Gallstones, fatty liver – WLD recommended.

Danielle writes:

This isn’t really a submission, although you can feel free to post it on the site if you want to (hey, maybe one of your readers will be able to help?). I’m very new to the concepts of Fat Acceptance, HAES, and intuitive eating, although they have already led to some positive changes in my life. However, I’m facing my first real challenge to those concepts since I started learning about them, via my husband, and I was wondering a) what you think, and b) how I could find some resources to either confirm or challenge what our family doctor is telling us.

Here’s the story: my husband has had weird gastro-intestinal events all his life. Prior to meeting me, these events mostly took the form of massive stomachaches consisting of vomiting, diarrhea, and severe abdominal pain, usually to the point where he would scream for hours on end. To my knowledge, he never really had these investigated, and he concluded that they were usually caused by something he ate. At the time, he was living in Montreal and relying mostly on public transportation, so he walked a lot and ate a fairly balanced diet for a bachelor (although he did and still hates most veggies and won’t eat them). He had a bit of a belly and was overweight, but in fairly good shape, health-wise.

However, since he came to live with me in the States, he’s had a fair number of lifestyle changes. We live in the suburbs, so he’s been forced to drive more and walk a lot less, he eats a lot more fatty foods, and has worked high-stress social work jobs for the past 7 years. In the past few years, he’s had a few debilitating bouts of abdominal pain that differed from his past pain in that they were mostly characterized by severe pressure in his upper-right quadrant and blood in his urine, no vomiting of diarrhea. After his most recent one (a couple of weeks ago) and an all-night stay in the emergency room, he’s finally decided to have it looked into, and tests have shown that he has gallstones and fat deposits in his liver.

So, here’s where the doctor’s advice is bumping against my new HAES outlook: she wants to remove his gallbladder and has ordered him to get on a weight loss program to help with the liver.

Now, I absolutely think that he could make some changes to start living healthier per HAES — he definitely needs to start getting some kind of regular physical activity, and he should probably eat less greasy take-out and start trying to work some more healthful foods into his diet (changes I’ve already started to make for myself). However, after reading some of the stories on your site, I’m very wary of the “lose weight” part of the treatment plan. Thanks to the resources I’ve found on the fatosphere, I no longer believe in weight loss for the sake of weight loss, and I distrust the popular link between weight and health. Since my husband and I are both veterans of Weight Watchers, I know he can temporarily lose weight just by eating less of the same crap he’s eating now. But if it’s his diet that’s causing his liver to have fat deposits, just losing weight by eating the same stuff isn’t going to help the problem, although it may fool the doctor into thinking he’s doing well.

I also want to emphasize that I’ve had this doctor for over ten years, and while she wasn’t a weight fanatic when I first started seeing her (at age 20, 5’6″ and probably about 230 lbs), but she’s mentioned it at every annual check-up in the past 5 years (since I went up to 290 after the first couple of years of my marriage, then dieted myself down to 250, then regained up to 308). After my regain, telling her I had just joined or was about to rejoin WW has kept the haranguing to a minimum, but I haven’t seen her since I started trying to practice HAES, so I don’t know how she’ll react to that philosophy.

So, here are my questions: does anyone know about fatty liver disease and it’s relationship to weight? Does anyone have any good resources where I could look to get the 411 on the disease (liverdisease.com and Wikipedia both link it specifically to obesity, but I’d really like a FA source to either confirm or dispute that)? Also, how do you folks deal with family and friends that reject HAES and believe in traditional WL dieting? I’ve expressed concern to my husband, my sister, and my mom about the “lose weight” treatment plan, and they all act like I’m crazy, or worse, like I’m trying to talk Husband out of a life-saving measure because I “just want to stick [my] head in the sand and believe it’s okay to be fat, when this shows pretty convincingly that it’s not,” (says my currently-on-WW sister, who herself is very fat, believes everything the MSM has to say about fat, and sees no difference between HAES and WLD). And finally, am I making a big deal over nothing? I know I can’t stop Husband from doing a WLD if he wants to (not that I would try), but I do think it would divert him from the true goal of getting healthier, and that worries me that his real problem will get worse while he works on the part that’s not really the problem.

I know this is really long, and I’m not sure this kind of advice is your site’s purview, but any guidance you could give me would be really appreciated. Thanks so much!

Leave a comment

21 Comments

  1. What your husband used to have, with the horrid pain and the vomiting, sounds like colic to me. That is something that could be caused by gall-stones. My Mother-in-law recently had these problems, and she had some complications too, what with after 5 endoscopies they still hadn’t removed all the gallstones. But gallstone attacks have nothing to do with weight, it happens to lots of people of various sizes.

    that’s just my two cents.

