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liver disease (NAFLD & NASH)

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#1
georgepds

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As if there's not enough to worry about, I came across this interesting article on liver disease http://www.usagiedu....d05/nafld05.pdf. This disease is found in the obese and T2 diabetic population It is similar to that affecting alcoholics, but you do not have to drink to get it.

The relevance to T2 diabetics is in the following statistic "Steatohepatitis is found in 3% of lean, 20% of obese, and almost half of morbidly obese people....Of severely obese patients with diabetes, 100% have at least mild steatosis, one half have steatohepatitis, and 20% have cirrhosis.1"

The progression of the disease is described "It has been proposed that progression from simple steatosis to steatohepatitis and to advanced fibrosis results from 2 physiologic events (“hits”). The first event is thought to be insulin resistance, leading to the accumulation of fat within hepatocytes and associated increased lipid peroxidation. Second, oxidative stress increases, precipitating cytokine release ..."

In short insulin resistance is the first hit and oxidative stress the second. There is not much you can do about it except to get lean and treat the insulin resistance

Curious to know if anyone has actually been diagnosed with this disease, and what they do about it.

--G

#2
georgepds

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Found a better , less technical description, here Non-Alcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis (NASH)

"The medical term for a fatty liver is hepatic (liver) steatosis (fat). A
fatty liver is considered a benign (harmless) condition characterized by
fat deposits in liver cells (hepatocytes). This is a reversible
condition, and does not have the potential to lead to cirrhosis, liver
failure or liver cancer. NASH is when a fatty liver has progressed to
something worse ---namely inflammation (steatohepatitis) and scarring
(steatonecrosis) of the liver. Unlike a fatty liver, NASH is not
considered a harmless condition, but rather a liver disease with the
potential to cause cirrhosis, liver failure, and liver cancer. "

#3
DMD

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Loss of excess weight is a mainstay of therapy for nonalcoholic fatty liver disease. A very-low-carb diet works better than a reduced-calorie diet, according to a recent study in the American Journal of Clinical Nutrition.

Nonalcoholic fatty liver disease (NAFLD) occurs in 20 to 40% of the general population, with most cases occuring between the ages of 40 and 60. It’s an accumulation of triglycerides in the liver. In my experience with patients, it's very common. Unfortunately, many doctors seem to ignore it, probably because getting patients to lose excess weight is so frustrating.

Nonalcoholic steatohepatitis (NASH) is a subset of NAFLD, perhaps 30% of those with NAFLD. Steatohepatitis involves an inflammatory component, progressing to cirrhosis in 3 to 26% of cases.

Researchers at the University of Texas Southwestern Medical Center assigned 18 obese subjects (average BMI 35) to either a very-low-carb diet (under 20 grams a day) or a low-calorie diet (1200 to 1500 calories a day) for two weeks. Liver fat was measured by magnetic resonance technology. The low-carb groups’ liver fat decreased by 55% compared to 28% in the other group. Weight loss was about the same for both groups (4.6 vs 4 kg).

Bottom Line

This small study needs to be replicated, ideally with a larger group of subjects studied over a longer period. Nevertheless, it appears that a very-low-carb diet may be one of the best dietary approaches to nonalcoholic fatty liver disease. And I bet it’s more sustainable than severe calorie restriction. The Ketogenic Mediterranean Diet, by the way, provides 20-30 grams of carb daily.

-Steve

#4
mjrc64

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I have NASH. I was overweight at diagnosis. About 3 years ago, it was fatty liver i knew Ihad, and diabetes was not in the picture(well, I am sure it was, or was brewing). I am one who has progressed to fibrosis, not yet cirrhosis, anf hopefully the changes I have made will prevent that.

My liver enzymes are lower now than ever. And in the normal range. Just got a letter from the hepatologist saying they are "excellent", as was my A1C. Two excellents in one short note. I hope that indicates a good prgonosis.

I do need regular cancer screenings, and follow ups. But the hope it the inflammation is gone with the changes I have made and that stops more scarring.

mi
Michele

A1c: 8.3 on 9/9/10 and
5.3 on 12/6/10
5.0 and fasting BG 96 on 12/2/11
5.0 and fasting BG 105 on 1/6/13
5.2(different lab) and fasting BG of 103

TG: 456 on 9/9/10, 125 on 12/6/10, 195 on 1/6/13, 106 9/13/13(Yay!)

Maintaining a 50 pound weight loss, striving to make it 60 or 70!

#5
foxl

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Thank you for posting this -- one more reason not to drink if your blood sugars are not well-controlled, too!

And yes I DO know of a situation in which NAFLD was aggravated by drinking.
Linda


[B]Jan A1c 6.3/B]
Jul 09 ... C-pep 1.3, GAD-65 > 30
Mar 10 C-pep 2.8 (20 g carb); GAD 3.2
dx 02/09 in DKA


Levemir 12U per day; novolog PRN TDD ca 16U
MetforminXR 1000 mg BID
Ramipril 5 mg
T4 112 mcg
Chia oil
Vitamin D3, 4000 IU
Eating 20 - 45 g carb per day ovo-lacto-vegetarian
Walking 30 min 6x week

#6
mjrc64

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Mine certainly was. While I am not/was not alcoholic, I certainly enjoyed my wine. Wine and food, and was very inactive. Add that to a metabolic syndrome body type, sky high triglycerides, etc.... I had the double whammy. But, I was questioned carefully about lifestyle and I have the diagnosis of NASH. And, in the presence of liver disease, many chemicals are not good to take either, like tylenol, ibuprofen. I can *never* take more than 2 doses of tylenol in a day, and things like that. That stuff will never go away.

