Liver cancer mortality rates resulting from cirrhosis are increasing and in the coming decades will become a leading cause of death.  Liver cancer has increaesed 300% since 1980 in step with the obesity and fatty liver disease epidemics. It is currently the 5th most common cancer in men and the 8th in women but increasing rapidly in both sexes.

If you know someone at risk consider passing this information along.

“Liver cancer death rates are increasing at a faster pace than any other cancer. A major factor contributing to this increase is the comparatively high prevalence of hepatitis C virus (HCV) infection among those born during 1945 through 1965, also called ‘baby boomers.’ The sustained rise in obesity and type 2 diabetes over the past several decades has also likely contributed to the increasing liver cancer trend,” Farhad Islami, MD, PhD, from the American Cancer Society, Georgia, and colleagues wrote. “The incidence of liver cancer varies by race/ethnicity and state, mainly because of differences in the prevalence of major risk factors and, to some degree, because of disparities in access to high-quality care.”

These are among the reasons that we are developing our mobile liver van. Many at risk people never have an opportunity to be evaluated for fatty liver disease and the problem is worse for women and ethnicities.  By taking our service directly to the people we can do our small part to reduce these problems

Average yearly rate of the attacks doubled in people with the liver disease

From Cornell -- Cirrhosis -- a stiffening of liver tissue that's often tied to excessive drinking of alcohol -- may also raise an older person's odds for a stroke, a new study suggests.

"In a nationally representative sample of elderly patients with vascular risk factors, cirrhosis was associated with an increased risk of stroke, particularly hemorrhagic stroke," wrote a team led by Dr. Neal Parikh, of Weill Cornell Medicine and New York-Presbyterian Hospital in New York City.

Hemorrhagic or "bleeding" stroke comprises about 13 percent of strokes and occurs when a blood vessel ruptures, according to the American Stroke Association. The majority of strokes (87 percent) are ischemic -- meaning they are caused by clots.

In the new study, Parikh's team tracked 2008-2014 data for more than 1.6 million Medicare patients older than 66.

The research showed that while just over 1 percent of people who did not have cirrhosis suffered a stroke during the average year, that number jumped to just over 2 percent for people with the liver disease.

The study couldn't prove that the cirrhosis actually caused any of the strokes. According to the authors, possible explanations for the association between cirrhosis and increased stroke risk include impaired clotting ability. Or, patients' heart risk factors may be exacerbated by cirrhosis and the underlying causes of cirrhosis, such as alcohol abuse, hepatitis C infection and metabolic disease, they said.

Unhappiness with modern medicine is becoming pretty common, at least our ability to tell the stories has expanded.  The internet has become the campfire we sit around and share the tales of our lives and as our expectations of medicine have grown our impatience with its problems has flowered.  In the liver community the stories of delayed or missed diagnosis, lack of communication, hurried explanations, and fear of the future are common.  Some of that kind of stress led to the creation of this foundation as I went through years of being told I was OK when that just couldn't be really true. At times the anger I felt post diagnosis about my loss of time and life energy was heavy on my soul.  I'm perhaps a bit wiser now as I've been able to understand the bigger picture and the challenges doctors face with the limitations of our tools and the mindless bureaucracy that has bound us all in soul searing edicts.  I recently found a wonderful blog by a doctor who speaks of his profession with a clear eye but unbounded humanity.  I'd like to share one of his posts with you and encourage you to get acquainted with his work.  He is Dr Jeremy Topin and this is a link to his blog

https://jtopin.wordpress.com/

I want to share a little from one of this entries called "Walk with me".

Walk with me, why don’t you? It’s about time, don’t you think? We have been avoiding this for quite a while. But it is best to bring this out from the shadows and into the light. Let’s take a walk… Thru a part of my day. But be careful. You won’t like what you see. Push open that door. Let’s take a peek. Could have been a lot of things behind “door number one” but probably best we start here. Walk inside. She won’t mind.  Yes. I assure you she is alive. I am very good at what I do and what I am doing for her is keeping her alive.  This can be hard. One might say it’s just semantics, but I do believe in the power of words. “Keeping someone alive” sounds good. Feels good. Invokes heroism and strength and knowledge and courage and bravery. But I promised to be honest. And honestly, she is alive. Because I am preventing her from dying. Because if you get rid of the fuzzy and you really take a look here… you would be hard pressed to say she is living. Alive yes. Living no. You looked, you know that although she is alive, she is not living.

