So You Have A Fatty Liver

So You Have A Fatty Liver

Adrian had been gaining weight for awhile now. She was quite depressed as her clothes did not fit as much as she tried. It did not seem at all like she was eating anymore than she did in the past. If anything, she probably was eating less.

The final straw was at a routine doctor visit her doctor drew some blood to check things and her liver enzymes were elevated. An ultrasound was ordered and the result was “fatty liver.” She hated that word-FAT. She would rather be called a profanity than that. There was no escape. She was sent to a liver doctor who went over her labs and ordered more tests. She was advised to stop any alcohol and Tylenol (acetaminophen) neither of which she did very much of. She returned and was asked “Is this the most you ever weighed?” She was upset. She did not even want to go back. She then was told that she did have “steatohepatitis” which was just a nice way of saying fat liver. The treatment offered was a low fat diet and exercise and to return to her primary care provider (PCP). She ate more and became more depressed.

Over the next several years, Adrian gained more weight and then developed diabetes. Her blood pressure began to elevate and she started to notice that her ankles started to swell a little. She got even more nervous. She went back to her PCP and her liver enzymes were worse. Unfortunately, her blood showed more abnormalities and it appeared that she was developing cirrhosis (scarring) of the liver. She did not believe this was possible. Returning to the liver doctor he told her that her liver was about 90 % gone and she needed to have an abrupt turn-around in what she was doing at home. At 45 she weighed 240lbs and this was double what she weighed at 22.

Fatty liver seems to be replacing alcohol as the number 1 cause of cirrhosis. There appears to be a lot more eating than drinking and the results are terrible. The best treatment for fatty liver is what most of America has the most difficulty doing: exercise and a low fat diet. California, which always seems to be leading the country in trends, has been trying to keep everyone thin and fit and they appear to be correct. Not to the point of anorectic malnutrition, but to a healthy lifestyle of exercise and low fat food. For Adrian, the prescription did not work and she needs help. Weight loss programs are increasing in number to address the problem. It turns out that it is not just the weight that is the problem but the damage that it does to every organ in the body.

Fatty liver has no real medication that can treat it. Diabetes, heart disease, and arthritis all have treatments that help. So what can be done? Gastric bypass surgery is drastic but does help fatty liver…unfortunately it has many complications one of which is death. A new look at weight loss medications is now being done. Phentermine and even hormonal manipulation is being tried. Although controversial because of side effects, Adrian is suffering from multiorgan failure. The safest approach is to get the weight down. Phentermine is approved by the FDA for the short term treatment in weight loss under careful physician supervision. It seems to work as long as exercise and diet are being followed after the cessation of the drug.

Adrian, and the rest of us that are overweight, do not want to be fat. We want to eat. However, our diet is not in line with a long lifespan. With the weight of the whole country increasing, the complications are adding up. Fatty liver is an insulting term – but it is the medically correct term. If it takes a slightly risky drug to effect a change in lifestyle, perhaps that is much less risky than death by organ failure.

Adrian started on the new drug and did change her diet. Her weight slowly decreased. She was happier with each pound that she lost. Her diabetes started to be under control and her liver enzymes started to head down. She actually had to keep buying new clothes. Her smile could not have been brighter!

Key Points:

  1. Nonalcoholic fatty liver disease occurs when the liver has trouble breaking down fat
  2. Fatty liver can lead to other diseases such as diabetes, cirrhosis and liver failure.
  3. Fatty liver is reversible.
  4. Some weight loss programs and medications are beneficial, if supervised by a physician.

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