Living with Fatty Liver and NASH

Experts to the left, Experts to the right, into the valley of death ride the 6 million NASH patients

Experts to the left, Experts to the right, into the valley of death ride the 6 million NASH patients

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NASH is the silent stalker. The hidden instrument of the pain and suffering that is our modern plaque of caloric poisoning. History might one day choose to call this time "The White Death" to balance tales of "The Black Death" of Medieval Europe. When the mortality statistics correctly include the comorbidities of NASH and cirrhosis, this time will be reckoned as the greatest mass death in human history. It will be viewed as a strange period when much of the society willingly chose to adopt behaviors that would lead to their early and painful deaths.

Well, enough prophecy. It is well established that diet is producing the majority of the liver disease epidemic. We grow fatter each year and even when we try to change that the cacophony of advice is overwhelming. Groups are passionate about the extremes of food and you can find advocates for eating all combinations of diets with "expert" advice about high and low fats, carbs, and proteins. The vegans vs the paleo, for example, are both confident that they are correct and experts are available to support each group. There is a great middle, of course, who have no real doctrine and just eat what is convenient and appeals to them, but like a great herd of wildebeest, they move always toward the river where the crocodiles lie in wait.

If you are someone who wishes to step out of that migration what do you do? It is very difficult to not be confused by claims. A major source of the challenge is the miracle that is your liver. Consider this, we have had societies that lived on 80% carbs and we have had societies that lived on 80% fat. That illustrates the magic of your biochemistry. The liver is able to turn carbs to fats or fats to carbs as it needs to. That is why you can eat such a variety and not poison yourself. The extreme diets have their own challenges, but clearly, with such a powerful tool for your use, there must be a "best" mix of material to feed the liver for optimal operation. As a liver patient, that is quite clearly the challenge. Once you have harmed the organ your goal is how to take the best care of whatever function remains.

What might liver kindness look like? Do you think it would be good to ask it to do as little work as possible? Clever idea, don't you agree? So how to do that? In broad terms, the body needs glucose and fatty acids for energy. Different organs use different combinations of fuel. For example, the brain is a glucose fanatic and the heart burns only fatty acids so both are required. The liver adjusts everything to maintain a proper balance no matter what you eat. The problem comes when what you eat overwhelms the liver's capacity and things will then go wrong.

We have all been told that everything we eat goes through the liver but suppose there was a food that didn't. Might that be a useful tool? So let's all ride on a triglyceride.

All fats are triglycerides which just means they are made with three fatty acids. When you eat them they go into the small bowel where they are broken apart by enzymes and each fatty acid is grabbed by two sodium atoms and they are sucked through the walls of the bowel. Inside the cell, they are rebuilt as triglycerides again and here is where it becomes interesting. Molecules like glucose are short and are able to pass directly into the bloodstream and go directly to the liver so they are the first responders you might say. This is true for molecules with up to 12 carbons in their chain and that would be coconut oil which can also enter the bloodstream directly.

The longer chain fatty acids, however, would be trapped except that they are formed into packets with multiple molecules in a ball and are sent to the lymph system instead. The interesting thing is that the lymph system bypasses the liver and instead injects the fat into the bloodstream on the other side of the liver. Now, this is important. That means that cells that can use those fats can extract them from the blood before they return to the liver for processing. That is so interesting.

If you only ate sugar all of it would have to go to the liver where some of it could be made into fatty acids and that would be a hard job for it. If you ate only fats some of it would have to be processed into glucose to meet that demand, again a hard job. You don't have to be a scientist to think that perhaps there is a balance point which puts the least strain on the liver.

There are a lot of intricate details in the metabolism of carbs, fats, and proteins which we can highlight in future articles. They write entire books on each subject. The point here is when you are being pitched by the various experts you should wonder, even just briefly, how little details like the dual path energy routing done by the bowel might be affected and whether it is going to lighten the load of your liver. If you would like a little bit fuller explanation you can click this link.

Below is a link to the diet discussion on our website. Like so many, we have a point of view about what is best for most people. The site also has links to the science that supports our recommendations and you can explore the science and other aspects of the disease if you want to understand things more fully.

We hope you are well and please pass this along to anyone you feel might benefit.

3 Replies

Well that was a very interesting read; i have cirrhosis. Ten years this june.caused by alcohol. I have always had a healthy diet after i was discharged from hospital and under a nutritionists as i was just about 6stone in weight with no muscle at all .

I have been under QEHB liver unit since feb 2017. I have now been told i have fatty liver 🤔..i was always under the impression that cirrhosis was the last thing you had after inflamed and fatty liver. So the fatty liver is now causing more damage to the cirrhotic liver .. its so very hard these days to keep up with all the fresh cooking as i have two prolapse disc in my lower back and osteopenia in right hip. So mobility is an issue and sitting in front of the tv every night eating big bars of chocolate. I dont smoke or drink ...i have reached a point where i am actually tired of being good 😏


Hi Millie

You are having a journey to be sure. Alcohol damages the liver is a somewhat different way than problems with dietary fat. So technically I guess it may be possible to describe both but really cirrhosis is cirrhosis in either case so it seems like an odd diagnosis. That said the dietary stress is likely adding to the prior alcohol damage. It is often a very difficult challenge once the body suffers debilitating damage. If you can manage a liver friendly diet you may be able to get some relief but I know it is a very hard place to be. Here is our recommendation about diet, and I wish you the best.


1 like

Many thanks Wayne, appreciate your reply. I will have a good read up on the links .kind regards linda