Are you thinking of traveling to East, Southeast, or Central Asia? These are exciting destinations for cultural explorations, historical appreciation, and world-class cuisine. However, be cautious when eating undercooked or raw fresh-water fish, as a high prevalence of cases of liver fluke infection have been found mainly in these global regions.  As well, cases have occurred in South America, Africa and Eastern Europe. Researchers estimate that around 17 million people worldwide, most in Southeast Asia, are affected by opisthorchiasis.

Liver fluke disease is a serious parasitic inflammatory disease of the bile ducts caused by eating fluke-infested fish from freshwater sources like rivers and lakes. A liver fluke is a flatworm. Three most common types of liver flukes that induce infections in humans are Opisthorchis viverrini, Opisthorchis felineu, and Clonorchis sinensis. Once ingested, they make their way into the liver’s bile ducts where they incubate and grow. Adult flukes live in the small intrahepatic bile for 20 to 30 years and may cause severe and long-lasting inflammation of the bile ducts.

What are the tell-tale signs of liver fluke infections?

While liver fluke infections don’t present symptoms in most infected individuals, many experience severe inflammation suffer from nonspecific abdominal, malaise, hives, nausea, fever, vomiting, decreased appetite and weight loss, diarrhea, and jaundice. More severe consequences are an enlarged liver, stone formation, recurrent pyogenic cholangitis — and cholangiocarcinoma, which is a type of cancer that grows in the bile ducts, both inside and outside the liver.

In severe cases of liver fluke infections, the outlook is not very good: a five-year survival rate for this type of liver cancer, and with only 20-50% chances of survival — even when the cancer is detected early.

Because liver fluke infections are asymptomatic for many people, it is hard to detect them. In asymptomatic cases, people with liver fluke infections can live their lives normally. When symptoms arise, they can be treated and most often curable. However, to ensure that liver fluke infection is cleared, a thorough medical checkup should be in place.

Testing for liver fluke infections

Methods to detect liver fluke infections include the following: full blood count, ultrasound or CAT scans of the liver, stool analysis, and immunological testing to detect worm-specific antibodies in blood samples or worm-specific antigens in feces samples. The most common method of testing is stool analysis because it is easier to perform and is more affordable than the other methods.

Common Treatment

The World Health Organization recommends Triclabendazole to treat fascioliasis, which is an infectious disease caused by fasciola parasites or flatworms also known as liver flukes. The use of triclabendazole as a treatment for liver fluke disease has been proven to be effective in the majority of the cases because it is effective against immature and adult parasites, and therefore can be administered as treatment throughout all phases of the liver fluke infection. Aside from the high success rate, the documented side efforts are also usually mild and temporary. The recommended single dosage for prevention and treatment is 10 mg/kg body weight.

How to avoid liver fluke infection

Remember these important tips to prevent infection, especially when traveling to places with known cases:

1. Avoid eating raw or undercooked fresh-water fish.

2. After traveling to regions with high cases of liver fluke infections, have yourself tested for this particular disease.

3. Should you choose to eat it raw or undercooked, buy your fish from trusted, reputable hygiene-focused food establishments that are conscientious about potential cross-contamination through utensils and food handling. 

4. Practice utmost hygiene when eating or sharing food with others.

5. Seek medical attention upon experiencing symptoms of liver fluke infections.

To learn more about liver fluke disease, check out these useful resources:

• https://www.healthline.com/health/liver-fluke
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088844/
• https://www.medicalnewstoday.com/articles/319479.php

With the Thanksgiving holiday fast approaching, many of you may be on a hunt for an easy, healthy, and super-tasty stuffing recipe to wow your family and friends at the table. Given all the rich and guilty ingredients, a traditional Thanksgiving meal, with all the trimmings, may not be too friendly to your liver. So, as a smart and yummy alternative, we picked out these flavorsome liver-healthy stuffing recipes that make use of fiber-rich alternatives like cauliflower, spinach, and fruits. Try these delicious ingredient side dish hacks that your liver will thank you for – again, and again!

