Exercise and NAFLD

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What Type of Workout should People with Fatty Liver Disease Complete?

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, owing in no small part to the increasingly high rates of obesity in the American population. In a 2019 study published in Gene Expression: The Journal of Liver Research, researchers found that physical exercise could benefit people with NAFLD - including those who had the disease in its most inflammatory form - nonalcoholic steatohepatitis (NASH). In their study, they relied on a moderate exercise routine lasting 20-to-60 minutes for four to seven days a week. The routine included both aerobic and weights/resistance training. Their results showed that the positive effects of exercise were observed whether or not participants lost weight.

Both Aerobics and Strength Exercises are Key

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The Link between Gestational Diabetes and Fatty Liver

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Around one in seven births are affected by gestational diabetes - a severe threat to maternal and child health - as stated by the International Diabetes Foundation. Gestational diabetes is one of the reasons why maternal programs include careful testing and control of glucose levels. The disease can have long-term health effects for mothers and their children, heightening the risks of obesity, diabetes, hypertension, and kidney problems in children. However, one consequence many women do not know about, is that of fatty liver disease.

A 2019 Study Showing the Link between Gestational Diabetes and Fatty Liver

A recent study by Sarah R. Donnelly et al found that women with gestational diabetes mellitus (GDM) have an increased risk of fatty liver disease nine to 16 years after giving birth. This is the case because chronic hyperglycemia is a risk factor for liver fat accumulation and potential liver dysfunction. Specific liver enzymes are created at

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Doctors may underestimate patient pain, But Why?

I was recently asked to talk about the patient view of liver disease by a group known as ICER, A nonprofit group that studies fair drug pricing.  They are working on how drugs for #NAFLD and #NASH might be priced.  The team includes a wide range of expertise which includes some doctors and during the discussion I talked about the fear people experience when diagnosed with cirrhosis or stage 4 NASH.

I was surprised when a primary care doc reported that he didn't see that much fear in his practice which made me wonder why our views of the average patient response was so different.

I think the answer lies in the nature of the relationship.  When we go to a doctor we are dealing with a power figure.  We hope for solutions to our  troubles and we want the doctor to think well of us and to help us.  We want to be a "good" patient and we are more likely to do our best to present our problems and to listen respectfully to what the doctor has to say.  It is a process which engages our attention. Most of us, even if we express our fears, will be reluctant to try to describe or act them out in front of the physician so it has an element of intellectual control even if fear grips us in the doctor's presence.

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Red Meat good - bad ? Another health information debacle

Big news, red and processed meats are now OK.  Another example of how the news and the drive of researchers to publish is making us crazy.  We all remember the butter bad, margarine good mess or eggs bad, no eggs ok.  Health news is designed to be something for everyone.  You can find support for anything you think you might like to try.  Entertaining I suppose and lots of jobs are created but if you are a patient, particularly a liver patient, this is all dangerous.

Here is the latest bombshell that all the talking heads are exploding over.

Red and processed meat are OK to eat, controversial new guidelines claim.

Since you are here you must be interested in liver disease so keep that in mind.  One of the irritating aspects of so much research is they speak about heart, diabetes, and cancer then generalize the comments as though the information is good for everyone.

A major issue here is saturated fat and the claim it is not an issue.  Well, for what they studied that is true.  The heart, for example burns almost nothing but fat and does pretty well with any of them.  Diabetes is a sugar issue and cancer is vastly complex but liver cancer is kind of in a class by itself and they don't address that.

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CBD Oil - Stranger Danger - be afraid, be very afraid

CBD oil is all the rage and many people want to try it. The health hustlers are gearing up to take advantage of the fear of sick people and they have no concern about whether you live or die.

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CBD shows promise but we don't really know the details yet and you can be confident that it won't be a miracle drug for everyone.  The issue today is that you have no idea what contaminants will be in the product you are buying.  CBD is being added to hundreds of products and recent testing is very disturbing.  How about these facts as food for thought?

Recent testing of the top-selling 240 CBD products for 300 contaminants showed 70 percent of them to be "highly contaminated" with heavy metals like lead and arsenic, herbicides like glyphosate (the active ingredient in RoundUp) and a host of other contaminants including pesticides, BPA and toxic mold. One product — by Ananda Hemp — contained levels of lead so high, it exceeded by 100 times what the EPA would consider actionable for drinking water.

