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a recent article on liver disease provides a glimpse at why america cannot get healthcare right, no matter which party is in charge



“In the past few decades, nonalcoholic fatty liver disease (NAFLD) has become more prevalent in U.S. adolescents and is currently the most common cause of chronic liver disease in this age group.  ‘NAFLD is almost always associated with obesity; we are seeing this correlation in both children and adolescents.  Various studies estimate that roughly 30 to 50 percent of obese patients have NAFLD’ says Praveen Selvakumar, MD, Pediatric Gastroenterologist in Cleveland Clinic’s Department of Pediatric Gastroenterology.  ‘Left untreated, the presence of fat in the liver can lead to significant liver damage, and even end-stage liver disease. Even adolescents and young adults have required liver transplantation due to end-stage liver disease caused by NAFLD’.  Dr. Selvakumar and his team of collaborators recently examined the prevalence of NASH and advanced fibrosis, two of the most advanced stages of NAFLD, in US adolescents.  ‘We found a fourfold increase in the prevalence of NASH in adolescents from 1988 to 2010. The rates of NASH occurrence increased from 0.74 percent in the 1988-1994 period all the way up to 3.4 percent in the 2005-2010 period….”  Cherry-picked from Cleveland Clinic’s September 2018 article, Prevalence of Nonalcoholic Steatohepatitis and Advanced Fibrosis in U.S. Adolescents: The Rising Burden of NAFLD Why is the liver so important?  Acting as both an endocrine and digestive organ (HERE), it also happens to be the body’s center of detox along with a critical function known as methylation (HERE).  And while everyone is aware that alcoholism often leads to a scarring of the liver known as fibrosis (fibrosis in the liver is called cirrhosis), what you may not be aware of is that there are other fibrotic liver diseases that are far more common than alcohol-related cirrhosis. Enter NASH and NAFLD.

NAFLD (Nonalcoholic fatty liver disease) is an overarching term for several diseases; one of which (NASH —- nonalcoholic steatohepatitis) is so much more common than the others that it and NAFLD are frequently used interchangeably.  Although I am not going to delve into the subtle differences, just realize that these two diseases represent the most common cause of liver dysfunction in Westernized society, with over 1/3 of our nation’s population affected.  What’s it look like?  Just look around you.

Thanks to our CARB-RICH DIETS, OBESITY has exploded here in America, with 70% of the adult population overweight or obese, and another 7-10% appearing that way via blood work even though their scale might say they are of a normal weight (HERE).   The result is that fat accumulates not only around the liver, but (gulp) in the liver (this fatty accumulation within the liver’s cells is called “steatosis”).  Without intervention (we’ll get to what that looks like in a moment), NAFLD will progress to NASH in a significant part of this population, leading to massive inflammation (hepatitis) and subsequent scarring (cirrhosis), because as I’ve shown you repeatedly, inflammation always leads to fibrosis (HERE).

Not surprisingly, NASH is associated with MOST OF THE DISEASES ON THIS LIST — particularly METABOLIC SYNDROME / DIABETES —- simply because they are all intimately related to inflammation.  And lest I forget to mention, the rate of a certain NASH-related cancer (Hepatocellular Carcinoma or HCC) is literally exploding.  Considering we already know that sugar and simple carbs are cancer’s fuel-of-choice (HERE), not to mention the fact that OBESITY IS HEAVILY LINKED TO ALL CANCERS, we shouldn’t be shocked.  And once you realize that “Immune activation is a prerequisite for the development of NASH” (HERE), you’ll understand why it’s thought to be AUTOIMMUNE as well.

Why do I being this all up?  Last Sunday’s edition of CNBC carried a story by Lorri Ioannou titled The $35 billion Race to Cure a Silent Killer that Affects 30 Million Americans.  After providing numerous scary facts, including the exploding incidence in young adults and even children, we learned that there is no drug to treat this problem (thus the title); a fact noisily touted by every single study I read on the subject.  But with a 35 billion dollar market at stake, the race is on like Donkey Kong.  And unfortunately, that was where the article ended.  It was a piece about BIG PHARMA and sick people blaming others for their sicknesses (the quote below comes from a person who was diagnosed with NAFLD several years ago, but only recently diagnosed with NASH).

