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We’re excited to be joining wotj Intercept for the TRUTH About NASH roundtable discussion in Washington, DC. We’ve assembled a dynamic group of people who all touch this disease in diverse ways, and look forward to a robust conversation encompassing varying viewpoints. As NASH progresses to becoming the leading indication for liver transplants in the U.S., we believe cross-stakeholder discussions like this are imperative – not only to help identify barriers to care and gaps in knowledge, but also to begin to pave the road to potential solutions for this community.
We will be reviewing the findings from a new survey that takes a 360º look at NASH from the perspectives of healthcare professionals, diagnosed patients and the American public. We believe the survey will provide great stimuli for a discussion of some of the challenges facing people living with NASH.
This effort is part of our program to expand the discussion of liver disease and seek better solutions for patients and those who are asymptomatic but at risk.
THE PROBLEM: The real liver experts don’t offer effective diet advice
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
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.
As I write this I see the covid numbers are rising again. I hear people in denial, it could never happen to them. Today I have something equally life threatening to write about. It is not about Covid. It’s about ANOTHER little recognized epidemic. I lived it. I will be very happy if this resonates with just one person.
Here’s my story.
Christmas Eve 2013, I was feeling pretty proud of myself. I was on my way to a healthier life. Earlier in the year I joined my local YMCA. I exercised 6 days a week. I was eating healthy and watching calories. All in an effort to lose weight. I had been overweight since I was a child. Smaller clothes was just a small part of why after 30 years I was losing weight. Feeling good was a great reason but what gave me real motivation was the fact I wanted to be a living kidney donor for a family member. I had lost 96 pounds in 7 months. Then I woke up with what I thought was the flu. By evening I thought I was doing better. When I got sick and vomited up a huge amount of red blood. I found myself in my local ER where I was literally bleeding to death with no clue why. I was taken to the back where I was still very much awake and scared to death.Read more
This is what you will find here:
- Non-technical explanation of how your body actually works
- How the liver develops disease over time
- Why fats are a critical source of fuel for your cells
- How the liver manages triglycerides
- How the course of fatty liver disease depends on triglycerides and carbohydrates
- How the kind of dietary fat you use matters
- Information by a liver patient for liver patients
- Information about diet based upon bio-chemistry not fads
We are a nonprofit foundation and we do not represent anyone but the patient. If you are looking for advice on supplements or quick fixes this is not the place for you. We offer extensive information about the body in general, the liver specifically, and we recommend lifestyle strategies that have worked for me specifically and which I believe are valuable for anyone concerned about liver health to be familiar with.
Why outbreaks like coronavirus spread exponentially, and how to “flatten the curve” (Washington Post)
Coronavirus Live Updates (NYTimes)
Coronavirus: Why You Must Act Now (Medium)
COVID Tech Handbook: Resources for Doctors (Crowdsourced)
COVID-19 Maps & visuals (CIDRAP)
COVID-19 Disease Resources (WHO)
COVID-19 diagnosis and treatment (JAMA)
Helping with Seniors' mental health
Tracking Every Coronavirus Case in the U.S.: Full Map (NYTimes)
A detailed guide to the coronavirus drugs and vaccines in development (STAT)
Identifying Communities at Risk of COVID-19 (XY.AI)
-Coronavirus: Why You Must Act Now (Politicians, Community Leaders and Business Leaders: What Should You Do and When?)
-More COVID-19 Resources here (including patient facing ChatBots and more).
My poor inbox groans under the weight of CBD articles and pitches. I've hesitated to jump into this pit again but I get a steady stream of questions from patients about using it.
We need to be clear about this issue. CBD oil is biologically active. However, that doesn't mean it is good or bad for you. In reality we just don't know enough yet to have a valid opinion.
Let's be clear. I'm not part of the debate about this plant.Read more
Fatty Liver & Liver Cirrhosis Are At Epidemic Levels!
- 100,000,000 Americans have a fatty liver. Most don't know it.
- 20,000,000 will develop liver fibrosis disease or NAFLD (nonalcoholic fatty liver disease) as a result.
- 5,000,000 million will progress to liver cirrhosis or NASH (nonalcoholic steatohepatitis) and possibly end stage liver failure.
- Some will be lucky enough to be listed for a transplant, the only cure for late stage liver disease, but 30% of those listed will die waiting. Death by liver failure is long and difficult.
- We want to help you avoid this kind of death by helping you understand how you may be killing yourself slowly. And, what you can do about it.
- If you are already ill, we will do our best to help you with that process.
To improve the diagnosis, treatment & support of Americans with fatty liver, NAFLD or NASH through awareness, education, screening and patient advocacy.
We Advocate Early Screening
Typically, nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are silent diseases. They have no symptoms. Even if cirrhosis has developed, there are often no symptoms until the liver has become so damaged that the only option is a liver transplant.
There is currently a quick, easy and economical method to screen for fatty liver disease called a FibroScan. Unfortunately, the current medical standards policy is not to screen for liver disease. And, unless you are sick and have symptoms, insurance probably won't pay for the scan, even if you're lucky enough to have a testing system in your area.
The Fatty Liver Foundation is championing a nationwide program to provide liver screening services in cooperation with Liver Care Canada and Echosens, the manufacturer of Fibroscan, to make it possible for people who have a concern for their liver health to get an inexpensive scan. Since insurance doesn't normally cover screening for people who aren't sick yet, it will be on a private pay basis. However, as a nonprofit foundation, we believe we can deliver this service at an affordable price.
If you would like to watch some very good videos about liver disease,