Fatty Liver, Me and Weight Loss!

By: Holly L. Thacker, MD • Dianne Dunkelman • Posted on November 12, 2019

Part 1: Speaking of Women's Health Founder and Chief Strategist Shares Her Health Story

Well, my friends here is how the story of your Founder and Chief Creative Strategist goes!

For a few years my doctor would do my annual checkup. She would say, "Your liver enzymes are just a tad elevated. Loose a few pounds and they will be normal." I am a doctor's dream because I'm that girl who dashes off to the doctor when one of my friends gets sick just to make sure I don't have that! I never do, but my doctors are patient with me and reassure me. I have certainly had my share of CTs, never an issue - well, wait - reports did say "fatty liver." I heard, again, "This is pretty common in post-menopausal women. Diet and exercise, and you will be fine." OK, I thought. I had a new boyfriend and everyone reassured me that I just looked happy, not motivating for a diet and exercise regimen. So I figured when I lost a little weight my tush would be a bit smaller, my arms will be a bit firmer, I would have a bit more stamina, and the fat would also go away from my liver.... when I got motivated. But I didn't get motivated!

Then, on one of my visits to my doctor my blood work was done, and she reported, "You are fine, but you really should exercise and diet. Your liver enzymes are up a bit, again." Then came the following sentence, "Sometime in the future we might want you to see the medical partner of our friend who is a liver transplant doctor."

“Whaaaaaat?!” I exclaimend. You have no idea how fast I was on the phone getting an appointment with the hepatologist- a full blown liver specialist. When I went into his office he said, "Your numbers aren't that bad." He examined me physically and said that I had no outward evidence of lack of liver function. Whew! I asked what could be the big deal about having a fatty liver. He replied, "Well, in a subset of a subset of a subset of people with fatty liver can cause inflammation, increase liver enzymes and then turn turn into cirrhosis." Not too worried I thought to myself well, I also have never been hit by lightning. The doctor said that his tech assistant was in the office so we should do a fibro scan. Fine, I thought a baseline. Good idea. With that the tech said, "This is a super simple test. I will put a drop of gel on your belly and give a little ping and have a look at your liver on the screen. It will just take a minute. I am pretty good and I can usually get the reading with one ping." Fair enough. So by the time she was doing the 7th ping I thought, "Either she is not as good as she thinks she is OR I am not as good as I thought I am! My heart began to beat just a bit faster. The expression on her face did not change but within seconds the doctor came right through that door and stared at the screen. (The tech must have had a buzzer under her chair. The one that indicated to the doctor, get in here NOW.) He said, "You already have scarring of the liver by the fibroscan."

"What does that mean?" I asked.

He said, "You have NASH (NonAlcoholic SteatoHepatitis). The beginning of cirrhosis."

The adrenaline rush started in my shoulders and ran down to my feet as I sat on that exam table. My beau was sitting in that little room with me and I saw the look on his face- "Oh @#*%!"

I said, "What do we do?"

He replied, "We have no medication for NASH yet. There is a medication that is being studied. However, you can work to lose 10% of your weight in 3 months and we will see if you can stem this," and he was out the door.

My beau and I walked out in silence. He drove me back to my office. We didn't say a word. For about 45 minutes I walked around stunned. Then I knew I had to take action. If I wanted to avoid cirrhosis of the liver with the need for a liver transplant in the future. I needed a plan and a team to guide me to the victory of getting the fat and liver inflammation out!

I put away the emotions and I made some calls, and within a few hours I had a dietitian and a physical trainer lined up. My time was going to be dedicated to their help - not dinners out, not new clothes, not a fun vacation. But I was ON IT! I avoided asking myself, "Why didn't I do this before it got this far when all I had to do was diet and exercise?" I needed all of my energy to be positive. And I needed to keep my sense of humor. When my beau was about to leave my office he asked, "Honey, what would you like for dinner?"

"Not liver and onions," I replied. He laughed out loud and said, "That's my girl!"

The fabulous news is that 90 days later when I walked back into the hepatologist's office they were in awe! I had exceeded my goal and my liver fibroscan "ping test" showed terrific improvement and all my liver function tests normalized with weight loss and healthy eating. Good for me, but it was now something I had to deal with for the rest of my life.

As I mentioned, I did NOT ask myself, "Why didn't I do this before it got this far?" So I AM going to ask you, "Will you let a fatty liver get this far when all you have to do is eat right and exercise?" NO, you will NOT! I have confidence in you ;>)

-Dianne Dunkelman
Founder and Chief Creative Strategist, Speaking of Women’s Health

Part 2: Dr. Holly L. Thacker and Ms. Dunkelman Share Tips for Preventing and Treating Fatty Liver

Fatty liver is common, under recognized and can silently lead to liver damage especially in women!

The first response the liver has to injury can be to accumulate fat, which can lead to inflammation (elevated “liver function tests”) which can lead to scarring. The liver is a wonderful, hard-working powerhouse that:

Metabolizes nutritional substrates and hormones
Stores glycogen for sugar release and builds protein for the blood stream
Activates and metabolizes several important medications
Detoxifies many substances
Produces bile which aids in digestion

The liver has regenerative properties which can allow for regeneration of new tissue. It is one of the reasons healthy people can do a living related liver transplant, and after part of their liver is donated, the rest of the liver regenerates!

For folks with cirrhosis of the liver, sometimes statins (cholesterol lowering medications) may be prescribed. Periodic surveillance of the liver with chemistries - the ALT, AST and protein and albumin levels are important along with periodic imaging of the liver and an upper endoscopy to check for esophageal varices (a consequence of high liver pressure from liver scarring/cirrhosis). Progressive liver scarring leads to progressive liver failure which can causes ascites (swelling of the abdomen with fluid), confusion, gastro-intestinal bleeding and even hepatic encephalopathy that affects brain function.

Some cases of ‘crypto-genic’ meaning ‘unknown cause’ is actually from undetected, untreated fatty liver.

Common causes of fatty liver

Weight gain
Alcohol
Medication side effects
Uncontrolled Diabetes Mellitus
Elevated blood fat levels
Obesity
Iron overload
Viral infections like hepatitis C
Pregnancy
Too much of some medications, even over the counter medicines like acetaminophen (Tylenol®) can damage the liver!

Some fatty liver progresses to Non-Alcoholic Steato-Hepatitis (NASH) like Ms. Dunkelman experiences and up to 1 in 6 women with NASH develop NALD (Non-Alcoholic Liver Disease), which can include progressive scarring that can lead to cirrhosis which can lead to complete liver failure.

The good news is YOU can reverse fatty liver and liver injury in many cases.

Treatments to Reverse Fatty Liver

Remove the offending liver toxins
Lose weight and drop insulin levels
Consider intermittent fasting which drops insulin levels
Ingest healthy fats and avoid trans-fats
Daily exercise
Ditch the booze and any gratuitous substances that damage your liver, i.e. excessive acetaminophen/Tylenol®
See your medical physician to treat diabetes and elevated blood lipids, and consider Metformin/Glucophage® if medically indicated

Some Great News!

Caffeine in the form of coffee or tea in moderation can help reduce liver fat.
The silymarin in milkthistle tea may be beneficial.
The supplement SAMe is an anti-oxidant liver protectant and might help boost the mood and help joint pain.

Any and all supplement use should be under your physician’s supervision as some over the counter supplements can be hard on the kidneys and the liver!

Be Strong. Be Healthy. And Be in Charge!

-Dianne Dunkelman and Holly L. Thacker, MD

women's health, fatty liver, healthy diet, nutrition, exercise, weight loss, cirrhosis

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