“The 71-year-old got ascites, varices in his esophagus and severe muscle cramps. Three months later he was diagnosed with liver cancer at Mount Sinai Hospital after his family decided to take him to its Recanti/Miller Transplant Institute in New York City for evaluation.  ‘I feel like my hometown doctors let me down,’ he says, now grateful to be on the liver transplant lists at both Mount Sinai and the Mayo Clinic in Florida. ‘For the most part, the medical community is not addressing this horrible disease, testing for it or offering any treatment.”

Doctors aren’t offering treatment because there is no treatment — at no least no pharmaceutical treatment.  The harsh reality is that while it’s true that few physicians will spend the time to educate patients about the LIFESTYLE CHANGES needed to actually reverse disease BY CHANGING PHYSIOLOGY, the harsher reality is that STATS LIKE THESE (along with the quote above) prove that patients aren’t listening anyway.  It’s why the current Republican / Democrat healthcare debate is moot.  No matter how you slice it; without some serious national dietary and lifestyle changes, our current healthcare trajectory is totally and utterly UNSUSTAINABLE.

An excellent (free) study was published in last August’s issue of Frontiers in Endocrinology, titled Pathogenesis of Nonalcoholic Steatohepatitis and Hormone-Based Therapeutic Approaches.  What I want you to notice here is that mainstream medicine is showing you that not only is NASH linked to diet, it’s linked to several factors that are directly mediated by diet (LEAKY GUT SYNDROME — intestinal permeability issues, DYSBIOSIS / MICROBIOME PROBLEMS, TRANSLOCATION OF BACTERIA, and ALTERED IMMUNE SYSTEM FUNCTION), all of which are HALLMARKS OF AUTOIMMUNITY.

“Non-alcoholic fatty liver disease (NAFLD) is an emerging global health problem and a potential risk factor for type 2 diabetes, cardiovascular disease, and chronic kidney disease. Nonalcoholic steatohepatitis (NASH), an advanced form of NAFLD, is a predisposing factor for development of cirrhosis and hepatocellular carcinoma. The increasing prevalence of NASH emphasizes the need for novel therapeutic approaches. Although therapeutic drugs against NASH are not yet available, fundamental insights into the pathogenesis of NASH have been made during the past few decades.  Growing evidence suggests that the intestine-liver axis plays a crucial role in the maintenance of metabolic homeostasis, and that its impairment is an important causal factor in the pathogenesis of diverse liver diseases such as obesity-related steatosis, NAFLD/NASH, and liver cancer. Feeding…. NASH diets causes impairment of intestinal barriers, dysbiosis of the microbiota, and alterations of intestinal immunity, leading to increased translocation of bacteria or bacterial products into the systemic circulation.”

What’s most telling are the guidelines for dealing with NASH as put forth by insurance giant, Cigna.  I realize that insurance companies are schmucks, but it’s interesting that in their article titled Nonalcoholic Steatohepatitis (NASH): Topic Overview, they mentioned things like REDUCING CHOLESTEROL (which does not work as touted when drugs are used), CONTROLLING DIABETES (ditto), along with WEIGHT LOSS, CUTTING OUT THE BOOZE, and REGULAR EXERCISE, but no specific meds.  For people interested in having their health done for them via medication, as opposed to having to do anything difficult themselves, this is a bitter pill to swallow (no pun intended).

What are my recommendations if you have NAFLD or NASH?   As is always the case, it’s critical to look for ways to reduce systemic inflammatory load.  While MY GENERIC PROTOCOL is not the entire ball of wax for everyone, for most people (talk to your doc), it’s a great way to get the ball rolling.  The super cool thing is that the most effective methods of dealing with weight also happen to be the most effective methods of dealing with overall health — a big deal when you remember how intimately these twin diseases of liver destruction are related to DIABESITY.  Oh; and be sure to like, share or follow on FACEBOOK to reach the people you love and value most.


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