Fatty Liver and Kidney Stones: Dietary Insights and Management

Abdominal ultrasound

Hello Doctor: Last year, due to abdominal pain, I was examined and found to have kidney stones and moderate fatty liver.
Over the past year, my weight has been stable at 92 kg (height 166 cm), and I have been controlling my diet for about a year.
I believe I have been drinking enough water.
The left kidney stone increased from 0.4 cm to 0.6 cm, and there is also a new stone in the right kidney measuring 0.4 cm.
My usual dietary habits this year include: in the morning, I consistently drink a cup of unsweetened green tea (700 cc) and a Guanyin latte with one sugar (700 cc).
For breakfast, I usually have soy milk, a pork chop sandwich or an egg pancake with two soup dumplings.
For lunch, I eat 10 potstickers with a bowl of soup, ramen, or a hamburger with grilled chicken, or pasta.
For dinner, I have a chicken rice box with meat thick soup or a small hot pot (pork hot pot or home-style dishes).

Report from October 2022:
[Chief Complaint] Mildly elevated bilirubin
[Findings]
Liver: The liver has a normal size with a smooth surface.
The echogenicity is diffusely increased with far attenuation and blurring of vascular structures.
Two hypoechoic shadows measuring 1.9 cm and 1.2 cm over segment 4 were found.
Gallbladder: The gallbladder is relaxed without definite stones or polyps.
Biliary duct: The CBD is not dilated.
Vascular system: Vascular structures are unremarkable, including the portal vein, IVC, and abdominal aorta.
Pancreas: The pancreas is partially obscured by bowel gas.
No abnormalities could be detected.
Spleen: The spleen has a normal size and similar echogenicity to the liver.
Kidney: Left kidney stone: 0.4 cm.
Both kidneys are normal in size and cortical thickness with a stone of 0.4 cm over the left kidney.
[Impression]
(1) Moderate fatty liver
(2) Focal sparing left renal stone
Report from November 2022:
[Chief Complaint] Fatty liver
[Findings]
Liver: The liver has a normal size with a smooth surface.
The echogenicity is diffusely increased with far attenuation and blurring of vascular structures.
A hypoechoic shadow measuring 1.5 cm over segment 4 was found.
Gallbladder: The gallbladder is relaxed without definite stones or polyps.
Biliary duct: The CBD is not dilated.
Vascular system: Vascular structures are unremarkable, including the portal vein, IVC, and abdominal aorta.
Pancreas: The pancreas is partially obscured in the head and tail areas by bowel gas.
No definite abnormalities could be detected in the visible portion.
Please correlate with clinical symptoms and data for either follow-up or further study of the pancreas.
Spleen: The spleen has a normal size and similar echogenicity to the liver.
Kidney: Left kidney stone: 0.6 cm, Right kidney: 0.5 cm.
Both kidneys are normal in size and cortical thickness with echoes about 0.5 cm over the right kidney and 0.6 cm over the left kidney.
[Impression]
(1) Moderate fatty liver
(2) Focal sparing bilateral renal stones
I would like to ask the following questions, thank you.
Q1: Is there any problem with my diet?
Q2: The doctor informed me about the fatty liver and kidney stone issues, but did not mention any other problems.
Based on the diagnostic report, is everything still okay?
Q3: Regarding the kidney stone issue - I have been controlling my diet, but the problem has not been resolved.
I am unsure how to proceed.
The doctor advised me to drink more water, avoid holding my urine, and exercise.
Q4: Regarding the fatty liver issue - I am currently unable to lose weight.

Frank, 30~39 year old female. Ask Date: 2023/12/13

Dr. Lin Minghui reply Gastroenterology and Hepatology

The patient has moderate obesity with a BMI of 33.3, and there are kidney stones present with minimal changes observed in the follow-up ultrasound.
The abdominal ultrasound shows slight changes in non-fatty areas and multiple small right-sided kidney stones.
It is recommended to consult with a metabolic specialist and a nutritionist.
A diverse diet is advised, as consuming specific foods high in sodium, sugar, protein, oxalates, and animal protein can increase the likelihood of developing kidney stones.
It is suggested to limit soup and tea intake while increasing water consumption to 2000 to 3000 cc daily.

