In the Know – Fatty Liver

By Karen Morrissette


Non-alcoholic fatty liver disease (NAFLD), sometimes known as known as hepatic steatosis, is characterized by abnormal amounts of fat within the liver cells. It is quite common in developed countries and may affect nearly a quarter of the U.S. population. A proportion of those will progress to cirrhosis, or scarring of the liver, and liver failure similar to that seen in some heavy drinkers.

Often there are no symptoms and it may go undiagnosed unless blood tests or imaging are done for other reasons. Early symptoms may include fatigue, right upper quadrant abdominal pain, or nausea with eating. Later symptoms associated with advanced disease may include abdominal swelling, enlarged blood vessels just below the surface of the skin, enlarged spleen, and jaundice, a yellowing of the skin and whites of the eyes.

Hepatic steatosis is linked to obesity, insulin resistance and elevated blood sugars, hyperlipidemia (particularly triglycerides), and certain medications. Long term glucocorticoids, often just called steroids, are some of the most frequent medications associated with this condition. It is also more common in those with advanced age, body fat concentrated in the abdomen, polycystic ovarian disease, sleep apnea, and hypothyroidism. Complications associated with progressive disease include ascites (fluid accumulation in the abdomen, bleeding from enlarged veins in the esophagus, neurologic impairment, liver cancer, and end-stage liver failure. It is estimated that up to 12% of patients with NAFLD will have progression.

Blood tests are important for diagnosis and may include blood glucose, hemoglobin A1C, lipid panel, liver function tests (LFT), and screening for infectious causes of liver disease. Imaging, such as an abdominal ultrasound or CT/MRI of the abdomen, is usually required for diagnosis as well. Sometimes, a liver biopsy may be needed, especially if advanced disease is suspected.

Lifestyle changes including a healthy diet, regular exercise, and maintenance of a healthy weight are the cornerstone of treatment, especially in early disease, along with avoidance of other chemicals that can damage the liver further. These include alcohol and certain medications, such as Acetaminophen (Tylenol) or steroids. Even though there are no specific medications for NAFLD, medications to improve control of underlying disease processes can be beneficial. This includes hyperlipidemia, diabetes mellitus or insulin resistance, and hypothyroidism.

If you have been told you have a fatty liver, are obese, or have any of the associated medical conditions noted above, please consult with your primary care provider for proper diagnosis and to help determine the appropriate course of action for your particular situation. In some cases, you might need referral to a specialist who is specifically trained in liver disease. Address it today before it has a chance to progress.

PART II: ON READING  An essay dedicated to my former colleagues, Ms. Kay Randall, and Mrs.  Andrea Chiaverini.



“You don’t have to burn books to destroy a culture. Just get people to stop reading them.”

Margaret Atwood, Canadian poet, novelist, and literary critic

After a brief perusal of favorite historians preferred by this writer, I now turn to the dearth of reading that has afflicted a large percentage of Americans, due, for the most part, to the addictive propensities of advanced technologies, and an excessive amount of television time, robbing us of the connection between reading for pleasure and enlightenment. Research provided by the National Endowment for the Arts shows that only 43% of American adults read one work of literature, i.e. novels, short stories, and poems each year, a dramatic decline in the past 20 years. American 15-year-olds ranked 15th out of 31 industrialized nations in reading ability; furthermore, since good writing is a direct result of intensive reading, the percentage of high school graduates deemed by employers as “deficient” in writing was a dismal 72%. Ironically, our elementary kids soar in reading, especially those in the 9-11 age groups, a reflection of the emphasis on reading and the skills of our elementary teachers. Upon reaching high school, however, where kids are exposed to an extensive emphasis on electronics, often with no counterbalancing reading efforts, the decline in reading and writing abilities plummet dramatically. And while new grants for more technology pour in as Federal “freebies” to local schools, libraries are decimated, and replaced by computers, while superb, veteran librarians and excellent English teachers have become expendable.

So, does it matter? An emphatic YES, it matters!

According to studies provided by the National Endowment for the Arts, proof that reading actual books on paper is more beneficial than “skimming” social media posts (a whole other topic to be addressed in PART III of this series) or news updates on digital screens. Reading actual printed books: (1) boosts the quality of human empathy for others. (2) Exhibits increased brain power. (3) Raises human intellect. (4) Reduces the potential for Dementia. (5) Helps substantially with sleep habits (6) Reading to elementary kids “rubs off” and promotes potentially good reading habits (Not a day goes by up at Turning Winds where my kids don’t ask what I’m reading. Since our kids are limited in electronic access, we have a school of readers, and consequently, a large number of excellent writers).

Accordingly, studies are clear that literary people are more likely to exercise, visit art museums, keep up with current events, vote, and perform voluntary work, as well as an lengthening life span! The truth of the matter is that research clearly shows that readers are more active than those who spend their day watching television, on the internet, playing video games, etc. These are significantly more passive activities, not active ones. Thus, Dana Gioia, NEA chairman, asserts that “the majority of young Americans will not realize their individual, economic, or social potential, as they are lacking in critical thinking and communication skills.”

What then is to be done? If schools, of all places, won’t set aside technology for a period of time, families should: (l) Encourage reading. (2) Set an example. (3) Promote books that are fun to read. (4) Keep reading materials in one’s surroundings. (5) Explore different book genres.

(With regards to “different book genres,” in my 45 years-plus in education, I’ve never met a high school student who was “damaged” by reading a controversial book, but I’ve met plenty whose self-worth was severely damaged and scarred on social media sites. That doesn’t seem to be a matter of huge concern for the book-banning crowd!)

Let me conclude this missive by citing Neil Gaiman’s latest introduction of Fahrenheit 451, written by Ray Bradbury and first published in 1951: Gaiman writes:

“When I reread it as a teenager, Fahrenheit 451 had become a book about independence, about thinking for oneself. It was about treasuring books and the dissent inside the covers of books. It was about how we as humans begin by burning books and end up by burning people. (Heine, German-Jewish philosopher, 1821)  Ideas-written ideas-are special. They are the way we transmit our stories and thoughts from one generation to the next. If we lose them, we lose our shared history. We lose much of what makes us human. And fiction gives us empathy: It puts us inside the minds of other people, gives us the gift of seeing the world through their eyes. Fiction is a lie that tells us true things, over and over.”

Finally, my dear friend Andrea Chiaverini recently lent me “Suite Francaise,” an account of the Nazi occupation of France in 1940, narrating the story of men and women thrown together in circumstances beyond their control with human folly and economic divisions surfacing in every imaginable way. According to the biographical information presented, the author, Irene Nemirovsky, “was already a highly successful writer living in Paris But she was also a Jew, and in 1942 she was arrested and deported to Auschwitz, where she died. For sixty-four years, this novel remained hidden and unknown.” I am grateful to Andrea and many others for suggesting fictional works that correspond with my historical background throughout this French, Vichy-controlled, time period. Thank you, Andrea!

“Until I feared I would lose it, I never loved to read. One does not love breathing.”

– Harper Lee, American novelist and author of “To Kill a Mockingb