    Reply
  2. Tish

     /  August 10, 2009

    I was diagnosed with NASH at 20. I was 5’6″ and approx 190 lbs. I was diagnosed after a huge amount of painful and humiliating tests. My doctor told my grandfather that I was a hypochondriac while I was still under anethesia from a painful liver biopsy which showed, miracle of miracles, that there was something wrong with me. Many years of researching this disease, which is also called fatty liver by some, shows most people do not know what causes it. Yes, having a bad diet and not exercising does not make it better but also does not cause it. I would love to know how to “fix” it. As of 10 years ago I had beginning fibrosis of the liver. After all the drama I have never gone back to check the status of my liver. I wish your husband all the luck dealing with this.

    Reply
  3. Halle

     /  August 10, 2009

    http://diabetesupdate.blogspot.com/2009/03/how-to-reverse-fatty-liver.html Please ignore the weight loss talk — the rest of the info is good.
    Now, following the general food guidelines recommended by that site, your hubby *may* or *may not* lose weight, but stay focussed on the idea that you are attempting to ameliorate fatty liver, not lose weight, and if weight is lost it will be incidental and not in conflict with your HAES approach at all (however the doc may want to chalk up an improvement just to that…don’t be fooled).

    Reply
  4. lilacsigil

     /  August 10, 2009

    Halle is right – a lot of the factors that can lead to fatty liver can also lead to weight gain in susceptible people, hence the apparent correlation with obesity. HAES means finding what’s right for your body, and you are helping your husband do just that.

    Reply
  5. O.C.

     /  August 10, 2009

    Here’s some overarching advice from a librarian (me!) on finding good health information. I mean this for every reader of this site, not just the poster of this entry.

    First, do not rely on Wikipedia. I know it’s the first result you get when you google a topic. And it MAY have accurate information in it. It may also have bunk, either written by someone who’s not as much of an expert as they think they are, or by someone who is deliberately trying to mislead. I think we can all picture medical industry reps editing entries to make their medications and procedures look good, can’t we?

    Instead, start at http://medlineplus.gov. It’s the consumer health website hosted by the National Library of Medicine. It’s easy to use, easy to read, and encyclopedic in its coverage of conditions and medications. Yes, its material, like medical material everywhere, will glorify the benefits of weight loss. Ignore those parts and read the rest. Because after you’re done there you will go to…

    http://pubmed.gov, which is an online database of just about every medical journal published. It’s an exhaustive, and current source of the medical research that’s getting published in legitimate medical journals. This is where you can find out whether there is EVIDENCE that weight loss cures whatever problem you’re dealing with. This is where you can see what DOES show genuine evidence of helping your problem.

    Caveats: Pubmed will only give you abstracts of articles, unless you’re accessing it through a library’s website. But often the abstract is enough. If not, take down the citation of the article and contact your public library. Ask them to show you how to use interlibrary loan services to get a copy.

    Also, since these articles are written for medical professionals the terminology can be thick. But Pubmed is designed to search for synonyms of your search terms. So if you dive in and search for “fatty liver” it will also search for the medical term for fatty liver.

    Helpful add-on terms to include in your search: Treatment, prognosis, etiology.

    More broadly than just giving you information about a particular condition, this is where I send people when we’re debating whether long-term weight loss is even possible. Rather than going on the defensive (because I’ll never win that way, not against their miraculous anectdata about the time they lost five pounds!) I’ll say, ok, go to pubmed. Find me studies that show significant weight loss (10% of starting body weight) sustained over a period of five years or more. If it’s possible, it’ll be there. Show me.

    They can’t. The studies aren’t there.

    Reply
  6. Is the problem gallstone-related? Because if so, dieting (especially the kind of crash dieting people tend to do under heavy pressure to slim down) is only going to make it worse. But let’s put it this way. If he comes in with his liver in better shape even if he’s not thin, is your doctor really going to complain? If she is, you need a different doctor. Seriously. (Also, constant high stress like he’s experiencing at work can screw up the gallbladder pretty badly.)

    Also, has he ever been tested for hemochromatosis? It’s something a lot of doctors don’t think to check for, but an iron panel should probably be done on anyone who’s having liver issues, especially someone younger than 60 who isn’t a seriously hard drinker or drug abuser. It’s not a common disease, but it’s a nasty one that often isn’t discovered until serious organ damage has already happened.

