Hopefully you clicked on the picture to hear the very short quote from Shakespeare.  Sometimes I can't resist a bit of drama.

Since you have an interest in liver disease, I wanted to let you know that we have reached a real milestone in the development of the foundation.  We intend to help change the way liver disease, particularly NASH, is managed and to save the lives of millions who do not know today that they are at risk.

There are some benefits to being an advocate.  Sometimes you get to be first. We just finished training and certifying our staff to do FibroScan tests.  As part of that I got to be the first one tested.  Getting to this point has been a long journey, about 9 months, so a birth of sorts though happily a painless one. Everyone shows off baby pictures, here is beauty for anyone who hasn't seen a FibroScan report. This is my new scan. Click on it if you'd like to see the full size view.

Although this note is about our screening project, it is also an opportunity to reinforce our view that with lifestyle changes it can be possible to improve liver health, even for a cirrhosis patient. 

In every battle there are moments which mark the end of an era. They portend the beginning of something new and a time when tiny things can sprout and grow to a vast scale. Sometimes analogy man gets loose in my mind and I apologize in advance, but I'm drawn to the stories of things that speak to universal truths. Did you know that the biggest living thing on earth, the giant redwood, grows from one of the smallest tree seeds? The Wellness League may be that tiny seed that just grows.

I recently wrote about my view that for the first time a cirrhosis patient could look forward to real medical therapies.  A few folks felt that I was planting false hopes and that such miracles weren't going to happen.  In light of that, I thought I might provide a broader view of the situation today.

Some of you are old enough to remember that not so long ago Hep C was unknown.  We called the illness non A non B hepatitis. Today we have a cure. A miracle perhaps but also a lesson.

For cirrhosis patients there has always been a doomsday clock.  We all know that there are no treatments and only a transplant can save us.  Transplant is on the mind of a lot of us but what do the statistics say?

OK, get ready. BORING government statistics coming. Sorry, but sometimes it is really important to know what is happening to our children.

Statistics from the CDC, from 1999 to 2016, annual U.S. mortality from cirrhosis increased by 65% from 20,661 to 34,174. Let that sink in for a minute. What if we chart the rate of change of various disease.  Not the number of patients but how it is changing.  Look at this chart for a minute. This shows how fast things are changing and those liver statistics are horrifying.

If so, you are not alone. This is a link to some patient education materials we are working on as part of our mission to bring the problem of liver disease into the public discussion.

A personal journey with NASH, things you need to know.

The Fatty Liver Foundation exists because I was not willing to be a well behaved member of the parade of misery that liver disease is becoming for our society.  My bucket list includes not dying of liver disease. I do a review from time to time for all the new people. Hopefully it is of some benefit to the old timers, but lets step back and think about our goals.

It is said that death and taxes are the only constants but we should include the Law Of Unintended Consequences as a universal truth.  For patients this is particularly true.  We want to be well but every decision carries the potential for things we didn't expect.

How bad is it? It has been projected that today's children will be the first generation in history to have a shorter life span than their parents. Even with the rapid advancement of medicine the society is becoming less well and chronic disease in many forms is epidemic. Even if we live longer, the end of life when we suffer and die slowly and painfully is getting longer for many.  Not the ideal trade off perhaps.

I bet you didn't know you had a Bliss Point, but you do, and it is being manipulated every day by strangers in white coats.

Not to be confused with the G spot, the Bliss Point, is also a source of pleasure but it can become a pathway to disease and death.

The Bliss Point is a concept developed by food researchers.  This is the industrial food industry at work.  The way we perceive most foods is by the combination of salt, sugar, and fat which we interpret as "tastiness".  That perfect combination satisfies our brain and makes us feel good and we "like" that particular food. Well whoop di do, that seems like a good idea, who could object to good tasting food?  Well, none of us really, but how might our response to food be used against us?

Just a brief programming note.  I spent this morning doing a radio interview tour around the country talking about liver disease.  I was working with Ann Moore, a nurse practitioner specializing in liver disease.  We did interviews with 17 internet only  and live radio stations in an effort to educate the public broadly about liver disease, the need for early detection, and the role of the foundation.

Most of the interviews were live to tape so I don't know when they will air, but if you listen to any of these stations perhaps you will get a chance to hear them.

Last year I wrote about an experience I had while out jogging.  I persist in believing that the doctors know what they are talking about regarding exercise and liver disease so it is a subject that comes up from time to time. For anyone who is interested in the challenge of self image versus father time, here is a link to that earlier item which you might relate to.

I was out on the greenbelt yesterday and there is a nice spot near the river where people like to stop and rest or reflect. I had stopped there and a young woman came running along and also decided to take a break.  Surprisingly, she recognized me as the old guy that she had passed last year and we had a few chuckles about the event.

First I apologize if this gets too technical.  I usually try to provide information in some hopefully entertaining way but sometimes I have to dig into the details because they are important.

An article in the current New England Journal of Medicine has this article.

Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts

This demands a bit of background since we are a liver disease group and the report is measuring cardiovascular disease.  There are studies of olive oil and liver disease but generally they are not as long or big as this one and many studies lack the rigor. You should also remember that liver disease is the master of co-morbidity.  It is generally not understood that cardiovascular disease is the number one cause of death related to cirrhosis.

I talk a lot about the problems sugar causes for the body. If you had to pick one reason for why your kid's generation will die younger than yours and be sicker in old age than they should have been you could do worse than pick a soda.  We have a very curious relationship with sugary drinks.  We will happily drink a 16 ounce soda and easily serve it to our kids.  No parent or other apparently rational person will sit down and eat 10 teaspoons of sugar and yet that is a common amount in our soda.

This is a small diversion, but

did you ever wonder how to kill a rat with food?

Remember from prior blogs, that fibrosis forms first as long strings that associate over time and are eventually arranged into a very stable triple helix that is zipped together by vitamin C.  There are many kinds of collagen in your body and they have different characteristics depending on their specific chemistry.  The progress of cirrhosis is determined by how that collagen forms and matures.

As a way to think of it, collagen is a cousin to the plastics that are everywhere in your everyday life.  They are polymers which are large groups of similar molecules that link together.  Like many collagens in the body, those in the liver are flexible and stretchy, think skin as an example, when they are formed.  It is the nature of many polymers to take some time to "cook", that is to form the structure and then to cross connect to other molecules nearby.  They attach to each other in dense mats which leads to the kind of tissue you see in a scar in your skin. It is basically a "mat" of fibers.  As those mats get thicker and stronger they begin to destroy function in your liver and we call that cirrhosis.

So many of us take supplements, pills, potions, elixirs, lotions, bromides, miracle secrets from the ancients, super foods, substances of all kinds, as well as what our doctors prescribe, and with all of them we are told they are good for us.  We are mostly immune to the cautions about side affects and don't even consider how much we don't know as we swallow that bit of magic that will help us be well.

I'm an engineer, not a doctor so I can ask you a what if question, which you, as a smart person can consider.  What if one of the pills that everyone thinks is good for you can kill you by destroying your liver slowly?  Would that be something you would think about?  If you will stay with me here for just a bit I'll tell you a story about how some well intentioned advice may kill you.

In my last note I talked about how collagen forms to become a deadly enemy for your liver.  To be clear collagen is a very good thing.  Much of your body is made of it.  You couldn't exist without a robust collagen process. But like so many things, too much in the wrong place or time and the engine of life starts to fail.

Remember this process where the initial fibers of a blood clot wind themselves into a very tough triple helix which eventually destroys your liver as tough scar tissue?

Sometimes what everyone knows is just wrong.  Can cirrhosis improve? Care to join me for a walk down cirrhosis lane?

First what is cirrhosis? In simple terms, it is the formation of scars everywhere in the liver which causes it to fail.

OK, what then are scars?  We all know them, we can see scars on our body where we have been wounded.

When liver cells are injured the same process occurs as when you cut yourself.  Scar forming processes move in and try to repair the wound. This happens at the cell level so scar tissue forms everywhere within the liver and when it gets bad enough to disrupt the normal function of the liver we call it cirrhosis. That leads to ESLD, end stage liver disease, and death.

So what is a scar really? In the liver, inflammation is a typical culprit.  Something, lets say too much fat or alcohol for example, damage liver cells and some of them die. That degeneration of cells causes clotting processes to start and platelets and the other wound healing chemicals move into the area.  This process is crucial to your health but it is a balancing act.  If the debris removal systems are able to clear out the dead cells all is well and that brief episode of cell death and inflammation is gone and all is well.  Liver cells die by the millions every day and this is the normal process.

An ironic curse with the clear implication that 'uninteresting times', of peace and tranquillity, are more life-enhancing than interesting ones.  Another cautionary message is 'be careful what  you wish for', and yet another 'fools rush in where wise men never go'.

Cliche man is here apparently, but the old warnings aren't necessarily wrong.  I want to let you know that the foundation has entered an 'interesting time'

We have been greatly honored with support and now it is time for us to stop talking and start dancing.  Intercept Pharmaceuticals has agreed to provide the first funding for our screening program and we plan to open our first pilot facility in Houston in the summer.  For those who have joined us recently, we advocate building 400 screening centers across the US and to screen 1 million people a year who are at risk for liver disease from the large co-morbid (people with multiple diseases) population.

When I think about screening for liver disease I often find that tune from My Fair Lady, "Why Can't A Woman Be More Like A Man" running through my mind.

It is an odd mental tick I suppose. One of my favorite musicals connecting to a potentially terminal illness, but the challenge we face as liver patients would largely vanish if only a liver was more like a breast.

OK, I stretch the analogy a bit here but consider how cancer is managed.  We search diligently for cancer and while there are significant differences between cirrhosis and breast cancer the statistics are interesting. There are around 40,000 deaths annually from each disease, but we search out the tiniest incidence of breast cancer that we can find and manage it aggressively but we ignore liver disease until it presents serious symptoms.  Think about that for just a moment.  Why would we test breasts regularly but intentionally ignore early liver disease?