Low-Carb Cauliflower Stuffing (from www.delish.com)

INGREDIENTS

4 tbsp. butter

1 onion, chopped

2 large carrots, peeled and chopped

2 celery stalks, chopped or thinly sliced

1 small head cauliflower, chopped

1 cup (8-oz.) package baby bella mushrooms, chopped

Kosher salt

Freshly ground black pepper

1/4 cup freshly chopped parsley

2 tbsp. freshly chopped rosemary

1 tbsp. freshly chopped sage (or 1 tsp. ground sage)

1/2 cup low-sodium vegetable or chicken broth

DIRECTIONS

1. In a large skillet over medium heat, melt butter. Add onion, carrot, and celery and sauté until soft, 7 to 8 minutes.
2. Add cauliflower and mushrooms and season with salt and pepper. Cook until tender, 8 to 10 minutes more.
3. Add parsley, rosemary, and sage — and stir until combined. Pour over broth and cook until totally tender and liquid is absorbed, 10 minutes.

Spinach and Artichoke Stuffing (from www.delish.com)

 INGREDIENTS

1 large loaf French bread

2 cups frozen spinach, defrosted and drained

1 can artichoke hearts, drained and chopped

2 cups mozzarella, divided

1 tbsp. butter

1/2 onion, finely chopped

2 stalks celery, finely chopped

2 garlic cloves, minced

1 tsp. freshly chopped sage

1 tsp. freshly chopped thyme

1 tsp. freshly chopped rosemary

1/2 tsp. red pepper flakes

1-1/2 cups chicken broth

8 oz. cream cheese, cubed

Kosher salt

Freshly ground black pepper

DIRECTIONS

1. Tear or slice bread into cubes and leave out overnight to dry out. (Alternately, place bread on baking sheets and bake at 200°F for 20 minutes.)
2. Preheat oven to 350°F and grease a large baking dish.
3. In a large bowl, combine bread, spinach, artichoke hearts, and 1 1/2 cups mozzarella. Set aside.
4. In a large skillet over medium heat, melt butter. Add onion and celery and cook until onion is translucent, 3 to 4 minutes. Add garlic and herbs and cook until fragrant, about 2 minutes. Add chicken broth and cream cheese and bring to a simmer until cream cheese melts. Season with salt and pepper and remove from heat.
5. Pour bread mixture into prepared baking dish, making sure it is evenly distributed. Pour over cream cheese mixture and sprinkle with remaining mozzarella. Bake until the liquid fully evaporates, and the cheese melts — and appears golden — for about 20-25 minutes.

Quinoa Stuffing with Apples, Sweet Potato, and Hazelnuts (marlameridith.com)

 INGREDIENTS

1 cup (212 g) dry quinoa, cook according to package directions

2 (265 g) sweet potatoes, cut into small wedges

2 large apples, cut into half-inch pieces

1 tablespoon lemon juice

1/2 cup (100 ml) pure maple syrup, divided portion in half

Fine sea salt

2 tablespoons melted coconut oil

Few pinches ground cinnamon

Few pinches ground ginger

1 tablespoon fresh thyme leaves

1 cup hazelnuts, chopped

Fresh or dried cranberries for garnish

DIRECTIONS

1. Rinse quinoa. Combine with 2 cups water and a pinch of salt. Bring to a boil and then reduce to a simmer for about 20 minutes until all of the water is absorbed. Fluff with a fork and remove from the heat.

2. Preheat oven to 400 F degrees, with the rack in the middle. Be sure to coat apples with lemon juice so they don’t turn brown. Toss sweet potatoes & apples with 1/4 cup of the maple syrup, coconut oil and a few pinches cinnamon, ginger and salt. Roast for about 35-40 minutes until tender and fragrant.

3. Combine the quinoa with the roasted mixture and the remainder of the maple syrup (1/4 cup) in a large bowl. Fold in thyme and hazelnuts. Season to taste with more salt and spices.

Vegan Sausage Pear Stuffing (from www.marthastewart.com)

INGREDIENTS

1 loaf day-old rustic bread, dark, hard crusts removed and bread cut into half-inch cubes (about 12 cups)

1 stick unsalted butter, cut into pieces, plus more for baking dish

1-1/2 large onions, chopped (about 3 cups)

2 small leeks, trimmed, thinly sliced into half-moons, and rinsed well (about 3 cups)

3 stalks celery, chopped (about 1-1/4 cups)

1 large fennel bulb, chopped (about 2 cups)

12 to 14 ounces firm-ripe bosc or anjou pears (about 3), chopped (about 3 cups)

