There is a lot of information below.

If you would like a short summary click this link.

DO YOU KNOW HOW TO KILL YOUR LIVER?

Your liver is like a very complex factory

There are many diets being advocated but most of them do not talk to you about specific liver health issues like how their program impacts your liver.  The assumption is that weight loss alone is good for you.  While generally true, if we consider the liver the kind of calories you consume is important. You can feed it almost anything and it will try to make something out of it.  It is filled with about 500 robots that each know how to do one thing.  As long as a robot knows what to do with what you send it and the supply isn't overwhelming all is well.  However, if you supply more than it can process bad things happen.  With too much raw material things in the factory can pile up.  When a robot is broken or over supplied, the wrong product might be made or the robot might fail.  Break too many of your liver robots and the entire factory fails.  These are the reasons why what you eat really does matter to your long term health.

When you hear the term fatty liver you instinctively assume that eating fat is what caused it and the siren song of low fat diets that get so much attention have appeal.  The problem is that the important thing is not what you eat but what does your liver do with what you eat.  As you think about the rest of this material remember this one fact as you learn about fatty liver disease and lifestyle.  The first step in carbohydrate metabolism is to turn the carbs to fat in the form of palmitic acid. Excess carbohydrates in the body are converted to palmitic acid which is the first fatty acid produced during fatty acid synthesis and is the precursor to longer chain fatty acids. The critical idea here is the presence of excess carbohydrates. 

Palmitic acid is a major body component of the body and is made primarily in the liver.

Sugar is also half fructose.  Unlike glucose, which is a direct fuel for all organs, fructose can only be processed by the liver and it is turned into fat inside the liver cells.  That process is unlimited so unlike glucose it just keeps building fatty acids in the liver and if you exceed what the liver can manage bad things happen. You can learn about that here.

https://www.fattyliverfoundation.org/tags/fructose

When you eat too much sugar some of it is converted to fat in your liver cells and if the amount exceeds what the liver can dispose of you get accumulation.  There are many other chemical pathways in the liver but you can probably see how this might apply to you.

What is a good diet for a healthy person

What is a diet for fatty liver or NAFLD

What is a diet for a damaged liver NASH or cirrhosis

Much of this advice will be familiar to you, however, there is one critical food item which under official US food advice is different.  That is the extensive use of extra virgin olive oil. It is important to be aware that the Official American Dietary Guidelines  advise  calorie reduction and exercise with limited dietary fat. It limits saturated fats but ignores the differences between various oils.  If you want to study the official recommendation you can do it here.  You might wonder whether the official federal policy has anything to do with the vast amount of disease afflicting our society.

USDA Dietary Guidelines

The nutritional approach to fatty liver disease has a broad base of support among providers, including MDs. The optimal approach is still a matter of investigation and debate. However, the Mediterranean diet is one of the most studied diets in science and medicine. As the most common cause of mortality among patients with NAFLD is cardiovascular events, the impact on mortality alone make it worthwhile to adopt. The anti inflammatory and anti-fibrotic literature for the diet are also compelling and since we are focused on liver disease that is the focus of this information.

Much of our advice is built around extra virgin olive oil. If you would like
more information see this link on olive oil
but if your interest is about
fatty liver disease and its complication click here.

If you have a liver problem, you should be aware that liver disease is ignored by almost all diet plans.  The reason is that it is mostly symptom free and there are no treatments so most of the research has been on heart and diabetes issues.  If you are concerned about your liver you are part of an ignored patient group.  If you would like to test that theory,

US News has an excellent summary of popular diets which you can look at here for an overview.

Just be aware that they ignore the questions that brought you here. Diet plans mostly ignore the liver even though its health is the foundation upon which most of the bio-chemistry that is you depends.  So look around but come back here when you find out that the diet plan advocates ignore you.

A COMMENT ABOUT POPULAR LOW CARB DIETS

Please note that extreme low carb plans are probably bad for you.  Your body must have fuel and when we eliminate sugar that comes significantly in the form of fats and carbs.  The kind of carbs is what you need to pay attention to.  Ideally you want to eat a good supply of resistant starch, that is starch that is digested in the colon and not the small intestine.  This is very important for the health of the colon as much of its energy is in the form of short chain molecules called butyrate which are produced by the healthy bacteria.  Take those away and the cells lining the colon suffer.

Resistant starch is considered both a dietary fiber and a functional fiber, depending on whether it is naturally in foods or added. Although the U.S. Institute of Medicine has defined total fiber as equal to functional fiber plus dietary fiber, U.S. food labeling does not distinguish between them.

IMPORTANT LITTLE KNOWN OR UNDERSTOOD FACTS ABOUT STARCH

Processing may affect the natural resistant starch content of foods. In general, processes that break down structural barriers to digestion reduce resistant starch content, with greater reductions resulting from processing. Whole grain wheat may contain as high as 14% resistant starch, while milled wheat flour may contain only 2%.

