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In the Rezdiffra age a healthy diet is required, but what is that?

An interesting aspect of the Rezdiffra approval is that FDA mandates that it be used in conjunction with a diet and exercise program.  We have advocated that for years, but as a condition of drug therapy it will change the way doctors approach it. It will be important that docs deal with the issue in a nuanced way as we all have our own practices with regard to food.  I thought a return to basics might be helpful to patients dealing with the issue.

Beyond basic nutritional needs, the key element of our diet is to provide the fuel our bodies require. How we do that in a way that is not a burden for our liver is critical to any diet.

Our strategy for caring for a sick liver is simple. Always reduce the work load of the liver as much as possible. When your have an overburdened liver the best thing you can do is to reduce the amount of material that you ask it to process. It has an amazing capacity to heal itself if given a break. So how do you do that?

The body is vastly complex, but it has two key fuels glucose and fats.  All of the many systems of your body require energy and the source of that is obviously your diet.  The brain is the hungriest organ and uses about 22% of the total energy.  Most people don't realize that the liver is second at about 21%.  The heart uses about 9% and the rest is spread through the many organs and systems of the body. Glucose accounts for about 60% of energy use and fats about 40%.

An important fact to remember is that glucose levels are tightly controlled and that work is done by the liver.  It is a key system of the liver which aims to support the brain primarily. Consume too much sugar and the liver makes fat. Consume too little and it turns other chemical substrates into glucose.

Fats are energy storage chemicals which are used  primarily to make ATP, the magic molecule that transports energy for use by all of the body's functions, and is produced in the mitochondria. This complex chemical dance is supplied by what you eat so what are the basics to consider for meal choices?

A first step is to have smaller meals more frequently. You wouldn't ask a car with a struggling engine to suddenly go 100 miles and hour so try to let your liver just idle along.

knowing that glucose is your key fuel, it is tempting to think you should eat sweets. Sadly that is wrong. Fructose is quite sweet and our standard table sugar is 50% fructose. Fructose is almost exclusively processed to fats in the liver and is therefore an unwelcome workload for an ailing organ. The sugar in fruits is absorbed slowly so they are generally a net positive.  Refined sugars in candy and pastry is an assault on a struggling organ.

Carbohydrates are the other big major category that is part of the energy story. Sugars are simple carbs and starches are complex carbs.  The carbs may participate in a variety of chemical processes and may be converted to glucose, but an important process is that the liver turns them into palmitate or basically palm oil and manages them as fats. Palmitate is a saturated fat which requires more energy than unsaturated fats for processing.

The kind of fats you consume is important.  Saturated fats are more energy intensive so are more difficult for the liver to manage.  The liver has a preferred fat which is oleic acid, an unsaturated fat found largely in olives.  The liver has a cascade of reactions starting with stearic acid, or beef fat, where it can step the fat molecule down a chain of molecules from stearic to oleic acid.  It has been shown that oleic acid is the cleanest burning fat for the body so we advocate for the use of extra virgin olive oil as our preferred fat. This reduces the chemical steps the liver is doing and provides the most efficient fuel.  In general saturated fats are more inflammatory as they require extra energy for manipulation so the advice is to limit them in favor of unsaturated fats.  The liver can manage the various fats but why ask it to when it is struggling.

This is getting long. I'll comment on other aspects of food and nutrition in the future but the foundation of diet is energy in fats and glucose.  

If you haven't joined our survey on the care patients are receiving already, I invite you to consider helping us.  We seek to document how patients are being served by their docs in this important time of change for our patient community.

The State of Steatotic (Fatty) Liver Care in America is an annual survey of liver patients seeking to understand what their experience with doctors treating the disease has been.  We need your input to help us advise doctors where we, the patients, feel the care given needs to improve. Please click the link below to go to the survey.  It is completely anonymous.

What you should expect, it will take about 20 minutes and there are 50 questions. LABORIOUS, I know. I hate surveys myself but this is to help us, the patient community, not some company, so please give it your attention.


If you would like to read the 2023 report the link below will take you to that one.