Liver – Precision Digestive Care

Treating Fatty Liver Disease with Diet, Lifestyle, and Psychology

Posted on August 5, 2024 - 6:13 pm by Frederick Gandolfo MD

Did you know that more than 30% of Americans are currently diagnosed with fatty liver disease? This alarming statistic highlights the importance of understanding this condition and taking proactive steps to manage it before things get out of hand.

This article is a supplement to two episodes of Dr. Gandolfo’s podcast The Real GI Doc Show:

“The Natural Way to Treat Fatty Liver Disease at Home” Listen to the full episode here.

“The Psychology Behind Healthy Habits: Expert Tips for Real Change with Noreen Vail, PhD” Listen to the full episode here.

What is Fatty Liver Disease?

Fatty liver disease, recently renamed as Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD), is a condition where more than 5% of liver cells contain fat. This can lead to inflammation, fibrosis (liver scarring), and in severe cases, cirrhosis. The condition is closely linked to metabolic issues such as obesity, type 2 diabetes, and hypertension. Understanding these connections is crucial for effective management and treatment.

Jim’s Case: A Common Scenario

In a recent podcast episode, Dr. Gandolfo introduces us to a hypothetical patient, Jim, a 48-year-old man with prediabetes and mild hypertension. Jim’s routine blood work reveals mildly elevated liver enzymes, leading to further tests that confirm he has fatty liver disease. Jim’s history is not unique, and it serves as a reminder that many people may be living with this condition without even knowing it.

The Importance of Early Intervention

By the time fatty liver disease is diagnosed, the underlying metabolic issues have often been present for years. Early intervention is crucial. Dr. Gandolfo emphasizes that the best time to make lifestyle changes was five or ten years ago, but the second-best time is right now. This proactive approach can prevent the progression to more severe liver conditions. Early detection and lifestyle modifications can make a significant difference in the prognosis of the disease.

Natural and Effective Treatments

Dr. Gandolfo outlines two primary, cost-effective treatments for managing fatty liver disease:
weight loss and exercise.

Weight Loss: A modest weight loss of 3-5% can start the healing process in the liver. For more significant improvements, especially in cases of inflammation and fibrosis, a weight loss of 10% or more is recommended. Sustainable dietary changes are key. Dr. Gandolfo suggests finding a diet that fits your lifestyle and preferences, with the Mediterranean diet being
particularly beneficial. This diet is rich in fruits, vegetables, whole grains, and healthy fats, which can help reduce liver fat and improve overall health.

Exercise: Regular exercise, independent of weight loss, improves cardiovascular health and insulin sensitivity. Dr. Gandolfo recommends moderate exercise, such as walking, swimming, or weightlifting, for at least 150 minutes per week. Building muscle mass is also crucial, as it helps to combat insulin resistance. Incorporating physical activity into your daily routine can be a game-changer for liver health and overall well-being.

The Role of Coffee

Interestingly, Dr. Gandolfo highlights the benefits of coffee for liver health. Up to three cups of black coffee a day can reduce liver inflammation due to its antioxidant properties. However, he advises avoiding high-calorie coffee drinks that can negate these benefits. The antioxidants in coffee can help protect the liver from damage and reduce the risk of liver disease progression!

The Psychology of Creating a Healthy Lifestyle

Dr. Gandolfo acknowledges the challenge many patients face in creating and maintaining these lifestyle changes. To help make these healthy changes easier, on episode 11 of The Real GI Doc Show he interviews a special guest, Dr. Noreen Vail, a licensed psychologist with a PhD in clinical psychology. Together, they delve into the psychological aspects of making lifestyle changes, particularly focusing on fatty liver disease.

Dr. Vail introduces the transtheoretical model, a well-researched framework that outlines five stages of behavioral change: pre-contemplation, contemplation, preparation, action, and maintenance. She emphasizes the importance of assessing where a patient is on this spectrum to tailor advice effectively. For instance, a patient in the pre-contemplation stage may not be ready to hear detailed diet plans, whereas someone in the preparation stage might benefit from specific actionable steps.

One of the key takeaways from the episode is the significance of setting realistic goals and keeping a journal. Dr. Vail suggests that writing things down can help patients become more mindful of their behaviors and track their progress. This data can be invaluable during follow-up appointments, providing a clear picture of what’s working and what needs adjustment.

Dr. Gandolfo and Dr. Vail also discuss the common excuses patients use to avoid making lifestyle changes, such as lack of time, holidays, or injuries. They stress the importance of consistency over perfection. Missing a day of exercise or indulging in an unhealthy meal occasionally doesn’t derail progress; it’s the long-term habits that count!

Another crucial aspect covered is the role of family support. Dr. Vail advises against nagging and instead recommends a supportive approach. Encouraging loved ones to join in on healthy activities can create a positive environment that fosters change.

Finally, the episode touches on the limitations of time during medical consultations and the importance of a multi-specialty approach. Dr. Gandolfo acknowledges the challenges posed by insurance and the need for accessible pathways to dietitians, psychologists, and other specialists.

This episode is a must-listen for anyone struggling to make lifestyle changes for fatty liver disease or any other health condition. Dr. Gandolfo and Dr. Vail provide practical advice and insights that can help you overcome psychological barriers and set yourself on a path to better health.

Take Action Today

The episodes both conclude with a powerful message: Start today. Whether it’s a 15-minute walk or a small dietary change, taking immediate action is essential for long-term health. Small, consistent efforts can lead to significant improvements over time!

For more in depth information, listen and subscribe to the show here.

Medication for Fatty Liver Disease

If you have been diagnosed with fatty liver disease, there is now an FDA-approved medication called Rezdiffra available for some patients with liver fibrosis. To see if you qualify for treatment, a measurement of your liver health is taken with a FibroScan test. This simple ultrasound test is done in the office and can determine if have significant fatty liver disease, and will also measure the fibrosis level.

To make an appointment for an assessment, send us a message here or call the office during regular business hours.

How Exactly Does Alcohol Cause Liver Problems?

Posted on January 12, 2018 - 3:53 pm by Frederick Gandolfo MD

Alcohol has been enjoyed by people throughout the world from the beginning of recorded history up until present day. It is an important part of many cultures and social gatherings, but because alcohol is available almost everywhere it is also easily misused and abused. By now, it is pretty much common knowledge that drinking a lot of alcohol is not really great for your liver. But how does alcohol actually cause liver damage?

To understand how alcohol causes damage, we need to understand what happens in the body when alcohol is ingested. After alcohol is consumed it is absorbed by the stomach and small intestine and delivered to the liver through the portal vein. The liver now has to deal with the alcohol by metabolizing it into something less toxic for the body.

The liver detoxifies alcohol in two main ways: First, there is an enzyme called alcohol dehydrogenase which is present in the liver cells with the main job of breaking down alcohol into something called acetaldehyde. The only problem is that acetaldehyde is kind of toxic too, and can cause damage to the normal proteins in the liver. If too much acetaldehyde forms, one can experience flushing, nausea, vomiting, palpitations…hopefully this doesn’t sound too familiar! Acetaldehyde is then broken down by an enzyme called aldehyde dehydrogenase to a substance called acetate, which is released from the liver cells and can be turned into energy by the heart and muscles.

Alcohol is also broken down by a family of liver enzymes (called cytochrome P450 enzymes) which also convert alcohol to acetaldehyde. However, not only is acetaldehyde toxic in its own right, but the cytochrome P450 enzyme system also causes the formation of nasty reactive oxygen species as a byproduct. (Reactive oxygen species are also called “free radicals” and are unstable molecules that cause damage by oxidizing critical proteins and other materials in cells. Think of pouring hydrogen peroxide on an open wound…that is what free radical damage looks like, only on a smaller cellular level.

This is a huge oversimplification and there are many other ways that alcohol a) gets metabolized, and b) causes liver damage. However, since this is not a textbook we will move on to the fun stuff next.

Alcoholic liver disease (ALD) is the general term used for liver problems related to excess alcohol ingestion. There is a spectrum of liver disease seen with alcohol use, which usually occurs in a continuum from mild and reversible, to severe and irreversible.

The first manifestation of ALD is alcoholic fatty liver. The alcohol-induced inflammation described above alters metabolism of triglycerides and fatty acids in the liver favoring accumulation of these substances in the liver cells. The liver becomes swollen and inflamed, leading to the leakage of liver enzymes into the blood. Blood tests may show high levels of these liver enzymes (called AST and ALT). Ultimately, fatty liver is reversible once excess drinking is stopped.

However, if the patient with alcoholic fatty liver continues to drink, one of two things will usually happen depending on the patient’s sex, genetic predispositions, nutritional state, the time course of the drinking, the sheer amount of alcohol consumed, and many other factors: Alcoholic hepatitis or alcoholic cirrhosis.

If someone drinks a large amount of alcohol in a relative short period of time, they are at risk of developing alcoholic hepatitis. In alcoholic hepatitis, the inflammation in the liver goes into overdrive causing liver swelling, abdominal pain, fever, jaundice (yellow skin), and often ascites (fluid in the abdominal cavity) and/or encephalopathy (confusion). Left untreated, alcoholic hepatitis is often fatal, and unfortunately even with the best medical care the outcome remains rather grim. Once activated, the massive levels of liver inflammation seen in alcoholic hepatitis can continue to worsen even after the patient quits drinking alcohol entirely.

Most patients who survive the experience of alcoholic hepatitis eventually find out that underneath all that liver inflammation is cirrhosis. Cirrhosis is when the liver becomes fibrotic (filled with scar tissue) and functions poorly, causing a host of problems. Cirrhosis also can occur slowly and quietly without having to progress through alcoholic hepatitis; this is often seen in the “heavy social drinker” who never really drinks that much in any one sitting. However, over the course of a week or so, the heavy social drinker consumes quite a bit of alcohol and as we know, weeks lead to months, which lead to years. Just like interest in a retirement account, the slow progressive damage adds-up over the years of “social drinking” and causes cirrhosis just the same as if the person binge-drank their way there in only a few years of heavy alcoholism. At least when someone drinks with fury the liver damage is expected: The slow silent damage is more insidious since there are no great ways to tell that liver damage is happening until the damage is done. In fact, liver function blood tests may be normal despite the presence of cirrhosis.

There is an old adage that states “The dose makes the poison.” That is, anything can be a poison in sufficient quantity (think water, potassium, or oxygen for example), and if you take a real poison like cyanide and dilute it down so it’s barely detectable than it ceases to cause damage. In that same vein, alcohol is basically poison that people ingest willingly for pleasure, but just how much alcohol does it take to poison your liver? How many drinks separate safe social drinking from “heavy” social drinking, from a full blown bender? Well, that is an excellent topic for a future post, so stay tuned!