When a medical provider recommends a medication, a common and valid question you may ask is: What are the side effects?

What if the consequences of not taking the medication were less tolerable than any potential side effect of the medication? That’s the position one of the Veterans I work with found himself in recently.

I’m a VA registered dietitian and this Veteran was initially referred to me because he was interested in weight loss. When I reviewed his medical record, I noted he also had non-alcoholic fatty liver disease (NAFLD).

With NAFLD, there is excessive fat accumulation in the liver. This puts an individual at risk for inflammation of the liver which in some individuals may eventually result in scarring of the liver and cirrhosis.

Difficult to exercise due to arthritis

It was very difficult for this Veteran to exercise due to poorly controlled pain from rheumatoid arthritis and injuries. He tried multiple treatments over the years with little relief.

When he started Remicade, he was very hopeful and excited, as his pain had subsided.

However, following routine lab work, his liver enzymes were significantly elevated and his medical provider suggested he stop the medication. Once he stopped the medication, the pain and swelling returned. He was determined to reduce his liver enzymes to a safer level so he could resume the medication.

Recommended diet and lifestyle changes

This Veteran continued working with me and his hepatologist (liver specialist). Some of the diet and lifestyle changes recommended for individuals with NAFLD include:

  • Drink 2-3 cups of unsweetened coffee a day. (Coffee is thought to be protective to the liver. He stopped adding sugar to his coffee.)
  • Avoid sugar sweetened beverages, especially those containing high fructose corn syrup. (He replaced regular soda with seltzer and water.)
  • Increase daily servings of whole fruit and non-starchy vegetables (providing antioxidants and filling dietary fiber). He snacked on fruit and carrots instead of dessert and chips.
  • Avoid alcoholic beverages.
  • Incorporate omega-3 anti-inflammatory fats (nuts, salmon, sardines) and reduce saturated fats (whole milk dairy, poultry skin, butter).
  • Lose 5-10% of body weight.

The Veteran has resumed taking Remicade. Other medications that may increase risk for liver injury have been stopped. He’s lost 10 pounds from his peak weight. One of his liver enzymes has normalized and the other has decreased by 80 points.

With the right understanding and motivation, you, too, can make a change to your health for the better.

I encourage you, like this Veteran, to meet with a VA registered dietitian.

Contact the PACT or MOVE! team at your local VA to set this up.

Related blog post: Fresh Focus #23: MOVE!

By Michelle Hyman is a registered dietitian with the MOVE! program at the VA New York Harbor Healthcare system

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Published on Jul. 26, 2021

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