General Wellness

Hello everyone,

Dr. Chuma here and I wanted to talk to you today about fatty liver disease. 

This is not a topic people want to hear about during the Holidays, but it’s an important topic nonetheless.

The liver is best known for being the organ which filters out and breaks down toxins from the body, especially alcohol. But it does a lot more than that. It has a crucial role in metabolism and blood sugar regulation. In fact, overnight while you sleep, your body does not run on the food you ate during the day but on the glucose your liver releases from its stores. The liver also produces cholesterol and triglycerides. Most of the cholesterol that is measured on blood tests comes from the liver. But levels become excessive when liver function is disrupted. The extra fat and sugar in the blood resulting from liver dysfunction is toxic.

There are many conditions which can affect the liver, such as excessive alcohol consumption or viral infections like hepatitis C but the most common condition is fat depositing in the liver, known as non-alcoholic fatty liver disease. In the past, alcohol-related liver disease was the principal reason for liver transplants but today, the main reason for transplants is fatty liver disease. This condition is purely diet-related and is reversible if treated early enough. 

Fatty liver affects an estimated 30% of Americans. This is not surprising given the sad state of our population’s routine diet and lifestyle, resulting in poor health. Nearly half of Americans are obese and another 25% are overweight. That’s ¾ of the country! 

There are 3 locations in the body where fat deposits. These are under the skin, the most obvious site, but it also deposits in between our organs and in our organs.

1. SUBCUTANEOUS FAT is the fat you can see under the skin. It’s where we first start to store fat, evolutionarily, as a source of energy when food is scarce. Today, we have a massive surplus of food but our bodies continue to store it, hence, our obesity crisis. When this location is saturated, fat starts to deposit in other locations. Everyone’s saturation point is different.

2. VISCERAL FAT is the fat that fills the space between organs. It is much more dangerous than subcutaneous fat and starts to accumulate when we have saturated our ability to store fat under the skin. Although you can be skinny on the outside with a lot of visceral fat on the inside and vice versa, there is a general correlation between excessive subcutaneous fat and excessive visceral fat.
   
3. ECTOPIC FAT is the fat that deposits in our organs like the liver, pancreas, heart and muscle cells.This is the most dangerous fat as it impairs organ function. If you have fat in any of those organs, it is in all of those organs. If you have visceral fat, you always have ectopic fat.

Fat in the liver is foundational to all chronic diseases. With increased fat deposits, the liver produces excessive amounts of glucose and becomes resistant to insulin, the pancreatic hormone responsible for transferring glucose from the blood into the cells where it is stored or used as energy. This leads to higher glucose levels in the blood forcing the pancreas to produce more and more insulin. It becomes a spiral of worsening and worsening insulin resistance and higher glucose levels in the blood leading to diabetes and all the organ damage that comes along with it. Years before people are diagnosed with even pre-diabetes, their body is struggling with insulin resistance. It’s not measured on routine bloodwork.

Fortunately, we can remove the fat from our organs, including the liver, before it starts to cause scarring and permanent damage. Unfortunately, patients are told very little about how serious fatty liver is and how they can reverse it.

Although drugs like Ozempic can help you lose weight and reverse fatty liver, they don’t fix the fundamental problem, which is eating too much fat and sugar. I’ll do another segment on the benefits and dangers of Ozempic later. 

Here are some ways to prevent and reverse fatty liver disease:

1. CREATE A CALORIE DEFICIT, meaning, consume fewer calories than your body uses up. This can be achieved in a few ways.
   1. Calorie restriction. Simply put, eat less and eat less often.
   2. Reduce consuming calorie dense foods which often contain fats and simple sugars like flour. Sugars, especially fructose, get converted into fat in the liver. That’s why sugar sweetened beverages, including fruit juices, are so dangerous over time. With very few exceptions, plants are not calorie dense. They are full of water and fiber as well as vitamins, minerals and antioxidants. It’s no surprise that fatty liver disease is non-existent in the Blue Zones populations where their animal product consumption is less than 5% of their total caloric intake.
   3. Time restricted feeding is a good strategy. Eat all your food within a narrower window allowing at least 12 hours of not consuming anything other than water or black coffee or tea. Let your body and your organs rest.
      
2. EAT LESS SATURATED FAT AND REFINED SUGARS.
   1. Reduce ultra processed foods such as poor quality bread, cakes, pastries and chips and crackers. These refined sugars are converted into fat in the liver. These foods are also usually loaded with saturated fat which also deposits in the liver.
   2. Focus on leaner foods, but keep in mind that even “lean” meats like salmon and chicken breast still have a lot of cholesterol and saturated fat. Almost as much as red meat. Again, fruits and vegetables have no cholesterol and very little fat and are leaner by nature.
   3. Watch excess amounts of oils, especially tropical oils like palm and coconut which are almost all saturated fat. Even olive oil is still 14 grams of fat per tablespoon, 2 grams of which is saturated.
   4. Watch higher fatty plant foods. Although the fat profile of such popular foods like avocado, nuts and seeds is better than animal fat sources, they are still very fatty. Eat them, but don’t overdo it.
      
