FAQ about fatty liver and disease

In the past 20 years fatty liver has increased over 20 times.

100 million American have fatty livers or worse

Do You Care?

As a result of changes in the American diet and the resulting obesity of the average citizen liver damage is epidemic.  The result is that there is a large wave of liver disease moving toward the medical community. A complication is that the damage is usually silent until it becomes life threatening. The average overweight person thinks of being overweight as mostly an appearance issue and not as a very slow but dangerous problem.  Obesity induced liver failure is projected to become the number one reason for a liver transplant by 2020. The Foundation's goal is to help stem that tide. 

 If Fatty Liver disease or its cousins concern you, join the Foundation, its free

Watch this short video for a quick overview of fatty liver disease and how it develops.

Wayne, why are you doing this, really

I am a liver patient and the experience led me to want to do what I could for other liver patients

A:

On the morning of December 23, 2010, after having my gall bladder removed, I was shown a picture of my liver and told I had a stage 4 liver cirrhosis. It was a powerful and frightening moment – one that is seared into my memory. And one that began more than a half-decade of tests, misdiagnoses, and, eventually, lifestyle changes.

I was astonished that morning to learn that my case was pretty typical. Cirrhosis, the final stage of liver disease leading to liver failure, is commonly reached without any warning symptoms. I remember very clearly my doctor’s words: “I’m sorry, but we have nothing to offer. There is no treatment.” My vision of my liver was that of a deadly beast that would kill me. Being told that losing weight and exercising could help didn’t inspire.

Later, the pathology report came in and showed that I did not have cirrhosis, not even fibrosis. Shocker. But in hindsight that report was an error: In 2014 after a series of blood tests I was diagnosed as having cirrhosis as a result of hemochromatosis. That was certainly a blow but at least this kind of cirrhosis, I was told, was potentially manageable with phlebotomies. And over time I had seven liters of blood drawn.

I’m an engineer, so learning about the beast was natural for me. I made it my goal to understand the details. I sought second opinions. I read the research. I got my biopsy slides and got a pathologist to sit at the microscope with me and explain the nuances. Eventually, assuming possible liver failure, I got a referral to a transplant center and went through yet another analysis. I was told I actually don’t have hemochromatosis but I’m a cirrhotic NASH (non-alcoholic steatohepatitis) patient.

By then I understood the diagnostic challenges so I was more prepared than most people for what I heard. And because of my research I had internalized the message of the importance of lifestyle change and weight loss — and I was determined to do everything I could to defeat the liver beast.

The result: I’ve lost 45 pounds with a healthier food strategy without feeling hungry or deprived. Learning about vegetables I’d never tried has been an adventure. Not eating juicy steaks, sugary deserts or other foods I had once loved is doable with a clear goal in mind.

The payoff came during my recent biopsy: All of the relevant tests looked good, and my disease doesn’t appear to be progressing. My wife and I celebrated with a salad.

The tests and various diagnoses haven’t been easy, nor has changing my lifestyle. But I’ve managed to avoid backsliding because I had my research and knew that change could help. For now I’ve shackled the liver beast in my belly, though I can’t help but wonder if yet another twist lies ahead.

What is fatty liver?

A:

Fatty liver is a reversible condition wherein large vacuoles of triglyceride fat accumulate in liver cells via the process of steatosis (i.e., abnormal retention of lipids within a cell). Despite having multiple causes, fatty liver can be considered a single disease that occurs worldwide in those with excessive alcohol intake and the obese (with or without effects of insulin resistance). The condition is also associated with other diseases that influence fat metabolism. When this process of fat metabolism is disrupted, the fat can accumulate in the liver in excessive amounts, thus resulting in a fatty liver.

fatty liver

Fatty liver (FL) is commonly associated with alcohol or metabolic syndrome (diabetes, hypertension, obesity, and dyslipidemia), but can also be due to any one of many causes.

Metabolic
abetalipoproteinemia, glycogen storage diseases, Weber-Christian disease, acute fatty liver of pregnancy, lipodystrophy
Nutritional
malnutrition, total parenteral nutrition, severe weight loss, refeeding syndrome, jejunoileal bypass, gastric bypass, jejunal diverticulosis with bacterial overgrowth
Drugs and toxins
 highly active antiretroviral therapy, glucocorticoids, environmental hepatotoxins (e.g., phosphorus, mushroom poisoning) and many other drugs can react negatively in the liver.
Alcoholic
Alcoholism is one of the major cause of fatty liver due to production of toxic metabolites like aldehydes during metabolism of alcohol in the liver. This phenomenon most commonly occurs with chronic alcoholism.
Other
inflammatory bowel disease, HIV, hepatitis C (especially genotype 3), and alpha 1-antitrypsin deficiency

What is NAFLD?

