Fatty Liver, the main problem highlighted in this issue, is an excellent example of the web-like function of our holistic body, an approach we document monthly in this newsletter. Fatty Liver also illustrates why an integrative approach is necessary to optimally treat it and several other related conditions. This is the wisest, cheapest and no doubt the approach to healing that will prevail in the future.
Hugo Rodier, MD
The silent epidemic of Fatty Liver is causing significant health problems; yet, it is seldom looked into, nor diagnosed, hence, rarely treated. It is defined as a liver covered and infiltrated by fat cells; it may be incidentally diagnosed while doing an ultrasound looking for painful Gall Bladder stones, which is a related condition. In fact, Fatty Liver is the reason why bile, secreted by the liver to digest food, is synthesized a bit thicker, or inflamed, which, when stored in the Gall Bladder may precipitate into stones. The resulting painful contractions of the Gall Bladder when called to contract to squirt bile into the intestines to digest fats in the diet may land you in the Emergency Room, where said Ultrasound is emergently performed.
Some of you have lost your Gall Bladder after the process noted above. No doubt a proportion of these surgeries are quite necessary, IF the Gall Bladder has become gangrenous and you are quite ill. If a patient presents with fever, vomiting and intractable right upper quadrant abdominal pain, said surgery may even be lifesaving. However, a significant number of patients have a less dramatic and insidious presentation. In my experience most of them may save their Gall Bladder IF they get off processed sugars and eat whole food, mainly fruits and vegetables.
A cleanse with lemon juice often causes the Gall Bladder to contract and many stones are then eliminated if small enough to pass. Not paying attention to early discomfort in the abdomen may cost you your Gall Bladder, which will then require that you take bile salts with each meal to compensate for the loss, a fact that is seldom addressed after surgery has been done. The latter often takes place without any discussion on how it is that the Gall Bladder came to be dysfunctional, or how to cope with the loss of that organ. In my opinion, these omissions are due to many doctors considering the Gall Bladder a non-essential organ. True, indeed, but suboptimal digestion as a result and not addressing the root issue, insulin resistance, will surely lead to many problems in the future.
In addition to the problems already listed, there is also the fact that poorly digested foods will result in an imbalance of the microbiome, or the intestinal flora, thus leading to practically all diseases, as amply demonstrated in previous issues. To add insult to injury, many patients are treated, before and after surgery, with acid blockers like Prilosec, Nexium, etc. By altering the acidity of the gut, these agents have also been associated with an altered microbiome.
Oh, the problem “sickens:” with a dysfunctional microbiome and a Fatty Liver we are not able to optimally detoxify many ubiquitous chemicals in the environment that have been shown to increase insulin resistance. The poster chemical these days is BPA, Bisphenol A, which we have also amply documented in Integrative Health. These fattening chemicals are called “obesogens.”
Is it worth to eat foods laden with chemicals, preservatives, colorants, and now riddled with pesticides in their genes (GMO)? BTW, Sugar Sweetened Beverages have been linked to kidney stones in case you have not been “stoned” enough.
“The US Health Disadvantage Relative to Other High-Income Countries.”
Remember that we waste $765 billion in Health Care in our country. The above issues are an example of said waste. The Institute of Medicine published a report on how it is that the USA spends double the amount of money per patient compared to other wealthy countries, yet, it ranks dead last in health care outcomes like longevity. Here are the main points:
“The US spends more on HC than does any other country, but its health outcomes are generally worse than those of other wealthy nations. Although this disadvantage has been increasing for decades, its scale is only now becoming more apparent.”
“Shorter life expectancy than 16 wealthy nations (including newborns). The USA ranks near the bottom on both prevalence and mortality for multiple diseases, risk factors and injuries.”
“Why? A lack of Universal health Care, weaker primary care, greater barriers to access and care coordination is also a problem.”
“People in the US consume more calories. pronounce income inequality. high rates of poverty. The US ranks below other countries in social mobility.”
“The US health disadvantage may only worsen with time. committee urged prompt action of proven strategies such as those outlined in Health People 2020 and the recommendations of the National Prevention Council which target the conditions responsible for the US health disadvantage-from infant mortality to injuries, obesity and chronic diseases.”
“Primary Prevention of Cardiovascular Disease with a Mediterranean Diet.”
Not to belabor the point, but here is yet another article on how prevention, specifically diet is the way to go. The Mediterranean diet lowers the risk of heart disease by 30%. Despite this type of evidence being around for decades in less prestigious journals (guess why it has taken so long for this data to surface in the bigger journals) I have had cardiologists tell me that diet has nothing to do with heart disease. I will never forget the one who told me I should let my patients enjoy their soda..
