Today’s PrimalMed Prescription…”Save the Liver!”
Protect the liver since IT is the quarterback overseeing YOUR metabolic health.
Since WHEN do I start with a video? Since today!
If you haven’t seen this one, then take 4 minutes and cozy up to this classic BEFORE we take a deep dive on the liver, and in particular FATTY LIVER.
It’s Thanksgiving time, and this post is not a call to ingest some good ol’ liver and onions just like your mama used to make (not that there’s anything wrong with that), but rather to appreciate the organ in the right upper abdomen just behind and under your rib cage…YOUR liver.
How important is your liver? Just ask Prometheus. Surely you remember your Greek mythology. Prometheus stole fire from Zeus and the Olympian Gods and his punishment was to be chained to a rock and have a bird peck away and eat a part of his liver EVERY day. The liver regenerated a bit but every day, that bird was back, pecking away. Stay tuned as the analogy to our love affair with ultra-processed food will soon be apparent.
It’s time to take care of your liver, so it can take care of you! Remember the post about your mitochondria, the batteries of your cells? Take care of them and they will see you right. Well then let’s talk about the liver…why it is such a crucial organ, and why we don’t want to have a fatty liver.
So here’s the deal: I read a lot of imaging studies every week. CT scans, and Ultrasounds and MRI’s of the abdomen for ‘upper abdominal pain.’ The usual suspects such as gallstones and pancreatitis are far LESS encountered, than this villain… drumroll please…’Fatty liver!’ In our reports, we call it Hepatic Steatosis, which means, liver fat. Here is a recent image:
The liver is in the upper left corner but since Radiologists read in reverse, we call it the RIGHT upper quadrant. The liver is that big dark triangular thing and the bright lines are portal and hepatic blood vessels. Bonus points if you can identify the kidneys, heart, aorta, and spleen!
This person has a fatty liver. It is TOO dark. It should be a bit lighter, like the spleen. It is TOO big. He has an enlarged, fatty liver. He presents to the Emergency Room with a chief complaint of ‘right upper quadrant pain.’
Here’s another scan of a young male in this late 20’s. CT and Ultrasound. Dark liver on the CT. The US on the right shows a bright liver, TOO bright or ‘echogenic’ and that is indicative of fatty liver or hepatic steatosis. Almost every day, I see the scans of patients with abdominal pain or abnormal liver function tests (LFTS). What’s going on?
Fatty liver comes in two main varieties: Alcoholic and Non-alcoholic. It is not a shocker that alcohol is a toxin that directly impairs liver function. Duh.
Today’s post however is about a more villainous scourge, the ‘silent killer’ known as NAFLD or NON-alcoholic fatty liver disease.
What concerns me is that we are seeing NAFLD more and more in younger and younger patients. Kids!
Read about it here: Fatty liver in the pediatric population.
The pathogenesis of NAFLD can be complex but in the pediatric population, obesity and insulin resistance are the main contributors. The above reference states that NAFLD can be seen in up to 12% of the pediatric population and over 70% of obese children. Look around…lots of kids and young adults today are not just overweight, but over-fat, and it is being normalized. I’m all for body positivity but when you SEE the scans, and see more and more under 30 year olds presenting with hepatic steatosis as a cause of pain, it is concerning. It is the tip of the iceberg, as it increases their risk to develop Type 2 Diabetes, and progressive obesity, which in turn compromises liver function.
In kids, teens and adults, the liver has so many key functions in monitoring and overseeing your metabolic health. The liver produces bile to break down and digest fat. The liver is the key organ that breaks down alcohol and other toxins such as the glyphosate, and heavy metals and microplastics that are in our everyday lives.
And equally important from a metabolic perspective is that the liver, along with the pancreas, plays a role in deciding how to metabolize and store excess energy. Remember that when we eat, we are either eating protein (to build and repair) or energy (Carbs and Fat). The liver is the quarterback and it decides what to do with all that incoming fuel!
Now of course we all need fuel in the way of fats and carbs to make our mitochondria sing BUT too much ultra processed junk, especially sodas and anything with High Fructose Corn Syrup, and you are flooding your liver with a fructose storm!