 

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SUNN study milestone achieved

In the land of the blind, the one eyed man is crazy ... he sees things that others do not and dreams of things that are thought impossible by the blind.

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We have reached our initial goal of screening 1,000 asymptomatic people who have no diagnosis of having liver disease.  We will be reporting the results in due time but this is a milestone rarely reached by non profits to be the sponsor and to execute a formal study.

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Sugary Foods And Poor Dental Care Increase Risk Of NAFLD

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Your sweet tooth and poor dental care could increase your chances of developing serious liver conditions. People of all ages with poor oral health, bleeding gums or loose teeth, have a 75% increased risk of developing non-alcoholic fatty liver (NAFLD) and liver cancer. Meanwhile, a study by a researcher at the University of California has linked regular consumption of added sugar to a number of serious conditions, including NAFLD.

Fructose Increases Risk of NAFLD

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A Parents’ Guide To Fatty Liver Disease in Children

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Non-alcoholic steatohepatitis (NASH) or non-alcoholic fatty liver disease (NAFLD) affects nearly 10% of children in the US, aged from 2 to 19 years old. The condition has become more common in children over recent decades, partly due to an increase in childhood obesity. Parents and families have an important role in not just spotting signs of fatty liver disease in their children, but in addressing lifestyle and dietary changes in their family to help reduce their child’s risk of developing the condition.

Fatty Liver Disease In Children

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What Diet Should You Follow If You Have Fatty Liver Disease?

An article by Jackie

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There are no medical treatments for non-alcoholic related fatty liver disease, according to the American Liver Foundation – indicating the extent to which a healthy diet and exercise are key to preventing or reversing early-stage fatty liver disease. Far from having to excessively count calories or otherwise follow an intensely strict dietary regimen, people with fatty liver disease can progress significantly by embracing a nutritious, delicious Mediterranean diet. Known as ‘the heart-healthy diet’, it is also rich in healthy Omega-3 essential fatty acids and low in refined sugars, and can be a nutritious tool against fatty liver disease.

Why The Mediterranean Diet?

 

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What to take to the hospital a post by Jackie

Getting Ready For A Hospital Stay

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As many as 30 million American adults have non-alcoholic steatohepatitis (NASH), a fatty liver disease characterized by inflammation and scarred tissue. More commonly referred to as non-alcoholic fatty liver disease, a patient will often have no symptoms and may have only come to medical attention when tests have been carried out for something else. This may happen if an ultrasound shows that your liver looks unusual or if you have an abnormal liver enzyme test. You will likely be required to have a series of tests to determine the diagnosis and severity of the disease. Most of these tests and later any required treatment will likely require a stay in hospital.

Preparing For Hospital Stay

 

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Alcohol and aging a comorbidity of NASH

We don't normally write about alcohol abuse, but for people with an injured liver from other causes alcohol is particularly dangerous.  Since many people have cirrhosis without symptoms they likely won't appreciate the increased risks they have due to alcohol use.  This is becoming a bigger problem for our older population and the link below is to an excellent article from the National Council for Aging Care that is useful even if you are young.

Alcohol is a major part of the culture of the United States. In 2014, alcohol sales—which include beer, wine, liquor, and other alcoholic beverages—totaled nearly $225 billion. The following year, more than 15 million Americans over the age of 18 reported having Alcohol Use Disorder (AUD), known more commonly as alcoholism. That number is even higher among people who haven’t reported the disease or have yet to see a doctor for a diagnosis.

A number of people in that group are seniors. About 10 to 15 percent of people don’t start to drink heavily until they are older in age, according to UCLA professor Dr. Alison Moore. Because of this, alcohol-related emergency room discharges among the elderly reached nearly a three-quarters of a million in 2012. This number—as well as the number of alcoholics who are also seniors—is expected to rise as the senior population grows to 80 million by the year 2050.

