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Living with Fatty Liver and NASH
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Fatty Liver (Hepatic Steatosis)

Hi guys,

I thought of joining this forum after reading lots of stories related to fatty liver.

Just a little background on me. I am 38 year old and between 34 and 37 year age, I used to lift heavy weights, eat lots of multivitamins, creatine etc. basically I was a heavy lifter but never did any cardio. In December 2017, I received my first anxiety attack and from there everything went down hill. I was 184Lb and cannot go to the gym and lift heavy because every time I did, my heart was beating a lot which was giving me panic attack. From December 2017 - June 2018 I have been to ER 4 times several blood tests and everything came normal. I do have high cholesterol 255.

Between my anxiety I started eating everything. Basically eating was bringing my anxiety down. I used to never eat sweets but I got a sweet tooth between this time and in October 2018 I was 205Lb. I was just eating everything oily food, ice creams you name it. Between this time anytime I used to sit down, i felt like my right side was touching my ribs. The more I sit the more soar it did get. I didn’t pay attention too much until some nights I used to get like a stabbing pinch for 5 seconds where it was waking me up. So I ended up going to my GP and she examined the area especially the lower rib and pressed every region but could not find anything neither it did not feel pain. So she said we can do abdominal ultrasound and will do blood test. October 19th The blood test came with ast=36 and alt=58 and ultrasound simple stated ‘fatty infiltration in the liver’ impression was hepatic steatosis. At this time I also had a small pea size pimple to the right rib.

Also, my Trig = 93, LDL = 180 and HDL = 33

So fast forward now, on december 5th my Alt=35 and ASt=30 and I weigh 175LB as of today. I’ve gone to low carb diet and have lost the pregnant belly fat which I used to have it with fatty liver. All I do is eat chicken breast, salmon, broccoli, olive oil, 100G of salt only, broussel sprouts and couple protein shakes unsweetened and no carb non GMO.

Working out 6 days a week with 20 min carido(Elyptical) & lifting weights and 2 days of strength training with a trainer. Now my BP is normal, i will be doing another cholestrol test end of Jan to see if diet has helped in briningmy cholestrol down. also, the right lower rib pain has subsided alot but it is still there.

So my questions to follow gurus who had fatty liver (non alcoholic) or has reversed it.

Q) did you had lower right rib discomfort ? It’s more of a dull ache pain. The discomfort has subsided for me now due to weight loss but if I do a machine exercise whic has a cushion and I press my chest on it, it hurts. I went to several doctors and they state that it’s more of a muscle spasm. Can you please tell me what might be the cause for this ?

Q) I also can feel that my right side is swelled or not even as compare to my left side where the liver is. When i touch my ribs on the right side, it feels a little swollen as compare to left side. This is why when i sit i had an extra roll of fat. I went to 4 different doctors and they state it’s due to the fat distribution in your body and not related to any thing else. All 4 of them pressed hard in every region but no discomfort but when i press my chest hard on a machine press as stated earlier then i can feel the discomfort. If i do ab crunches, i can feel the discomfort on the rigth side also. Did you all encounter any of this issue also ?

Q) every doctor I went states that ‘fatty liver’ cannot be reversed but more of managed and as long you stay away from alcohol and Tylenol you should be fine. Only AFLD is reversible. Well I’ve seen slot of people on the forums who have reversed it so not sure why the doctors don’t believe in what’s posted online vs reality. What are your thoughts ?

Q) any input or suggestion you want to provide on my post or any future guidelines on what i needed to do ? I really appreciate it or any suggestions

#fattyliver #nafld

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A lot of people with liver distress have right side discomfort but that can be other things as well so it doesn't prove it is your liver. Now that you are eating a better diet, that is the best thing for your liver. At your age and with normal blood tests there isn't a lot that a doctor can say. A healthy diet and exercise are the best things for you so be aware of the possibility that things may change but try not to worry too much.

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Thanks Nash. Appreciate the reply. Doctors are not concerned about my fatty liverZ she didn’t even say anything. All the doctors stated was ‘fast at night for 12 hours, and that’s about it.

I educated myself by searching for answers and thanks to some online articles I’ve realized that diet is the only way. However, reversal or not is still tricky for NAFLD. I’ve only seen 3 post online on the forums for the people who were able to reserved it. I guess with simple fatty liver it can be only manageable so it does not progressed further (correct me if I am wrong please).

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Lots of people improve with a good diet. I'm one of them. Here is a short version of my story if it interests you

fattyliverfoundation.org/my...