Coarse salt and freshly ground pepper

2 tablespoons finely chopped fresh rosemary leaves

2 tablespoons finely chopped fresh sage leaves

1 lb. vegan sausage (the original recipe called for sweet Italian sausage, which you can replace with your favorite vegan alternative)

2 cups Easy Turkey Stock (which you can replace with vegetable stock, as a vegan alternative, especially to serve as a side, on its own, to your vegetarian guests)

2 large eggs, lightly beaten

3/4 cup chopped fresh flat-leaf parsley leaves

DIRECTIONS

1. Preheat oven to 350 degrees. Spread bread cubes on a rimmed baking sheet and bake until crisped but not golden, about 10 minutes. Let cool. In a 14-inch straight-sided skillet (or 2 large skillets), melt butter over medium-high heat. Add onions, leeks, celery, fennel, and pears; season with salt and pepper. Cook, stirring occasionally, until vegetables and pears are softened and start to turn golden — about 15 minutes. Stir in rosemary and sage.
2. Meanwhile, cook sausage in a skillet over medium heat, stirring occasionally and breaking into large crumbles, until browned and cooked through, about 10 minutes. Drain on paper towels.
3. Stir into vegetable mixture, then transfer to a large bowl. Add bread cubes and toss well. Drizzle stock over mixture, add eggs and parsley, and toss to combine well. Season with 2 teaspoons salt and ½ teaspoon pepper.
4. Use 10 cups stuffing to fill bird; place remainder in a buttered 8-inch-square baking dish.
5. After turkey is out of oven, bake at 350 degrees until heated through and top is browned, 40 to 45 minutes.

ADRLF wishes you a delicious, nutritious, and memorable Thanksgiving holiday! Safe travels & healthy eats!

For more vegetarian stuffing ideas, click here

For a full liver-healthy Thanksgiving menu, click here

Screening remains to be the best defense against detecting the hepatitis virus in its earliest stages, and potentially developing life-threatening complications, later down the line. Dubbed as the “silent killer,” hepatitis doesn’t exhibit obvious symptoms in many people, who may live, comfortably, with the virus for years and only discover their condition at its advanced, acute stage. Noting the importance of the timeliness of testing, Texas-based Link2Labs is making affordable hepatitis C tests available to uninsured and underinsured people.

BARRIERS TO TESTING AND TREATMENT

Even with health insurance, many people are unable to secure testing. When Wayne Gosbee – the current CEO of Link2Labs — worked at Texas Medical Center for over 20 years, he repeatedly witnessed the all-too-familiar scene of individuals missing their hepatitis C test because of insurance issues. “Many barriers exist [around screening] that need to be overcome, but I believe the two greatest are: screening individuals and access to care,” he noted. “All healthcare providers should be asking and testing their patients, based on the guidelines from the Centers for Disease Control and Prevention, and United States Preventive Services Task Force. And all recovery and medication assisted treatment (MAT) facilities need to make testing mandatory.”

Notably, New York State has enacted the first state-level Hepatitis C Testing Law that has boosted rapid testing rates since 2014. However, access to treatment remains a challenge in the state, as well as in the rest of the country. There are clearly “not enough providers to treat, and the cost for everything—lab tests, consultation with a liver specialist or hepatologist, and medications,” pointed Gosbee, is out of reach.

HOPE IN COLLABORATION

To address these challenges, Gosbee shared some tested strategies at Link2Labs.

“I collaborate with clinics, organizations, and county health departments to offer free hepatitis C screening. These are the locations that individuals are going to seek general health advice and care,” he said. These locations have reported an average a 10% hepatitis C antibody positive prevalence, while recovery and MAT facilities reported 17.1% to over 50% prevalence.

With Link2Labs’ focus is on Texas, Gosbee shared that those who screen positive for hepatitis C at the lab would get baseline and pretreatment tests (CBC, CMP, PT INR, HAV, HBsAg, HBsAb, HBcoreAB, and HIV) at a deeply discounted price ($64 vs. $1,900 in other clinics). Gosbee also works with hepatologists via telemedicine and with non-profit organizations to connect patients with affordable and accessible treatment.

For example, as Gosbee shared, an uninsured patient at a gastrointestinal doctor’s office was told that the baseline lab tests are going to cost $1,958; the patient had just paid $250 for the consultation. Thankfully, a nurse at the clinic heard about Link2Labs and shared its contact information with the patient, who was later given a free test via telemedicine.

