Fatty liver spectrum of disease

DEAR DR. ROACH: I am a 79-year-old woman, recently diagnosed with fatty liver. When I asked what to do about it, I was told to eat more fiber. No one gave me a suggested eating plan to help me do this.

My present weight is 221 pounds, and I am 5 feet, 5 inches tall.

I take oxcarbazepine for epilepsy and amlodipine for high blood pressure. I was never a drinker, just an occasional drink on a special occasion.

Otherwise I am an active senior. I am not opposed to doing something natural instead of getting another prescription drug, unless that’s the only way to go.

ANSWER: Fatty liver, in people who do not drink excess alcohol, is a spectrum of disease.

It ranges from mild enlargement of liver with fat (usually in association with being overweight, and called “non-alcoholic fatty liver disease”) to inflammation of the liver (nonalcoholic steatohepatitis). This last can lead to fibrosis of the liver and eventually cirrhosis.

The best treatment for NAFLD is a change in diet. Fiber certainly is one important component, but it’s disheartening to me that you didn’t get even a basic discussion of what your diet should be.

The optimal diet for someone with NAFLD is similar to that for a person with diabetes, and any registered dietician nutritionist would be able to help you with that. Staying active while making some changes in your diet can help you lose a few pounds. Oxcarbazepine can make people gain weight.

The next time you see your neurologist, you might ask about an alternative, if possible. I also would recommend complete abstinence from alcohol (although a rare drink is unlikely to cause much harm). Just changing your diet will help, but usually weight loss is necessary to reverse the fatty liver. Some experts in this condition prescribe drugs to promote weight loss or even consider bariatric surgery (though not normally to someone in your age). However, most people are able to make significant improvement without resorting to these therapies.

Vitamin E sometimes is used in people who already have some fibrosis in the liver (which is on the pathway toward cirrhosis). The evidence in favour of use is not compelling, but vitamin E is generally considered safe.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.