This is video introduction to the foundation

fattyliverfoundation.org/about

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Wow I am so sorry to hear that but I am happy at the same time that you were able to fight and make sure the disease did not progress further.

I am actually surprised that weight loss and diet can be so effective. I hope you recover soon.

BTW I took the diet approach from your blog couple of months ago but did not knew it was you ;). I am glad that you are an engineer as I am as well also. We engineers tend to go in depth of the disease but I am no where like you who went DEEP down in this disease ;).

All I do now is eat broccoli, fish, Broussard sprouts, chicken breast, carrots, white raffish, fruits and vegetables and bought a juicer omega 9 for extracting fresh vegetable and fruit juices by myself.

Just recently I have introduced carbs like brown rice because I have reached my ideal weight in 2 months and have lost 25LBs and now I need to maintain it. So thank you for posting the diet plan for NAFLD.

My docs want me to start statin for my cholesterol and I told them NO since statins are prone to damage the liver more hence I decided to go the diet route and hopping that diet might make a difference in lowering my cholesterol.

Any other thoughts or recommendation on when do I do my next ultrasound ? And if there is anything else I need to be aware of ? Thank you so much for everything

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You didn't mention if you were using olive oil, if not consider it as cholesterol will frequently reduce if that is the source of most of your dietary fat fattyliverfoundation.org/ol...

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Yep I forgot to mention that I do use olive oil in my food and salads. Pre fatty liver, I used to use vegetable oil but now totally converted to olive oil.

Nash: did liver ever caused you any pain ?. I am not sure why my rib on the right side is a little swelled and when I stretch myself all the way back, I get a discomfort but only when stretching all the way back or if I put my chest on a cushion on a machine exercise and put pressure then also I feel discomfort. My left side seems to e totally fine. Just wondering if you know what might be the cause since I know fatty liver does not cause any pain

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pain varies a lot. Everyone is different. It is true that the liver has no nerves but the membrane that covers it does so when it is swollen it can cause pain but it is a very individual thing depending on how the various tissues actually connect.

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From my reading, it seems that NAFLD and NASH can be improved but not reversed, if by reversed one means totally cured. It can certainly be halted.

The idea that statins damage the liver is not accurate in terms of those with either condition, and they have been shown to be not only safe, but more than likely beneficial. I just researched it myself because my LDL cholesterol is inexplicably rising ... well, perhaps not inexplicably because high LDL is a side effect of OCA, a drug that I may or may not be taking (it is a clinical trial so I might be getting the placebo) so I took it as a good sign that I am likely receiving the real deal rather than the placebo. If, in 3 weeks my LDL has risen, my hepatologist will put me on statins. I consider the apparently minimal risks acceptable weighed against the benefits. You can research this yourself (are statins safe for NASH patients).

People with NAFLD and NASH are at greater risk of cardiovascular disease and death from it than others, so lowering cholesterol is important to me. Organic extra virgin olive oil is great for lowering cholesterol. Avocado oil can help raise HDL cholesterol and lower both LDL cholesterol and triglycerides so I include both in my duet.

I trust both my internist and my hepatologist, and if a doctor is competent, I keep in mind that doing no harm is a big part of practicing medicine. I am VERY picky about my doctors. I get lists of doctors who accept my insurance and then look them up ... credentials, education, experience, etcetera.

There are risks with any medication, as well as with supplements. For instance, drinking green tea is good for the liver, whereas green tea supplements are not at all safe. Drinking paper filtered coffee is good for the liver, but I would not use chemically bleached coffee filters. Also, the caffeine in coffee can raise cortisol levels (particularly bad for me since I work a third shift that elevates my cortisol) but the solvents used in the decaffination process are cause for concern. A medication I take for my diabetes can cause kidney failure but I take it because it reduced my insulin I need to take, which allowed me to lose weight, in addition to the medication having a protective effect on the liver.

Diet and exercise are really the best approach I think, with medication to treat synptoms as needed. I avoid most supplements, and always discuss the few I consider with both my PCP and my hepatologist. For instance, vitamin E supplementation is recommended for NASH but very dangerous and not recommended for those with both NASH and diabetes.

Your diet sounds a good deal like mine ... lots of cruciferous veggies, fatty fish, and lean chicken. Soy is beneficial for the liver so I switch between tofu and salmon but do not go overboard with protein.

