What I wish I had known before liver disease

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    •You must be your own advocate and an active participant!
    ◦The days of “the doctor knows best” are long past; no doctor can know it all and specialists only address issues specific to their specialty
    ◦Educate yourself and ask questions
    ◦If the doctor in front of you cannot answer your questions, get in front of one that can
    ◦If the diagnosis does not feel right, it probably is not; get a second or third or fourth opinion until things add up and make sense
    ◦If you are too sick to be your own advocate, find someone that can do it for you
    ◦When the doctor tells you what you want to hear, but it does not really add up, do not simply accept it

    •You can have advanced liver damage (i.e. stage 4 damage with cirrhosis) and have absolutely no symptoms.
    ◦Your liver test values can be completely normal
    ◦You can feel fine and not have jaundice or any other symptoms

    •A liver biopsy can confirm that you have liver damage. Unfortunately, in the early stages of the disease, it cannot confirm with 100% confidence that you do not have damage.
    ◦Since the damage can be patchy, it can depend on where the biopsy is taken and whether the sample size is adequate
    ◦Pathological interpretation can vary
    ◦It can also depend on how experienced the pathologist is in reading liver biopsy slides

    •The average primary care physicians and Gastroenterologists know little to nothing about fatty liver and liver disease.
    ◦They believe that fat in the liver is benign and will not hurt you; they are likely to tell you “it is nothing to worry about”
    ◦They tell their patients that there is no treatment for NAFLD and NASH since there is not a pill they can prescribe
    ◦They may mention in passing, but do not emphasize the importance of losing weight, getting exercise and changing what you eat
    ◦They do not believe their patients are capable of changing their behavior and losing weight
    ◦They do not tell, that for some patients, fatty liver can progress to NAFLD, NASH, cirrhosis, liver cancer and even death

    •What I thought was a healthy diet, really was not.
    ◦Too much sugar is as damaging to the liver as too much alcohol
    ◦Too much sugar is the primary thing that turns to fat in the liver
    ◦Eating excess white flour, white rice and potatoes is almost the same as eating sugar
    ◦Saturated fats (e.g. milk fat, red meat fat, etc.) cause inflammation which is bad for the liver

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