Managing Fatty Liver and GERD: A Patient's Journey to Health

I have a question I would like to ask the doctor?

Hello Doctor: I have had abnormal liver function since 2003.
I do not smoke, drink alcohol, or chew betel nut, but I have always loved sugary drinks.
In the past, I also frequently stayed up late, and I only exercised during physical education classes; otherwise, I rarely engaged in physical activity.
My liver enzyme levels once peaked at over 130! Currently, my liver enzyme levels have dropped to around 41, and I only occasionally stay up late (playing on my phone).
I have managed to change my bad habit of staying up late, but I still drink sugary beverages every day, and sometimes I drink tea.
I am aware that I have gastroesophageal reflux disease (GERD), as I sometimes feel a foreign body sensation in my throat, but I currently do not have time to undergo an endoscopy.
I need to schedule time off to get checked.
I have previously undergone multiple endoscopies due to GERD and have also tested positive for Helicobacter pylori.
Recently, an ultrasound showed that I have moderate to severe fatty liver.
I have also stopped eating fried chicken, which I used to consume frequently.
However, drinks are my favorite; I realize that as long as I drink sugary beverages, GERD and fatty liver are always present! Although I sometimes drink plain water, I currently do not exercise at all! I know that managing fatty liver requires dietary changes, weight loss, and exercise.
However, my job is really exhausting, and I am the type of person who works very diligently, so I consider my work as a way to lose weight.
The more tired I get, the more I believe I am effectively losing weight.
On weekends, I also have household chores to do.
Nevertheless, my weight has remained around 68 kg, and my BMI consistently indicates that I am overweight! Ever since I developed athlete's foot, I have only been able to use topical treatments, but they are too cumbersome and have become a recurring issue.
Later, my blood tests surprisingly showed normal liver enzyme levels!? I don’t understand why this happened.
I continue to drink sugary beverages, my weight hasn’t changed, and I haven’t exercised, yet my liver enzyme levels are normal! I am unsure if there was an error in the tests.
I also don’t know how to quit sugary drinks.
Thank you for your response.

A Yao, 30~39 year old female. Ask Date: 2019/07/26

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello,
1.
For those prone to gastroesophageal reflux disease (GERD), it is advisable to pay attention to diet by reducing coffee intake, and limiting chocolate, spicy foods, and high-fat foods.

2.
Helicobacter pylori is associated with chronic gastritis, gastrointestinal ulcers, and gastric cancer.
If previously treated, testing for the presence of the bacteria can be performed.

3.
The most common cause of abnormal liver function is non-alcoholic fatty liver disease (NAFLD), although fatty liver does not always indicate liver dysfunction.
NAFLD, when associated with long-term inflammation and severe fibrosis, increases the risk of cardiovascular diseases and liver-related complications such as cirrhosis and liver cancer.
Although liver enzyme levels may improve, ultrasound examinations may still show moderate to severe fatty liver.
The liver enzyme levels in NAFLD can range from normal to slightly elevated or even up to ten times higher.
The long-term implications primarily depend on the degree of liver fibrosis.
It is recommended to address fatty liver through diet, weight loss, and exercise.
Elevated liver enzyme levels do not necessarily indicate severe issues.
A decrease in liver enzyme levels is a positive sign.
Do not indulge excessively just because liver function appears normal; the healing of the liver primarily depends on the degree of fibrosis.

Please pay attention to your lifestyle and diet, limit sugary beverages, control your weight, and consider consulting a nutritionist regarding dietary choices.

Wishing you health and success!
Sincerely,
Dr.
Ming-Hui Lin, Attending Physician, Gastroenterology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2019/07/26

More Info

Managing fatty liver disease (FLD) and gastroesophageal reflux disease (GERD) can be quite challenging, especially when lifestyle habits and dietary choices play a significant role in both conditions. Your journey reflects a common struggle many face, and it's commendable that you've made some positive changes over the years. Let's break down your situation and explore ways to improve your liver health and manage GERD effectively.

Understanding Fatty Liver Disease
Fatty liver disease occurs when excess fat builds up in the liver cells. This condition can be caused by various factors, including obesity, poor diet (especially high in sugars and unhealthy fats), sedentary lifestyle, and metabolic disorders. In your case, the history of high sugar intake and a lack of physical activity likely contributed to the development of fatty liver. However, it's promising to hear that your liver enzymes have improved significantly, dropping to around 41. This indicates that your liver function is stabilizing, which is a positive sign.

The Role of Diet
While you mentioned that you have reduced your intake of fried foods, the continued consumption of sugary drinks can still pose a risk to your liver health. Sugary beverages are high in fructose, which is particularly harmful to the liver and can contribute to fat accumulation. To manage fatty liver effectively, consider the following dietary adjustments:
1. Reduce Sugar Intake: Gradually decrease your consumption of sugary drinks. You might start by replacing one sugary drink a day with water or herbal tea. Over time, aim to eliminate them entirely.

2. Increase Hydration: Drinking plenty of water can help your liver function better and may also alleviate some symptoms of GERD. Aim for at least 8-10 cups of water daily.

3. Balanced Diet: Focus on a diet rich in whole foods, including fruits, vegetables, whole grains, lean proteins, and healthy fats (like those from nuts, seeds, and avocados). This can help reduce liver fat and improve overall health.

4. Limit Processed Foods: Processed foods often contain hidden sugars and unhealthy fats. Cooking at home can help you control what goes into your meals.

Exercise and Weight Management
While you mentioned that you find it challenging to incorporate exercise due to work and fatigue, physical activity is crucial for managing both fatty liver and GERD. Regular exercise helps reduce liver fat, improve insulin sensitivity, and can aid in weight management. Here are some tips:
1. Start Small: If you're not currently exercising, begin with short walks or light activities. Aim for at least 150 minutes of moderate aerobic activity each week.

2. Incorporate Movement into Your Day: Look for opportunities to be active throughout your day, such as taking the stairs instead of the elevator or doing household chores more vigorously.

3. Set Realistic Goals: Focus on gradual weight loss (1-2 pounds per week) rather than drastic changes. This is more sustainable and healthier for your body.

Managing GERD
GERD can be exacerbated by dietary choices and lifestyle habits. Here are some strategies to help manage your symptoms:
1. Avoid Trigger Foods: Common triggers include spicy foods, citrus, chocolate, caffeine, and, of course, sugary drinks. Keeping a food diary can help you identify what worsens your symptoms.

2. Eat Smaller Meals: Large meals can increase pressure on the stomach and lead to reflux. Try eating smaller, more frequent meals throughout the day.

3. Stay Upright After Eating: Avoid lying down immediately after meals, as this can promote reflux. Aim to stay upright for at least 2-3 hours after eating.

4. Consider Timing: If you experience nighttime symptoms, try to have your last meal at least 3 hours before bedtime.

Conclusion
Your journey towards better health is ongoing, and it's important to remain proactive about your lifestyle choices. While it may seem daunting, making gradual changes to your diet and incorporating physical activity can significantly impact your liver health and GERD symptoms. If you're struggling to make these changes on your own, consider seeking support from a registered dietitian or a healthcare professional who specializes in metabolic health. They can provide personalized guidance and help you create a sustainable plan that fits your lifestyle. Remember, every small step counts towards achieving better health!

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