A Pill Too Bitter to Swallow

by Bettina Elias Siegel on June 16, 2014

Many years ago, I mentioned to a doctor friend that a woman I knew – a Seventh Day Adventist who never touches alcohol — had been told she was at risk for cirrhosis of the liver due to her poor diet and excess weight.  My doctor friend looked at me skeptically and said I must have misunderstood the diagnosis – one could not get cirrhosis that way, she said – and since I’m no medical expert, I assumed I’d been misinformed.

But while “nonalcoholic fatty liver” was so rare thirty years ago there was no medical name for it, the New York Times reports it now affects one in ten American children, with the rate among children and teens more than doubling in the last two decades.  Of those afflicted, 10 to 20 percent will eventually develop the liver scarring that can lead to cirrhosis, liver cancer and liver failure, requiring a transplant for survival.  The condition is also a risk factor for developing heart disease and Type 2 diabetes.

The cure for nonalcoholic fatty liver is quite straightforward: improving one’s diet by cutting out fast and processed foods and sugary beverages.  But despite incredibly powerful motivators  –  “crippling” abdominal pain (one patient referred to it as “being stabbed in your stomach with a knife”) and the possibility of needing a liver transplant (or, far worse, needing a transplant and and being unable obtain one, as demand outstrips the number of organs available) – many patients still find this “treatment” just too difficult:

Yubelkis Matias, 19, . . .  was told she has NASH several years ago. She is reminded of the trouble brewing in her liver by the sharp abdominal pains that come and go. . . . [S]he has been told by her doctors that diet and exercise may be her only shot at reversing the disease. But at 5-foot-5 and 200 pounds, she finds every day a struggle.

“I’m on a roller coaster,” she said. “I eat healthy, then not healthy — pizza, McDonalds, the usual. My doctor told me I have to quit all of that. But it’s cheap, and it’s always there.” . . . .

“A lot of times when I see a patient with fatty liver,” [Dr. Shahid M. Malik of the Center for Liver Diseases at the University of Pittsburgh Medical Center] said, “the first thing out of their mouth is, ‘Well, is there a pill for this?’ And there’s not. There just isn’t. You have to make lifestyle changes, and that’s a much more difficult pill for people to swallow.”

One could attribute the inability of these patients (or anyone suffering from weight-related disease) to improve their diets to a lack of individual willpower, but this conclusion ignores a whole host of societal factors that make eating healthfully on a regular basis extremely difficult for many.  As Dr. Thomas Friedan, director of the Centers for Disease Control and Prevention, once memorably said:

. . . if you go with the flow in America today, you will end up overweight or obese.  That is not a reflection of individual personal failing.  It’s a reflection of the structure of our society. . . . [T]he popularity of weight loss programs is a reflection of both the intense desire of many people to lose weight as well as the great difficulty of doing so.  [Emphasis mine]

Meanwhile, when you have a condition like fatty liver disease that’s growing ever more prevalent, and patients clamoring for “a pill” instead of weaning themselves off their unhealthful diets, it’s predictable that drug companies would see the potential for huge profits.  The Times reports that at least two companies are now scrambling to develop drugs which will help treat the disease, and one of those companies saw its stock price “soar” when its first clinical trial showed promise.

Too bitter a pill for our elected leaders to swallow?

Too bitter a pill for our elected leaders to swallow?

There’s nothing new about any of this, of course.  Food companies profit from our dependence on their products while drug companies reap the profits on the other side of the equation.  But somehow the prospect of kids doubled over with liver pain and facing potential liver failure, entirely due to Big Food’s grip on our palates and our lifestyles, got to me on a visceral level.

I’m reminded of this quote in the film Fed Up from Dr. David Ludwig, a professor at the Harvard Medical school and a pediatric obesity expert:

What does it say about our society if we would rather send children to such mutilating procedures but yet lack the political will to properly fund school nutrition and ban junk food advertising to children? It reflects a systematic political failure. We’re the richest society in the world. We’ve failed because we’ve placed private profit and special interests ahead of public health.

Dr. Ludwig was referring to a morbidly obese teen undergoing gastric bypass surgery, but he could just as well have been referring to an overweight child needing a liver transplant.  And, indeed, we are clearly in the midst of a “systematic political failure,” because just as we already know the “cure” for fatty liver disease, we also already know the the “societal cures” for all obesity-related illnesses:

  • Restructuring the agricultural subsidies that make fast food and processed food unnaturally cheap, while inadequately supporting farmers growing fruits and vegetables;
  • Banning the advertising of junk food to children;
  • Taxing and/or placing health warning labels on non-nutritive, sugar-sweetened beverages;
  • Investing more money in federal school meal reimbursement, so schools can afford to buy healthier food and pay for the increased labor needed to prepare it;
  • Investing in school infrastructure, both to build school kitchens in which scratch-cooked meals can be prepared, as well as home economics classrooms where children can acquire basic cooking literacy and skills; and
  • Requiring and funding meaningful nutrition education curricula, including home economics, throughout the K-12 school years.