Love your livers, as we say on my liver disease forums! Diabetes is very related to liver disease. And not just fat people get NAFLD/NASH. They are at a greater risk, but there are situations where it seem to happen in thin people too. But the connection does seem to be to processed foods, and sugar intake, regardless of diabetes. Those things drive up triglycerides.

I also know liver disease sufferers(serious disease-cirrhosis), who had normal liver enzymes. It can be missed. Seems to me a good idea to check with ultrasound every now and again if one has ever had some elevation in liver enzymes, and if one is diabetic, withthe 50% stats I am seeing.

I am sure my lower carb, and especially lower sugar diet are a big effect of my bloodwork now being normal. And of course, I *did* need to quit my evening glass or two of wine. :( That sort of regular consumption is not compatible with any liver disease.

mi
Michele

A1c: 8.3 on 9/9/10 and
5.3 on 12/6/10
5.0 and fasting BG 96 on 12/2/11
5.0 and fasting BG 105 on 1/6/13
5.2(different lab) and fasting BG of 103

TG: 456 on 9/9/10, 125 on 12/6/10, 195 on 1/6/13, 106 9/13/13(Yay!)

Maintaining a 50 pound weight loss, striving to make it 60 or 70!

#7
MCS

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Dxed with NAFLD along with D. Lowered BG level and took lots of Milk Thistle, Dandelion root, all gone now, last two sets of blood work show no sign of anything wrong with my liver.
---------------------------------
Asprin 2-6 325mg per day
Amino Acids, Vitamins Bx, C, D, E
Hi-Maize 260, Ground and Whole Flax Seed
COQ10, Magnesium, Zinc, Fish Oil, Lisinopril
A1C estimate of 10-12 at dxed 5.6, 4.8, 4.6
Everyone has something to offer, you just have to listen

#8
mjrc64

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That is great, MCS.

Actually, if I walked into the doctors office today, and had the usual screening for fatty liver, it would come back normal! My liver enzymes and all hepatic panels are now normal. But, I had a liver biopsy, back when my tests were elevated for a couple of years running. That is what revealed the moderate fibrosis.
Michele

A1c: 8.3 on 9/9/10 and
5.3 on 12/6/10
5.0 and fasting BG 96 on 12/2/11
5.0 and fasting BG 105 on 1/6/13
5.2(different lab) and fasting BG of 103

TG: 456 on 9/9/10, 125 on 12/6/10, 195 on 1/6/13, 106 9/13/13(Yay!)

Maintaining a 50 pound weight loss, striving to make it 60 or 70!

#9
Daytona

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Sorry to hijack the thread but how does one go about getting a diagnosis? I have had terrible liver numbers for years (with liver related symptoms) and can't get any doctor to do anything more than order the same blood tests and "wait and see". Is there a threshold for #'s that I just haven't reached yet that would warrant a biopsy or ultrasound? My AST, ALT, AP and GGT are all quite high (depending on the # being measured from 114 to 400).
Diagnosed 12/2010 @ 10.7, Latest A1c 11/2011 @ 5.3!
30 years old
Ketogenic Paleo Diet
www.sweetgeek.net

#10
mjrc64

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That is great, MCS.

Actually, if I walked into the doctors office today, and had the usual screening for fatty liver, it would come back normal! My liver enzymes and all hepatic panels are now normal. But, I had a liver biopsy, back when my tests were elevated for a couple of years running. That is what revealed the moderate fibrosis.


When I had elevated liver enzymes the very first time, (numbers in the low 200's), I was sent for abdominal us and scans and diagnosed with fatty liver.

I did not have a diabetes diagnosis, and so, my eating was low fat, but very high carb, and often high sugar, and I loved red wine. More than is healthy for a woman. Often 2 glasses at night. I was unable to lose weight, I was exhausted, etc...

So, when I got the D diagnosis, it was also during my regular physical, and I was found to have still elevated liver enzymes. The short story is, it was time to do a biopsy.

I had grade 3 inflammation and fibrosis. Thankfully, I took my biopsy to a liver transpalnt facility, to a hepatologist, and it was reviewed to be a 2/3 fibrosis. which is a significant difference. That difference makes the difference beteeen 6 month follow up, down to yearly, and much lower risk of liver cancer and tumors.

If you can control it, and I seem to have, the prognosis can be very good. Just lifestyle changes that are very compatible with managing diabetes.

I think my diabetes diagnosis saved my life. It got me focused on a different type of diet. I did not count calories, I counted carbs and went walking everday. And 60 pounds fell off of me. I really tried alot less hard than in the past when I felt deprived and starved!

Controlling the D was the key for my weight loss and feeling better. I am sure I was insulin resitant for a very long time.

Persist in getting an abdominal ultrasound, at the very least, if you have had repeated elevated liver enzymes.

mi-
Michele

A1c: 8.3 on 9/9/10 and
5.3 on 12/6/10
5.0 and fasting BG 96 on 12/2/11
5.0 and fasting BG 105 on 1/6/13
5.2(different lab) and fasting BG of 103

TG: 456 on 9/9/10, 125 on 12/6/10, 195 on 1/6/13, 106 9/13/13(Yay!)

Maintaining a 50 pound weight loss, striving to make it 60 or 70!




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