Other types of processing increase resistant starch content. If cooking includes excess water, the starch is gelatinized and becomes more digestible. However, if these starch gels are then cooled, they can form starch crystals resistant to digestive enzymes such as those occurring in cooked and cooled cereals or potatoes (e.g., potato salad). Cooling a boiled potato overnight increases the amount of resistant starch for example.

Resistant starch does not release glucose within the small intestine, but rather reaches the large intestine where it is consumed or fermented by colonic bacteria (gut microbiota).^[10] On a daily basis, human intestinal microbiota encounter more carbohydrates than any other dietary component. This includes resistant starch, non-starch polysaccharide fibers, oligosaccharides, and simple sugars which have significance to colon health.^[10][12]

The fermentation of resistant starch produces short-chain fatty acids, including acetate, propionate, and butyrate and increased bacterial cell mass. The short-chain fatty acids are produced in the large intestine where they are rapidly absorbed from the colon, then are metabolized in colonic epithelial cells, liver or other tissues.^[13][14] The fermentation of resistant starch produces more butyrate than other types of dietary fibers.^[15]

Modest amounts of gases such as carbon dioxide, methane, and hydrogen are also produced in intestinal fermentation. One review estimated that the acceptable daily intake of resistant starch may be as high as 45 grams in adults,^[16] an amount exceeding the total recommended intake for dietary fiber of 25–38 grams per day.^[17] When isolated resistant starch is used to substitute for flour in foods, the glycemic response of that food is reduced.^[18][19]

Here is a link to a discussion of Resistant Starch

If Fatty Liver disease or its cousins concern you join the Foundation, its free

 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.  

If fatty liver disease or its cousins concern you, join the Foundation, its free click here

My mother, Geneva Eskridge, was one of the inspirations for this foundation. She passed away, a few days short of her 94th birthday of complications arising from her lung cancer. Her family was there and had been with her during her final days. She was well and truly loved by those who knew her and she rarely met anyone whom she did not befriend. She will be sorely missed by many.

For anyone not familiar with her and for those who knew her well I’d like to offer a brief visit with her indomitable spirit. Geneva exemplified the best of us and we can but hope to approach our lives in the same spirit. When diagnosed with lung cancer at the age of 91 she decided to go skydiving rather than retreat from life. The link below is to her first jump and the second is when she jumped again at 92

https://www.youtube.com/watch?v=iG17sLXxQIU

https://www.youtube.com/watch?v=Z5xGKVLJxxE

I only hope that I can live up to her example with my life and our family offers her memory to you as an example of a life well led. I regret that the role of caregiver, which I worried that I might be unable to perform adequately, was cut tragically short by unforeseen events.

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.

I was astonished that morning to learn that my case was pretty typical. Cirrhosis, the final stage of liver disease leading to liver failure, is commonly reached without any warning symptoms. I remember very clearly my doctor’s words: “I’m sorry, but we have nothing to offer. There is no treatment.” My vision of my liver was that of a deadly beast that would kill me. Being told that losing weight and exercising could help didn’t inspire.

You can read the article in the Stanford Medicine Blog Scope here

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

If you want to really understand Fatty Liver Disease, spend some time watching the videos below.  They present a great deal of information, but if knowledge is your goal, this is a great place to start.

Part of dealing with liver disease is to understand it.  In order to help you, we are working with Armando Hasudungan who produces superb short videos to explain complex medical subjects.  We use them throughout the site to help you understand your body and specifically your liver.  The first video gives you a view of the liver overall and the following ones focus on details.

So how does what I eat cause me problems?

OK, but how does Cirrhosis happen?

So what is cirrhosis that is the one that scares me.

I suppose the next question is what are the signs and symptoms and management of liver disease.

Darn, so how bad can it be really?

Causes part 1

Causes part 2

If you would like to explore the science behind the diets click on this link.

We start with the fact that the fundamental problem is the bio-chemical flow between the liver and fat cells. When diet is poorly balanced, over time fat accumulates in the liver and by itself is rather benign but when other chemistries like insulin management begin to degrade you get inflammation which leads to fibrosis and if not stopped progresses to cirrhosis. Since there is no treatment your tool is diet and the question is to avoid anything that stresses the liver and load up on anything that is protective. Easy peasy right. Well let's take a look

• eliminate all alcohol
• eliminate most saturated fat and no red meat
• eliminate all non skim dairy products
• eliminate trans-fat and all hydrogenated oils
• eliminate all high fructose corn syrup
• eliminate most sodium -- the goal 1,500 mg of salt or less.
• eliminate all added dietary sugar
• eliminate processed grains, no white flour or white rice
• Avoid most products hustled by the supplement industry
• Make sure that any medications you take are not harming your liver

Oh my god. That is a terrible list. Not possible to live that way. OK, take a breath. The goal is to take as much pressure off the liver as possible, provide molecules from your diet that are protective and don't stimulate the stellate cells to initiate scaring, but still provide proper nutrition. So what do you do?