What we have here is “a failure to communicate”. But to be fair, there is more to the story than just poor bedside communication skills between the doctors and her family. I mean I am a doctor. I am her doctor. And being biased, I view myself as a decent human being. Empathic, compassionate even. So there must be more to the story.

Family. Each bring to this room layers. Years of complicated relationships filled of love, hate, resentment, guilt. Overtones of religion and cultural bias.  Pre-conceived notions of health, life, disease, prognosis with variable degrees of inaccuracy. And in this powder-keg, we will add the specter of death as an accelerant. We don’t know any of them. The chances of having any relationship or trust prior to crossing that threshold are slim to none. But I am supposed to guide this family, with these layers, to a better understanding of what lies ahead for mom or dad or sister or brother. Five minutes maybe? How about ten? Not really a lot of extra time in my day to work thru this mess. Virtual piles of notes and documentation still to be done.  Beware of the son who knows it all. Beware of the daughter who doesn’t trust doctors. Beware of the child from the coast who hasn’t seen mom in years and decides to play an active role now. Beware of giving any information that contradicts any given prior that will fuel the seeds of mistrust. Beware of the primary MD or the consultants who give updates. Now you think you can do this in 5 minutes?  10 minutes? A day? A week? Would you sacrifice going to your son’s baseball game to work through this? How about your daughter’s musical recital? Do you skip your lunch when you haven’t had breakfast? Best to kick that can down the road a little bit.

I frequently talk about how to test for or stop liver fibrosis but it is also important to understand how to manage it.  An important consideration is that the disease is usually symptom free until it is severe and there are a lot of medical tests that are needed to manage secondary problems.  It is valuable to know when a particular test would be useful in order to avoid the cost, discomfort, and risk associated with many of them.

The American Gastroenterolgy Association recently released guidelines for how to use Fibroscan to decide whether the liver disease is advanced enough to consider testing for complications of portal hypertension or esophageal varices.

It isn't common to be able to report really important clinical research results where liver disease is concerned, but today is one of those days.  Intermountain Hospital's lead researcher and associate director of the medical center's transplant program, Dr Charlton, announced their results at a Czech medical conference.  The study found that seriously ill patients who exhibited a positive reaction to the drug sofosbuvir were also 50 times less likely to die from severe cirrhosis, a liver illness usually brought on by hepatitis C or alcoholism, than similar patients never given the drug.

Why do I get so tired? Even when I don't feel sick I am sooo tired.

Is there anything I can do? It just seems so hopeless.

OK, lets take a look at this.  Fatigue is common to a lot of problems, but with liver disease it makes everything much harder.  These comments will apply to a lot of fatigue issues but I'll refer to liver in this discussion.

When you think about energy you have to forget that you like to imagine yourself as a "person".  You have to understand that at the core of your problem you are a bunch of mitochondria.  These are small, self contained structures that float inside of your cells.  They are the focus of this discussion because they are the power source of the cell.  There is a vast and very complex chemistry that does its magic to allow you to live but at the root of everything is energy.  You eat to get fuel for your body but ask yourself just when does that fuel turn to the energy?  What the heck is energy anyway?  Ah, there you have it. That is the nut isn't it? when you feel fatigue, even when you eat good food, why doesn't it work for you?

Since the function of the liver is so very complex, it should not come as a surprise that it can play a role in a vast array of diseases.  Like so many problems, psoriasis has been treated symptomatically as a skin problem but research is now coming along which links it to more profound causes and suggests that addressing liver damage may be the best way to treat psoriasis.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5209456/pdf/PG-11-25606.pdf

 Psoriasis is a chronic inflammatory disease that affects the skin. Studies have shown that psoriasis is not merely a skin problem; psoriasis is linked with various comorbid conditions, especially obesity and metabolic syndrome [1–5], which are known risk factors for non-alcoholic fatty liver disease (NAFLD).

The amount of alcohol required to produce hepatitis or cirrhosis varies among individuals, but as little as 40 g/day (Table 1) for 10 years is associated with an increased incidence of cirrhosis. There is considerable evidence to suggest that females require less total alcohol consumption (20 g ethanol/day) to produce clinically significant liver disease.

Patients with cirrhosis who were treated with human albumin experienced improvement in a number of outcomes, including overall survival, compared to standard therapy, according to data presented at the International Liver Congress.

