I’m happy to see a fatty liver thread here because my liver has received more medical attention in the last month than it could ever have wished for. I have a lot to unload, so please forgive the length of this post. CTs of my abdomen taken over the last 20 years for other purposes often include incidental findings of fatty streaks in my liver (hepatic steatosis – I had to look it up). This is only one of the many manifestations of metabolic syndrome so I didn’t pay much attention. However, a couple of months ago I had a weird episode of lightheadedness and very low blood pressure (85/55) that lasted all afternoon, sending me to the emergency room out of concern for internal bleeding. I won’t bore anyone with the multiplicity of procedures that ensued: echocardiograms, EKGs, CTs, MRIs, scopings from both ends, you name it. (Thank you, Medicare.) The relevant test was an endoscopy that revealed esophageal varices, which are swollen veins in the esophagus that have an unfortunate tendency to bleed profusely. They are most often found in older, chronic alcoholics due to serious liver disease – fibrosis or cirrhosis – that stiffens the liver to the point that blood has trouble squeezing through. This, in turn, causes high blood pressure in the portal vein, forcing blood seeking a path out into small veins that primarily serve the stomach or lower esophagus. The portal vein, by the way, is where the little veins that drain the intestines converge so that the liver gets first crack at the nutrients picked up there. I was referred very quickly to a hepatologist who banned alcohol, put me on a beta blocker to lower pressure in the portal vein, and ordered tests. He told me that varices could result from non-alcoholic fatty liver disease (NAFLD, pronounced “naffle-dee” so it rhymes when one says “I hope that you will never be diagnosed with NAFLD”), and that mine had apparently progressed to the danger point. The word transplant was mentioned. Fortunately, things took a major turn for the better when ultrasound elastography (which measures how fast a sound wave passes through) and an MRI showed that my liver is soft and pliable with no portal vein hypertension. Moreover, a second look at the photos of my gullet showed the varices to be way up at the top, far from where they should be with cirrhosis, and my liver enzymes were perfectly normal. So I am left with a medical mystery that is still under investigation, but I have the pleasure of knowing that my liver is healthier than it’s been for years. In fact, the MRI found no evidence of hepatic steatosis! I’m seeing the liver doc on Monday, but if the report is to be believed, I’m not only free of any fibrosis, but the fat may be gone as well. Which brings me to me the reading I did. I am always very cautious about putting too much faith in a single article, especially one that is not particularly recent, but I was impressed by M. Snel, et al., “Ectopic Fat and Insulin Resistance: Pathophysiology and Effect of Diet and Lifestyle Interventions,” International Journal of Endocrinology, Article ID 983814, 2012, https://doi.org/10.1155/2012/983814. This treats fat in the liver as just one of many kinds of “ectopic” fat: fat deposited someplace other than where it belongs in a healthy person, which is mostly under the skin. Fatty liver gets a lot of attention, because it’s so harmful, but if I understand these authors correctly, I not only had the liver of a Strasbourg goose, but the muscles (including heart muscle) of a well-marbled beefsteak, and other fat-infiltrated or fat-encased organs, all caused by the same process. The explanation offered is too technical for me to understand, let alone summarize, but the gist of it seems to be that as we get more obese and insulin resistant, our adipocytes grow overly large and dysfunctional (like me!) and have difficulty both taking up and releasing lipids, causing their redirection towards peripheral tissues, including skeletal muscle, liver, pancreas, and heart. My non-technical understanding is that like Tribbles in a Star Trek episode, the excess fat ends up in all the wrong places. I am very reluctant to quibble with PaulL because he is usually right, but this offers a different perspective on the cause of fatty liver than the de novo lipogenesis (DNL) he mentions. Although DNL indeed takes place in the liver, the fat that gets stored there comes from many sources. I stumbled on the description of using radioactive tagging of various lipid sources to show that a majority of liver fat comes from circulating free fatty acids that derive mostly