by Dr. Sean Bourke, MD
In the U.S. we spend $2.7 trillion annually on healthcare, 2.5 times more per capita than any other developed nation. Yet our citizens are neither comparably healthier nor live longer than those citizens in any of those other countries. 75 percent of that $2.7 trillion is spent on chronic diseases that are preventable. Arguably one-third of that spending is due to dietary triggers: yet we only spend 3 percent of those monies on preventive, pre-emptive care that would make us markedly less sick if we simply changed our medical emphasis from symptom focused disease care to address the root cause of our problems with lifestyle changes.
In honor of National Liver Awareness month this October, I share a common JumpstartMD scenario as illustrative of this point that highlights the transformative power of lifestyle changes to inspire an epidemic of health and well-being over illness.
A patient in the middle of his or her life arrives at JumpstartMD with a body mass index consistent with obesity, newly diagnosed cholesterol abnormalities in the form of a low HDL and high triglycerides, and / or the surprising revelation confirmed by his or her doctor that their fasting glucose is now in the pre-diabetic range. To boot, it appears through liver function tests and a confirmatory ultra-sound that liver enlargement and inflammation is present. An appointment with the liver transplant surgeon is scheduled “just in case” the patient’s condition progresses to cirrhosis. A variety of medications to treat the downstream consequences of the patient’s underlying insulin resistance syndrome (aka “metabolic syndrome”) and associated complications are commenced.
Simultaneously, a referral to JumpstartMD for weight loss through lifestyle changes is commenced and here’s what happens: weight is lost; pre-diabetes, cholesterol abnormalities, and liver inflammation reverse; blood pressure improves and patient feels better and younger than they have in years.
Why, might I ask does this not occur more frequently? Why do we continue to throw pills and surgery at problems that are imminently reversible if we simply changed our emphasis?
Fatty liver disease is a classic example of where lifestyle changes like those we support can be impactful. Fatty liver disease, also known as non-alcoholic fatty liver disease (NAFLD) is estimated to affect 30 percent of the U.S. population – 45 percent of all Latinos, 33 percent of all Caucasians, and 24 percent of all African Americans. Many will be asymptomatic while around 5 percent will advance to an inflammatory hepatitis, non-alcoholic steatohepatitis (NASH) that can scar the liver and lead to cirrhosis in 5 percent of NASH patients. With rises in the prevalence of obesity nationwide, NASH, now the third most common indication for liver transplant, is forecast to become the most common indication for transplant soon. Liver transplants for a nutritional disease that’s preventable? Is this madness?
Here’s what happens in fatty liver disease and here’s why it’s preventable with lifestyle changes. Fatty liver disease is, at root, another facet of the metabolic syndrome. It has insulin resistance as its root cause in combination with inflammation and oxidative stress. No surprise given their common core, fatty liver disease and metabolic syndrome are tightly linked with obesity, diabetes, excess accumulation of abdominal fat and creation of the most dangerous small low-density lipoprotein (LDL) particles.
Fatty liver disease arguably begins with a diet composed of excessive amounts of carbohydrates, particularly refined ones like sugars, grains, and starches like corn and potatoes. One of the building blocks of carbohydrates, namely fructose (half of table sugar and high fructose corn syrup), is broken down directly in the liver into fat and, in excess, begins to accumulate there as fat. In the words of University of California at San Francisco’s Dr. Robert Lustig, herein describes the “fate of fructose”:
“After a large fructose bolus is ingested, it is transported from the duodenum straight to the liver via the portal vein, where it overwhelms the capacity of mitochondria to metabolize it…The liver cell (hepatocyte) has no choice but to convert the excess energy substrate into fatty acids through a process known as de novo lipogenesis. These excess fatty acids have one of two fates: to get packaged into very low-density lipoproteins (VLDL, measured in the triglyceride fraction of the lipid profile), which promote cardiovascular disease; or get stuck in the liver; where they lead to fatty liver disease and promote hepatic insulin resistance, which drives hyperinsulinemia, weight gain, and puts you at risk for type II diabetes.” – San Francisco Medicine
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If that doesn’t sound bad enough, the other common carbohydrate building block, glucose, stimulates insulin to store finite amounts of glucose in the liver as glycogen. That’s a good thing up to a modest point but not the point that our modern, processed carbohydrate rich diet leaves us, where quantities of glucose in excess to our finite need for glycogen stores are then converted in the liver to fat until the liver, like our abdomen, becomes enlarged by infiltration with accumulated fat, eventually inflamed in many cases, and sometimes scarred as a result.
With a strong commitment to reducing the quality and quantity of carbohydrates consumed, the stigmata of metabolic syndrome and fatty liver disease can reverse even before weight loss although much more dramatically in combination. For example, with as little as 10 percent weight loss, which 95 percent of our clients achieve at 6 months, NAFLD is often reversed. Cost wise, patients without NAFLD show a 26 percent lowering in their health costs over 5 years.
But more importantly, with pre-emptive elimination of fatty liver disease, there’s no need to see the transplant surgeon. The prescription is simply guiding and supporting people toward healthy lifestyle changes that work to preempt diseases like fatty liver disease or the others that go along with it: diabetes, heart attacks, strokes, metabolic syndrome, various cancers, and arguably dementia. The improvements are dramatic, transformational, and utterly sensible.
As a country and as individuals isn’t it time we worked together to inspire an epidemic of health by returning to the consumption of whole, real, and fresh foods in a way that is a practical, sustainable, and realistic answer to our healthcare crisis through the prevention and treatment of disease.
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