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Living with Fatty Liver and NASH
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NASH & Bariatric Surgery

I've just been diagnosed with an advanced case of NASH, right on the cusp of cirrhosis. My doctors all say I should have bariartric surgery as soon as I can.

Have any of you out there gotten the same recom-mendation, and if so, what did you decide, and how did it work out?

-- afraid of cutting out 85% of my stmach

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Surgery always has risk but it has been shown to benefit the very obese patients who fail conventional therapy. No personal experience but I do know people it has worked for

WAYNE

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Thanks! Were they able to delay or even avoid cirrhosis? And what kind of surgery did they get? Lap band, endoscopic gastroplasty, sleeve gastrectomy, Rou-n'Y? Where is the best place to get good information?. Thanks very much -- I appreciate it

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Hi RSF

You are taking me down paths I can't go here as I'm not a doctor but let me help you find your way. Here is a link from the National Institute of Health about the current research.

ncbi.nlm.nih.gov/pmc/articl...

Reports like this are hard to read but here is the quote that is probably most important to you.

bariatric surgery is the most reliable method for achieving substantial, sustained weight loss. This procedure is safe when performed by a skilled surgeon, and the benefits include reduced weight, improved quality of life, decreased obesity-related comorbidities, and increased life expectancy.

Now, remember that ALL surgery has risks and there are people who have bad outcomes but you have every right to ask all of your questions of your physicians and keep asking until you understand. We advocate diet as the first way to manage the disease and here is a link to our suggestions, though I know it doesn't work for everyone.

fattyliverfoundation.org/na...

Good luck

Wayne

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Thank you!!

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Can I just comment here? This is just an observation & comment. Nothing more...

In speaking of my bile problem, bile in my stomach and esophagus, doctors are baffled. They state that they would understand if I had had barbaric surgery, but they don't have an explanation for me. Maybe ask about bile complications.

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Interesting. Thanks for giving me the heads up. I'm also concerned about gastro complications from bariatric surgery, especially nausea, which I'm particularly prone to.

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That stands for Non Alcoholic SteatoHepatitis. More info available online -- just Google "NASH" liver.

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Hi Doodle

I don't know how to combine two accounts. Never been asked that. I suppose the simplest would be to delete one that you don't want, but I'll ask the webmaster. The forum is hosted on Health Unlocked servers, but I am part of the Fatty Liver Foundation and we work with the patient's questions. I'll let you know if there is another solution.

Wayne

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When irreversible gastrectomy was presented to me as essentially my only option, I looked around and found the University of Chicago Fatty Liver Clinic.

Two things:

First, they told me that, in my case, while bariatric surgery is a treatment possibility, they didn't think I was there yet, and first should try their dietary recommendations, which are:

- Take 4 tbl of olive oil per day

- Drink 3 cups of paper filtered coffee per day

- Follow a Mediterranean diet.

The 1st two sound goofy, but evidently there's loads of scientific research supporting both protective effects of coffee on liver, and ability of olive oil to steady or even reverse fat accumulation in liver, and reduce inflammation as well.

Second: If bariatric surgery does turn out to be what I need, I'm hopeful that I can get an endoscopic gastroplasty -- essentially a reversible stapling version of a sleeve gastrectomy.

Currently.it's not covered by insurance, though it saves so much in hospital costs and recovery time that I hope insurance companies will catch on soon.

As far as I know, the gastroplasty is being done at UChicago, Mayo Clinic (which originated the procedure), John's Hopkins, and (I think) Columbia Presbyterian in New York. (Maybe a couple other places, though I can't recall any offhand.)

I'm going back for my 1st follow-up visit to the Liver Clinic in about three weeks to see if olive oil/coffee/Med diet (and exercise) has helped. Fingers crossed.

I'll keep you posted on how things go...

Good luck!

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The thing to keep in mind is that it took years to get to this condition so it will take time to change. If you want to dig into the subject you might start here.

fattyliverfoundation.org/co...

Wayne

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Thanks for the reminder. Though you mentioned to me that it's taken you about 3 years to go from cirrhosis to stage 3 NASH by using the olive oil and other recommendations, yes?

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Yes, If you are getting fibroscans, my score was 21.5 when diagnosed in January 2015, today it is 9.6. There is no quick fix and lifestyle change needs to be permanent.

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My fibroscan results don't show up in my medical records so far, but I'll start keeping track of them. 👍

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You're quite welcome!

I'm not a doctor -- but here's the best of what I've found out/ been told.

1. Sounds like you're talking about lap band surgery, which doctors have told me isn't as effective as gastrectomy (cutting away 85% of the stomach) or gastric bypass. In fact, I've been told that most doctors aren't even doing lap band surgery at all anymore.

Sleeve gastrectomy seems to be the most popular choice now, though it is irreversible. (Other than lap band, the only other reversible bariatric procedure I know is the endoscopic gastroplasty, which I described above.)

2. I usually go for 2tbl of olive oil at a time, 2x/day, but do whatever feels right to you. I've been taking it straight, like medicine, but it's also pretty easy to mix some into Greek yogurt or a can of tuna.

3. Lots of Mediterranean diet info out there online you can search for, including cookbooks and meal plans. My nutritionist says skinnytaste.com is a good site for advice on healthful eating.

Basically, it's increase: fruits, vegetables, fish (especially fatty fish like salmom), whole grains (oatmeal; whole grain bread, including rye; brown rice, etc.), legumes (peas, beans, lentils, etc.), nuts and seeds, and healthy fats (esp. olive oil).

Eliminate or decrease as much as you can: sugar; unrefined or "white" carbohydrates (white bread, white rice, white potatoes, regular pasta, etc.); animal fats, which means limiting beef and other red meats, and choosing nonfat dairy.

Try not to eat too much carbohydrate at one meal, i.e., no more than 30g if you can manage it (but no more than 45g). See carb counts in nutrition labels on most packages of food.

Try to limit calories and carbs enough to help you control your sugars and lose weight.

Put exercise in the mix.

4. For medical follow-up -- I don't think it's necessary to see one of the high-powered places I mentioned -- just go with the most experienced doc who seems to make the most sense that you and who you're comfortable with.

If you do want to be seen at one of the other places, check with your insurance company. They might cover the visit, though you'll likely need a referral from your primary doctor.

All this can be a lot to take in at once. Just start, one step at a time, and do the best you can. :)

Good luck!! Hope everything goes well for you.

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