3. EXERCISE. All forms of exercise are good but aerobic exercise like running, biking or even brisk walking, seem to target visceral and ectopic fat more.
   
4. There are other lifestyle factors like managing stress and getting better sleep which are also helpful. 

So don’t ignore fatty liver disease if you have it and improve your lifestyle and diet so you don’t get it.

See you next time.

Radio show transcript from last week Friday.

This week’s medical moment is based on a listener’s request and is a very important topic. In this age of information overload, it can be very confusing who to trust when getting information from the media, social media and the internet. Unfortunately, anyone, regardless of credentials, can post and publish whatever they want and they will likely gather followers very easily. 

From the perspective of the listener, you can literally find support for whatever you want to believe if you look hard enough.

To make matters worse, search engines like Google will advertise and suggest sites to you which are based on your searches and what you read, or even listen to, making it easy to get a distorted, one sided perspective.

I will use a specific example of a health claim I was asked to comment on which is the danger of plant compounds called lectins, a topic I wanted to speak about anyway. The idea that lectins are unhealthy and that we should avoid them at all costs has been popularized by the web influencer Dr. Steven Gundry, and it is a complete distortion of what is actually true.

Dr. Gundry has impressive credentials. He is an accomplished pediatric heart surgeon who was a professor and chairman of cardiothoracic surgery at Loma Linda University. After many years of being a surgeon, he went into preventative medicine and runs experimental clinics in Palm Springs and Santa Barbara, California. He is the author of several books promoting a low-carbohydrate diet, including the NYT bestseller “The Plant Paradox”. One of its most controversial claims is that humans should avoid all foods that contain compounds called lectins, arguing that they cause inflammation and are partly responsible for most modern diseases. However, scientists and dietitians have called his claims pseudoscience.

Lectins are a very large family of protein molecules which bind carbohydrates. At least 200 different types have been identified and the reality is that, just like fiber, each type of plant has a unique form of lectin. Lectins on one cell recognize and bind to surface carbohydrates on another cell and in doing so, they protect the host plant from microbial infection. The same features that lectins use to defend plants in nature may cause problems during human digestion. They resist being broken down in the gut and are stable in acidic environments, features that protect plants in nature. 

But lectins are also present in humans. They actually play many important roles in the human body, including:

• Boosting our immune response
• Improving cell to cell communication
• Assisting in tissue development
• They are antioxidants, protecting cells from damage. 
• They slow digestion and stabilize blood sugar. 
• And they can even help prevent cancer.

The main lectin containing foods that are on Dr. Gundry’s do-not-eat list include legumes like beans and lentils, certain grains like quinoa and vegetables like tomatoes and mushrooms. 

The real issue is that when not properly prepared, plant lectins can cause gastrointestinal issues and can prevent absorption of important nutrients. But when properly cooked, the lectins are inactivated. No food is good when consumed in excess or when not properly prepared. Heck, even apples have arsenic in the seeds. So, does that mean you should never eat apples? Of course not because you could never eat enough apples to get sick since you’d fill up and vomit long before you get arsenic poisoning! The healthiest mushroom to eat is the simple button mushroom. You should limit eating it raw since, like lectins, it also contains a toxin, which is also inactivated when cooking. 

In fact, small amounts of any toxin actually stimulate our bodies to protect itself. This phenomenon is known as hormesis.  There is truth in the saying “That which does not kill you makes you stronger”.

All the hubbub about lectins started after an incident in 1988 in Japan. As Japan started to westernize their diet, the population started to become unhealthier. The government organized a “Healthy Eating Day” and were promoting eating more vegetables, including beans. At one site where food was made for the public, a batch of red beans was under cooked and a number of people developed some bloating, cramping and diarrhea. Red beans contain large amounts of a particularly irritating lectin. Despite reports of hospitalizations and serious illness, there were no actual documented cases of such events and everyone recovered without complications. 

The most important message is not to avoid beans but to cook them properly! Beans are regularly consumed by all the healthiest and longest lived societies.

When it comes to information you gain from any source, you need to be skeptical, educate yourself and read all sides of an issue before deciding not only what to eat but also which medications to take or what medical treatment to pursue.

Also, as a general rule, if someone is promoting a specific health topic and sells a product on their website to deal with that problem, beware. Dr. Gundry sells a number of supplements on his site, including an anti-lectin supplement called “Lectin Shield”. That’s not to say that anyone selling anything is immediately dishonest, but you just need to do your research.

And remember that Science is not truth. Science is the pursuit of truth. True scientists change their views based on the most recent evidence, which is constantly evolving. Be cautious of anyone who sticks with an idea at all costs, just because they want it to be true or they were taught something 20 years ago. Medical students are told that by the time they graduate from medical school in 4 years, half of what they learn will be out of date. 

Knowledge evolves. We should evolve along with it.

See you next time.