    Reply
  7. I had gallstones, and getting my gallbladder removed was the best thing I did for myself. At the time, any fatty food would trigger an attack of pain, and for the month before the surgery, I ate a non-fat diet and had no attacks. After the surgery, i was able to eàt fatty foods again, BUT at a minor cost. Now, if i eat too much fat or fried foods, i get minor diarhhea. Similar to being on Alli, the OTC wieghtloss pill.

    As for fatty liver. I dont know anything about it, but I think it wouldnt hurt to eat less fat–not for the purpose of losing weight: thats a crock of bull–but for the purpose of reducing stress on the liver, and the colon (simply because fatty foods will cause diarrhea).

    Forget the weightloss bupkis. Focus on eating happy, body-comforting foods. His body will take care of itself.

    Reply
  8. Gallstones can cause intense pain (they were probably the worst pain I’ve ever had) — and a high-fat diet can lead to both the gallstones and fatty liver. Changes in diet and adding in more movement can help with both — but rapid weight loss can also lead to gallstones.
    I would think that setting out to improve health is the foremost goal. If weight is lost along the way, so be it, but measuring things like fitness and reduction in pain may be better measures to assess success of a plan more than weight.

    Reply
  9. livvy8

     /  August 10, 2009

    Although you obviously don’t want to do anything extreme, and surgery can definitely sound extreme, he probably should get the gallbladder removed. I’m 20 and not overweight, but I had my gallbladder taken out a year ago after years of suffering like the kind you described. I’ve been perfectly fine ever since, thank goodness–gallstones can be incredibly painful if left untreated, and the ailment will only get worse if he keeps the gallbladder. There’s only so much you can do to reduce pain, and it’s certainly not related to weight loss. So regardless of losing weight and liver fat, etc, I would definitely recommend the gallbladder surgery!

    Reply
  10. There’s definitely a dietary change to be made (in addition to removing the gall bladder – gallstones cause problems because you’re trying to digest fats, so your husband needs to lower his overall fat intake both immediately and in general. Once I had my GB out I couldn’t eat meals with lots of fat in them anymore).

    I don’t know a great deal about fatty liver, but I think rather than focusing on weight loss for the sake of weight loss, you may want to steer your husband towards the changes in diet and exercise that will help with that and the gallbladder and put aside the weight loss. If it happens, it happens, if not, he’s still doing what needs to be done to help his overall health.

    Reply
  11. Jae

     /  August 10, 2009

    Also, let’s not overlook a very important part of this story: he was having severe problems even when he was living a more active lifestyle and eating a healthier diet.

    Personally, if I was in your husbands shoes, I would get myself to a gastroenterologist because a lot of times, nonspecialists are only seeing a piece of the puzzle. Ancedata: A friend suffered for years from painful stomach aches and sudden, severe, bouts of diarrhea; regular doctors told him constantly that it was just stress and/or a sensitive system. Their advice was that he reduce stress as much as possible and avoid all foods that caused a bad reaction. Eventually he got himself to a gastroenterologist (and he had to see a couple before he found one who would take him seriously), and he was diagnosed with Crohns Disease.

    Point being that something is causing this to happen to your husband and it is something that has been going on for a long time. While eating a healthier diet and adding more movement are positive changes, it seems to me that something bigger is going on here. It is easy to blame symptoms first on diet, lifestyle, body weight, what have you, this blog is filled with stories like that after all, but the symptoms you describe existed no matter how he was living. Get him to a specialist, give them a full and total history of the problem, and find out what the underlying cause.

    Best of luck to you both!

    Reply
  12. jennhi

     /  August 10, 2009

    Can’t vouch for the gallbladder thing, but I can tell you that my experience with gastrointestinal problems can be treated with good eating and exercise. Unfortunately for doctors, “diet” and “weight loss” are apparently synonymous, and it took some prodding on my part to get my doc to stick to just “good diet”. Walking is always something she recommends, although her daily walking time prescription always varied between 20 and 45 minutes. Both things help the GI tract move things through easier.

    Reply
  13. Piffle

     /  August 10, 2009

    My husband had an inflamed gallbladder for a year, getting it removed helped him immensely. I second getting tested for hemachromatosis, the initial test should just be a blood draw and ferratin level. If that’s high then there’s a gene test if you want to be absolutely certain.

    The other symptom that concerns me is the blood in the urine. I don’t see any reason either gallstones or fatty liver should cause that. In addition to the other things make certain they’ve tested for UTI infections/kidney stones. This could be going on in addition to other stuff.

    Reply
  14. Eve

     /  August 10, 2009

    I’ve been diagnosed with fatty liver, and my doctor sent me to a nutritionist who gave me a diet to follow. I suck at following diets but I am doing my best. They didn’t really mention weight loss after I told them I believe in HAES. My doctor did say that most people who have fatty liver never have any problems from it, so apparently it’s not that serious.