Fun fact, the chemical make up of fructose and alcohol is not very different and the liver does not really differentiate on a chemical level. Both EXCESS processed and ultra processed fructose especially is a direct toxin to the liver. Just like alcohol. And the liver cannot handle an excessive input of sugars and processed carbs. Only so much glucose can be converted to glycogen for energy storage and the excess fructose gets converted into fat by a process known as DNL, or De Novo Lipogenesis. DNL! The liver needs to decide what to do with that fat! Some is stored in the fat cells known as adipocytes and some is stored in the liver around those cells. The adipocytes are endocrine organs too and can secrete inflammatory cytokines and other molecules that can lead to inflammation of the liver. Inflamed liver??? Yikes.
That is called NASH, or Non-alcoholic Steatohepatitis! BAD. Now, the liver is inflamed and you are dealing with an acute and then chronic stressor that can lead to liver fibrosis, increased risk of hepatocellular carcinoma (HCC) and eventually put you on the list for a liver transplant. Link here!
OK… so NOW WHAT?
Q: What’s the deal with fruit? Isn’t that fructose?
A: Whole fruit is OK since it naturally contains antioxidants and fiber. And it is hard to over consume. Who eats 3 apples? It’s the ultra processed high fructose corn syrup found in not just sodas and fruit drinks that’ll get ya. It’s everywhere! Just read those labels (shout out to PrimalRD here… check out her past blogs!)
Q: How do I know if I have a fatty liver?
A: You don’t. That’s why it’s a problem! If you go for a blood test and your LFT’s are high, you may have NAFLD. Same if you are obese or diabetic or have a lot of hard midsection fat (that’s visceral fat, not the jiggly love handles). You may need an ultrasound which is quick, non-invasive and has no radiation. You don’t need the fancy $2500 whole body MRI to diagnose fatty liver. In severe cases, where liver function is compromised, or you have symptoms such as bile blockage or jaundice, more extensive testing and even a liver biopsy may be needed.
Q: Can I avoid fatty liver?
A: Yes! This falls into the Captain Obvious camp. Be aware of your alcohol consumption. Imbibing every night will bump your triglycerides and LFT’s. But this post is about NAFLD and kids! So…limit the junk food, sodas, treats, fiberless smoothies and juices, and packaged franken-foods etc. Nothing we haven’t talked about before. It’s obvious to us adults but we MUST set an example for the kids. Regular physical activity! Another DUH. Kids need to move and get off the couch.
Teach your Children Well!
Q: Can I REVERSE fatty liver?
A: Yes. YAHOO! The liver is a forgiving organ. Just ask Prometheus. If you cut out the vino, and the overconsumption of junk fructose and energy, your liver gets a break. It isn’t creating excess triglycerides and DNL is decreased. Your liver cells can get back to doing what healthy livers do. Short term restriction of carbs is key.
A recent journal article says just that! Therapeutic Carbohydrate restriction will improve hepatic metabolic function and improve liver fat levels. READ THIS.
It is time for the TL;DR!
What is today’s PrimalMed Prescription?
How do we go from learning to doing? What is the tool we use today to stay PrimalMed approved?
You don’t need to be a science geek. PrimalMed reads the articles so you don’t have to. Just read our blogs.
Recognize that Fatty Liver is a thing, and you and the youngsters in your life may be at risk. With proper nutritional intervention, it can be reversed. If the Kids in America are getting overfat with increasing incidence of liver issues and diabetes, it’ll be a huge burden not just on a personal and family level, but impact our health system at large.
Enjoy Thanksgiving. Of course have a slice of your Auntie Harriet’s world famous sweet potato pie! If there is a marshmallow topping or a side dish of canned cranberry sauce with HFCS, keep those portions small. You can go back to protecting your liver on Friday.
If you do nothing else, at least watch the SNL video at the beginning!
The only good NASH, is the music of legendary Graham Nash.
And of course a song about the Kids in America. Say NO to Hepatic Steatosis. I like the Green Day remake:
Feel free to comment below! And enjoy the video and musical interludes!
Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.
Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.
Thank you Nick for reading and commenting. You are a true inspiration to the Kids in America and Gen Z ! Not to mention the MRI staff at the hospital !!!
Never too young to be PrimalMed approved!!!
Schedule your next MRI at Manchester Memorial Hospital. You may be scanned by Primal Med Jr Jr! Great post.