The holidays are a difficult time for managing your diet. Navigating the day to day challenge of what to eat is difficult for most of us, but it is easier if you understand how things work. That gives you a way to evaluate the advice and the choices that you deal with when choosing what to eat.
A key premise of our approach to food is to try to minimize the amount of work the liver has to do. It is capable of a vast array of chemical tasks, but when it is ill the best strategy is to be kind to it and to ask it to do as little work as possible.
In my prior life, before being diagnosed with NASH/cirrhosis, I was an engineer. Engineers approach problems by first understanding how systems function and what the constraints are. When I was faced with NASH, I needed to lose 30% of my weight. The docs will say at least 5% but I was serious about solving my problem so I went all in. When I was diagnosed, my liver was an S3 steatosis, very fatty. My first fibroscan stiffness reading was 21.5 which is an F4. I was a classic case. Today my liver is completely fat free and my stiffness is 10 which is F2/F3. In this blog I'll explain how I did that, but from a system perspective, not a cookbook.
The variety of diets around the world is spectacularly varied. People function on an amazing variety of different foods. That tells you that your digestive system is extremely versatile and robust. Understanding how that works is the key to judging a particular food that you might eat.
There are a few key things to understand.
- There are two types of fuel that are key to your ability to function
- Fat and glucose are what the body burns for energy
- Complex carbs are best
- Protein is critical
When we look at basic metabolism, we find that the brain mostly burns glucose and the liver and heart mostly burn fat. Those both come from our diet and/or they are produced by the body from our food or from our tissues. The liver manages that energy flow by converting what you eat into short term fuel or by storing it as fat for later use. That is why several small meals is better for youthan a few large ones.
The liver manages glucose carefully in the bloodstream because the brain is very sensitive to the flow of energy. You might think that having plenty of glucose in your diet would be a good thing, but it isn't as you can't really control your blood levels well enough. You can safely eliminate sugar completely and allow your liver to manage its glucose/glycogen cycles using starches and amino acids from the diet. Those are chemically slower processes and deliver an easier workload for the liver. When the circulating calories are lower than what your system needs, the liver pulls fat back into circulation and over time allows you to lose weight.
The low fat diets that are all the rage from time to time are really wrong headed if your liver is ill. Since the heart and liver both run on fat, together they are about 30% of your basal metabolism, cutting out fat from the diet imposes a big workload for the liver as it has to convert a lot of carbs into fatty acids which can be used for energy. A lot of the fatigue patients feel is because their energy systems are not working well. A relatively high fat diet is a kindness to a sick liver. As in all things, too much fat is bad as it must then be processed into fat storage and ultimately re-mobilized, which are both liver workloads. Again, more frequent small meals are kindest for your liver.
There is a lot of confusion about fats. The good fat / bad fat debate is common but it is actually simple to understand. Saturated fats require more processing by the liver before they can be used by the mitochondria for energy. Unsaturated fats are less work and of those, oleic acid, most abundantly found in olive oil, is the easiest for the body to use. We suggest up to 1/4 cup, 3 tablespoons, of extra virgin olive oil a day and 1 tablespoon of fish oil.
Carbs are a basic feedstock for the liver's chemical factory. It is helpful to limit the amount of simple carbs, sugar is the most obvious, as they hit the bloodstream too fast. The more complex carbs in vegetables, beans, nuts, and seeds, as examples, take longer to process so are a lighter workload.
You do, of course, have to get the recommended vitamins and minerals, but they are not part of the energy cycle so they aren't a workload issue. They are important to the function so you have to have them. That goes double for protein for overall body health, so the diet we recommend has significant fat and protein with substantial complex carbs. If you would like more information on the science behind these recommendations, click on this link.
For those who haven't seen it yet, the 2024 edition of our Care Survey is ready. It gives a view of how patients experience liver disease over time, and how contact with medical care evolves. We are beginning to see changes in patient care that are encouraging as the education efforts of patients and physicians begin to show results. I invite you to click on the image below and take a look at the report.
Many people don't know what services are available to them in their local area. Finding those local resources in their local zip code is often a challenge. We are developing a tool to help with that. Just click on the link below: enter your local zip-code in the form: to explore the services available to you in your area.
The Wellness League Local Search Tool
We wish you all a healthy and happy holiday season.
