THE PROBLEM: The real liver experts don’t offer effective diet advice

(click here for a pdf with all the science references)

Currently, the experts who treat liver disease, (the specialists of AASLD), do not officially recommend any specific diet for liver health. The reason is because there are not enough well-designed dietary clinical trials focused specifically on the liver to give the organ experts confidence to make official dietary recommendations. This creates a serious dilemma. As patients we don’t have that luxury. We must make choices. We must live every day making food decisions and hope that our diet is a healthy one even if the experts can’t help us. No wonder we see endless variety in dietary advice and “experts” of all persuasions.

OUR GOAL: Design a diet strategy that minimizes the liver workload

THE PROBLEM: The liver experts don’t offer effective diet advice

(click here for a pdf with all the science references)

(click here for a one-page guide to the Liver Friendly Diet)

Currently, the experts who treat liver disease (AASLD), recommend no specific diet for liver health. There are not enough well-designed clinical trials focused specifically on the liver to give the organ experts confidence to make official dietary recommendations. This creates a serious dilemma. As patients we don’t have that luxury. We must make choices. We must live every day making food decisions and hope that our diet is a healthy one even if the experts can’t help us. No wonder we see endless variety in dietary advice and “experts” of all persuasions.

THE GOAL: Design a diet strategy that minimizes the liver workload

The Fatty Liver Foundation recommends a diet high in oleic acid (omega 9) unsaturated fat (30%), primarily from extra virgin oil, low in saturated and trans fats (7%), with a omega 3 and 6 fatty acids approximately equal (8% each). Protein is about 20% of calories and carbohydrates are primarily in the form of fruits, non-starchy vegetables, and whole grains (27%). Simple carbs, such as sugars and refined grains, are minimized. The goal for salt intake is about 70% of the USDA recommendation. Processed foods and red and processed meats are avoided. (see this pdf for the research supporting this strategy)

Nonalcoholic fatty liver disease (NAFLD) affects approximately one third of adults in the United States and is the most common cause of chronic liver disease worldwide. About 20% of patients develop the more serious steatohepatitis (NASH) which is becoming epidemic as a result of the rising rates of obesity and metabolic disease. Emerging data suggest weight loss of greater than 10% of body weight is beneficial in resolving steatosis and reversing fibrosis due to NASH.

The liver disease specialists don’t have enough proof that they are willing to endorse a specific diet, so keep that in mind as you listen to the sales pitches. There are thousands of claims about food. Here we are trying to give you the most complete picture that we can, but just remember, if someone is selling you something, they have an agenda and real evidence is hard to get.

As patients where do we look for dietary guidance?

We understand the challenge for science to provide specific and verifiable data, but as patients we still have to live each day and we make decisions about our diet by making use of whatever information is available to us. We also must live within the cultural and food availability situations that we find ourselves. 

It is very difficult to do effective random, blinded, controlled trials (RCTs) of the diets of humans. There are myriad ethical and cultural concerns with human experimentation and the human diet is vastly complex within different cultures and practices. In our role as the voice of the patient, we believe that a position of offering very limited guidance is inadequate so we are providing this information as a patient resource for those who seek to understand the components of diet and available research which we believe offers a coherent view from which to make decisions about diet. The goal of our lifestyle strategy is not to diet but to adopt habits that are fundamentally healthy long term and probably contribute to a healthier liver and a better life.

Making the best choices we can with the information we have

A lifestyle that is fundamentally healthy is built on a vast series of small choices made each day over a lifetime. It is a pattern of behavior based upon choices which are, on average, neutral to healthy while minimizing ingesting things that compromise function.  There is no one size fits all solution. Human metabolism is quite robust and is able to accept a wide range of inputs and to use them to sustain bodily functions.

In our role as a supporter of people concerned about liver health, our goal is to support a lifestyle which minimizes the work that the liver must do to sustain our lives. Conceptually, when any of the parallel processes taking place within a liver cell is either oversupplied with or denied those dietary elements that it needs to maintain a stable response we have failed in that goal.  In making decisions about food, the goal is stability of function, stability of supply, and minimizing toxins. A sick liver benefits from a strategy of making it do as little work as possible.

Talk to your doctor

All patients should discuss dietary strategies with their doctor. This information cannot substitute for guidance by your physician. This material provides research-based information that will help you better understand your doctor’s advice but cannot be relied upon for personal health decisions.  Information is critical to help plan and implement a strategy to adopt lifestyle change but there is no single solution to decisions about diet and this information is therefore incomplete and may well be proven to be incorrect as research is performed in the future. This discussion provides information from a health perspective broadly which can inform choices about what constitutes a liver supportive diet.  A broader benefit is that this approach provides a holistic regimen which benefits many co-morbid conditions such as diabetes and cardiovascular health as well.  In many ways, what is good for the liver is beneficial for the body as a whole.