Regarding soy, there are concerns that it contains lectins but fermenting and cooking pretty much nullify them. Another concern is that it will cause gynecomastia but that is a myth. Perhaps if a man were to consume massive amounts of soy, it could lead to a hormonal imbalance that could then possibly lead to "man boobs" but it is very rare and it would have to be a massive amount of soy.

Just my thoughts ... I do a lot of reading about NASH, fibrosis, diabetes, and heart disease and it can be a challenge to separate sound, evidence backed recommendations from hype and nonsense. There is a lot of fear mongering to promote this or that diet, this or that supplement.

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Thanks for so much detail. I am also very concerned about my diet but recently I have reached my ideal weight which is 172 and now I need to maintain it. If I keep eating what I am then I am more loosing weight. In order to maintain my weight, I have introduced quinoa, brown rice and home made wheat bread. Carbs is the only thing which makes me maintain weight but I have no other choice.

I see you talk about supplements. I do take fish oil and multivitamin every day and 1 scoop of unflavored protein shake 30g every day. Your thoughts on the above supplements ? Obviously my doc is against supplements before I even met her but everyone is different and I have heard that protein powder will do no harm to the liver (atleast my research) please elaborate

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I was writing about herbal supplements for the most part. I think they are dangerous because they are unregulated and while a very few have been shown to slightly improve liver enzymes, in my opinion, the potential damage is too great. My doctor is all about adding seasonings to food rather than taking supplements, so I make sure to have garlic and ginger every day, for instance. Assuming you are not diabetic, you might want to ask your doctor about vitamin E. I cannot take it because of my diabetes. Howevrr, a good multivitamin/mineral supplement covers most bases according to my doctor, though one without iron is better for those with compromised livers. NASH2 is spot on with his recommendation of extra virgin olive oil. There is a lot of iffy labeling when it comes to olive oil though, and I always get organic olive oil produced in the US because labeling laws are more stringent here. It is pricey but cheaper than a lot of dubious supplements that do little good and can do harm. A little goes a long way though. As for protein supplements, personally I would avoid any gelaron or collagen protein supplements and stick to pea and brown rice. If your insurance covers it, you might consider consulting a registered dietitian to determine how much protein you need. Too much can strain the liver. It looks like you are taking good care of yourself ... exetcise is particularly important ... cardio will "burn" excess blood glucose so it is not shuttled to the liver and stored, whereas resistance exercise that builds muscle can help in the long term, as the muscles store glycogen so the liver stores less of it. Cardio also helps reduce triglycerides and LDL cholesterol.

Fish oil can help with triglycerides but raise LDL cholesterol. I switched to a fish oil supplement with only EPA fatty acid, as that does not raise LDL cholesterol. Also, walnuts are very good for the liver, and a good source of healthy omega 3.

One often neglected piece of the puzzle is getting enough quality sleep. Sleep deprivation can damage the liver, lungs, and small intestine. So don't neglect your zzz.

There is a good article that my phone is not allowing me to copy and paste here regarding macronutrients in the diet for people with NASH ... dietary recommendations for patients with non-alcoholic fatty liver disease. It is at the NIH website. Another recommendation I read in a NIH article suggests that 20 percent of protein should come from soy. Also, I would not worry about carbs if they are from fruits and vegetables and whole grains. Very low carb diets are not as effective for fatty liver as moderate (healthy) carb diets.

Eat right and exercise is such vague advice! And eating right for liver health can be a puzzle.

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Thanks so much. I think it will be nice for me to meet with a dietician or hepatalogist to have that relationship.

My LDL is very high and I am doing another blood work and lipid test end of January. So I am hoping in 3 month of diet I should see some difference.

Thanks for all the details you have provided lassie as this is very helpful. Sometime you feel like why did we get thus fatty liver. I wish people need to be aware of this.

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I am not sure whether Fatty Liver will ever be completely recovered. But for me, my fatty liver has been getting better each day. here is my little short story that i posted in this forum - healthunlocked.com/fatty-li... Pls feel free to take a look & hope it helps u in anyway possible. Take care & happy New Year!

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That’s very good to hear huldc. I am so glad to read your story and happy that something did worked out for you which brought the liver enzymes to normal.

Btw did you ever got lower rib discomfort or swelling ? Or any kind of liver pain ?

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besides my stomach feel pain & bloated, sometimes my liver/rib area also felt like a lot of gas in there, it was like swelling .....really uncomfortable. Pain not that i know of. Anyway, it was quite sometime ago. I am glad I no longer having that discomfort.

