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Consolation and Keto

 


“Clouds in the sky very much resembles the thoughts in our minds!
Both changes perpetually from one second to another!”
- Mehmet Murat ildan

Jeff had an appointment with Primary Care today, the first since the endocrinologist called to tell him that he had Class A liver cirrhosis.

The period between the phone call and today's appointment was grim and frightening. He might only have 15 years left. It would continue to get worse day after day. It's a bleak future filled with pain, and then liver failure, without time to get on the liver donor list.

Or not.

Dr L was thorough and answered every question. The appointment ran an hour and gave us hope again. It was at Class A, sure. But careful diet and new attitude would certainly extend things, especially as it was caught before any major damage had been done. Jeff also has his diabetes under control and, partially thanks to my shitty comfort food, his weight is down and he's no longer considered obese. 

I stood up and pulled him into a hug, avoiding the military pins in his ball cap as I kissed him. And I could hardly hold back tears. I had the love of my life back. I wouldn't have to say goodbye to my constant companion, my best friend.

 

Eating patterns and habits need to change. The next few weeks will be hard. It's an almost Keto diet.

I really don't have a problem with Keto. If you are considering this diet plan, you should speak with your doctor and dietitian prior to starting, especially if you have liver or kidney disease, or other factors that outweigh the benefit of a keto diet.

Several short-term studies were published concerning nonalcoholic fatty liver disease (NAFLD) and the positive effects of a keto diet. A solid paper came out in 2020, "Effect of a ketogenic diet on hepatic steatosis and hepatic mitochondrial metabolism in nonalcoholic fatty liver disease". I've dropped the link in the citation below.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease and can progress from steatosis to advanced liver disease, including liver cirrhosis and hepatocellular carcinoma (–). It is strongly associated with insulin resistance, which is characterized by excessive hepatic glucose production and compensatory hyperinsulinemia (–). In adipose tissue of subjects with NAFLD, insulin fails to suppress lipolysis, which leads to increased hepatic delivery of nonesterified fatty acids (NEFA), the main substrate for synthesis of intrahepatic triglycerides (IHTG) (–). Excess substrate and hyperinsulinemia may stimulate re-esterification and de novo lipogenesis (DNL) of fatty acids, which can further increase IHTG content and overproduction of very low-density lipoprotein (VLDL)-TG into circulation (–). Together, these features of NAFLD increase the risk of type 2 diabetes and cardiovascular disease (, ).

Basically, this is what the disease is, this is what it affects, and this is what things can lead to if NAFLD is left unchecked.

Since obesity is an important cause of NAFLD, its management is underpinned by weight loss (–). Recently, low-carbohydrate ketogenic diets (KD) have gained popularity in the treatment of obesity, type 2 diabetes, and NAFLD (–). While long-term data comparing different weight loss regimens in NAFLD are virtually nonexistent, a low-carbohydrate diet has been reported to induce a threefold greater IHTG loss than a low-fat, high-carbohydrate diet after 48 h of caloric restriction (). We previously showed that a hypocaloric, KD induces an ∼30% reduction in IHTG content in 6 d despite increasing circulating NEFA ().

KD increases plasma NEFA concentrations, the main substrate of IHTG (). In the liver, NEFA can either be re-esterified into complex lipids, such as TGs, or be transported to the mitochondria to be metabolized by β-oxidation into acetyl-CoA, which in turn can either be irreversibly condensed with oxaloacetate by citrate synthase to form citrate and enter the TCA cycle for terminal oxidation to CO2 (, ) or it can enter the ketogenic pathway, where it is converted into acetoacetate (AcAc) and β-hydroxybutyrate (β-OHB) (). These mitochondrial fluxes are tightly regulated by substrate availability and product inhibition (), mitochondrial redox state (), and hormones, such as leptin () and triiodothyronine (T3) ().

Granted, this is a specific study on the impact of short-term KD on hepatic steatosis in overweight/obese subjects before and after a 6-day KD. We can infer that the same benefits might apply to those that have advanced from steatosis to liver cirrhosis and/or hepatocellular carcinoma. 