It is important to remember that your doctor may have little nutrition education.  We rely on them, but many are unprepared to really help us with diet decisions. Current medical education does not provide much focus on the issues of diet. This paper contains references to research which we have relied upon in developing it so you may be able to use it to engage your physician in the science argument about various aspects of diets. The material presented is not exhaustive or necessarily authoritative but is a coherent way to approach the lifestyle challenge.

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

An article by Jackie

image credit My Fit Station

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?

Do you know what the simplest diet advice that can actually work is?

Try this.

Don't eat anything white

Can't be you say? Think of it this way.

Don't eat sugar, salt, refined grains, rice, or potatoes for starters

If you do this, you will likely find that the choices you make will automatically be healthier than your current diet and for most people it will lead to weight loss and better health.

There are a lot more detailed discussions on the site which you can explore.

Click here for more information.

If you think about the co-morbidity illustrated in this image, it is clear that there are at least 40 million Americans who are at some level of risk for developing advanced disease. The question, "WHAT TO DO" hangs there in the face of vast suffering to come.

Studies are coming in as research focuses on liver disease and the challenges that we face.  A whole body view instead of organ by organ is becoming more common which recognizes that the liver is so foundational to health that a very wide range of diseases are co-morbid with liver disease. That is a fancy word that means the problems are related.

It is well established that diet is producing the majority of the liver disease epidemic.  We grow fatter each year and even when we try to change that the cacophony of advice is overwhelming.  Groups are passionate about the extremes of food and you can find advocates for eating all combinations of diets with "expert" advice about high and low fats, carbs, and proteins.  The vegans vs the paleo for example are both confident that they are correct and experts are available to support each group.  There is a great middle, of course, who have no real doctrine and just eat what is convenient and appeals to them, but like a great herd of wildebeest they move always toward the river where the crocodiles lie in wait.

It is very difficult to not be  confused by claims.  A major source of the challenge is the miracle that is your liver.  Consider this, we have had societies that lived on 80% carbs and we have had societies that lived on 80% fat.  That illustrates the magic of your biochemistry.  The liver is able to turn carbs to fats or fats to carbs as it needs to. That is why you can eat such a variety and not poison yourself.  The extreme diets have their own challenges, but clearly with such a powerful tool for your use there must be a "best" mix of material to feed the liver for optimal operation. As a liver patient, that is quite clearly the challenge.  Once you have harmed the organ your goal is how to take the best care of whatever function remains.

What might liver kindness look like.  Do you think it would be good to ask it to do as little work as possible? Clever idea, don't you agree? So how to do that?  In broad terms the body needs glucose and fatty acids for energy.  Different organs use different combinations of fuel.  For example, the brain is a glucose fanatic and the heart burns only fatty acids so both are required. The liver adjusts everything to maintain a proper balance no matter what you eat.  The problem comes when what you eat overwhelms the liver's capacity and things will then go wrong.

The links on this page will take you to various discussions about liver health and diet.  We hope they are  of value to you.

If you would like to start with the overview you can go here

THE SIMPLEST DIET ADVICE THAT CAN WORK

But you can start digging in by clicking this link

DIETS AND SUPPLEMENTS HOW DO WE THINK OF THEM

The four horsemen of the apocalypse.  The vision of death and destruction for humanity from the new testament is a chorus of the woes that can befall society.  It evokes hazard from all directions bringing misery and the pale horse called death.

When you come to grips with the health aspects of liver disease it is a surprise to learn that our understanding of our bodies as an integrated system is so poorly appreciated.  The mix of chemical processes that are done routinely by the liver cannot be duplicated by our chemists.  It is estimated that over 500 functions are performed by the cells of the liver and they affect every other kind of tissue in the body. Imagine that, all of that activity in a cell about one fifth the width of a human hair.

Exercise as a patient is a popular subject which reminded me of a recent experience.  If you have ever been a runner you likely know of what is called the "runners high".  It is a feeling of euphoria brought on by the release of endorphins.  Running is mostly hard work but occasionally it is magic.

There is a greenbelt along the river where I live that bikers and pedestrians enjoy.  It is really quite a nice amenity.  It is local custom for bikers to signal with a bell perhaps or more commonly to announce "on your left" when passing to avoid startling walkers. 

I was jogging along recently and it was a perfect day.  A gorgeous morning and I felt good.  As I went along everything came together.  I was the winged god Mercury floating effortlessly through space with the wind and gravity paying me hardly any mind as I flew past.  A glorious experience that I would gladly become addicted to. I could have run all day with no effort at all.