General Wellness

Hello everyone,

Dr. Chuma here for another segment, the last of the year.

I received a great recommendation on a follow up topic to last week’s segment which I would like to discuss today. What are the signs and symptoms of fatty liver disease? 

A big thank you to my biggest fan, my mother Bohdanna, for always encouraging me and always offering advice, in this case, about this important topic.

But before I get into it, I just wanted to remind everyone about the importance of keeping everyone as safe as possible with the upcoming holiday season. 

Although Covid cases remain low, it is still out there and the incidence of the flu as well as RSV and pneumococcal pneumonia has been growing steadily. In addition, I have seen many patients with prolonged symptoms, sometimes over a month, who have tested negative for all those specific microbes. There are a lot of bugs out there and we need to protect ourselves and those around us.

It is not too late to get your Covid booster or flu, rsv or pneumococcal vaccines. There are lots of opportunities to get together with people in the upcoming months. It may be a little late for Christmas, but the season is just starting. There are still New Years, all the holiday parties and the upcoming Debutante Balls, for all those Ukrainians out there.

Also, if you’re sick, just stay home. It may be sad for you to not participate in celebrations, but it’s better than getting someone vulnerable, really sick and then needing to go to a funeral!

Now onto the main topic.

As far as signs and symptoms of fatty liver are concerned, the simple answer is that the vast majority of people with this disease are walking around, not knowing that they even have it since in the early stages, there are no symptoms. 

If you want to revisit the basics of fatty liver disease, you can read the transcript of last week’s segment on my website doctorchuma.com, where all my posts are stored. But, just as a reminder, this condition occurs when a person has reached their threshold of being able to store excess fat under their skin and starts to store it in between and in their organs. The most commonly affected organs are the liver, pancreas, heart and muscle.

As the fat builds up, it causes those organs to deteriorate and malfunction. The pancreas loses its ability to produce insulin, the heart develops arrhythmias and arterial disease and the kidney stops filtering blood and getting rid of excess toxins. In the liver, fat impacts on the liver’s ability to regulate glucose and fat production, as well as act as the body’s main detoxifying organ.

The most common early sign of fatty liver is simply being overweight or certainly obese, whether it’s because of some other condition, medication or poor lifestyle choices. Other common conditions associated with fatty liver disease include pre-diabetes or diabetes, elevated cholesterol or elevated blood pressure. But other than in advanced cases or with imaging, there is no way to know for sure. 

As the disease progresses, some of the signs and symptoms may include:

• Fatigue.
• Generally not feeling well, also called malaise.
• Pain or discomfort in the upper right belly area where the liver is located.

Some of the symptoms of advancing liver disease from fatty infiltration include:

• Itchy skin, a result of early build up of bile, a liver byproduct, in the skin.
• Advanced bile build up leads to yellowing of the skin or eyes, called jaundice.
• Abdominal swelling called ascites which occurs from fluid build up because of poor blood flow through the liver.
• Shortness of breath occurs as the abdomen fills with fluid and an enlarging liver pushing on the diaphragm.
• Swelling of the legs and enlargement of the spleen from poor blood return to the heart from an engorged liver.

• Red palms. This occurs due to dilated blood vessels, often linked to hormonal imbalances caused by liver dysfunction.
• Easy bruising and red spots on the skin, a result of coagulation abnormalities because of liver disease.

If you are at this stage, the poop is really hitting the fan and you are quickly heading towards irreparable damage and scarring, called cirrhosis. Early liver damage is still reversible but once there is scarring, you may be headed towards developing liver cancer or needing a liver transplant.

If you are concerned about fatty liver disease, the simplest test is an ultrasound of the liver. There is no radiation involved and it is quick and accurate. But this tells you nothing about the liver’s function. Blood levels of liver enzymes will indicate if your liver cells are starting to be damaged. But before that happens, your liver will start becoming resistant to insulin and your blood sugars may start to rise significantly. In addition, elevated cholesterol is a sign of a malfunctioning liver, as well as too much added cholesterol in the diet.

If you are concerned, see your doctor.

Simple steps you can take to prevent or start reversing fatty infiltration of all organs is:

1. Lose weight. Even a few pounds can be beneficial.
2. Stop eating so much.
3. Cut way back on fats, especially saturated fats, from all sources.
4. Cut out all added sugars, including simple hyper processed carbohydrates, which are quickly converted into fat in the liver.
5. Consume lots of fruits and vegetables. They do have sugar, but are also packed with fiber, nutrients and water. Fructose from whole plants is processed differently than added sugar in processed foods.
6. Watch the alcohol which is directly toxic to the liver.
7. Drink coffee. Both regular and decaffeinated coffee has been shown to be very beneficial to liver function.
   

I know that this is tough advice as we are about to enjoy Holiday celebrations but remember that any improvement is better than no improvement when it comes to lifestyle changes. However, the more you change, the better off you’ll be.

Have a great and safe holiday season and see you next year.

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.