This article is also remarkable because the Mediterranean diet, with its emphasis on healthy omega oils (olives, avocados, fish, and nuts) showed its superiority to a low fat diet: more proof that the cholesterol hypothesis needs to be tweaked. In my opinion it is not being told accurately; we have demonized cholesterol without understanding the nuances involved. In short, cholesterol is a healthy molecule necessary for repairing hyper-permeable arteries, in addition to synthesizing hormones, maintaining cell membranes, especially in the brain, etc.
Cholesterol becomes a problem only when it and the the lining of the arteries are oxidized. Both become “sticky” (ICAM, VCAM,) which is why plaque starts to form. Think of Velcro. Cholesterol, instead of doing its job, repairing the “leakiness” of arteries, forms plaque. Think of the natural patch-up job getting botched. By eating the high antioxidant Mediterranean diet, the oxidation of arteries and cholesterol is reduced, arteries are healed, and cholesterol goes down, relieved that it does not have to work so hard. This is why the American Heart Association has stated that “TLC” should be tried first, that is, “Try Lifestyle Changes” first, at least for 6 months before turning to cholesterol lowering drugs.
And now for a contrasting point of view
Overweight and mildly obese people (BMI 25-34) have lower mortality rates than normal weight people. The researcher who documented these findings drew fire from all corners, including Dr. Willet, he of Harvard fame and author of many articles and books on nutrition. The good doctor went as far as saying that such articles should not be published. His attitude was surprising to me. I feel that no matter how we feel about a study, we do well to withhold judgment until the matter is vetted a bit more, which it will be, given that we have all been on a crusade to fight obesity.
Why might such a result be true? In my opinion, it could be because mild obesity is often associated with a more care-free, even jolly disposition, which could mitigate the negative factors associated with obesity. Think of an uptight, over achieving, type A person getting up to run at 4 AM, even when the air is extremely polluted and the roads icy and treacherous. Often, these super athletes have some form of mental illness and concomitant relationship problems. If you want to know more about how good relationships often trump good diets, google “Roseto, Pennsylvania,” where cohesive Italian immigrants had better health than adjacent All American Communities with less social bonds.
“FDA warning: driving may be impaired the morning after taking sleeping pill,”
“Prenatal folic acid supplement (lowers) risk of Autism,”
“Prenatal exposure to mercury and fish consumption during pregnancy and Attention Deficit Disorder-related behavior in children,”
“Exposure to environmental tobacco increases risk of dementia,”
Infections and the Flu
Quietly, the CDC announced on February 2013 that the Flu vaccine is only 9% effective in people over 65 years of age, a pesky and well known fact. The CDC still suggests that the elderly get the shot, without any mention of diet and many other factors that can boost the immune system to defend ourselves from any infection. The most reported to date are probiotics, vitamin D and Zinc. Get rid of processed sugars and eat a lot of veggies while you are at it.
 “The New Health Age: the future of Health Care in the USA,” David Houle; Sourcebooks, 2011
 “Silent epidemic, Fatty Liver,” J. Family Practice News, January 2013 page 17
 “Risk of Clostridium difficile Infection With Acid Suppressing Drugs and Antibiotics: Meta-Analysis,” American J. Gastroenterology 2012;107:1011
 Journal Environmental Health Perspectives February 2012 Cover issue:
“Obesity is rising steadily around the world. Convincing evidence suggests that diet and activity are not the only factors at work in this trend-chemical “obesogens” may alter human metabolism and predispose some people to gain weight,” “An Environmental Link to Obesity,”
J. Environmental Health Perspectives 2012;120:a62
 J. Family Practice News January 2013
 JAMA 2013;309:771
 New England J. of Medicine Epub February 25th 2013DOI: 10.1056/NEJMoa1200303
 “Reduced Atherosclerotic Burden in Subjects With Genetically Determined Low Oxidative Stress,”
J. Arterioscler Thromb Vasc Biol 2013;33:406
“High Anthocyanin Intake Is Associated With a Reduced Risk of Myocardial Infarction in Young and Middle-Aged Women,” J. Circulation 2013;127:188
“High-Density Lipoprotein and 4F Peptide Reduce Systemic Inflammation by Modulating Intestinal Oxidized Lipid Metabolism: Novel Hypotheses and Review of Literature,”
J. Arterioscler Thromb Vasc Biol. 2012;32:2553
 J. Diabetologia 2002;2:210
 J. Family Practice News, August 15th 2006, page 12
 JAMA 2013;309:71
 “Running and all-cause mortality risk–is more better?” American College of Sports Medicine 2012
Annual Meeting; June 2, 2012; San Francisco, CA. Presentation 3471
“Potential adverse cardiovascular effects from excessive endurance exercise,”
J. Mayo Clin Proc 2012; 87:587
 JAMA 2013;309:645
 JAMA 2013;309:570
 J. Arch of Ped & Adol Med 2012;166:1123
 JAMA 2013;309:649