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I read your post and wanted to say have you looked at Costochondritis I do not have any liver issues it's my husband but I do have Costochondritis and what you describe sounds familiar. The more activity I do in my upper torso and say like the action of cleaning windows the worse it gets, I thought a couple of times I was having heart issues in the end i used my blood pressure monitor to check my pulse, it was ok. I got myself checked out with a rheumatologist and confirmed Costochondritis. I also have a couple of other conditions one being EDS as in joint hypermobility syndrome with associated issues which probably does not help either.

I have that lower rib touching pelvic area feeling much more through specific exercise, its like it aggravates the area, my physio also thinks it involves the large muscles in this area too.

Gillian

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Hi Gillian. I didn’t go to rheumatologist but did got to several GP. Actually I believe costochronditus was ruled out because as per one GP if it was Costo then if I raise my hands up, then I should feel the pain which i didn’t. I only feel the nagging pain is if I sit for too long or I stretch all the way back standing. The pain is also under the right lower rib. There are days where I won’t have any discomfort and then there are days where I feel the discomfort. Makes my anxiety worse !

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I have to disagree I do not feel the pain when I lift my arms up... I get mine just as you are describing, maybe your GP is not specialist enough and a trip to a rheumatologist might be more beneficial. I am in the UK not sure how your system works.

What do you feel like when you do a side standing or sitting stretch/bend to the opposite side, how about do you feel any relief if you try to elongate yourself out of you waist, slouching causes more discomfort.

Hope you can get some answers soon.

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Thabk you Gillian. Yes I do feel relieved for that moment when I try to elongate myself to the left or right.

Today was one of those days where I felt the discomfort pretty much all day. It’s like something is stuck in my right side but then I don’t feel the discomfort some days and when I tell the doctor they either think it’s my anxiety which is not.

My left side feels no discomfort what so ever.

I will get an appointment with the rhumertalogist.

Just a quick question? Do you feel that your right rib is swollen or different from left rib ?

Also what remedies have you tried so far for getting relief from Costo and how long it’s been there with you? Really appreciate

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The swelling I really would say for me I don't see this I just feel like it's inflammation. Never on my left always the right. I also get sore in the sternum and especially tender at the very bottom of this. It affects the back and front ribs more around I'll say like a wide band around the brasserie area for a lady 🙄 I first notice the discomfort when my husband gave me a tight hugs I would say try not to dig your fingers in my ribs, which he wasn't it just felt like it, I saw a specialist who advised me that we all have nerves that run along the ribs and this must be the reason... this was probably about 10 years ago. I think the bottom of the ribs on the right started around 3 to 4 years ago.

Over the years I have had pain relief but I hate tablets they mask so much, I have used anti inflammatory medication and anti inflammatory gel, the gel does work and at least its topical. When it's so bad I use a heat pad in bed and it definitely helps, I try and elongate my right leg out of the pelvis as much as possible otherwise it feels like the bottom of the ribs are touching/rubbing the top of the pelvis. I've tried lots of gels and lotions, aloe vera, CBD balm, comfrey balm, homeopathy pills and exercise, exercise definitely but only when elongated out of ribs and pelvis first. I also do stretching to relieve this but have to be careful not to overstretch due to having ehlers danlos.

I used to see a chiropractor who advised me she thought my pelvis was slightly twisted on the right but not sure how this impacts on my ribs...

I definitely feel better when I exercise and sit when I try and lift my ribcage away from my waist/pelvis I also am not sure completely that the ride sided bottom of my ribs is costo but I know the other stuff in the ribs is so I blame it 😏

I have even wondered when the pains been so gnawing with pain whether I could have the bottom rib removed :-(

Whilst I was away over the festive period and not as active as usual I felt my bottom right rib pain was less, it really is a pest...

Gillian 🙂

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Thanks gillian. I have just given up on diagnosing what might be the problem. Like Tuesday i did ab exercise and since wednesday i started feeling constant nagging dull ache. It was gone when i start diet and workout and now have come back.

I just don't know what to do or who to seek help on what is going on. Now i curse myself as to why i did my ab work out which might have done something horribly wrong. I guess my next stop would be not to go to an internist but go to a gastrologist to see what he/she says.

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Best of luck, looks like you are doing well. I understand you have lots of questions.

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Thanks man. I will be going for my next ultrasound in March which will be 6 month. So hoping that the weight loss and dieters changes, i will be able to reverse it

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