from lipolysis in adipocytes. DNL contributes 26 percent, and 15 percent comes through the portal vein from the guts. Moreover, the DNL contribution to liver fat is about the same as its contribution to fat in VLDL particles, which to me implies that even though DNL takes place in the liver, the triglycerides it produces go everywhere and those that end up infesting the liver come from everywhere. K.L. Donnelly, et al., Sources of Fatty Acids Stored in Liver and Secreted Via Lipoproteins in Patients with Nonalcoholic Fatty Liver Disease, Journal of Clinical Investigation, 115(5):1343-51, 2005, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1087172/. That doesn’t mean that avoiding fructose isn’t a good thing to do – it’s a great thing to do – but it works because it works for the whole body, not just the liver. And that was, I thought, the most useful information from the ectopic fat paper. What I was originally looking for was the best way to reduce the amount of fat in my liver, and at least according to these authors, there is no better way to reduce fat in your liver than to reduce fat in your body as a whole. When you successfully lose weight, fat in the liver is the first to be “mobilized,” followed by visceral fat. The authors say that “it has been shown that even a relatively small drop in BMI of 3–6% is associated with a considerable reduction in hepatic TG [triglyceride] content of 34–40%. The main reduction in hepatic TG content already occurs in the first two weeks of dietary restriction.” (Citations omitted.) Nothing I read contradicted this. I was looking for something extra I ought to do to get the fat out of my liver, but it turned out I am already doing what I need to do by losing weight on keto. And if that MRI is to be believed, it works.
Stomach
Thanks for the info.I lost weight but I got a BMI 30%.I have dropped a lot of weight 4 pant sizes.I never drink nor tobacco.I eat under 1600 calories 5% are carbs.My body likes fat more than protein.I can tell when protein is to high.Again thanks.
For every problem concerning the liver, you can’t go wrong in taking milk thistle. It repairs the liver.
Aside from your liver, you seem to have a problem losing fat. In my opinion, you need to eat more. You don’t eat enough calories for your level of activity (and maybe not even enough to fuel your basal metabolic rate). It’s probably the reason why your body retains so much fat.
I know it’s counterintuitive to eat more to lose fat, but it works. I Hope it helps and that your health will improve.
Your right but being single makes it hard just to cook for one.Example yesterday 6 eggs scambled tea cup yougart with blue berrys 3 cup keto coffee that’s it today only one cup keto coffee it’s almost 1pm
Nobody said you did, @x-Dena-x originally replied with a liver cleanse recommendation she’s used (not a bad idea) and mentioned that she did the gallbladder one as well, which worked very well, and it took off from there.
But you ARE losing the belly fat, what with your waistline decreasing like that! CONGRATS
I have fat Thu torso waist to chest a layer.My family in men had the same.I sweat buckets when working diet is clean 8. % carbs for last 3 months still no fat loss .Well play with diet see what I can do.Increase to 2 complete meals a day instead of one and a small kinda snack
%'s don’t work, are you tracking all your macros or just watching carbs? If there’s no fat loss (not weight loss) your diet isn’t right for you, however seems that there is if you’ve dropped 4 pants sizes. If you are tracking, what’s your typically breakdown daily? BMI also doesn’t matter, My BMI is like 33 and I’m around 10% bodyfat, completely useless measurement. Dropping 4 pant sizes is huge, and shows that you’re going in the right direction, but 1600 cals is way too low unless you’re completely sedentary.
That’s a huge overstatement. Milk Thistle was extremely overhyped. We took the crap out of that in the 90’s in the weight lifting world thinking it would help, it barely does anything. NAC actually helps a lot and will show on your labs.
I recently listened to a podcast with Ben Bikman. In that podcast he mentioned that while eating a low-carb diet can get blood sugar normalized almost right away, it can take a while for high insulin levels to normalize. This is just a guess on my part, but if your insulin levels are still high, you are probably going to have a hard time getting rid of that belly fat. It could be that some more healing needs to occur, and your insulin levels need to become lower, before you can lose the rest of that belly fat.
