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.

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.

Welcome to the Fatty Liver Foundation's Webinar Hub!

Here you can find all of the info about our upcoming webinars, as well as the details and links to recordings of previous webinars.

NEXT WEBINAR: Wednesday February 3, 2021

Wellness Webinar Part 1 (COVID-19 and Liver Disease) click here to register!

In 2020 we produced the LIVER (Live Interactive Virtual Education and Review) Webinar Series, consisting of four parts.

In 2021 we are producing the Wellness Webinar Series, consisting of six parts.

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.

What You Should Know (CDC) 

CDC Interim Clinical Guidance for Management of Patients with Confirmed Covid-19

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)

How to get a COVID-19 Vaccine: a State by State Guide (WSJ)

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)

Center for Infectious Disease Research and Policy

Centers for Disease Control and Prevention

Johns Hopkins

World Health Organization

-CDC Interim Clinical Guidance for Management of Patients with Confirmed Covid-19

-UCSF COVID-19 Clinical Resources

-CDC Information for Healthcare Providers

-New England Journal Of Medicine, COVID Resources

-Lancet- COVID-19 Response Center

-JAMA Updates on COVID Diagnosis and Treatment

-Detailed Notes from an ICU Doctor in Seattle on COVID Experience

-Up to Date: COVID-19 Testing Capacity

-Dispatch #3: Dr. Shlain reporting from the front lines

-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.

Clinical Trial Overview

Clinical Trial Finder

If you have diabetes and are overweight, you can have silent liver disease too

Learn about fatty liver disease and NASH, and see if you may qualify for a clinical trial.

About NASH

If you have diabetes or struggle with your weight, you may have fatty liver disease. A severe form of fatty liver disease, called nonalcoholic steatohepatitis (NASH), often has no symptoms but can cause significant damage to your liver if not diagnosed early.

About the Clinical Trial

The MK-3655 Clinical Trial is evaluating the safety and effectiveness of MK-3655, an investigational medication for people with NASH. This trial will test MK-3655 compared to placebo. A placebo looks like the study medication but contains no active ingredient.

You may be able to participate if you: *

• Are a male or postmenopausal female, 18 to 80 years of age [in Japan: 20 to 80 years of age]
• Have NASH confirmed by a liver biopsy
• Do not have type 2 diabetes OR have type 2 diabetes that is well controlled by diet or a stable dose of diabetes medication
• Have had a stable weight for at least 3 months

If you qualify and decide to participate:

• Your liver and your overall health will be monitored closely by an experienced study team
• You will receive the investigational medication and study-related doctor visits at no charge
• The information gathered may help advance medical knowledge about NASH and may improve patient care in the future
• Participation is voluntary and you are free to withdraw from the study at any time. Your privacy will be maintained throughout the clinical trial

To learn more, including the possible risks and benefits of participation, visit NASH3655Study.com.

For a copy of this information, you can download this flyer.

*There may be additional requirements to participate. The study doctor can provide you with more information. Additional potential risks and benefits will be fully described to you by your study team.

Fighting A Fatty Liver As We Age

When people think of an unhealthy liver, they most often think the leading cause to be alcohol-related, but an even greater concern is Non-Alcoholic SteatoHepatitis (NASH), an abnormal accumulation of fat in the liver which can lead to cirrhosis. In the U.S. about 16.5 million people have NASH, with a majority of sufferers between the ages of 60 and 74 years old according to a 2018 report by the National Aids Treatment Advocacy Project. On the bright side, a fatty liver is a reversible condition at any age that can be managed and minimized by concentrating on healthy diet and lifestyle changes. 

Recognizing A Fatty Liver

Non-Alcoholic SteatoHepatitis occurs in every age group but is most prevalent in seniors who are more prone to obesity and type 2 diabetes, both leading causes of NASH. An annual blood test is the simplest way to detect a fatty liver along with physical warning signs that include a swollen belly, red palms, a yellowish hue to the skin or eyes and larger than normal breasts in men. Whether the senior with NASH still resides at home or is being cared for in an assisted living facility, there are diets and programs that caregivers or family members can oversee to reduce the liver's size and prevent further damage.

Since you are on my mailing list you know about NASH, unlike most of the people.  We had the 2019 version of NASHday on the 12th and  as I think about how that event went I am struck by the fact that as a health outreach it was unusual.

I'll explain why but first, the punchline, NASHday was about people's lives and not about money.

We have every kind of "DAY" that you can think of.  Every cause has a day or a month, some peg to hang the cause on and to focus attention. Just as an example, these are the top five unofficial holidays according to toptenz.net.

1.      Black Day.

2.      Autistic Pride Day.

3.      International Free Hugs Day.

4.      Monkey Day.

5.      Record Store Day.

This page loads slowly.  It is a series of videos about NASH, be patient if you are interested in a good explanation of this disease.

These videos were part of our #NASHday June 12th 2019 event. Click here for details