Specifically, I would love to see a long-term study on KD for patients with Class A liver cirrhosis.

 

As for Jeff's own KD? As I said, he'll likely have issues with some of it. People that love tasty carbs often do. You aren't a bad person for craving them. It takes a while for your body to get over its addiction to them. Jeff will run into temptation. He'll justify every reason to eat crap. 

Moderation is a bitch. Too much of a desired thing can lead to consequences we don't want. Usually, we often don't know what the consequences are until after they've started to affect our health. Or we go into denial.

I endure this shit every time I quit smoking. I crave the nicotine. I can't go without it. My mother has lung cancer. I know the consequences of smoking. So I stop. And then something stressful happens and I tell myself, "Just one can't hurt". But I bought that pack to have just one cigarette. "Now I should smoke the pack so it isn't wasted money."


As for my temptation? I decided to give up unhealthy food in solidarity with Jeff. What do I see when I stopped to fill the Bronco? Stephen Colbert's AmeriCone Dream is on sale. 

This shit is my absolute addiction. It was incredibly difficult to walk away from it, especially as it was the last tub of it. I felt that I was depriving myself of joy... until I remembered that I also have NAFLD.

My unhealthy habits are slowly killing me. There isn't any such thing as "moderation" or "just one won't hurt me". Most addicts fall completely off the wagon with they tell themselves this bullshit. 

"Just one beer, just one spliff, just one opioid pill, just one box of mac and cheese, just one cigarette. That's all I need. Just one won't hurt me, right?"

Wake up, people, and look at pictures of the body parts you're permanently damaging. With my own NAFLD, I took this approach...

This is a liver: 


If you mix mac and cheese with red cranberry sauce, you get this:



Those two images come from The National Institute of Diabetes and Digestive and Kidney Diseases website, by the way. I recommend reading through their information on cirrhosis.

 

Jeff has an appointment with a dietician next week. I'm hoping it will help us make sense of everything. My endocrinologist has also referred me to a dietician. Between the two, we should be fine.

 

INTERESTING READS

Luukkonen, Panu K et al. “Effect of a ketogenic diet on hepatic steatosis and hepatic mitochondrial metabolism in nonalcoholic fatty liver disease.” Proceedings of the National Academy of Sciences of the United States of America vol. 117,13 (2020): 7347-7354. doi:10.1073/pnas.1922344117

 

“How Long Can You Live With Cirrhosis of the Liver?” Fatty Liver Disease, 16 Sept. 2020.

How Long Can You Live with Cirrhosis of the Liver?
While cirrhosis can not be reversed there are some things that can be done to avoid liver damage and to reduce its progression rate. These include;

  • Avoiding alcohol – Alcohol is notorious for causing harm to the liver and its best that you abstain from it especially if your liver is already damaged.
  • Limit salt intake – Liver cirrhosis makes it difficult for the liver to retain blood fluid. Consumption of salt increases the chances of the fluid becoming excess. You don’t necessarily have to remove salt entirely from your meal but you can avoid using too much of it while cooking and restrict processed foods.
  • Lessen infection risks – A healthy liver would produce proteins that assist the body’s immune system fight off infection. A sick liver will not be able to do this efficiently so you have to help it by doing all you can to put yourself away from the reach of infections. Wash both hands frequently. Limit physical contact with people, especially those with an active infection like flu.
  • Use medications carefully – This is specifically for over the counter drugs. Your liver process all medications and chemicals that you take into your body. Inform your doctor if you are using any over the counter drugs, herbs or supplements to ensure that you are not stressing your liver.
  • Coping Mechanisms
  • Sitting across the doctor and hearing for the first time that you have cirrhosis can be too much to take in. The first question you might ask immediately how long can you live with cirrhosis of the liver. Even if you had no knowledge about this illness, the name alone sounds like a big deal and can cause you to panic.



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