About 4.5 million American adults have been diagnosed with some form of liver disease, and some portion of those patients will go on to need a liver transplant. What interventions are available to avoid that procedure? And if someone does get a transplant, how can their diet support their new liver so it stays as healthy as possible?
On this episode of On Nutrition, transplant clinical dietitian Heather Bamlet explains how she helps transplant patients of all kinds, and how to avoid – and in some cases, reverse – certain liver diseases.
Listen to Liver health: You don’t need a detox
Read the transcript:
Tara Schmidt: This is “On Nutrition,” a podcast from Mayo Clinic where we dig into the latest nutrition trends and research to help you understand what’s health and what’s hype. I’m Tara Schmidt, a registered dietician with Mayo Clinic in Rochester, Minnesota. And in this episode, Liver Health.
But first, we have a listener question from Pamela about our episode on protein called “Debunking the Protein Propaganda.”
Pamela: Hi… I’d love to be more plant-based focused on getting my protein, but I’m kind of hung up on getting complete protein since I’m into my seventies and want to make sure I’m doing all the right things.
Oh, one more thing too about the carbohydrate usage like the beans and rice. I’m concerned about how many carbs are mixed in with that in order to get the protein and sort of how do I balance that throughout the day.
Thanks very much. Bye now.
Tara Schmidt: Hi, Pamela. A lot of older adults aren’t meeting their protein needs, so you’re on the right track when it comes to being mindful of your intake. To answer your question, let’s start with understanding protein at a molecular level. Protein is made up of amino acids, and while your body produces some of the non-essential ones, we need to get some of the essential ones through our food in order to function properly.
Foods like eggs, dairy, poultry, beef, fish, but also some plants like soy and quinoa are complete proteins, meaning they contain all nine essential amino acids, incomplete proteins, often plants like nuts, seeds, and beans, don’t deliver these inadequate amounts, but that doesn’t mean they’re not nutritious.
It just means we have to do some combining in order to get the whole package. Examples of these complementary combos include peanut butter on wheat bread, or your example of beans and rice. Remember that these don’t necessarily need to be eaten at the same meal or every meal.
The goal is to balance them throughout the day in terms of portion meal balance and controlling for carbohydrates. Just think of the plate method. Aim for half of your meal to be fruits or non-starchy vegetables, one quarter of your plate as a plant or animal-based protein, and the last quarter as a whole grain.
This ensures you get protein at each meal, but also a variety of other nutrients. Thanks for your question. If you have another follow-up question, leave us a voicemail at (507) 538-6272, and we’ll answer it in a future episode. Now onto the show.
About 4.5 million American adults have been diagnosed with some form of liver disease, and some portion of those patients will go on to need a liver transplant. What interventions are available so we can avoid that procedure? And if we do get a transplant, how can our diet support our new liver so it stays as healthy as possible?
Thankfully, we have one of the best in the biz here to help us understand. Heather Hamlett is a transplant clinical dietitian at Mayo Clinic in Rochester, Minnesota.
She helps transplant patients of all kinds, prepare for and recover from their procedure and knows all about how to avoid, and in some cases, reverse certain liver diseases. Hey, Heather. Welcome to “On Nutrition.”
Heather Bamlet: Thanks for having me. I’m kind of nervous and kind of excited all at the same time.
Tara Schmidt: Oh my gosh, you are an expert. This is such an important topic, especially when we’re going to use one of my least favorite words, which is. Detox, and I’m sure you might even hate it more than I do. Is that true? Do you hate it?
Heather Bamlet: Just a little bit probably. I really do, yes.
Tara Schmidt: We’re both like cringing right now because the internet just loves to talk about quote unquote detoxing the body. I like to tell them about what organs they have that do that for them, but let’s play a little. Let’s play health or hype. Can you tell me if any of these are health or hype when it comes to ridding the body of our toxins? Are you ready?
Heather Bamlet: Yep, absolutely.
Tara Schmidt: Okay. Aloe vera juice. I’ve had this before. It’s pretty good.
Heather Bamlet: I would say from the idea of actually detoxing the body, probably hype. The best study I found to kind of back up my claim to hype here is in 35 healthy individuals, seven did not complete the study because of the GI side effects that aloe vera can have.
At the end of the study, which was 12 weeks, there were no improvements in what they were looking for.
Tara Schmidt: It’s also really sugary.
Heather Bamlet: That’s really true and as we talk about liver disease and metabolic associated things, sugar’s kind of the thing we want to talk about a lot.
Tara Schmidt: All right, Kiwi.
Heather Bamlet: Kiwi.
Tara Schmidt: With a Kiwi.
Heather Bamlet: Absolutely. Kiwis have tons of good antioxidants, lots of fiber, all of those good kinds of things. Where this one comes from is in rat models. Kiwi is actually shown to help reduce cholesterol, but we haven’t seen that translated to humans. And nobody’s going to follow a kiwi only diet.
This is one you want to incorporate? Great high fiber, lots of antioxidants, good stuff. But to say that it’s going to make your liver detox better, don’t think so.
Tara Schmidt: Flax seeds?
Heather Bamlet: Flax Seeds are kind of really interesting to me in terms of detox and maybe not so much, but a couple of studies really show people have up to 30 grams of flax in a day, which is like a couple of tablespoons worth. We actually can see a reduced amount of fat in the liver, which of course in the end is going to help the liver do good things.
Maybe a little bit of truth to this one, but is it going to make the liver actually detox better? Nah.
Tara Schmidt: Magnesium. We both know our wonderful genius and lovely colleague Joy Heim Gardner, who we had a whole episode with on magnesium. What from your specialty are we talking about with magnesium?
Heather Bamlet: If we just think about the liver magnesium’s involved in a lot of the different kinds of pathways through the liver for reducing toxins and things like that. However, if someone’s healthy and has normal magnesium levels, taking extras is not going to make that better, right? We’re just going to have higher magnesium urine in the end.
Tara Schmidt: And is that true of all supplements that we’re talking about? That the more supplements we’re taking, the more work the liver has to do?
Heather Bamlet: In a sense, right, because we need to get rid of it, either the kidneys or the liver, the two things that help detox our body have to do that extra work. Absolutely.
Tara Schmidt: And then lastly, supplements in general. Is there any supplement that actually helps the body rid itself of toxins?
Heather Bamlet: I wish I could say yes, it’d make my job a whole lot easier. There is some big meta analysis where they went and they looked at liver detoxing supplements on the market and by and large there was no real health literature to back up the claims. Save your money.
Tara Schmidt: There we go. Just expensive pee.
Heather Bamlet: Yeah.
Tara Schmidt: Is this true, that the liver has over 500 functions?
Heather Bamlet: Yeah.
Tara Schmidt: What are some of the main responsibilities, top ones, however many you want to give us?
Heather Bamlet: It was like a dietitian. I’ll focus, probably, on mostly the nutrition-related ones, our liver helps us to make bile, which helps us to break down and absorb fat. That’s an important piece. Our liver makes cholesterol, which is usually a good thing. We need good cholesterol levels in our body, but if somebody’s got a genetic condition where it overproduces, well, maybe we need to watch that there.
Making certain types of proteins, of course, clears the blood of toxins, stores different nutrients, and it involves helping to regulate our blood sugars, especially during times of fasting. That’s a key component, and all of these things are involved in every second we’re awake, every second we’re alive.
Tara Schmidt: Tell us more about your job, and the types of patients that you work with, and how you help patients with their liver health.
Heather Bamlet: I am a solid organ outpatient transplant dietician, which means when I first meet most of my patients, they have liver disease that is going to require transplantation for them to get better.
And essentially, I’m talking to patients about how we eat around what your liver’s not doing for you. Which I think is kind of an interesting take on it. Like I said, the liver does help to regulate blood sugar through releasing glucose into the blood when we’re fasting, and if that’s not happening the body starts to break down muscle and fat like crazy.
And of course, if we’re thinking about putting somebody into the operating room, I want them to be as strong as possible. We talk a lot about how we eat around that — how we feed you so that doesn’t happen.
Your body never has to knock on the liver asking for that glucose, essentially. We work with people, Pre-transplant who are very, very sick. And it’s a different kind of conversation than we have post-transplant, when the liver is now new and healthy, and how we keep it healthy. And in that kind of setting, we’re talking a lot about blood sugar management.
We’re talking a lot about restoring and rebuilding muscle mass. We’re talking a lot about just keeping blood sugars under good control, helping to keep cholesterol levels, triglycerides, all sorts of things. That we don’t put fat in the liver. We don’t cause long-term issues with the new liver.
Tara Schmidt: We’re going to get into how you advise those patients later. Sorry, I can’t see, and we’re going to get into how you advise those patients later, but for someone with, let’s say, a healthy liver, how can what we eat be negatively impacted? Are there preventive strategies to keep it healthy?
Heather Bamlet: First and foremost, when we talk about keeping the liver healthy, for those of us who have a healthy liver, moderating any kind of alcohol consumption, because alcohol does cause damage to livers, a high kind of sugar diet like added sugar, honey, all of the sweet maple syrup, should really be kept as a simple intake or along with carbohydrates. The way that I’ve heard it best described is when we consume, especially sugar-sweetened beverages, we can get this spike in blood sugar levels, and if everything’s working, the body wants to package that up right away.
One way it does that is high blood sugars and high triglycerides. Triglycerides like to deposit themselves as fat inside our livers, and we’re trying to avoid fat getting into our livers as much as possible.
That’s a really important component. The other component is, we all have a little fat in our livers. That’s normal. What we don’t want to have happen, is that that fat becomes inflamed. We don’t want inflammation in the liver. A diet that includes lots of anti-inflammatory foods, lots of fruits, vegetables, all of those bright, beautiful colors.
Each of them has their own function to help with something, and we want to incorporate a wide variety of those so we can help to prevent that inflammation.
Tara Schmidt: We talked about alcohol and sugar. What other factors put stress on the liver?
Heather Bamlet: Carrying any excess weight puts more stress on the liver. One from having that fat may be deposited in it, but two, if you think about it, the liver has to clear toxins from the whole body. The bigger the body, the more toxins the liver has to remove.
Smoking can be a stressor, as it is for many things in our body. Excessive intake of over-the-counter medications, like too much Tylenol, things like that, can be stressors for the liver. Lack of sleep puts stress on our bodies and can stress out other things.
Tara Schmidt: Just your basic good old health advice.
Heather Bamlet: Basic, good old health advice. Absolutely.
Tara Schmidt: Now. I feel like it’s a little bit trendy to be learning more about ourselves and our health, which is great. I support that, but sometimes I catch it in the realm of people getting unnecessary testing or testing that isn’t validated, etcetera. Now, there’s a legit test for liver function, right, or liver enzymes. Who needs to be getting their liver enzymes tested?
Heather Bamlet: That’s a really fair question. And as a dietician, I’m going to always defer that back to primary care physicians, hepatologists, whoever our patients are seeing. But in the general big picture, anybody who carries any excess body weight, anybody with diabetes, hypertension, high cholesterol, big scheme, anybody who drinks alcohol, which probably is a lot of us, right?
Certain people who take certain medications should also have their liver screened, chemotherapy agents, things like that. We should be screening for liver enzymes to make sure that the liver’s not taken too bad a hit with those.
Tara Schmidt: We often associate liver dysfunction with jaundice, right? That’s very visual for us, that the skin and the eyes can get a yellow hue. But there are obviously some conditions that are not as evident from the outside. Are there any indicators and, what may they be, that someone should be seeing a doctor about the health of their liver? Does that exist?
Heather Bamlet: Yes and no. A couple of things like rapid weight changes potentially, or somebody who’s been going along and all of a sudden they’ve got a massive edema where their legs really get super swollen or they feel like their abdomen gets kind of really full with fluid.
They’re not pregnant, but they look like they’re nine months. Those could be signs that liver’s really not working very well. Other things, like itchy skin, can be a sign that bilirubin’s building up in the blood. One that’s uncomfortable to talk about, but if you’re noticing a change in the color of your stool.
If it’s normally kind of brown, but now it’s very light tan, almost gray or white, there’s a sign that bile is not moving through. If it’s floating a lot, sometimes that can be a sign of there being too much fat coming through? The bile is not helping us to absorb it.
There are some of those kinds of things that are important. Sometimes you’ll see fatigue. Well, we’re all fatigued.
Tara Schmidt: It’s like raising my hand.
Heather Bamlet: Right. Like, “Here’s me.” But that would be maybe a sign that you should see your doctor, if that’s not explainable. And then, what is it? Is it thyroid? Is it liver?
Tara Schmidt: Is it your job?
Heather Bamlet: Could be all of the above.
Tara Schmidt: Well, there might be plenty of voices online telling you to try magnesium, flaxseeds, or kiwi to detox your body. One of the best tools is already inside you, your liver. Your liver has over 500 functions, like filtering blood, making bile, regulating blood sugar, and supporting it isn’t about special cleanses.
It’s about basic health habits. Staying hydrated, limiting alcohol and added sugars, not smoking, prioritizing sleep, and not overusing medications like acetaminophen.
If you’re experiencing swelling in your legs or abdomen, itchy skin, pale or floating stools, unexplained fatigue or jaundice, you may need to get your liver enzymes tested, but you may also need to get tested if you have diabetes, high cholesterol, obesity, drink alcohol, or take certain medications too.
Now that we know the signs that something is amiss. Let’s talk about the most common forms of liver disease related to our diet.
Heather, we used to use the phrase fatty liver disease, but now that covers a spectrum of conditions under the umbrella of metabolic dysfunction associated. Why did we stop using the phrase fatty?
Heather Bamlet: With the fatty liver, it implied it only happened in people who carried that excess weight. That still gets thrown around some. But the heart of why is that it’s not just fat, it’s also blood sugar control. It’s also some of those other metabolic factors. And calling it metabolic dysfunction associated gives a better look at what’s really going on.
It’s not just simple fats. The other thing that is really important to note is that metabolic association doesn’t necessarily have to be in someone who’s overweight or obese, although we can see some of those components for even very thin people too.
Liver disease is now this spectrum of conditions. Starting with MASLD, which, thank goodness, is an acronym. It stands for Metabolic Dysfunction of Associated Liver Disease. Did I get that right?
Tara Schmidt: You got it absolutely right. MASLD, or the metabolic dysfunction associated with liver disease, is that complex thing that happens where blood sugars can be elevated. We can see high cholesterol levels and high triglycerides. There’s fat in the liver, excess fat, more fat than we want in the liver, just like extra fat on my underarm or other places on my body — we can reverse that, which is a super cool thing.
We can change our diet and exercise habits. Maybe think about one of your favorite topics. GLP-1s, things like that, to help reduce maybe that extra body weight, help to bring cholesterol, blood sugars, all those things back into better control. We can see that fat go away and melt out of the liver like it does in other places.
Okay. And then MASLD can develop into MASH, or metabolic dysfunction associated with steatohepatitis. What’s happening here?
Heather Bamlet: This is where the liver now becomes inflamed. Before, it’s just hanging out there. It’s got some extra fat. Now it becomes inflamed. And why? It could be a medication, could be an infection, could be just inflammation in the body overall. And that inflammation can lead to fibrosis in the liver.
The liver starts to get a little bit stiffer. Doesn’t work quite as well. And then, if that doesn’t get under better control, it can become scarred or cirrhotic, which is when they come to see me in the transplant world. In my simple way of dietitian-thinking, MASLD can lead to MASH, can lead to cirrhosis. That continuum.
Tara Schmidt: I’m hearing that MASLDs are reversible. What about MASH?
Heather Bamlet: To a certain extent. If we get too far towards the scar tissue, too much scarring, the liver’s not as able to fix itself. But the liver is one of the organs in the body that can regenerate itself.
Tara Schmidt: So crazy.
Heather Bamlet: The craziest, coolest thing where even in my transplant world, we can have a living donor liver transplant where the donor gives up a hefty portion of their liver, and within a very short period of time, both people have a fully functioning liver.
Tara Schmidt: I would give you half of my liver, Heather, I would. I’d give you half a mine. But it’s such a cool thing, but we could use it to our advantage. There’s damage to the cells, and they can repair themselves. We need to get some of that fat out of the liver. Weight reduction is a huge thing. With MASLD in the big picture.
Heather Bamlet: Some of the research says a 7 to 10% reduction in body weight. We really see that fat comes out of the liver. Outside of weight changes, some of the stuff that gets me really excited with the MASLD group is, regardless of weight change, some studies have shown that just increasing physical activity to that point of the average of 30 minutes a day. Just that increase in physical activity helps to reduce the amount of fat in the liver.
There are so many things that can help at that massed stage and even at the MASH stage. If we’re not too far towards the end of that spectrum, there can be some reversal and some healing there.
Tara Schmidt: Pretty general weight management guidance. Intentional activity. I always say, I want you to challenge your muscles either with strength training or with cardio, which then you’re challenging your heart, like something needs to be working fairly hard. When you have someone who’s super motivated to potentially have this reversal, do we also have them completely avoid alcohol? Would that be the best scenario?
Heather Bamlet: Yes, absolutely. Alcohol makes MASLD worse, period, the end. If we’ve already got this thing going on because alcohol damages liver cells as it’s being detoxed, if we want to use the word we started with, in the setting of something that’s already kind of making the liver not as happy as it could be, yes, we should avoid alcohol. If somebody is super motivated, we talk about what I call a modified Mediterranean diet.
Tara Schmidt: Same.
Heather Bamlet: Modified in that a true Mediterranean diet promotes the use of red wine — don’t want that, but what we’re really looking for in the red wine are a certain group of antioxidants, and we can find those in red grapes, blueberries, purple cabbage, and even super, super dark chocolate.
As you know, Tara, we have tons of educational materials around the Mayo Clinic for every topic you could ever imagine, and we don’t have a lot of nutrition education that says, just don’t do this.
Tara Schmidt: It’s not black or white. Unless you’re allergic to peanuts or unless you have MASLD, don’t drink the alcohol.
Heather Bamlet: And the research behind, especially sugar-sweetened beverages in MASLD, is strong enough that we went ahead and said, “Hey, this is how you help your liver out. Book our nutrition guidelines for people who have MASLD or want to prevent it.” We say, “Don’t drink sugar-sweetened beverages.”
Tara Schmidt: Let’s talk more about cirrhosis. A common misconception is that it’s usually or often related to alcohol use, but that’s not always true. The former acronyms that we used to use, said, “non-alcoholic, fatty liver,” et cetera. Tell us more about that.
Heather Bamlet: Cirrhosis is where the liver becomes very scarred, very hard. Those cells there are not doing all the filtering and all their 500 tasks that they’re supposed to do. It doesn’t have to be related to alcohol, though it can be. The damage that alcohol causes can also be that MASH becomes cirrhosis.
We can see it like hepatitis B, hep C, where that leads to cirrhosis. If we think about it that way, there are many causes, but definitely, if we’re looking at a MASLD, MASH picture, that can be diet and lifestyle-related.
Tara Schmidt: Are there any other common liver conditions that are lifestyle-related that we haven’t talked about?
Heather Bamlet: We’ve got alcohol, the kind of MASLD-MASH look at things. Lifestyle-wise, if we think about that MASLD-MASH picture, someone has really poorly controlled diabetes. They choose just not to take care of it. Can that lead to MASLD or MASH down the road? Yeah, absolutely.
Somebody who takes a ton of supplements without knowing what’s in those can also cause liver damage. And then that damaged liver can become scarred and can become cirrhotic. We’ve needed to transplant people because of different huge supplements on the market. They’ve just been sold to them, and their body doesn’t… It’s scary. Then the other probably big one that hopefully we don’t see quite as much, but would be: IV drug use, tattoos with unsafe needles, things like that, for some of those blood things, like hepatitis.
Heather Bamlet: Yeah.
Tara Schmidt: We know that the liver is the only organ that can regenerate itself. Is that only in a healthy liver?
Heather Bamlet: When we think about people with MASLD or MASH being able to have some repair, not necessarily, but a fairly healthy liver. There does come a point of no return with the liver, where it becomes so scarred, so cirrhotic, that liver transplant is the thing that’s going to help.
Tara Schmidt: What are the most common causes of liver transplant?
Heather Bamlet: MASH-related cirrhosis is the second leading cause of need for liver transplant in the United States, behind alcohol, for people who don’t have a certain kind of liver cancer called hepatocellular carcinoma.
It’s the second leading cause for need for liver transplant, which is huge. For people who don’t have that hepatocellular carcinoma, in 2013, 19% of transplants were related to MASH-related cirrhosis.
In 2022, 27% of those liver transplants were because of MASH-related cirrhosis. That’s a huge increase.
Tara Schmidt: Heather, after a patient has been diagnosed, you’ve referenced this — we’re not doing alcohol, we are not doing sugary beverages — after they’ve had a transplant, like “Here I go, Heather, here’s part of my liver that’s hopefully healthy and stays that way,” do we still need to avoid alcohol?
Heather Bamlet: Yes.
Tara Schmidt: Don’t take the risk of the nice present that I just gave you.
Heather Bamlet: Correct. Absolutely.
Tara Schmidt: There are two main liver conditions related to diet MASLD and MASH, which used to be known as fatty liver disease. MASLD, or metabolic dysfunction associated with liver disease, is related to blood sugar control, high triglycerides, cholesterol issues, and excess fat stored in the liver, even in people who appear thin.
The good news is that at this stage, it’s often reversible with minor weight loss, 30 minutes of daily intentional movement, improved nutrition, and avoiding alcohol and sugary drinks.
If MASLD progresses, it can become a MASH, or metabolic dysfunction associated with steatohepatitis. This is where the liver becomes inflamed. Then inflammation can lead to a stiffened condition known as fibrosis, and eventually cirrhosis, which is severe scarring.
Contrary to popular belief, cirrhosis isn’t always caused by alcohol. It can be a result of hepatitis B or C, poorly controlled diabetes, or certain supplements. Some cirrhosis damage can be reversed if caught early because the liver is the only organ that can regenerate itself.
But once scarring becomes advanced, there is a point of no return where a transplant may be necessary. MASH-related cirrhosis is now the second leading cause of liver transplant in the US. In cases arising even after a transplant, patients are advised to completely avoid alcohol to protect their new liver.
Now let’s talk about what happens after a liver transplant, why do so many kids now need one, and how else can we keep our livers healthy?
Why do so many transplant patients gain weight after their surgery?
Heather Bamlet: One. We know that your anti-rejection, post-transplant can kind of predispose some of those things, like elevated blood sugars, those kinds of things. The average person post-transplant, post liver transplant, some of the averages that get thrown out, most people gain 20 to 30 pounds within the first year.
Tara Schmidt: Which is not always bad, right? Because they may have been malnourished in the first place.
Heather Bamlet: Yes. And that is something that I’m always careful to point out, is that with cirrhosis, malnutrition is a very, very, very common thing. It’s the thing that I deal with and fight with, with our patients pre-transplant, every single day I come to work. How do we help you become less malnourished? How do we prevent malnutrition in the setting of cirrhosis?
Some weight-gain for some people is a really good thing. But most people will see that, above and beyond, what their goal weight was. Why? It’s a complex mass of a whole bunch of different things. But the heart of a lot of it is pre-transplant, most people lose a ton of muscle mass.
They just do. And post-transplant, we can be eating what would be considered perfectly normal amounts for ourselves. Yet with that decrease in muscle mass, we don’t burn nearly as many calories, and weight gain becomes really, really easy. I always, always, always stress how important it is that we rebuild that muscle mass for those patients.
Tara Schmidt: This is another stat that kind of stresses me out when you were talking about the need for transplant and the most common causes of transplant. We’ve got a big one going on, especially in America, with kiddos. We know about 5 to 10% of kids in the US have some sort of liver disease, and that’s about the same rate as asthma.
What is leading to that statistic, because I do not think that was true 10 or 20 years ago?
Heather Bamlet: I will preface this by saying I am not a pediatric dietician. However, what we’re seeing in terms of trends in adults, we’re also seeing in kids. There’s more access to high sugar foods, more obesity, and higher rates of type 2 diabetes. More of that insulin resistance, all of those things. Less activity. I think about how much time kids spend watching TV on a computer, on their phones. When I was a kid, my mom and dad would kick us outside. Don’t come home until the light comes on at the end of the driveway. I don’t see that now.
That combination of moving less in a lot of cases and eating more or more calorie-dense, more sugar-dense kinds of things, what we’re seeing in the pediatric population is echoing what we’re seeing in the adult population.
Tara Schmidt: Absolutely. This is never meant to be about shaming parents — you need a little screen time to do the dishes. However, what can you do?
What foods can you bring in the home? What foods can you limit in the home? What foods can you save for special occasions?
Heather Bamlet: What can we do inside? Up and down the stairs or dance parties or whatever, just to get moving going more.
Tara Schmidt: We mentioned doing a modified Mediterranean diet, earlier, for patients with MASLD. Does that advice continue for liver transplant patients?
Heather Bamlet: Yep. For any kind of transplant, not just liver transplants. Because the interesting thing about my role in post-transplant time is the anti-rejection medications people take after transplant are really very similar, if not the same, regardless of whether it’s a liver transplant, heart transplant, lung transplant, or kidney transplant. And they can all cause elevated glucose levels and changes in cholesterol levels.
We are trying to get everyone on a good heart, healthy liver, and healthy eating plan. I often tell them, times tell people if you’ve had a kidney transplant, you don’t want to show up back at our door needing a liver transplant in the future. These are things that help us keep your liver healthy too, when we know we might predispose you a little bit.
The other piece that I didn’t say with the Mediterranean diet — where we modify it — is true Mediterranean diet doesn’t put much limit on olive oil and some of those added fats.
Tara Schmidt: It’s pretty high in fat.
Heather Bamlet: Fats are calories in the end. Even though it’s good calories, it’s still extra calories. If we’re trying to prevent that unwanted weight gain, we also need to think about, if not calorie restriction, calorie moderation in the body so that we don’t overshoot the mark there.
Tara Schmidt: We still do the unsaturated fats. We still do the healthy version most often of the fats of the replacement. But we just need to be mindful that for every gram of fat, there;s nine calories, and that’s the most calorie-dense nutrient out there.
Heather Bamlet: Yep.
Tara Schmidt: Coffee.
Heather Bamlet: Yeah.
Tara Schmidt: I’ve heard some, I believe to be legit, research. Is this good for our liver, and what kind of coffee?
Heather Bamlet: In the beginning, we were talking about hype or health. I’m going to say coffee gets the “health.” I like plain black coffee, plain black coffee with a little milk or almond milk, or something like that, not terribly problematic at all to add something like that, that would be part of our healthy diets, anyway.
But the research really shows that there is less risk of that fat developing into fibrotic tissue and cirrhosis with good coffee intake. In fact, if I pulled it up in front of me, I’d have a 13-page paper all about the benefits of coffee for people with liver disease.
A whole bunch of antioxidants in coffee. Is it a synergistic effect where they all help or is it a specific one? I’m not sure. In my reading I have high coffee consumption, three cups a day.
It’s been shown to help reduce that progression towards more severe forms of liver disease, if you will. We actually have a hepatologist here in transplant who tells patients to drink three strong cups of coffee a day. The evidence is pretty strong.
Tara Schmidt: Can it be decaf, though? Because you told me that sleep has to be good, too.
Heather Bamlet: Yeah.
Tara Schmidt: Does decaf count?
Heather Bamlet: Decaf counts too. I oftentimes will counsel people that if you haven’t been a caffeine drinker, going from zero to three.
Tara Schmidt: Yes. What about intermittent fasting? Are there benefits to the liver if we give it a break, let’s say?
Heather Bamlet: The research was mixed, in terms of that. There was a big meta-analysis of different types of meta-analyses for those who don’t always read these studies and things. Let’s look at all the studies and condense it down and say, what do all of these studies say?
The researchers who did the big analysis were really careful to say it wasn’t just the length of eating or eating windows or, “Did I eat every other day?” Or whatever intermittent fasting looks like. But also the composition of the diet made a big difference. For many people who don’t have cirrhosis, I want to make that perfectly clear. When we get to the point that the liver is not doing that blood sugar regulation during times of fasting, we don’t want intermittent fasting.
In fact, I want people to eat all day long when that’s starting to happen. But for people who have, say, MASLD, they’ve got some fat in their liver, they’re working on that 7 to 10% weight reduction. And they come and they’re saying, “Hey, I want to try this intermittent fasting.” Okay, how does this work for you? How does it not? We also want to think about things like, what are you going to eat during your windows.
If somebody says they’re going to eat something in the evening time, like a high-calorie, high-fat, high-salt, high-whatever kind of snack, and they say, “I’m going to only eat within a 10-hour window.”
I’m not going to eat after seven o’clock at night, and I’m not going to eat until I get up tomorrow morning. Well, if you’re not eating some of those high-calorie, high-fat, high-sugar snacks, yeah, you’re going to lose weight. And if telling yourself that “I’m just not eating after that time” helps you do that, more power to you there.
Tara Schmidt: Heather, anything else listeners should know when it comes to liver health?
Heather Bamlet: Just a brief word on alcohol. Moderate consumption for people who don’t have liver disease as of today is still defined as two drinks a day for men and one drink a day for females. But what is a really important thing to talk about is what a drink is defined as, and what I would challenge people who do choose to have alcohol is to pour five ounces into a glass.
Get out your liquid measuring cup, pour it into your wine glass. Most of us, if we do consume some alcohol, are consuming more than we think we are.
That’s an important piece that always gets talked about — what’s a pour, what’s a drink? I encourage people, bust out that measuring tool, really know what you’ve got, so you’re not essentially lying to yourself.
Tara Schmidt: Heather, thank you so much for your time today. I just want to thank you for bringing all of your knowledge and experience to the podcast today.
Heather Bamlet: Thank you for having me. Hopefully, we reach someone who says, “I can do that. I can protect my liver,” because the best thing in the world for me would be people who have MASLD. They all reverse it, and they never need to come see me in Transplant World.
Tara Schmidt: The liver is one of our most resilient organs. It can regenerate itself, but there are still things we can do to keep it in tip-top shape. If your liver is relatively healthy, try measuring the amount of alcohol you’re drinking. It might be more than you think.
If your child is at risk for liver disease, encourage them to stay active and do what you can to reduce their intake of ultra-processed foods. If you have mazel or mashed that hasn’t crossed into cirrhosis, intermittent fasting might be a good option as long as the composition of your diet is fairly healthy.
Later stages of liver disease might benefit from three cups of black coffee a day and a Mediterranean diet without the red wine, along with a reduction in healthy fats like olive oil.
And if you’ve had a liver transplant, it’s normal to gain weight. What’s important is that you prioritize strength training to regain the muscle mass you’ve lost. No matter where you are in your liver health journey, it’s never too late to make a change.
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