TRIAL: A test to determine whether the species will create new organ designs to accommodate chronic over feeding or fail and result in mortality and long term decline. The alternate endpoint, increased intelligence in feeding strategies.
The test subjects all like sugar but dietary advice mostly says give it up. The question, what really happens when they eat excess sugar over time?
OK, but sugar is glucose and it is known that glucose is a fundamental fuel so what is wrong with that? Let's take a walk down bio-chemistry lane. Just a peak so easy peasy. This is really important if one has concerns about livers so don't run away yet.
First, sugar is not glucose. Sugar is a marketing term. It is actually two sugars that are joined together with a weak bond. One is the familiar glucose, the other is the mysterious fructose. The combination is called sucrose but we all love it as sugar. Surprisingly both of these have exactly the same chemical formula and are 6 carbon chain molecules.
Details shortly but an interesting factoid is that glucose is barely sweet. What you taste is mostly fructose when you eat sugar. On the sweetness scale glucose is a 75 but fructose is 175. This isn't important to the chemistry but tells you something about food marketing. Take a look at how the 6 carbon molecules are actually connected, that is the key to the mystery.
No need to go into the details, but that small difference at one end means that these almost identical molecules participate in different chemical reactions. In this case it means that after the bowel breaks them apart, glucose can circulate freely in the blood but fructose will be trapped by the liver. Glucose is available as fuel directly but fructose will be converted mostly to triglycerides by the liver and can overload it with fat. Too much glucose carries its own problems but this is why excess sugar is particularly bad for your liver. See, it is simple really.
OK, but why does everyone say to eat fruit? That is full of sugar. I love this question. All of the experts have punted that and just say that because the fruit is natural all of the other values in the fruit make it OK to eat. It turns out that ain't necessarily so. Remember, you are the transport system the bowel has constructed over eons to deliver food to it. The bowel is very wise and it always knew that fructose was a potential problem so it built in the ability to convert fructose into glucose in the small intestine before it enters the bloodstream. If the science interests you here is a link to the study.
OK, problem solved. We like sugar but as food it is hard to get, right? Well that was true earlier but in the past 200 years the consumption of sugar has increased about 100 times. The lesson, if you eat fruit like you are supposed to and don't go crazy with sugar your bowel will be happy with you. The bowel made a mistake in design, however, and didn't provide a stop signal when too much fructose was coming in. A bug in the system if you would like to thing of it in modern language so consuming more fructose than the system can manage is easy to do.
THE CLINICAL TRIAL OVERVIEW
Sometimes we step back a bit and look at the world more broadly. Consider that nature cares not at all about you individually. We have a fierce attachment to ourselves but nature built a very sophisticated body over a few million years and we have recently been running an experiment to see if over feeding is harmful. We have assembled a test group who practice obesity and there is a control group who do not. It is a fairly long experiment from our perspective but nature isn't bothered by time. Rather like researchers with their mice, just as an analogy.
So we have a free feeding experiment where nature will learn whether the bowel will build an organ able to handle lots of fructose without failing or will the test group fail to thrive. It is an interesting test because it is also an intelligence test. It is studying whether the obese group will choose to modify its feeding strategy in the event that the practice is harmful. If not that group will eventually be sacrificed. Their deaths will be humane we hope but the fate of failed experiments is usually not a kind one. The alternative endpoint may be that evolution creates a design that can process excessive sugar successfully. Like any good researcher nature cares not that a test fails as it moves the field along in the process of finding a better way. Some of the individual bowel transporters do have strong feelings about being in the bad part of the test but research sacrifices test subjects routinely so nature can't really be too concerned with those individual views.
This particular clinical trial is in its early signup stages. We currently have about a 30% participation in the obese group. Ideally we would like to see a 50/50 split. Of course, it is still possible to withdraw from the study. No one is required to be part of the obese test group. Since it is a free feeding model all you have to do is not participate. Your decision will ultimately be recorded in the mortality data.
Nature thanks you for your participation.
Improving together the medical learning about NASH to better address its causes and consequences and serve patients.
The NASH Education ProgramTM defines and drives initiatives in collaboration with an independent scientific committee² composed of four international key opinion leaders, well-known and respected in the field, with a footprint in both hepatic and metabolic diseases, and a strong presence in the United States as well as in Europe.
The objective of this public health initiative is to place the practitioner and the patient at the heart of tomorrow's awareness and education actions. It aims at producing essential and relevant scientific and medical knowledge, and at disseminating it towards targeted audiences:
- > All physician specialties, going beyond hepato-gastroenterology, i.e. including diabetologists, endocrinologists, obesity specialists, cardiologists, OB-GYN and general practitioners who will all have a key role to play in the clinical management of NASH patients;
- > Patients and their families, but also individuals at risk, who all need to understand causes, mechanisms and consequences of the disease, to fully appreciate the importance of an early diagnosis and a treatment well-suited to their condition.