“Long-term albumin administration to patients with decompensated cirrhosis could be seen as a disease-modifying treatment,” Mauro Bernardi, MD, of the University of Bologna, in Italy, said in a press conference. “At the moment, the only curative approach is transplant. Treatment to influence the survival of these patients is most needed.”

A new study of how the different saturated fats produce different illnesses

Saturated fatty acids induce development of both metabolic syndrome and osteoarthritis in rats

The predominant saturated fatty acids (SFA) in human diets are lauric acid (LA, C12:0) from coconut and palm oil, myristic acid (MA, C14:0) mainly from palm kernel oil, coconut oil, and butter fat, palmitic acid (PA, C16:0) naturally present in butter, cheese, milk, and meat , as well as cocoa butter, soybean oil, and sunflower oil and stearic acid (SA, C18:0) abundant in animal fat (up to 30%) , cocoa butter and shea butter.

The aim of this study was to investigate whether diets containing individual SFA together with excess simple carbohydrates induce osteoarthritis (OA)-like changes in knee joints and signs of metabolic syndrome in rats. Rats were given either a corn starch diet or a diet composed of simple carbohydrates together with 20% LA, MA, PA, SA or beef tallow for 16 weeks. Rats fed beef tallow, SA, MA or PA diets developed signs of metabolic syndrome, and also exhibited cartilage degradation and subchondral bone changes similar to OA.

One more sign that our children will die younger than they should because the national diet is simply broken.

Rates of new diagnosed cases of type 1 and type 2 diabetes are increasing among youth in the United States, according to a report, Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002-2012, published today in the New England Journal of Medicine.

In the United States, 29.1 million people are living with diagnosed or undiagnosed diabetes, and about 208,000 people younger than 20 years are living with diagnosed diabetes.

This study is the first ever to estimate trends in newly diagnosed cases of type 1 and type 2 diabetes

World's 'Heaviest' Woman Is Now Half Her Size After Losing 242 Kg In Two Months

While we can all be happy that this woman is finally getting some help, cases like this always make me wonder how it is even possible to get that morbidly obese? Who fed this woman so much food that she became such a pathetic creature?

If you are enabling an obese person to harm themselves by continuing to participate in what is in reality a slow motion suicide, might it be time to think about your own motives?  Here is a link to a discussion of the problem.

Why do loved ones of bedridden obese people overfeed them?

Since I advocate the use of olive oil, I thought I'd pass along this email from Apollo, my personal favorite.

Apollo Wins All Golds - Again!

We are very pleased to announce that the two flagship oils we always enter in competitions – the Sierra and the Mistral – both won gold medals at both the Los Angeles International Olive Oil Competition and at the California State Fair Olive Oil Competition. Soon, we'll hear the results from the New York International Olive Oil Competition as well.

Our Gold Series mono-varietals also garnered highly respected praise in a small private tasting with Pier Paolo Arca, an internationally recognized olive oil expert and Panel Head for the Montiferru Olive Oil Competition in Sardinia Italy. He had come to California for the hard work of judging dozens of olive oils at the Los Angeles International Olive Oil Competition. After all that tasting, he remarked that our Aglandau stood out as among the finest he'd tasted here this year.

Each year at the end of the milling season, we taste every one of our 50-gallon barrels and select the best four barrels to be our limited release mono-varietal Gold Series oils. There's not enough to enter in competitions, but you can know that they are the best of the best we produce. To learn more about these oils and to purchase visit

www.apollooliveoil.com.

Where other people see bacon, biologist Luhan Yang sees lifesaving organs — hundreds and thousands of them, pig livers and pig kidneys and diabetes-curing pancreases, and possibly hearts and lungs, all growing inside droves of pampered swine.

A key problem is that surrogate mother pigs don’t reinfect fetuses with “PERVs.” That’s crucial, because the memorably named infectious agents, short for porcine endogenous retroviruses, could cause tumors, leukemia, and neuronal degeneration if transplanted into patients. To make xenotransplantation succeed, PERVs have to go.

PERV genes are interwoven into the genome of pig cells, so eGenesis scientists start their work with CRISPR-Cas9, which has made editing organisms’ genomes so simple high-schoolers can do it. It takes far more expertise, however, to remove dozens of PERV genes at once, as eGenesis does in pig fibroblasts, which are connective-tissue cells.