Regarding fatty liver, it is important to identify the underlying causes such as alcohol consumption, obesity, hepatitis C, medications, or chemical exposure, and to address them accordingly.
Weight management can be guided by a nutritionist or a weight loss physician.
Obesity can lead to metabolic fatty liver disease.
Currently, there are no specific medications for treating metabolic fatty liver; however, lifestyle changes, weight control, blood sugar and lipid management, and exercise are essential for improving non-alcoholic fatty liver disease.

If metabolic syndrome is present, characterized by three of the following: hypertension, hyperglycemia, hyperlipidemia, along with two additional factors (excess waist circumference and low levels of good cholesterol), the patient may be diagnosed with metabolic syndrome.
The National Health Administration has a metabolic syndrome prevention and treatment program available at related clinics and hospitals to help patients improve unhealthy lifestyles.

Wishing you good health!

Reply Date: 2023/12/13

More Info

Understanding the relationship between dietary habits, fatty liver disease, and kidney stones is crucial for managing these conditions effectively. Based on your medical history and dietary practices, let's address your questions and provide insights into how you can improve your health.

Q1: Is my diet problematic?
Your current diet appears to be high in carbohydrates and fats, which can contribute to both fatty liver disease and kidney stones. For instance, consuming fried foods, processed meats, and high-sugar beverages can exacerbate fatty liver conditions. The presence of kidney stones can also be influenced by dietary choices, particularly those high in sodium, oxalates, and animal proteins.
To improve your situation, consider the following dietary adjustments:
- Increase Fruits and Vegetables: Aim for a variety of colorful fruits and vegetables, which are rich in fiber and antioxidants. These can help reduce liver fat and improve overall health.

- Limit Saturated Fats and Sugars: Reduce your intake of fried foods, sugary drinks, and high-calorie snacks. Instead, opt for healthy fats found in nuts, seeds, and avocados.

- Stay Hydrated: While you mentioned drinking enough water, ensure you are consuming at least 2-3 liters daily. Proper hydration can help prevent kidney stones by diluting the substances in urine that lead to stones.

- Moderate Protein Intake: Focus on lean proteins such as chicken, fish, and plant-based sources like beans and lentils, while limiting red meat and processed meats.

Q2: Is my current health status acceptable based on the reports?
Your reports indicate moderate fatty liver and bilateral renal stones. While there are no immediate life-threatening issues, both conditions require monitoring and lifestyle changes. Fatty liver can progress to more severe liver diseases if not managed properly, and kidney stones can lead to complications such as infections or obstruction. Regular follow-ups with your healthcare provider are essential to monitor these conditions.

Q3: How should I manage my kidney stones?
Given that dietary control has not resolved your kidney stone issue, it’s important to focus on prevention strategies:
- Hydration: As previously mentioned, drink plenty of water throughout the day. This is the most effective way to prevent stone formation.

- Dietary Modifications: Limit foods high in oxalates (like spinach, nuts, and chocolate) if you are prone to calcium oxalate stones. Reducing sodium intake can also help, as high sodium levels can increase calcium in urine.

- Regular Exercise: Engage in regular physical activity, which can help maintain a healthy weight and improve overall metabolic health.

Q4: Why can’t I lose weight with fatty liver?
Weight loss can be particularly challenging with fatty liver disease due to metabolic changes associated with the condition. Here are some strategies to consider:
- Caloric Deficit: Create a balanced meal plan that promotes a caloric deficit while ensuring you receive adequate nutrients. Consulting a registered dietitian can be beneficial for personalized guidance.

- Incorporate Physical Activity: Aim for at least 150 minutes of moderate aerobic exercise weekly, along with strength training exercises twice a week. This can help improve liver health and promote weight loss.

- Avoid Crash Diets: Rapid weight loss can worsen liver health. Aim for a gradual weight loss of 1-2 pounds per week.

Conclusion
Managing fatty liver and kidney stones requires a comprehensive approach that includes dietary changes, hydration, and regular physical activity. It’s essential to work closely with your healthcare provider and possibly a nutritionist to develop a tailored plan that addresses your specific needs. By making these lifestyle adjustments, you can improve your liver health, reduce the risk of kidney stones, and work towards achieving a healthier weight. Remember, consistency is key, and small changes can lead to significant improvements over time.

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