Diet guidelines NAFLD or NASH
The strategy – be kind to your liver - Food as medicine
1. Eliminate alcohol
2. Eliminate trans fats
3. Eliminate refined sugar and refined grains
4. Eliminate fructose other than that in fresh fruit
5. Reduce sodium to 1,500 mg per day
6. Minimize saturated fats to < 10% of total calories
- No red meat, moderate pork and poultry
7. Increase unsaturated fats to > 30% of total calories
- Extra virgin olive oil the main dietary fat, avocados, canola oil
- Eat fatty fish like salmon and sardines regularly
8. Do not diet, eat large amounts of plant based foods, all kinds of vegetables and moderate amounts of fruit daily
9. Eat a wide variety of beans, nuts, and seeds
10. Eat fiber rich foods like whole grains and resistant starches like parboiled and cooled rice.
The value of regular exercise can’t be over emphasized. A regular and varied pattern of physical activity is vital to liver health and not just as an aid to weight loss. Without exercise you will probably fail to manage your liver disease.
A WORD OF CAUTION
When you think about your diet remember that there are no shortcuts, super foods, magic pills, quick fixes or cleanses that will work. Your liver works every second of every day and what matters are your habits and what you do day by day for years. If your goal is liver health do not diet. Change the way you eat from now on. Lifestyle change really means for the rest of your life and there are no quick answers.
The four horsemen of the apocalypse. The vision of death and destruction for humanity from the new testament is a chorus of the woes that can befall society. It evokes hazard from all directions bringing misery and the pale horse called death.
When you come to grips with the health aspects of liver disease it is a surprise to learn that our understanding of our bodies as an integrated system is so poorly appreciated. The mix of chemical processes that are done routinely by the liver cannot be duplicated by our chemists. It is estimated that over 500 functions are performed by the cells of the liver and they affect every other kind of tissue in the body. Imagine that, all of that activity in a cell about one fifth the width of a human hair.
If you believe in miracles that is one to consider. Chances are you abuse your liver constantly without even considering it. Nutritionist Victor Lindlahr coined the phrase "You are what you eat" in 1942 but we pay little attention to that as we attempt to become sugar, salt, and alcohol. Your liver fights to keep you healthy but eventually your daily attacks wear it down.
I think of it rather like an abused wife who is beaten every day but trudges on until one day she has had quite enough and decides to do a Bobbitt on you. ( For anyone not a news junkie that was a wife who cut her abusive husbands penis off ). Once your liver starts to fail it affects all other organs in your body in some way. It is the common comorbidity of a very long list of disease conditions. Keeping it healthy is probably the single most important non medical thing you can do to give yourself the best shot at a quality of life as you age.
You don't have to be a food fanatic to treat your liver kindly and thereby add years to your life. It works very hard to protect you so just a modicum of care can save you a lot of pain in the end.
I recently attended the meeting of the AASLD, the American Association for the Study of Liver Disease, which is a group of world leaders in research into liver disease. I was very encouraged by what I heard there and I've been wondering how to explain that to the community dealing with disease.
Fatty liver has mostly been dismissed as a medical problem because it was often benign and even if it wasn't there was no treatment anyway so dealing with it was a matter of waiting until some organ showed symptoms and try to deal with those until you die. Many doctors today leave their patients with that feeling of hopelessness with the phrase, I'm sorry but we have no treatment.
There are two very important points that I want to make. First, it isn't correct to say there is no treatment. Diet and lifestyle have been well proven to be treatments and there is a lot of information on our website about diets. If you want to review, here is a link
More importantly, we live in a very fortunate time because medical knowledge is advancing at a torrid pace. I've struggled to put that into perspective and decided to relate a discussion I had with Dr Peter Traber, the CEO of Galectin Therapeutics, one of the companies researching liver disease treatment.
Dr Traber is also the author of the blog, LiverLine, which I suggest you read. It is excellent. He was relating the changes in health care over his career. His example was Hepatitis C. When he began his career the virus was unknown. Over the course of several decades it was discovered and even though it was very difficult a cure was developed and now we can defeat that disease. His observation of the state of liver disease research is that we are now on the brink of developing real treatments for liver disease. Even a veteran researchers like him is impressed by the speed and quality of the work being done on liver disease today.
There are over 400 drugs being actively evaluated and only a few will turn out to be of value but the research community is confident that they now know enough to be sure that we will get useful therapies in the next several years. The message for current patients is that for now diet and exercise are your only friends but help is on the way so a hopeful attitude is also part of the therapy.
