Case Study - You don’t have to be overweight to have a fatty liver
Anna was a delightful 45 year old lady who came to see me last week. She had several health problems but the most worrying was her recent diagnosis of thyroid cancer. Anna had just had her thyroid gland surgically removed and she was about to undergo radioactive iodine treatment, as a precaution to make sure all the cancerous cells were removed.
Anna wanted advice on how to strengthen her immune system and prevent developing cancer again; however her biggest concern at the moment was fatigue. She had been feeling very tired for the past few years but since the thyroid operation she felt completely exhausted and had to have an afternoon nap each day.
Anna had suffered long term digestive problems and she was actually under weight. She asked me for advice on how she could gain weight.
Anna presented me with a whole bundle of recent blood test results and I was intrigued to see that she had a long history of elevated liver enzymes. I queried that and she said her doctor had diagnosed her with a fatty liver many years ago.
How interesting to see an under weight person with a fatty liver!
Actually this scenario is far more common than you may realise. Having a fatty liver is not solely due to being fat. Liver cells can accumulate fat inside them as a consequence of chronic inflammation and cell damage.
I asked Anna to complete a detailed health questionnaire when she arrived as I want to know as much about her health history as possible. This would give me clues as to why she ended up with her current health problems. Another significant thing I noticed is that Anna had been diagnosed with osteoporosis two years ago. The only recommendation her doctor gave her was to take a calcium supplement.
Osteoporosis is a complex condition and Anna was very young to receive such a diagnosis. I noticed in her blood test results that she was deficient in vitamin D. That meant the calcium in her supplement and the calcium in the food she ate was not able to enter her bones and strengthen them. Vitamin D is essential for calcium absorption. Therefore I gave Anna a vitamin D supplement containing 5000 IU and asked her to take it each morning. This should also help with the fatigue she was experiencing.
Anna had discovered a lump in her neck six months ago and had been having difficulties swallowing. Her doctor sent her for a thyroid ultrasound and 2 large nodules were discovered. She had a biopsy and the larger nodule was found to contain cancerous cells. Anna had surgery to remove her entire thyroid gland a month before seeing me.
I asked Anna to take a selenium supplement because selenium is well known for helping to prevent thyroid nodules and enlargement of the thyroid gland (called goiter). Selenium is also a strong antioxidant, it improves the liver’s detoxification abilities and it helps to protect the DNA inside our cells from damage. This is significant for those of us who want to prevent cancer because cancer occurs when mistakes are made in DNA replication. I asked Anna to take 200 mcg per day of selenium.
I was startled when Anna told me she had been experiencing abdominal pain for the last seven years. Sometimes the pain would become extremely intense and, in fact, once a year for all of those seven years she ended up in hospital with the pain. No abnormality was ever found and she was eventually sent home.
Anna had several red flags indicating possible gluten intolerance, so I sent her off for a blood test to see if she has the genes for celiac disease. The test came back positive. Celiac disease causes malabsorption and can make it impossible for an underweight person to gain weight. The malabsorption is also a significant cause of fatigue.
Osteoporosis is a common manifestation of undiagnosed celiac disease and every patient who has been diagnosed with osteoporosis should be tested for celiac disease.
Celiac disease was probably responsible for the abdominal cramps Anna experienced and there’s a good chance it was also inflaming her liver, leading to raised liver enzymes. It is common to see patients who have suffered with long term digestive problems eventually develop liver problems. This makes sense because all the blood from the intestines travels first to the liver. If the bowel environment is toxic, these toxins must be dealt with by the liver.
I put Anna on a gluten and dairy free diet and gave her a Digestive Enzymes supplement. This would help her extract more nutrients from her food, therefore help to correct long standing nutritional deficiencies and improve her energy. I also gave her Livatone Plus to help reduce inflammation in her liver. The milk thistle in this formula helps to repair damaged liver cells and protects healthy cells from damage.
Anna is due to see me again in another four weeks but she has contacted me already and told me she feels immensely more comfortable in her digestive system after meals, and she feels nowhere near as tired. I will be interested to see her liver function test results in a few months.