensive) is sold as Lipicard (about Rs. 10 per tablet) and should be taken in a dose of one tablet (200 mg) once daily for four weeks and then triglyceride level determined again. I would also like to eliminate thyroid disease by doing thyroid function tests. If not already done an ultrasound to visualize gall bladder and liver will be very helpful. In addition to drug treatment you would need to do moderate exercise (brisk walk for 45 minutes to cover no less than 4.5 km at least 5 days every week), total abstinence from alcohol consumption and dietary measures to reduce saturated fat intake.