We all know that your body runs solely on glucose.  Right?  As a thought experiment would it change your diet choices if you learned that wasn't true? Would you care if you learned that excess carbohydrates, like dietary glucose, were challenging for your body and often lead to disease?  Suppose we look at that specifically.

Just as a hint, we now know that glucose is not the predominant fuel the body uses. At rest (and even during moderate exercise) fat accounts for at least 50-60% of fuel burned by tissue and much of the remainder is protein. This also means that according to current dietary guidelines from the government (which imply more than 50% carbohydrates consumption) our liver must turn carbohydrates into fat, as various fatty acids, to give our tissues the fuel they require.

So how do we know that? 

Fructose’s propensity to cause fatty liver is unique among carbohydrates. The fatty liver directly causes insulin resistance setting in motion the vicious cycle of hyperinsulinemia – insulin resistance. Furthermore, this harmful effect of fructose does not require high blood glucose or blood insulin levels to wreak havoc. Further, this fattening effect, because it acts through fatty liver and insulin resistance, cannot be seen in the short term – only in the long term.

Fructose, Fatty Liver, and insulin resistance

Fructose overconsumption directly produces fatty liver, which in turn directly creates insulin resistance. Fructose is five to ten times more likely than glucose to cause fatty liver. This sets off a vicious cycle. Insulin resistance leads to hyperinsulinemia, to ‘overcome’ this resistance. However, this backfires, as the hyperinsulinemia, made worse by the attendant glucose load, leads to further insulin resistance.

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 There is a concept of "healthy" saturated fat.  Since being saturated refers to a bio-chemistry definition in which all available  carbon bonds are used by a hydrogen atom I've wondered what that meant.  I had never considered how the research on fibrosis is actually done with animal trials but I was fortunate to be able to recently attend a conference of about 200 of the top liver researchers in the world. The official focus was to update everyone on the progress on the most interesting 20+ drugs inching closer to human trials and possibly a treatment for fibrosis but I was struck by the specifics of how the research is done.

When you want to study how a drug might work against liver disease in a mouse or rat you first have to give it liver disease. How might that be done quickly and cheaply and mimic human disease you might be moved to ask. Well, suppose there are two really good diets you can feed them. It is that simple. There are two main ones that are named the "Western Diet" and the "Fast Food Diet".

I wonder what might be in that food. Would it surprise you to learn they have two main components? Would you bet on lots of saturated fat and sugar? It is that simple. You can give a mouse cirrhosis in weeks by just feeding them what you eat and feed your kids every day.

The information on the bio-chemistry was absolutely fascinating but I was dumbfounded by the little detail of how to create illness that ran through the conference. I'm pondering how to make that more clear to people in general but I offer it here for whatever it may be worth.  

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For liver patients the discussion about salt in this video is not correct, but the discussions about fats and their effect on health is spot on and backed up by lots of research.

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Watch this short video to learn about why fructose is bad for you to consume

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Recent study showed that a high intake of sugar sweetened beverages was associated with high metabolic risk cluster among both sexes; with boys tending to consume more sweet drinks than girls. Adolescents who drank more than 500 mL daily showed an increased risk for high overall metabolic risk; boys had a 10.3-fold risk for contracting metabolic syndrome by International Diabetes Federation (IDF) criteria and girls a 5.1-fold risk  by Cook criteria.  Moderate and high-consuming male SSB drinkers had greater triglyceride levels compared with nondrinkers.

“The present results indicated that boys who consumed a high amount of sugar sweetened beverages exhibited a 5.1- to 10.3-fold risk of developing metabolic syndrome, even if the prevalence of this metabolic disorder is low,” the researchers wrote.

http://www.healio.com/hepatology/steatohepatitis-metabolic-liver-disease/news/online/

Drinks sweetened with fructose are setting our kids up for serious health problems as they get older by increasing the likelihood that they will suffer from liver disease and diabetes.  A factoid parents might like to keep in mind.

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One more reason why women live longer than men. Eating too much fat can make you put on weight and lead to heart disease - especially if you eat too much of the wrong kind of fat, such as the omega-6 fats found in many processed foods. But now it seems sausages, pastries and cakes are even worse for men than they are for women. @zoeharcombe #fattyliver

https://www.bbc.com/news/health-38963874

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This is a very thoughtful article about the generally poor advice patients get from their doctors.  Obesity is the stalking horse of death for many Americans and despite much marketing hype we are failing as a society.  The next generation is likely to be the first whose life expectancy will be less than their parents. Liver disease and the co-morbidity it contributes to are multi-decade killers.  This article is from StatNews by AGUSTINA SAENZ and is a good discussion of the problem.

TO BE TRUE HEALERS PHYSICIANS NEED TO LEARN MORE ABOUT  HEALTHY EATING

Clinicians, often get nutrition information that’s influenced by industries selling American-style fare, like red meat, sugar, ice cream, and soda. The “moderation” clause soon creeps in. Easy-to-grab, fast food options are even sold in hospitals, the sacred places where the sickest people go for treatment and recovery.

Nonalcoholic fatty liver disease (NAFLD) is a significant health problem and affects 100 million adults in the United States (30% of the adult population), and an estimated 20% of these individuals have the most severe form of NAFLD—nonalcoholic steatohepatitis (NASH).  A program targeting gradual weight reduction and physical exercise continues to be the gold standard of treatment for all forms of NAFLD.