• For oil get 60 ml, that's 1/4 cup, a day of extra virgin olive oil
• Take one tablespoon per day of refined fish or salmon oil
• Don't buy prepared foods without reading the label, there isn't actually much that you can buy
• Eat lots of fruits and vegetables but remember the salt limit
• Learn to like kale, lima beans, brussel sprouts, etc.
• Look for fiber like whole wheat bread no white breads and use brown rice
• Eat fatty fish like salmon at least a few times a week
• Eat skinless chicken or turkey and lean pork, fresh pork not processed like ham
• Explore new foods like quinoa as a grain
• Eat plenty of vegetable protein like beans.
• Take 400 mg to 800 mg of vitamin E
• Drink 3 to 4 cups of paper filtered coffee daily
• Be aware that eating out is tough as very little of it is good for you

You get the idea. you might call this a type of Mediterranean diet but the excess olive oil is specifically a medicine. The rest is mostly nutrition. The fish oil is to get a significant source of omega 3 oil to balance the omega 6 you routinely get in food. The salt limitation is good for you and lowers your blood pressure.

So why should you think this might work for you? Without getting too technical your energy systems are built around triglycerides. Any oil can be used by the body to make them but if made with unsaturated oil they are better for the body. More importantly olive oil is mostly an omega 9 fatty acid. Good olive oil is a complex mixture of around 30 oils and phyto chemicals which support liver function and soothe activated stellate cells which cools inflammation. Good olive oil causes a burning feeling at the back of your throat. Those are the phyto chemicals and more is better if you ever go to an oil tasting bar.  The omega 3 reduces the amount of inflammation caused by omega 6 and is required for good health even if you don't have liver disease.

Click here for a more general discussion about diets.

If you are interested in the science of liver disease here is a link to our educational videos.

DISCLAIMER: Be aware that I am not a doctor.  I cannot give medical advice.  I am a cirrhosis patient and I have apparently halted the progression of my disease following this strategy. You must not assume that this advice will necessarily apply to your situation and you must work closely with your physicians as your situation is unique to you.

Please note that everyone has different a different culture and diet preferences.  We cannot provide a diet plan that suits everyone so we offer you the general guidelines but each person has to look at their personal food choices and modify them to be as kind as they can to their liver.  There is no one size fits all plan.

As Shakespeare said “The fault, dear Brutus, is not in our stars, but in ourselves.”

OK, you feel that you are healthy but want to stay that way.  This site just deals with the fat aspects of health so keep that in mind.  We'll assume you are here because you have some concern over your liver's health, you fail at diets, or you just want to take a healthy approach to food. All of those concerns turn on the fact that our modern industrial diet is unhealthy.  Things you probably already know.

• We routinely consume too many calories
• We eat far too much sugar
• High fructose corn syrup is unhealthy
• Trans-fats are bad for you
• Saturated fats are not healthy
• We eat far too much salt
• We consume a lot of additives that may be harmful
• Our diet has far too little fiber

There are other issues but if you managed these it would address most diet problems. When you think about the problem it is clear that there are two fundamental issues.  First, of course, are the personal choices we make and the psychological aspects of diets and food.  The second is the actual contents of the foods we eat and how they have changed over time.

Well, isn't that lovely. I get that same pitch every day. I've tried all kinds of diets and nothing works for me. What a waste of my time this site is.

Yes, we get that all the time don't we?  I personally get really tired of all the diet and lifestyle products being pitched.  So here is the real story.  For most of us we diet repeatedly.  We don't really change our lifestyle or the way we think about food.  If you want to be healthy you do have to be aware that there are consequences for your health if you pay no attention to the quality of your diet long term.  If you live a lifestyle you don't have to diet, your body will respond in a good way.

Here is an eating plan that will help you think about how to approach eating.

Does being fat matter?

Do you care about dying?

How about being ill for years?

• Obesity accounts for 18 percent of deaths among Americans between the ages of 40 and 85
• The incidence of fatty liver disease has increased 20 times since 1983.
• A 5-year-old growing up today is much more likely to be obese than a generation or two ago.
• Once someone is obese, it is very difficult to undo. We won't see the worst of the epidemic until the current generation of children grows old.
• One in five US deaths is associated with obesity. What are your odds?
• Fatty liver disease is epidemic affecting about 100 million Americans.
• The good news, it is possible to take it off and keep it off but you must be serious.

Want to learn about why what you eat can kill you? Learn a lot by clicking on this link.

Did you know that the risk of death when you get to stage 4 fibrosis is 25 times higher than it is at stage 1?

Is there a short explanation about how what I eat can cause me problems?

For a start, watch this short video.

 If this causes you to want to learn more, click on this link for a fuller explanation of liver disease and why you should care if illness and death are not goals for you.

Click here for more information about the foundation or

Check out the drop downs in the boxes above for details.

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.