I think you just need to stay the course and give your body time. Like we frequently say on this form, it took years for your body to get to where it is. Change is not going to happen overnight.
You say you lost 45 lbs. and 4 in. off your waist, so you are obviously doing something right.
Forty-five pounds is 21% of your starting weight, so you have done very well. Your body may well need some time to adjust to the new situation before being willing to shed more fat, so you might wish to exercise some patience. In any case, returning to a carbohydrate-laden, high-insulin diet is not going to help and may very well cause you to gain back those 45 lbs.
Don’t forget that it is possible to shed fat and add lean mass at the same time, so the fit of your clothes is a more important measure of progress than the number on the scale. After my initial drop on the scale, my weight stabilised, but for the next twelve months I continued to lose another inch or so off my waist. So obviously there was some recomposition going on.
Need more studies on milk thistle and tumeric, I definitely agree.
Meantime, I’m taking them, buddy…I need all the help i can get at present, ebven if placebo!
All good friend. 
One thing to consider if the carb cravings are still there…
What types of carbs are you still consuming? My brain was telling me Onions are fine… Oh, and brown them (release the sugars!)…
It really matters. Also, diet sodas and artificial sweeteners can derail MANY people (some people tolerate them). Between my food addictions, and the “triggering” to overconsume I have to abstain. When I abstain for 2+ weeks (basically zero carb), the cravings are truly minor…
But I’ve been known to go from 1 Coke Zero (16oz), to 2L, to 4L, to 6L /day!!!
And it happens too quickly. The only reason I’ve never gone higher is that it’s physically hard to drink 8L of anything per day! You are constantly filling your glass and emptying your bladder. LOL.
So, not a moderator. I can moderate “pills” but not flavors especially sweet flavors.
Black coffee… Bleh… Cream and Splenda, or Just Splenda… And I will start drinking 1 and keep escalating. Although, it’s not has hyper-palatable as SODA…
Anyways, just chiming in. Make sure you are still not eating some foods that keep your addiction alive. Most of the time when I hear someone who fell off the wagon. It almost always started with KETO TREATS (Triggering the Sweet Cravings), then binging on Keto Treats. Then going F-That, and going off the reservation…
I am finally to place where I don’t go too far off the reservation. I had an Egg and Cheese Croissant the last time I went off the reservation. With 3 eggs! And it hit the spot, I managed my way back.
Good Luck. This is a great group. Paul is worth reading twice, I find. Always another nugget in his messages… And Robin, bless her soul, is such a peaceful influencer… Great support, and brilliant insight (it’s always an inside job)…
I was under the impression, for many years, that the gall bladder home cleanse was a bit of a scam?
Gallbladder cleanse: A 'natural' remedy for gallstones? - Mayo Clinic
Hi - it sounds like you have done amazingly well so far.
A big concern for the liver are seed oils (polyunsaturated omega 6 fatty acids) and (low levels of) vitamins A and D.
Chicken and pigs contain accumulated polyunsaturated fats as well as if you use seed oils to cook or eat any packaged KETO stuff. (Even though you don’t drink: the liver can handle alcohol and fructose if it is processing them with SATURated fat instead of polyunsaturated fats).
Vitamin A is needed (and then needs to be balanced with copper) - Eat LIVER and egg yolks - or get dessicated liver supplements. Only every other day if you hate it.
And then vitamin D.
Just keep eating whole foods - it took years for you to get where you are, it will take time to get back to where you should be - you can do it!
i realise you want to advise to be good, I really do.
Best advice you gave was whole foods 
Thanks for the good advice friend,
I’m living proof it’s not. Witnessed many, many, many, many gallstones expelled, each of the multiple cleanses I’ve done.
Don’t take this the wrong way, please!
You ■■■■■ out that nonnsense?
You I know i like ya- I just don’t believe it friend,
That’s all