Have a Coke and a Liver Transplant

Did you know that Nonalcoholic Fatty Liver Disease (NAFLD, which ultimately results in Nonalcoholic Steatohepatitis, or NASH) is the most rapidly increasing indication for liver transplants in young adults in the United States?

A comprehensive review of liver transplants performed between 2002 and 2012 revealed this astonishing fact. While NASH accounts for only 4.46% of 2012 liver transplants in people aged 18-40, that number is up from a minuscule 0.53% in 2002.

What could possibly explain an almost 10x increase in fatty liver disease progressing to NASH requiring transplantation among young adults? And why is NAFLD showing up in children as young as 7 or 8 years old?

According to the Washington Post, liver specialists still don't know:

Liver specialists still don’t know why fatty liver disease and NASH develop so rapidly, Wong added. Factors could include differences in metabolism, demographics and lifestyle, which researchers are still trying to pinpoint so they can better diagnose patients.

While liver specialists may not know, endocrinologist Robert Lustig wrote an excellent review article in 2013 detailing the mechanisms by which high sugar concentrations are gradually killing us, and our livers, through inflammation and accelerated aging leading to NAFLD and NASH:

Sugar (i.e., fructose-containing mixtures) has been vilified by nutritionists for ages as a source of "empty calories," no different from any other empty calorie. However, fructose is unlike glucose. In the hypercaloric glycogen-replete state, intermediary metabolites from fructose metabolism overwhelm hepatic mitochondrial capacity, which promotes de novo lipogenesis and leads to hepatic insulin resistance, which drives chronic metabolic disease. Fructose also promotes reactive oxygen species formation, which leads to cellular dysfunction and aging, and promotes changes in the brain's reward system, which drives excessive consumption. Thus, fructose can exert detrimental health effects beyond its calories and in ways that mimic those of ethanol, its metabolic cousin.

Concentrated, refined sugars such as table sugar and high fructose corn syrup are the worst offenders. Human studies (2008, 2009, and 2010) show associations between sugar consumption and the progression of fatty liver disease. Basic research presented in Dr. Lustig's article demonstrates that our livers are not prepared to process the amount of concentrated sweeteners that dominate our diet today.

What can you do to avoid a liver transplant? Skip soda, drink water. As much as possible, avoid all added sugar. Enjoy whole and minimally processed nutrient dense foods. The good news is that the liver is a remarkably resilient organ, and NAFLD is reversible in its early stages.

Finally, how is it possible that the impact of concentrated sugars on our health is not more widely known, or acknowledged in the popular press? The diffusion of medical knowledge is incredibly uneven -- consider that Dr. Robert Wong quoted above as not knowing why these diseases are progressing is also at UCSF along with Dr. Robert Lustig.

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