You might be wondering why I had chosen to speak about fatty liver specifically. Often times fatty liver disease is not something that you are typically looking for or even thinking of, but an incidental finding. This incidental finding is usually on an ultrasound or CT scan ordered when you are evaluating for gallbladder dysfunction or possibly because of a workup for elevated liver enzymes. Although you may not be looking for fatty liver specifically, you're usually not surprised when you find it and you definitely should not ignore it. Fatty liver is associated with and can be correlated to obesity and hyperlipidemia.

 

 The ultrasound report may read as “steatosis”, which means an abnormal buildup of lipids inside the hepatic cells.  This can be a mild finding, reported as “streaks of steatosis”, or severe fatty liver. A mild case can be very motivating and useful to encourage significant lifestyle changes. The most important factor is how it is presented to the patient. I am not saying that you should try to put fear into your patient, but I think that if you give them the big picture of what is happening by the time you find fatty liver on a diagnostic test and what this means for their overall health, they are going to listen a closer to what you have to say.

 

 If left untreated fatty liver can actually progress to fibrosis and cirrhosis or even cancer.  It’s an inflammatory disorder within the liver, like the inflammatory processes we see in the heart that precede an MI.

 

So, let’s do a little refresher on fatty liver. Fatty liver disease is almost always associated with obesity, elevated triglycerides and of course insulin resistance. Sadly, the incidence of fatty liver is quickly rising; and not just among the adult population, but in our children.

 

If you remember, way back in the beginning of this podcast adventure, I told you that a major reason I am doing this is because of my fear for what is happening to the next generation. We are supposed to protect our children. And you also know, if you’ve listened from the beginning, that I have a grandson who is at this time just under two years old. The thought of losing that child at a young age from something I could have prevented would be the end of me.

 

I beg you to take special interest in this move toward health, wellness and weight management with me to help prevent or reverse disease processes in the current population and to protect the next generation. Our society in general is ignorant to the fact of what is happening. I mean ignorance in the true sense of the word, oblivious.  Many unfortunately only see the exterior view of obesity. They're not putting together the big picture of the internal happenings associated with obesity. Obesity and hyperlipidemia are happening at younger and younger age,  which demands a wake-up call.

 

So, as I do this review of impaired hepatic function, I want you to not only think about what it is doing to your adult patients, but thinking about the impact it is going to have when it starts in adolescence. Just think about how long it is going to take to impact the body’s metabolic processes when it starts in this adolescent population. Not long at all. Which means we will start seeing poor outcomes in those in their 20s. Type 2 Diabetes, hypertension and sadly heart disease. I am guessing you are understanding my passion for this lifestyle and obesity management crusade a little better now….

 

About 100 million people are thought to currently have fatty liver disease. The prevalence of fatty liver disease has more than doubled in the last 20 years. And guess what else has more than doubled in the last 20 years?... You get where I am going with this… Yep, obesity.  There are NO symptoms of fatty liver until it progresses toward cirrhosis. Then the usual fatigue, abdominal discomfort, bloating, jaundice and fluid retention are present, as seen in cirrhosis from other causes, like alcoholism.

 

The liver is a pretty important organ, as you know. The liver is involved in making proteins, cholesterol synthesis, glucose regulation, energy, clotting factors, immune regulation, digestion, filtration, detoxification and many other regulatory processes.

 

One of the most significant contributing factors to fatty liver is insulin resistance. With insulin resistance there is an increase in gluconeogenesis because insulin-suppressing effects are impaired. This increase in glucose production by the liver, increases overall glucose levels, which leads to Type 2 Diabetes, which leads to an increase in fatty acids produced by the liver, which leads to an increase in triglycerides accumulating in the liver. When the liver is all clogged up, the normal functions of the liver are impaired.  Now the liver is getting swollen and inflamed. The inflammation starts to damage hepatic tissue, which leads to fibrosis. Fibrosis is like scar tissue.  Scar tissue doesn’t function and scar tissue has lost the ability to contribute to the work load of the liver. As more scar tissue is formed, more damage is occurring in the liver which leads to cirrhosis. Cirrhosis leads to liver failure and liver cancer. 

 

With all of the dark and dreary, doom and gloom I am sending out in this episode, there is a shining light …

 

Fatty Liver is treatable.

 

Controlling the contributing factors such as obesity, hypertension, hyperlipidemia and diabetes can stop the damage. When steatosis is still in the inflammatory phase, and has not progressed to cirrhosis, it can be reversed.

 

Reversal relies on strict adherence to lifestyle modifications.

 

It isn't wise to use a lot of pharmaceutical agents in someone with fatty liver, because most enzymes that are involved with the metabolism of medications require a functioning hepatic system. So, the healthy lifestyle wins!

 

Crazy how many things we can manage with lifestyle isn’t it?

 

And did you hear the word inflammation in there? Like a lot?

 

Key words to all of these Health Interventions For Your Practice are..…. Inflammation. Obesity. Diabetes.  Lifestyle modifications.

 

What’s the take home??

 

 If overweight consider fatty liver, if diabetic think fatty liver, if triglycerides are elevated assume fatty liver. Summarize all of this to the patient and begin efforts control weight, glucose levels and cholesterol. My analogy is that it’s like having a clogged oil filter in your car. If you don’t change the oil and the filter regularly, you will start to slow down, then sputter, then the engine blows up.. You can laugh, but that works well.. My dad is a mechanic, so I have million of those care analogies. He does diagnostics and repairs on cars, I diagnose and treat people.

 

I hope this was helpful to you in your practice. Until next time..

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Have a great week! May it be filled with many Health Interventions! Next week I will be making a BIG announcement. So make sure you come back. If you Subscribe to Health Interventions For Your Practice, you will get email updates when the podcast is released and much more!