Note: Only the Mediterranean diet reduces steatosis

A lot of people think that coffee may be harmful.  Recent research has shown that if is protective of liver health and an important part of the diet for anyone dealing with most liver diseases.

For anyone interested in the coffee research here is a link

https://www.ncbi.nlm.nih.gov/pubmed/26556483

It is interesting that there is a difference between filtered and unfiltered coffee. Not all types of coffee may be beneficial in liver disease. Numerous studies have shown a hepatoprotective role for filtered coffee, and a potentially deleterious effect for unfiltered coffee. It was postulated that this difference is due to the presence of kahweol and cafestol, which are caffeine diterpenes that are released from ground coffee beans but removed by paper filters. Moreover, another study found that espresso coffee had no beneficial effect on liver disease, particularly in NAFLD. Here is a link to that information.

http://www.medscape.com/viewarticle/827617_3

Monsanto's-roundup-linked-fatty-liver-disease/

The concern over wide spread chemicals such as RoundUp continues.  Of interest to this community is evidence that very low levels can cause fatty liver disease.  You can read about the research at the link.

https://www.ncbi.nlm.nih.gov/pubmed/23329830

Fatty acids are essential components of the dynamic lipid metabolism in cells. Fatty acids can also signal to intracellular pathways to trigger a broad range of cellular responses. Oleic acid is an abundant monounsaturated omega-9 fatty acid that impinges on different biological processes, but the mechanisms of action are not completely understood.

What does this mean to you? Fatigue is a major problem for many.  Part of that complex problem is how well your cells use the fuel available to them.  Olive oil is mostly oleic acid so as part of your diet it helps your cells function efficiently.

For those who have followed my musings along the way, I thought you might find some value in an update. A brief review. I happen to be under the care of a hepatologist who began his career in Europe. There is a lot of discussion of the so called mediteranian diet which includes olive oil but the standards of care are silent on the use of olive oil as a primary component of treating fibrotic liver disease. In my journal I've provided fairly detailed descriptions of my personal diet which includes 1/4 cup of extra virgin olive oil per day.

So, I've been doing this for a year now and it is fair to ask if there are any results. I'm happy to report that I recently had my second Fibroscan test. The results, in 2015 my reading was 21.5 well into the cirrhotic range. Today it is 14.3 near the bottom of the stage 4 range..

Most primary care doctors find it relatively easy to talk with their patients about topics like depression or cancer. Yet many shy away from talking about nutrition, or find it difficult to do. Avoiding that conversation is costly.

For someone with diabetes, it may mean the difference between losing a foot or keeping it. For someone with heart disease, that conversation could free them from workplace disability or empower them to work harder. For someone who is steadily gaining weight, it could save them from gastric bypass surgery or from a lifetime of medications to treat obesity and weight-related complications.

 Many people blame lack of willpower for gaining weight. According to the University of Chicago, consumers say that willpower is their No. 1 barrier to weight loss. Americans spend $60 billion each year on diet and diet aids, but aren’t much slimmer for it. Close to 70 percent of adults are overweight or obese. Sixty percent are on diets.

An article by Agustina Saenz, MD

https://www.statnews.com/2016/11/17/nutrition-doctors-patients/

Depressed?  Take one skydiving granny and call me in the morning.

My mother was diagnosed with lung cancer.  Her response "I want to go skydiving" a personal story about dealing with chronic and terminal illness.

https://youtu.be/iG17sLXxQIU

The Philadelphia Enquirer picked up the story and did a nice article in their health section.

http://www.philly.com/philly/blogs/diagnosis-cancer/How-a-skydiving-granny-gave-him-a-new-perspective-on-terminal-illness.html

This article in the Stanford Medicine blog Scope, talks about a personal journey to stop the progression of cirrhosis through lifestyle changes of diet and exercise.

http://scopeblog.stanford.edu/2016/12/20/the-beast-in-my-belly-living-with-a-chronic-liver-disease/

people with NASH usually have no symptoms. It’s estimated that roughly 2 percent to 5 percent of adults in the United States have the disease, and that another 10 percent to 20 percent may have its milder cousin, non-alcoholic fatty liver disease, or NAFLD, according to the National Institute for Diabetes and Digestive and Kidney Diseases. NASH is expected to become the most frequent reason for liver transplants by 2020.

https://www.statnews.com/2016/10/06/stealthy-liver-disease/

The local newspaper wanted to do a story about liver disease and came along on a visit with my hepatologist.  This is a link to their article.

http://www.deseretnews.com/article/865644704/Silent-killer-Doctors-battling-liver-disease-that-threatens-one-fifth-of-adults.html

As an analytical tool the GE MRI elastography was a vital tool in understanding my particular liver disease.  GE wrote a story about it and published it in their magazine GE Reports

http://www.gereports.com/this-mri-imaging-technique-helped-clinicians-unmask-silent-liver-disease/

On the morning of December 23, 2010, after having my gall bladder removed, I was shown a picture of my liver and told I had a stage 4 liver cirrhosis. It was a powerful and frightening moment – one that is seared into my memory. And one that began more than a half-decade of tests, misdiagnoses, and, eventually, lifestyle changes.