To first understand the severity of alcohol addiction among the elderly, though, we must first understand what an alcohol addiction is and can look like.

https://www.aging.com/alcohol-abuse-amongst-the-elderly-a-complete-guide/

 


A NAFLD/NASH review by Jackie

Fighting A Fatty Liver As We Age

When people think of an unhealthy liver, they most often think the leading cause to be alcohol-related, but an even greater concern is Non-Alcoholic SteatoHepatitis (NASH), an abnormal accumulation of fat in the liver which can lead to cirrhosis. In the U.S. about 16.5 million people have NASH, with a majority of sufferers between the ages of 60 and 74 years old according to a 2018 report by the National Aids Treatment Advocacy Project. On the bright side, a fatty liver is a reversible condition at any age that can be managed and minimized by concentrating on healthy diet and lifestyle changes

Recognizing A Fatty Liver

Non-Alcoholic SteatoHepatitis occurs in every age group but is most prevalent in seniors who are more prone to obesity and type 2 diabetes, both leading causes of NASH. An annual blood test is the simplest way to detect a fatty liver along with physical warning signs that include a swollen belly, red palms, a yellowish hue to the skin or eyes and larger than normal breasts in men. Whether the senior with NASH still resides at home or is being cared for in an assisted living facility, there are diets and programs that caregivers or family members can oversee to reduce the liver's size and prevent further damage.

 

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NASH: A Disease without Symptoms but Lots of Hope

What if you had a liver disease but nobody told you until it was too late?

Wayne Eskridge, Fatty Liver Foundation

Wayne Eskridge, Fatty Liver Foundation

Typically, nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are silent diseases. They have no symptoms. Even if cirrhosis has developed, there are often no symptoms until the liver has become so damaged that the only option is a liver transplant.

Early screening for NASH is essential, but obstacles abound. While there is a quick, easy and economical method to screen for fatty liver disease, it is not widely available and screening in the absence of symptoms is often not part of standard medical practice policy. Medical coverage for the test also may not be available if the patient isn’t sick or doesn’t have symptoms.

This article was recently published in Real World Health Care.  Here is a link if you are interested in reading it.

http://www.realworldhealthcare.org/2019/07/nash-a-disease-without-symptoms-but-lots-of-hope/


Time for THE TALK --- oh no!!! not THE TALK

Sorry to those who have been here and are already serious about your health but we have a lot of new people who are trying to understand how to be kinder to their livers and who need to understand things that matter.

Lipid metabolism, big words that mean how does your body use fat.  We see endless articles about fat in our diets.  Endless contradictory claims about special diets, miracle foods, buy my secret pills, doctor invented. blah blah.  Very confusing if you aren't a bio-chemist.

The subject is vastly complex.  In this note I'll try to simplify just one subject that you can have some control over.

There are many paths to the inflammation that is NASH/cirrhosis and a potential killer.  Your food is really a complex soup of chemicals that the body uses to your benefit or tries to defend itself against.  With inflammation or NASH the balance between things that make it worse and those that make it better, in simple terms, determine the outcome of fibrosis and cirrhosis resulting from NASH.

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NASHday was an uncommon event, do you know why?

Since you are on my mailing list you know about NASH, unlike most of the people.  We had the 2019 version of NASHday on the 12th and  as I think about how that event went I am struck by the fact that as a health outreach it was unusual.

I'll explain why but first, the punchline, NASHday was about people's lives and not about money.

We have every kind of "DAY" that you can think of.  Every cause has a day or a month, some peg to hang the cause on and to focus attention. Just as an example, these are the top five unofficial holidays according to toptenz.net.

1.      Black Day.

2.      Autistic Pride Day.

3.      International Free Hugs Day.

4.      Monkey Day.

5.      Record Store Day.

 

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Cost Implications and Medical Assistance for Patients of NAFLD

A blog post by Jackie

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The United States healthcare system spends an estimate of $32 billion annually on the treatment of Non-alcoholic fatty liver disease (NAFLD). Despite these huge figures, not every person suffering from NAFLD is able to receive treatment due to the high medical cost as the state covers just a fraction of it. Although people take health coverage to pay for medical costs, a survey conducted in 2017 showed that 11.3% of adult Americans had no medical coverage and those that have, it is limited to a certain amount leading to patients of NAFLD to seek alternatives to cover the deficit. Sadly, this disease is silent with over 100,000,000 Americans living with fatty liver and are not aware of it.