In another case, Link2Labs connected a patient who had a high insurance deductible ($4,800) with the Patient Assistance Network Foundation, which paid the deductible. The patient then got her lab tests from Link2Labs for a much more affordable price.

“My role is to build relationships with uninsured and free clinics, offer free Hepatitis C testing, write grants, and link individuals with [health] care,” said Gosbee. To date, Link2Labs is a two-man operation with plans of expansion, but its model of low-cost testing and inter-network collaboration promotes hope for accessible liver health care for underserved communities.

ADRLF is pleased to shine a spotlight on Link2Labs for its important work around a common goal we share to help curtail hepatitis — our mission to encourage all to:  Screen. Vaccinate. Don’t Hesitate!

To know more about hepatitis C testing, here are CDC’s recommendations

To learn more about keeping your liver healthy, visit our blog here

You might have seen this alarming recent story circle in mainstream news and social media: A 56-year-old resident of Hong Kong was reported to be the world’s first case of rodent hepatitis E. The diagnosis came when his doctors noticed that his test results showed abnormal liver function after receiving a liver transplant. So, what is hepatitis E — and what do we need to do to protect ourselves from yet another hepatitis scare?

Hepatitis E is a liver disease from a viral infection caused by the hepatitis E virus (HEV), which is one of the five hepatitis viruses. The ailing man who made headlines in the recent news was carrying a strain of hepatitis that is very unusual among the ones that commonly affect humans. This strain showed a rat variation of the hepatitis E virus. It is certainly not the first case of rodents transmitting diseases to humans, such as leptospirosis. In fact, the rodent variation of the hepatitis E virus was first discovered in Germany in 2009. And while the Hong Kong doctors have noted that the patient has been cured, this first-known, highly uncommon case clearly shows that humans are not immune to the animal transmission of hepatitis E.

Hepatitis E is found across the globe, but the prevalence is highest in East and South Asia. This virus is more common in resource-poor communities and areas without sources of safe drinking water. In the recently reported headline-making case, the patient’s doctors were not certain about how the rodent hepatitis E virus strain was transmitted, but they believe it may be through contamination of water or food by infected rat droppings.

While this viral infection is self-limiting, hepatitis E poses a high risk with serious consequence to the health and well-being of people with weak immune systems. In fact, according to the World Health Organization, hepatitis E is responsible for 3.3% of deaths due to viral hepatitis in 2015.

Symptoms of hepatitis E infection include: jaundice, pale stools, dark urine, nausea and vomiting, reduced appetite, skin itching and rash, abdominal pain, joint paint, and mild fever. Following exposure to the virus, the average incubation period is 5 to 6 weeks. It is common for people infected by HEV to excrete the virus, at any time from within a few days to 3 to 4 weeks after the showing the initial symptoms.

Generally, since hepatitis E infection is self-limiting, there is no specific treatment, and hospitalization is not required. Antiviral ribavirin may be helpful for those with chronic hepatitis E.

Protect yourself from hepatitis E with these simple strategies:

1. Strict hygienic practices that include hand-washing with clean water before handling food.
2. Ensuring that water sources are up to quality standards.
3. Avoid consuming water from unknown and potentially unsafe sources.

To learn more about this virus, click here

To see the WHO’s guidelines for possible outbreaks, click here

For safe food-handling tips, click here

 The season of hot weather, outdoor fun, and folks gathering up is not quite over yet! In fact, we encourage you to squeeze out the last bit of this season to the end. And with that, we’re guessing – are you looking for tasty and healthy summer desserts that don’t have to be diet gelatin cups, or load up your system with artificial sweeteners? You’re in luck! Here at ADRLF, we make sure to make the most of summertime dining — including having a selection of light and yummy snacks and desserts that are also safe and nourishing for the liver. While there are tons of recipes to choose from, it helps to keep some basic liver health fast facts in mind: antioxidant-rich fruits are your best bet! Anti-oxidants — such as beta-carotene and vitamins C and E — help the liver breakdown toxins from processed food and alcohol, thus ensuring the liver’s proper functionality. Anti-oxidants are often found in fruits and vegetables, particularly berries, which make for great desserts! Blueberries, for example, are nutrient-dense super fruits that pack the most antioxidants compared with other fruits. *Honey, coconut sugar, Stevia, date paste, or, of course, modified amounts of sugar can serve as healthier options to sweeten your homemade treats.    

