Gallipoli Medical Research Director of Research Professor Darrell Crawford spoke to Craig Zonca and Loretta Ryan at ABC Brisbane on Tuesday morning.

LORETTA RYAN: How’s your liver? It’s not often you ever stop to think about your liver really, I suppose?

CRAIG ZONCA: Can’t say I do that much, no.

LORETTA RYAN: Well you should. A leading liver researcher here in Brisbane says it needs to change, that thinking, particularly given Australia’s drinking culture.

CRAIG ZONCA: That researcher is Professor Darrell Crawford from the Gallipoli Medical Research Institute at UQ. Professor, good morning to you.

PROF DARRELL CRAWFORD: Good morning Craig, good morning Loretta.

CRAIG ZONCA: You’ve put pen to paper on an essay titled The State of the Aussie Liver. So I have to ask: what’s the verdict?

PROF DARRELL CRAWFORD: Well the verdict’s not good. We know that 30 per cent of Australians over the age of 50 are affected by fatty liver disease, but many have no idea of their underlying condition.

LORETTA RYAN: What causes that fatty liver?

PROF DARRELL CRAWFORD: Probably the two most common causes Loretta are related to the obesity epidemic and to alcohol consumption. We frequently see—most patients we see—with fatty liver disease are overweight, have a high BMI and then often other comorbidities related to their obesity, so it’s a big problem and of course, alcohol remains a big issue in the causation of liver disease.

LORETTA RYAN: Yeah, so it’s mostly lifestyle related then and you can change those behaviours – will that help?

PROF DARRELL CRAWFORD: Of course it helps. We know in terms of weight loss, if you lose 10 per cent of your body weight, your risk of progressive liver disease drops quite dramatically and of course, limiting, restricting alcohol consumption spares the liver as well. So we know that there are these lifestyle issues, which cause the liver disease but can be addressed quite easily.

LORETTA RYAN: When you say limiting your alcohol consumption—let’s talk about that—just how much is too much? How much do you limit it by? I’ve heard people say no alcohol is better.

PROF DARRELL CRAWFORD: No alcohol is certainly better in people who’ve got underlying fatty liver disease. That’s the current recommendation that patients with fatty liver disease shouldn’t be drinking any alcohol at all and in relationship to alcohol guidelines, the importance of alcohol-free days, restricting alcohol consumption to two or two standard drinks per day, with a number of alcohol-free days through the week is important. Not bingeing is terrifically important, so there’s a number of alcohol guidelines around there which we need to adhere to.

CRAIG ZONCA: You talk about diet and looking after ourselves more broadly, those lifestyle factors, Professor. Out of our vital organs, why is the liver often the one overlooked. In media coverage, we talk about heart and kidneys, but not so much liver.

PROF DARRELL CRAWFORD: I think you’re right Craig, we don’t get the advocacy that diseases of other organs do, and perhaps that’s related to stigmatisation around having liver disease, you know, since a lot of the causes are lifestyle related, I think there is stigmatisation to it. Certainly with liver disease caused by viral hepatitis, stigmatisation has often been the issue, with Hepatitis B or C.

We think that really should change, given this remarkably high prevalence of fatty liver in the community.

CRAIG ZONCA: You see this as a liver researcher. You talk about hepatitis – I do see it’s World Hepatitis Day today, 28 July. Professor, you’ve also been developing a saliva test to help diagnose liver disease. Why do you see that as such a critical step?

PROF DARRELL CRAWFORD: Liver disease progresses very insidiously over many, many years. Many people present with very advanced disease and this is particularly a problem in rural and regional areas because there’s a real lack of access to methods we use to diagnose progressive liver disease and so those tests are really blood-based tests which are not reimbursed by Medicare, and then another ultrasound-like test called a fibroscan, which is also not reimbursed by Medicare.

So access to those tests are really largely in metropolitan areas and the rural and regional population have limited access to this and we know that liver disease outcomes are worse in rural and regional communities than what they are in metropolitan communities.

We’ve brainstormed with our collaborators at Griffith University about a way to democratise access to healthcare and thought that saliva testing may be a method we could—of course, you can collect it very easily, we can store it and sample analysis—we’ve been doing work on measuring various proteins that are involved in liver scarring in saliva and have been able to develop a test based on those measurements to predict whether a person has underlying liver disease or not.

LORETTA RYAN: What’s the point that people might know they have some problem in their body with their liver and they need to get it checked?

PROF DARRELL CRAWFORD: I think that’s the problem Loretta, often the liver disease is very advanced by the time people recognise any symptoms. The early symptoms are progressive lethargy and fatigue, which are very common in the community, not a very sensitive set of symptoms.

The risk factors—I think people are probably better to think about the risk factors rather than the symptoms, so that patients who are obese, particularly patients with Type 2 diabetes are at risk of liver fibrosis and liver cirrhosis. Obviously people who consume heavy alcohol and of course you have people who are overweight to begin with, and they’re heavy drinkers as well.

I think GP awareness, self-awareness, awareness in other specialties that deal with metabolic diseases about the importance of testing for the liver, for the liver function, could be improved in those groups.

CRAIG ZONCA: Maybe we need to start a campaign Professor – give your liver some love! How about that slogan?

LORETTA RYAN: He likes that one

CRAIG ZONCA: Really appreciate your insights this morning, and the work you’re doing at the Gallipoli Medical Research Institute. Thanks for telling us about it.

PROF DARRELL CRAWFORD: Thanks Craig, Loretta, good morning.