Cost of Treatment for NAFLD

The annual cost of care for a NAFLD patient that has a private insurance poloicy is $7,804 and for new diagnosis is $3,789 - without treatment. Treatment cost for non-alcoholic fatty liver disease is very high according to a study presented at the International Liver Congress 2019 in Vienna. The annual cost of treating NAFLD has been approximated to range between $20,000 to $100,000 annually based on a study by a group of Israeli researchers. To meet these expenses, many have to rely on loans; however, it’s important to bear in mind that consumer debt is not the same as medical debt, as medical debt is not incurred voluntarily and does not involve credit extension.

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Liver damage and CBD oil

We support health writers who wish to spread their work to a wider audience.  This article was submitted by Natalie Shae.

Note, the study cited in the article was very small with children under physician care but if you are a liver patient it is a cautionary note if you are considering CBD oil.  We are not aware of any research that would suggest using it more broadly but consult your doctor.

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Liver Damage and CBD Oil

June 4, 2019 by Natalie Shae

The FDA has approved a CBD-based drug named Epidiolex®. The drug was researched and made by Greenwich Biosciences, and the company’s vice-president of U.S. professional relations, Alice Mead, has stated to the FDA that CBD is “potentially” a liver toxin. She said this during the FDA’s first public hearing on CBD oil on May 31, 2019.

What is CBD oil?

Cannabidiol oil is extracted from the hemp plant, which is in the same family as marijuana. Unlike THC in marijuana, CBD does not cause a “high” or chemical dependence. CBD that is extracted from the hemp plant is legal, but individual states have laws to regulate it.

Because CBD oil is not considered a drug, it can be a common additive in many products. This includes e-cigarettes (vape oil), lotions and various herbal supplements. It has also been shown to relieve symptoms of different disorders like epilepsy, anxiety and multiple sclerosis.

 

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Do you ever think about the death of self?

About one million Americans have cirrhosis and don't know it.  When they are told "You have cirrhosis, I'm sorry but we have no treatment", the future that they imagined lay before them dies.  It is, in a very real way, a death of self. 

We all know that we will one day die but we hold a sense of how we think or hope our future will unfold.  There is a continuity that flows with the preceding events in our lives as a single journey. If you have no warning, as so many liver disease patients do not, and your first information is that you have cirrhosis, a probably terminal illness, the self that you have known dies.  The life you thought you were living no longer exists and a new unbidden and unwanted future is before you and you must find a way to reconcile yourself with that new reality.

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RESEARCH – How Do I Love Thee? Let Me Count The Ways

with all due apologies to Elizabeth Barrett Browning.

I love thee to the depth and breadth and height my soul can reach.

As a patient, the scale of the effort directed at liver disease that has been put on display at AASLD, EASL and the NASH Summit recently was striking. Not being a veteran goer to this kind of event it was all a bit overwhelming.  As an individual the scope of the activity is very difficult to wrap ones arms around.  Interestingly, there is a great sense of gratitude attached to the experience of observing all of the effort that is being directed toward solutions that might one day mean life or death for me as an individual. The scale of the events is too big for me to digest in a meaningful way but are a powerful testament to the contributions of the health community to the best of us as a society.

I love thee to the level of every day’s most quiet need.

The day to day burden of living with chronic disease, of which cirrhosis is but one, cannot be appreciated by those who are not unwell.  Even those in the profession see mostly the surface and would go quickly mad if they were to allow themselves to be sucked into the suffering of those they care for in any deeply personal way.

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EASL Liver Meeting - a glimpse of the future

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I just returned from the EASL meeting in Vienna. It is one of the two most important gatherings of liver researchers and industry conferences focused on liver disease.  For many years this was a modest affair.  There have always been plenty of ways for the liver to be harmed but there was not much that could be done so, like the liver, the event cooked along in the background.  When the cures for Hep C and HIV were developed everything changed.  When it became clear that liver disease could be cured and that something could be done about the very large disease load peculating through our generations the spotlight turned squarely toward liver function.

Our epidemiological studies have, for years, been showing the burden of disease building in society with our steadily advancing obesity and comorbid problems.  Most of the attention has been focused on diabetes, cancer, and heart disease because we had ways to at least try to deal with these health threats.  The liver, which is a comorbid participant in a wide variety of diseases, was largely ignored because there was nothing medicine could do about the typical liver diseases of NAFLD and NASH.  Even though a stage 4 NASH is 7 times more likely to kill you than diabetes, it remained mostly out of sight because of its lack of symptoms. 

However, today the times they are achangin!

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