And yet, like a fatty liver patient addicted to fast food, our elected leaders are currently too addicted to Big Food’s and Big Soda’s lobbying dollars, and/or too afraid of “nanny state” rhetoric from the right, to muster the political courage to fulfill that Rx.

For four years now, I’ve been saying on this blog that some day the costs of obesity, both financial and personal, will be just too high for our legislators to continue to ignore.  But when you read about one in ten kids facing the possibility of a liver transplant due solely to the unhealthful American diet, you really do have to wonder:  where on earth is the tipping point?

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{ 13 comments… read them below or add one }

Casey June 16, 2014 at 12:45 pm

It got to me on a visceral level too.

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Beth @Goodness Gracious Living June 16, 2014 at 1:59 pm

I am as fed up as you are! We need to have a plan to engage our legislators to make changes so that each and every item listed on your photo is instituted. I am doing what I can in my town, but it’s not enough. How can we ban together to make this wish list a reality?

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Hanna June 16, 2014 at 2:49 pm

I also learned recently about nonalcoholic fatty liver, from the work of Dr. Robert Lustig (a pediatric endocrinologist who is also quoted in Fed Up) — and it shook me to the core. And apparently 40% of normal-weight people have metabolic dysfunction…we are at the tipping point. (We have to be!)

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Aviva June 16, 2014 at 3:02 pm

Bettina thanks for keeping the dangers, costs and potential solutions front and center on your blog. I am hoping the movie Fed Up moves more people away from processed foods and back into their kitchens (at home and at school). Now I’m inspired to make a fruit and veggie smoothie for the kids and me–BRB.

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Dana June 16, 2014 at 3:05 pm

In rats they have found that feeding the rat excessive fructose in the absence of sufficient choline was enough to induce non-alcoholic fatty liver disease. It would follow that cutting as much fructose out of your diet as humanly possible while increasing choline intake would reverse the condition; you don’t necessarily have to completely retool your diet.

Doctors, of course, are not up on the research. Neither are most nutrition writers.

It isn’t enough to ditch the junk food. Everything we think we know about nutrition in the mainstream of society is WRONG. “Eat more veggies” WILL NOT cure this because most veggies are not good choline sources. We are going to have to have a serious conversation about the scam that is vegetarian advocacy because the more of us try to eat that way, the more of us will be short on choline and high on fructose and frankly, there are not enough liver donors to go around.

We used to have a fairly good handle on what constituted a nutritious human diet. We need to get back to that again.

By the way, we can’t really know how prevalent NAFLD was thirty years ago because doctors and experts simply did not believe it was possible. If you had fatty liver back then, they automatically assumed you were an alcoholic and would not listen to you if you protested otherwise. There were sugar junkies thirty years ago; there were people who tried going without choline inadvertently through their experiments with “healthy diet.” They were probably overwhelmingly written off as “drunks.”

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Bettina Elias Siegel June 17, 2014 at 2:49 pm

Dana: I’m not an expert on the science and perhaps you are. But certainly the world is full of vegetarians (or people who eat relatively little meat) who do not have nonalcoholic fatty liver disease, most likely because they are also not heavy consumers of sugary beverages, highly processed foods, etc.?

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Alissa June 16, 2014 at 6:16 pm

First we had to rename Adult-Onset Diabetes to “Type 2″ because it was showing up too frequently in kids. Now we’re creating new names for liver disease caused by diet. I don’t understand how so many people don’t see how broken our food system is, but then again I once asked my father-in-law whether his doctor ever talks to him about dietary changes that can help him manage his diabetes and he looked at me like I was crazy – not a single word from his doctor about food, only meds and insulin. It’s insanity, and really sad to think how bad it will have to get before there’s widespread acceptance of the need to change.

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Bettina Elias Siegel June 17, 2014 at 2:46 pm

Alissa: When one alarm bell after another is rung and then ignored, such as the military finding it hard to locate fit recruits, or this report about liver disease, I find myself having to take a longer and longer view of the problem….

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Uly June 20, 2014 at 7:35 am

No, we call it Type 2 diabetes because the other sort a. shows up in adults as well (I know of somebody who developed it in his late 20s) and b. doesn’t go away as you get older, no matter when it developed.

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Robin June 17, 2014 at 10:00 am

Bettina, thank you so much for bringing this shocking problem to light! I did not have any idea this was happening, that these consequences with respect to liver disease can be so extreme.

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Bettina Elias Siegel June 17, 2014 at 2:45 pm

Robin: I, too, was astonished when I read the NY Times report and learned how widespread this condition already is. I wasn’t sure how many TLT readers would independently read the same article, so I was glad (or, more accurately, sorry) to share it here.

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Maggie June 17, 2014 at 1:46 pm

So…the possibility of pain and death isn’t sufficient…what do we do? Wall off the central aisles of food stores? Close every restaurant? If someone can prove they are healthy, could they still purchase the foods that are under suspicion?

I realize my comment is written in a snarky tone, but the question is sincere. Is it possible to roll back the habits that have formed, the expectation of quick, easy, incredibly tasty food at a moments notice? If so, how?

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Bettina Elias Siegel June 17, 2014 at 2:43 pm

Maggie – no snark taken. I actually have some thoughts. More to come.

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