So, check out these recipes that your family, friends — and your liver — will absolutely enjoy this summer!

PEACH-BLUEBERRY CRISP

 Ingredients

3 cups sliced, peeled fresh peaches (4 to 5 peaches total)

1 cup fresh blueberries

¼ teaspoon ground nutmeg

2 tablespoons flaked coconut

2 tablespoons butter, melted

¼ cup chopped almonds

¼ cup regular rolled oats

3 tablespoons packed brown sugar (*modify or substitute with a natural sweetening option, as preferred)

¼ teaspoon ground cinnamon

½ cup frozen light whipped dessert topping, thawed

Freshly grated nutmeg

Instructions

1. Preheat oven to 350°F. Spread peaches and blueberries evenly in a 2-quart square baking dish. Sprinkle the ¼ teaspoon ground nutmeg over fruit.
2. In a medium bowl combine almonds, oats, brown sugar, coconut, butter, and cinnamon. (Mixture will be crumbly.) Spread almond mixture on top of fruit.
3. Bake for 35 minutes, covering with foil for the last 10 minutes of baking to keep topping from getting too dark.
4. To serve: spoon crisp into serving dishes. Serve with whipped dessert topping and freshly grated nutmeg.

SUPER-SIMPLE SORBET

 Ingredients

1 lb frozen strawberries or 1 lb fruit

1⁄2 cup yogurt, creme fraiche or 1⁄2 cup silken tofu

1⁄4 cup sugar (*modify or substitute with a natural sweetening option, as preferred)

Instructions

1. Put the frozen fruit, yogurt and sugar in a food processor container along with a couple of tablespoons of water. Process until just pureed and creamy, stopping to scrape down the sides of the bowl as needed.
2. If the fruit does not break down completely, add a little more water through the feed tube, a tablespoon or two at a time; be careful not to over-process or the sorbet will liquefy.
3. Serve immediately or freeze for later. If serving later, allow 10 to 15 minutes for sorbet to soften at room temperature.

OATMEAL COOKIE FRUIT PIZZA

Ingredients

1½ cups old-fashioned rolled oats

1 cup white whole-wheat flour

½ teaspoon ground cinnamon

½ teaspoon baking soda

¼ teaspoon baking powder

¼ teaspoon salt

1 large egg

⅔ cup packed light brown sugar (*modify or substitute with a natural sweetening option, as preferred)

Instructions

1. reheat oven to 375°F. Line a large baking sheet with parchment paper.
2. To prepare crust: Combine oats, flour, cinnamon, baking soda, baking powder and salt in a medium bowl. Combine egg, brown sugar, oil and ½ teaspoon vanilla in another medium bowl. Add the wet ingredients to the dry ingredients and stir to combine. (The mixture will be dry.) Turn the dough out onto the prepared baking sheet and press into a 10-inch circle.
3. Bake the crust until golden around the edges, about 20 minutes. Let cool on the baking sheet to room temperature.
4. To prepare topping: Beat cream cheese, yogurt, confectioners’ sugar and vanilla in a medium bowl with an electric mixer until smooth. Spread the mixture evenly over the cooled crust. Decoratively top with strawberries, kiwi and blueberries.
5. To make ahead: Prepare cookie crust (Steps 1-3) and store airtight for up to 2 days.

BLUEBERRY LEMONADE SLUSHIES

 Ingredients

1 cup unsweetened frozen blueberries, thawed slightly

1 cup ice cubes, thawed slightly

2 cups lemonade (using modified or a natural sweetening substitute, if preferred)

Instructions

1. Place blueberries in a blender and blend until pureed.
2. Add ice cubes and crush until pulverized.
3. Place ½ cup blueberry mixture in a glass along with ½ cup lemonade.
4. Repeat with the remaining blueberry mixture and lemonade.

So, before you take out the baking pans and ice crusher, remember that eating anti-oxidant-rich food is among the many ways you can protect your liver. To stay liver-healthy this summer and year-round, be sure to keep ADRLF’s mantra in mind: Screen. Vaccinate. Don’t hesitate!

For more recipes, visit http://www.eatingwell.com

For liver-healthy salads and Dressing recipes, click here

For recipes on refreshing and anti-oxidant rich frozen pops, click here