The anti-PERV work is only the start of the changes eGenesis is making to pig genomes. Its scientists are also slipping into the pig ova up to 12 human genes “to make the pig organs more human-like,” Yang said in an interview. One gene, she said, would shield its organs from attack by the human immune system; another would revamp its coagulation system to reduce the risk of clots.

That’s a ton of genetic handiwork for one little pig to handle.

There are other concerns, scientists noted. Sometimes PERVs are found in the embryos before they’re implanted into surrogate mothers. The problem, Yang says is that removing the DNA-containing nuclei from pig ova isn’t always complete; occasionally some of an ovum’s own PERV-infested genes remain behind, so the embryo created from it also has PERVs, genetic analyses showed but are problems that can be solved.

Recent research from around the world shows that childhood obesity leads to greatly increased adult disease.  As a parent, who is knowingly making your children obese, should you be subject to punishment?  Beyond the "should it be a crime" question, as someone who loves your kids how do you feel about exposing them to disease and suffering as adults?  Imagine it this way.  If you were giving them a poison which killed them in a few months would you be OK with that?  If the damage hits in a few decades are you off the hook?

Recent studies from Sweden and China that followed large number of children for many years and recorded their BMI as they grew up found that their risk for developing liver disease and/or diabetes was up to 4 times greater for the obese kids.

As a parent, ponder that for just a moment.  No child says, "I want to grow up and be sick every day and have to give myself lots of shots and meds, and I really want to die young".  You are a big influence on their lives for a time.  If you would like to learn a little more about diet here is a link that might get you started

The liversaver approach to a healthy_diet

If you would like to learn more about how things work take a look at these videos

The challenge for anyone concerned about liver health health is that there is such a volume of often contradictory information.  Research is very focused on details so it is difficult to get a good overview.  Then you have the problem of all of the advertising for prescription and non-prescription drugs and supplements.  On top of it all the various governments make recommendations about diet that do not agree in fundamental ways.  It is very difficult as a patient to know how to think about it all.  The goal of the foundation is to provide, at a minimum, a clear view that is based upon data.  As part of that  we have added a new page which summarizes our view of the research.

I recently saw the shocking chart below which shows the percentage change in death rate for the major medical killers.  This is UK data because they have the big national databases but the US results are probably even worse.  Note that medicine is succeeding against most of our major killers but liver disease is rampaging through our society and mirrors the epidemic of obesity.

This blog entry will take a look at the omega 6 / omega 3 ratio. I am an advocate for the use of abundant omega 9 found in olive oil because I base the care of my cirrhotic liver on what I ask it to do. I am a "Be Kind to Your Liver" guy so I have to pay attention to the actual bio-chemistry I want to support. In a previous journal entry I talked about the olive oil so now let's look at the two "essential" fatty acids, omega 6 and 3.

The essential fatty acids are called that because they can't be synthesized by the body and must come from the diet. Therefore the proper question is how much of each is good for me and is there an amount that is harmful? The answer to that comes from nutritional research. Looking at human diets over time, we estimate that as hunter gatherers humans probably had a diet that ranged between one to one up to four to one omega 6 to omega 3. In simple terms, more 6 than 3 but not an overwhelming difference.

In our modern society things have changed. Some research suggests that our industrial diet may have an omega ratio as high as 50 to 1. The fat balance in our diets has changed dramatically in the past two generations and mirrors the obesity epidemic raging in our society.

If fatty liver disease or its cousins concern you, join the Foundation, its free click here

Analysts track changes in how frequently various diseases kill people.  They call it the standard death rate and they calculate it as a percentage change.  It tells us how our health is changing and how quickly we are being killed by different medical conditions.

The dashed line is liver disease.  If health concerns you at all you may be shocked as I was when I saw this data. Note this is British data but the US problem is probably worse, we just don't have the national data to make this analysis.

Make no mistake. This is like being stalled on a railroad track with a train bearing down on you.  Will you or someone you love  die too soon or will it be someone you know? No way to say yet but unless you are willfully blind to the evidence it is clear that we face a generational crisis, but do you care?

A major step for any organization wishing to do charitable or educational work is to be tax exempt.  I'm very pleased to report that we just received our official IRS notice that we are qualified under the 501(c)(3) rules as a tax exempt organization. Any donations you have made to us this year will be fully deductible on your taxes and we thank you very much for the support.