Historically fatty liver was viewed as being mostly benign. The theory was that while liver fat might make the organ vulnerable to other problems it was, after all just normal fat. This view naturally led to medicine focusing on other problems where symptoms existed. I thought that view made little sense if only because fat people died younger but the science wasn't there so that remained the story.
Research is now coming out which shows that a fatty liver is an active cause of disease in other organs. Did you ever wonder why people frequently get fat then get type 2 diabetes? Consider all the effort devoted to diabetes in the management of the symptoms and the long term medical needs. German research has now shown that a fatty liver begins to produce different secretions, such as one called fetuin-A, into the blood stream. Those substances enter other organs and trigger reactions there.
This image from IDM shows pancreatic islet cells surrounded by fat cells. The study was reported in Science Daily at this link but I'll summarize it below.Read more
The foundation was spawned out of my personal journey through undiagnosis, misdiagnosis, and finally a stage 4 NASH so I've chronicled my journey through our website. I just completed a checkup at the transplant center and now that we are two years into my treatment plan I am starting to get enough data that might be helpful.
I do have some very encouraging results to report. In 2015 I had an MRI elastography which reported my liver stiffness as 4.8 kPa. Their scale shows that to be a stage 3 moving into full cirrhosis which they start at 5.0 kPA. My biopsy called it cirrhosis and I also had a fibroscan that year which read as 21.5. Anything above 12 is considered to be cirrhosis. A long way around to say I really do have a liver in trouble even though I have never had a symptom of any kind. Go figure.
There are many ways to support the efforts of this foundation. General purpose donations are welcome from anyone concerned about public health in general or liver disease specifically. At the program level we invite sponsorship in the following ways.
The Diamond level sponsor supports the operation of our screening and clinical trial registration project with a minimum of $100,000. Up to 5 diamond sponsors may cooperate to fund a van and they will be featured prominently with logos on the van and information in all of our media efforts promoting their support for public health.
The Gold level sponsorship is anyone who contributes at least $50,000 to the foundation in general support but these sponsors do have the opportunity to direct their contributions to be dedicated to particular projects in partnership with the foundation. The van based screening project is our most visible patient outreach program but there are many needs within the obesity, fatty liver, and cirrhosis challenged patients that benefit from efforts surrounding the van events.
The silver level sponsor has provided a contribution of at least $25,000 which will be used for general and administrative expenses. Silver level sponsors will be honored on the company website with a display of their logo and links to their webpages for more information.
Bronze level contributors have provided contributions of at least $10,000 which will be used for general and administrative purposes and they will be honored on a page of our website recognizing their contributions.
Blue ribbon contributors have supported our efforts with at least $5,000 and these funds will go mostly toward internal non program expenses as they will be consolidated with smaller donations but they will be recognized on our blue ribbon page.
Green level contributions are all those less than $5,000. These represent the real public support of the foundation. Like the fertilizer that helps plants grow, the organic contributions of the public at large are the most valuable as they represent the patient and caregiver groups to which we dedicate our efforts.
Whatever level of support you can give will be greatly appreciated and will be used to maximize its benefit to the current and future patients of liver disease and the complications of obesity which is at the heart of most fatty liver disease.
This is an overview of our site. Liver disease is complex and we invite you to study it but if all you want is a quick summary the site probably isn't for you
I Was shocked to learn I am a cirrhosis patient and because of that I became a patient advocate. I decided the best way to have a voice was to create a non-profit foundation. If you are here, you or someone you care about, is obese, is ill, has or is at risk for liver disease or a co-morbidity associated with it. Obesity is a major cause of the problems. You won’t care about this topic except as a health or diet issue.
This site is not trying to sell you anything.
This is what you will find here:
- Non-technical explanation of how your body actually works
- How the liver develops disease over time
- Why fats are a critical source of fuel for your cells
- How the liver manages triglycerides
- How the course of fatty liver disease depends on triglycerides and carbohydrates
- How the kind of dietary fat you use matters
- Information by a liver patient for liver patients
- Information about diet based upon bio-chemistry not fads
We are a nonprofit foundation and we do not represent anyone but the patient. If you are looking for advice on supplements or quick fixes this is not the place for you. We offer extensive information about the body in general, the liver specifically, and we recommend lifestyle strategies that have worked for me specifically and which I believe are valuable for anyone concerned about liver health to be familiar with. The strategies are also the best we know of for weight control and management. If you struggle with weight you need to understand how the body works rather than just buy expensive stuff from the guru of the month. Our goal is to help you understand the problem so that you can deal with it effectively.
This site offers you extensive opportunity to add your own comments and experiences to the pages. We invite you to add your own thoughts if you would like to. Patient and caregivers stories are especially helpful to other sufferers.