    Reply
  15. Janemarie

     /  August 10, 2009

    As referenced in Halle’s link, non-alcoholic fatty liver disease is generally associated with high carbohydrate intake. It’s been my experience that my gallbladder is perfectly happy as long as I keep carbs moderate to low and make sure to include some fat in every meal. Nothing will wreak havoc faster with gallbladder than a low-fat diet because it’s an organ designed to process fat and it works best when allowed to do its job.

    Reply
  16. Janemarie

     /  August 10, 2009

    It just occurred to me that with a history of years of severe gastrointestinal symptoms, your husband may have undiagnosed gluten sensititvity/celiac disease. Something else to investigate.

    Reply
  17. I agree with Halle
    “http://diabetesupdate.blogspot.com/2009/03/how-to-reverse-fatty-liver.html Please ignore the weight loss talk — the rest of the info is good.”
    That blog isn’t as WLD obsessed as it used to be, she keeps up with the research. For people with insulin resistance, cutting back on sugar and starches to control blood sugar can often lead to weight loss, but there is a limit to how much of it is sustainable. I lost about 80 pounds, just from trying to control blood sugar, but have kept only about 60 lbs off for nearly 5 years (still ‘clinically obese.’)

    This article points to high fructose (in both sugar and HFCS) consumption being the major problem with NAFLD (WLD blog warning) and describes the process.
    http://www.proteinpower.com/drmike/saturated-fat/changing-dietary-trends-and-the-obesity-epidemic/
    This is a pretty good article describing the formation of gallstones: (WLD warning) He indicates in the comments section that you can eat more fat after gallbladder removal, you just have to gradually increase the fat, not do it all at once.
    http://www.proteinpower.com/drmike/uncategorized/carbohydrates-and-gallstones/

    Reply
  18. j

     /  August 10, 2009

    When I had my gall bladder out, I had a fatty liver, BUT, they didn’t rule out the gall bladder as the *cause* of the fatty liver : the gall bladder advanced to the point of fusing to the liver, thus contaminating it in a way. The theory was after having the gall bladder out, the liver would eventually heal itself (assuming diet doesn’t make it worse). Perhaps worth asking about?

    Reply
  19. kathleen

     /  August 11, 2009

    I’m an ultrasound tech and medical editor.

    There isn’t a linear relationship between gallstones and fatty liver. They often occur in the same patient.

    Gallstones form when the bile stored in the gallbladder isn’t active. This can happen because of hereditary factors, some diseases, and DIETING. A diet with no fat doesn’t trigger the gallbladder to squirt out bile to digest the fat, so the bile gets thick – it can form sludge balls (they are really called that), and those can, over time, harden into gallstones. I got my gallstones when I was about 21 and went on ol’ Jenny Craig.

    Fatty liver is correlated with obesity, but many many thin people have it. I agree w/the commenters who said no one really know what causes it. The liver has “portal triads,” little groupings of vessels consisting of an artery, a vein, and a bile duct. In fatty liver, hepatocytes become infiltrated with fatty globules which can (but doesn’t always) impair liver function. A diet to reduce fatty liver isn’t a bad idea, but i think the idea of weight loss should be discarded. Just move more and eat well….a little improvement at a time.

    here’s a pretty good study.

    http://www.medscape.com/viewarticle/458509_5

    i hope all this helps!

    Reply
  20. Fatty liver is a RESULT of metabolic syndrome (unless you are a drunk, in which case all bets are off), and I’d bet that his weight gain is a result of it, too. When the metabolic problem is under control (my doctor put me on Metformin), the liver will gradually heal itself. Weight loss when you have metabolic syndrome is virtually impossible.

    Reply
  21. Courtney

     /  August 15, 2009

    I had my gallbladder out in 1983 and in 1987 started having gallbladder attacks (extremely painful episodes like your husband described with nausea, vomiting and excrutiating vice-like pain around upper right abdomen. I have had 5 ERCP procedures to remove stones and “sludge” which get trapped in common duct. I must take Urisodol (think Drano for your body’s pipes) and eat an almost no-fat diet in order to keep the stones at bay. Please take your husband to a doctor who understands what biliary dyskenesia (sp.?) is. I have not had new stones in 9 years because I am so diligent about “NO FRIED FOODS.” That being said during my last ERCP in 2001 the doctor inadvertently punctured my small intestine (causing Peritonitus that almost killed me) and I’ve been in chronic pain ever since from the acid damage to my abdomen. Good luck!

    Reply

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: