Fisher Titus

Category: Digestive Health

  • Fatty Liver Disease: What It Is and Why It’s Becoming More Common

    Fatty Liver Disease: What It Is and Why It’s Becoming More Common

    Fatty liver disease affects roughly one in three adults in the United States, making it the most common chronic liver condition in the Western world. Yet most people who have it are completely unaware. The condition develops silently, without pain or obvious warning signs, and a diagnosis often occurs by accident, when a routine blood test or scan flags something unexpected. When caught early, it can be reversed. Left unaddressed, it can progress into life-threatening liver damage. Understanding the disease, who’s at risk and what can be done about it can help you protect your health.

     

    What is Fatty Liver Disease?

    The liver filters blood, metabolizes nutrients, stores energy and neutralizes toxins. A small amount of fat in the liver is normal, but when accumulation exceeds roughly five percent of the liver’s weight, it begins to impair function. In most cases, excess fat in the liver isn’t caused by alcohol consumption but the way the body processes food and manages energy, particularly in people with metabolic syndrome.

    “Fatty liver disease is how metabolic syndrome shows up in the liver. When the body can no longer manage blood sugar and fat the way it should, the liver takes the hit,” said Dr. Muhammad Talal Sarmini, MD, gastroenterologist and hepatologist at Fisher-Titus.

    Types of Fatty Liver Disease

    There are two primary types:

    • Non-Alcoholic Fatty Liver Disease (NAFLD / MASLD): This is the most common form, occurring independently of alcohol use. It’s closely associated with obesity, Type 2 diabetes, high cholesterol and other components of metabolic syndrome. The updated medical term is MASLD, which stands for metabolic dysfunction-associated steatotic liver disease.
    • Alcoholic Fatty Liver Disease (ALD): This condition is caused by excessive alcohol consumption, which disrupts the liver’s ability to break down fats. Liver damage can accelerate significantly when metabolic risk factors and heavy alcohol use are present.

    Both types can progress through four stages:

    • Simple steatosis: Fat is present in the liver cells, but inflammation and cellular damage are minimal. This stage may be reversible with lifestyle changes.
    • Steatohepatitis (MASH/NASH): The liver becomes inflamed and its cells begin to sustain damage. This stage carries a higher risk of progression.
    • Fibrosis: As the liver attempts to repair itself, scar tissue begins to form and accumulate.
    • Cirrhosis: Extensive, irreversible scarring has replaced healthy liver tissue. This is the most advanced and serious stage, and can lead to liver failure, liver cancer or a transplant.

     

    What Are the Symptoms of Fatty Liver Disease?

    Fatty liver disease is frequently described as a “silent condition,” and for good reason.

    “Routine bloodwork and standard imaging often won’t show us how much damage has already occurred,” Dr. Sarmini explained. “Unless a patient has reached cirrhosis, the liver can look relatively normal on a scan while the disease is quietly progressing.”

    That diagnostic gap means patients remain unaware of the condition until it has advanced to a more serious stage.

    When symptoms do emerge, they tend to appear in later stages of fatty liver disease and may include:

    • Persistent fatigue or unexplained weakness
    • Dull aching or discomfort in the upper right abdomen
    • Abdominal swelling or fluid retention in the legs
    • Jaundice, a yellowing of the skin or the whites of the eyes
    • Cognitive difficulties, such as confusion or difficulty concentrating
    • Tendency to bruise or bleed more easily

     

    Causes of Fatty Liver Disease

    Fatty liver disease rarely has a single cause. In most cases, it develops from multiple overlapping risk factors, such as:

    • Excess sugar consumption: Diets high in added sugars, particularly from sweetened beverages, refined carbohydrates, and processed snacks, overwhelm the liver’s capacity to metabolize fructose. The surplus is converted into fat and deposited in liver cells.
    • Alcohol use: Excessive alcohol consumption disrupts normal fat metabolism in the liver and causes cellular damage. Even alongside non-alcoholic fatty liver disease, alcohol can accelerate progression.
    • Obesity: Excess body weight, particularly visceral fat stored around the abdomen, is one of the strongest predictors of fatty liver disease. It increases the volume of fatty acids circulating in the blood and delivered to the liver.
    • Insulin resistance and Type 2 diabetes: When cells lose sensitivity to insulin, blood glucose remains elevated. The liver responds by converting excess glucose into fat, resulting in accumulation.
    • Genetics: Certain genetic variants influence how the body regulates fat storage and liver function. A family history of fatty liver disease or cirrhosis can increase your risk.
    • Metabolic dysfunction: High blood pressure, elevated triglycerides and low HDL cholesterol frequently co-occur with fatty liver disease.
    • Sleep apnea: Obstructive sleep apnea causes repeated drops in blood oxygen during sleep, which can impair metabolic function and promote fat accumulation in the liver.
    • Certain medications: Corticosteroids, some cardiovascular medications and certain chemotherapy drugs can cause fat to accumulate in the liver.
    • Rapid weight loss: Losing weight too quickly through crash dieting or other extreme measures can flood the bloodstream with fatty acids.

     

     Why is Fatty Liver Disease Becoming More Common?

    Shifts in diet and lifestyle have increased rates of obesity and Type 2 diabetes. Fatty liver disease is also developing in younger populations more frequently. Dr. Sarmini has observed this shift firsthand.

    “Since the 1990s, we have seen a significant increase in fatty liver disease across all age groups, including children. More calories, more sweeteners, less movement — it all accumulates, and the liver reflects that,” he said.

    When the disease begins in childhood, it has more time to progress and cause lasting damage, raising the stakes for early intervention.

     

    How Is It Diagnosed?

    According to Dr. Sarmini, “If you have Type 2 diabetes, PCOS, obesity or a family history of liver disease, we want to know what’s happening in your liver now, not after damage has already been done.”

    Diagnosis begins with liver enzyme blood tests, followed by imaging if your levels are elevated. Because standard imaging cannot measure fibrosis, Fisher-Titus offers FibroScan, a non-invasive test that assesses liver stiffness using ultrasound waves, as well as the ELF blood test for fibrosis risk. A liver biopsy remains the most definitive staging method when additional clarity is needed.

     

    Can You Reverse Fatty Liver Disease?

    In the early stages, yes. Weight loss, reduced sugar and refined carbohydrate intake, regular exercise and limiting alcohol can reduce liver fat and inflammation. Research also suggests that regular coffee consumption may have a modest effect on liver health. This organ can self-repair when underlying causes are addressed to produce lasting improvement.

    The FDA has recently approved two targeted medications for advanced cases:

    • A medication that acts directly on liver receptors to reduce fat and reverse fibrosis
    • Semaglutide (Ozempic/Wegovy) is approved for fatty liver disease that’s been diagnosed within the past year.

    Dr. Sarmini has seen strong results with the first medication in clinical practice.

    “The results we are seeing in our clinic are genuinely exciting. We now have tools that can stop the progression of this disease and, in many cases, reverse the damage.” he said.

    Additional therapies are currently in clinical trials, and further advances are expected. Without treatment, fatty liver disease can progress silently to cirrhosis and raise the risk of cardiovascular disease, stroke, hypertension and Type 2 diabetes.

     

    What to Do if You Suspect You Have Fatty Liver Disease

    Because fatty liver disease is often asymptomatic until it has reached an advanced stage, acting before the disease makes itself known is essential.

    Here are meaningful steps you can take right now:

    • Reduce or eliminate sugary beverages, including soda, juice and energy drinks.
    • Limit processed and fast foods in favor of minimally refined alternatives.
    • Get at least 30 minutes of moderate physical activity several times week.
    • Moderate or eliminate alcohol consumption.
    • Speak with your doctor if you experience chronic fatigue, snoring or sleep apnea.

     

    Manage Your Wellness with Support from Fisher-Titus

    At Fisher-Titus, our gastroenterology and hepatology team offers advanced diagnostic tools and treatment options to help patients understand and protect their liver health.

    “The goal is never to catch this disease after it has already caused serious harm,” Dr Sarmini said. “Gastroenterology gives us the ability to get ahead of it, to identify the problem early, monitor it closely and protect patients from complications before they happen.”

    Whether you have an incidental finding on a recent scan or simply want to know your risk, our team is here to help. Schedule an appointment with the Fisher-Titus gastroenterology team today.

     

  • The Importance of Colonoscopies

    The Importance of Colonoscopies

     

    By: Beth Steinmetz, APRN- CNP, Fisher-Titus Digestive Health

    A colonoscopy is an examination of your colon and rectum. Colonoscopies are performed to assist in early detection of colon cancer. During a colonoscopy, gastroenterologists and surgeons can also remove colon polyps to assist in prevention of colon cancer. Colonoscopies also assist in diagnosing various disorders in the lower gastrointestinal (GI) tract such as ulcerative colitis, Crohn’s disease, and colitis.

    The American Cancer Society recommends that individuals have a colonoscopy starting at age 45 and repeat the procedure every 10 years if the colonoscopy was normal. Individuals who have signs of or are at high risk for colorectal cancer, or have received a previous colonoscopy with abnormal results may be required to have Colonoscopies completed at an earlier age or more frequently. Risk factors for colorectal cancer include low activity level, family or personal history of colorectal cancer or colon polyps, smoking, heavy alcohol use, having diabetes, and older age.

    Preparation prior to colonoscopy is required. To prepare for the procedure, individuals will be instructed regarding certain dietary modifications such as being asked to limit or eliminate high-fiber foods leading up to the colonoscopy. You may be asked to take laxatives by mouth and be on a clear-liquid diet the day before. Your bowel must be fully cleansed before the procedure so a laxative or enema may be given before the procedure as well. Make sure to follow your doctor’s instructions carefully before having the procedure. Since you will be given sedatives during the procedure which will impact safe driving ability, it is also vital to make prior arrangements for transportation. Let your doctor know if you are pregnant, have lung or heart conditions, kidney disease, diabetes, or are taking medications that affect blood clotting, and include information regarding any allergies to medication before the procedure.

    Colonoscopies last for about 30-60 minutes. Prior to the procedure, you will be given sedatives and then be asked to lie on your side. A tubular instrument is inserted in the rectum that transmits an image of the colon’s lining that the doctor will examine for abnormalities. You may be asked to change position during the procedure and feel some minor discomfort. Biopsies may be taken of tissue while the colon is being inspected. Recovery takes about 30 minutes, and you may feel sensations of cramping or gas however, they will pass quickly. You may resume your normal diet after the procedure. Certain medications, such as blood thinners may need to be avoided for some time following the procedure.

    It is important to ensure that your digestive system is in good health. If you have any questions or concerns about having a colonoscopy, please contact your primary care provider.

    About Beth

    Beth Steinmetz is a Certified Nurse Practitioner at Fisher-Titus Digestive Health. Fisher-Titus offers Digestive Health services at our Norwalk location in Medical Park 3 to diagnose and treat a wide range of complications involving your digestive system. To learn more or schedule an appointment, go to fishertitus.org/digestive-health/.

  • Do Probiotics Aid Digestive Health?

    A decade ago, we didn’t hear much about probiotics. Sure, we had a vague sense that yogurt might be good for us, but most of us would have cited the calcium as its major benefit—not the live bacteria.

    Fast-forward 10 years and these alleged superheroes are everywhere. Probiotics—also called good bacteria—occur naturally in only a handful of foods, like yogurt, sauerkraut, kefir, raw cheese and miso. What’s new is that you will find them in dozens of supplements in the form of pills, powders and gummies. You also will see them added to a variety of food products, including chocolate, tea and even dog treats.

    Probiotics often get credit for improving a host of health problems, including allergies, eczema, depression, bloating, acne, urinary tract infections and even asthma.

    But do probiotics aid digestive health? And if so, what’s the best way to consume them?

    The truth is that the study of probiotics is what you might call evolving. Dozens of studies have been done, but none have been large or comprehensive enough to reach a definitive conclusion. The National Institutes of Health warns that the “marketing and use of probiotics may have outpaced scientific research.” Further confusing the issue is that there are many types of probiotics.

    Here is a sampling of what science is saying:

    • One 2016 review of seven studies found no evidence that probiotic supplements have beneficial effects on the composition of gut bacteria in healthy adults.
    • The Journal of Neurogastroenterology and Motility reported in 2017 that adults who suffer from irritable bowel syndrome found their condition improved after taking probiotic supplements.
    • A 2017 University of Florida study of 173 healthy adults who suffer from seasonal allergies found that the half who took a combination of the probiotics lactobacilli and bifidobacteria (sold as Kyo-Dophilus in stores) reported fewer allergy-related nose symptoms.
    • A 2017 study done by the University of Virginia School of Medicine found that eating lactobacillus, a probiotic bacteria found in live-culture yogurt, reversed depression symptoms in mice.

    While science is still working out the veracity of various claims, it can’t hurt to increase your intake of foods that contain probiotics. Unless you’re into miso or fermented sauerkraut (not the regular kind you buy in a bag) the easiest way to do that is by consuming yogurt or kefir (a fermented milk smoothie found in the dairy section of most grocery stores). Just be sure to check the seal for “live and active cultures” and avoid products with excessive added sugar.

    One thing most doctors agree on? It’s a great idea to consume more probiotics while on antibiotics, which take aim at all bacteria in your gut, both good and bad. For some, this results in antibiotic-associated diarrhea. Probiotics can help by building up your army of good bacteria more quickly.

    A word of warning: Do not skip your usual medication because you hope probiotics might help you with depression or some other condition. And if you’re considering a probiotic supplement, you should consult your doctor first. That’s especially important if you are pregnant, nursing or planning to give the supplement to a child.

    It’s all a little confusing, right? The reality is that while there is a lack of research, probiotics still have a lot of potential. If you think probiotic supplements might be right for you, make a note to discuss the issue with your doctor at your next appointment or, if you suffer from a digestive disorder, make an appointment with one of our experts to come up with a plan to improve your health and feel better.

    P.S. Looking for a great kefir smoothie recipe? Combine 1 cup of plain kefir with half a frozen banana and a ½ cup of frozen blueberries. Throw in a dash of cinnamon (and a handful of spinach if you’re feeling sneaky) and blend. Delicious!