A:

Non-alcoholic fatty liver disease (NAFLD) is one of the types of fatty liver which occurs when fat is deposited (steatosis) in the liver due to causes other than excessive alcohol use. NAFLD is the most common liver disorder in developed countries.

NAFLD is related to insulin resistance and the metabolic syndrome and may respond to treatments originally developed for other insulin-resistant states (e.g. diabetes mellitus type 2) such as weight loss, metformin, and thiazolidinediones. Up to 80% of obese people have the disease. Non-alcoholic steatohepatitis (NASH) is the most extreme form of NAFLD, and is regarded as a major cause of cirrhosis of the liver of unknown cause. Most people have a good outcome if the condition is caught in its early stages.

About 25% of people in the United States has NAFLD

What is NASH?

A:

Non Alcoholic Steatohepatitis (NASH) is a type of fatty liver disease, characterized by inflammation of the liver with concurrent fat accumulation in liver. Mere deposition of fat in the liver is termed steatosis, and together these constitute fatty liver changes.

There are two main types of fatty liver disease: alcohol-related fatty liver disease and non-alcoholic fatty liver disease (NAFLD). Risk factors for NAFLD include diabetes, obesity and metabolic syndrome. When inflammation is present it is referred to as alcoholic steatohepatitis and nonalcoholic steatohepatitis (NASH). Steatohepatitis of either cause may progress to cirrhosis, and NASH is now believed to be a frequent cause of unexplained cirrhosis (at least in Western societies). NASH is also associated with lysosomal acid lipase deficiency.

NASH is inflammatory but, what is inflammation? Click this link for a short video explanation

What is Cirrhosis?

A:

Cirrhosis is a condition in which the liver does not function properly due to long-term damage. Typically, the disease comes on slowly over months or years.

Early on, there are often no symptoms. As the disease worsens, a person may become tired, weak, itchy, have swelling in the lower legs, develop yellow skin, bruise easily, have fluid build up in the abdomen, or develop spider-like blood vessels on the skin. The fluid build-up in the abdomen may become spontaneously infected. Other complications include hepatic encephalopathy, bleeding from dilated veins in the esophagus or dilated stomach veins, and liver cancer. Hepatic encephalopathy results in confusion and possibly unconsciousness.

Cirrhosis is most commonly caused by alcohol, hepatitis B, hepatitis C, and non-alcoholic fatty liver disease. Typically, more than two or three drinks per day over a number of years is required for alcoholic cirrhosis to occur. Non-alcoholic fatty liver disease is due to a number of reasons, including being overweight, diabetes, high blood fats, and high blood pressure. A number of less common causes include autoimmune hepatitis, primary biliary cirrhosis, hemochromatosis, certain medications, and gallstones. Cirrhosis is characterized by the replacement of normal liver tissue by scar tissue. These changes lead to loss of liver function. Diagnosis is based on blood testing, medical imaging, and liver biopsy.

Why is sugar bad for my liver?

This discussion focuses on fructose and why it is a real enemy of your liver so think high fructose corn syrup. The little secret is that table sugar is 50% fructose so it is not just calories that we are concerned about.

A:

Fructose, or fruit sugar, is a simple ketonic monosaccharide found in many plants, where it is often bonded to glucose to form the disaccharide sucrose. It is one of the three dietary monosaccharides, along with glucose and galactose, that are absorbed directly into the bloodstream during digestion. Fructose is a very sweet, white, odorless, crystalline solid and is the most water-soluble of all the sugars. Fructose is found in honey, tree and vine fruits, flowers, berries, and most root vegetables. Excessive fructose consumption is a cause of insulin resistance, obesity, elevated LDL cholesterol and triglycerides, leading to metabolic syndrome, type 2 diabetes and cardiovascular disease, and fatty liver.

 

Coffee, good or bad for my liver

There is a lot of opinion about coffee but real research is coming in so what does it say.

A:

The pooled results of the meta-analysis indicated that coffee consumers were less likely to develop cirrhosis compared with those who do not consume coffee. For low or moderate coffee consumption versus no consumption hepatic cirrhosis was reduced. Additionally high coffee consumption could also significantly reduce the risk for hepatic cirrhosis when compared with no coffee consumption. The effect of coffee consumption on hepatic fibrosis was summarized as well. Hepatic fibrosis for coffee consumption versus no consumption was significantly protective. The protective effect of coffee on hepatic fibrosis and cirrhosis was also identified in subgroups of patients with alcoholic liver disease and chronic hepatitis C virus (HCV) infection.

CONCLUSION:

Coffee consumption can significantly reduce the risk for hepatic fibrosis and cirrhosis. Here is a link to the study.

https://www.ncbi.nlm.nih.gov/pubmed/26556483

There is also research which shows that how coffee is brewed.  It is important to use a paper filter to eliminate some harmful substances.  This link is to that research for those who want the detail.

http://www.medscape.com/viewarticle/827617_3

 

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