Ask Dr. H: Fatty liver, weight loss, and milk thistle

Question: Recent lab work showed that my liver tests were slightly abnormal. After an ultrasound of my liver, my primary-care physician diagnosed me with a fatty liver. He said that if I lost weight, it would go away. He also suggested that I take an herb called "milk thistle." Do you agree?

Answer: It's not too hard to see excess body fat of the hips, thighs, abdomen, and face. But the accumulation of fat around organs like the liver is not obvious at all. A fatty liver is one of those things you probably won't know you have unless there's an unexplained elevation in your liver enzymes on routine lab work. An ultrasound or abdominal CT scan will reveal an abnormally fatty-looking liver.

When looking at your lab report, you'll notice that one or both of the liver enzymes (AST and ALT) are elevated. They're released into the bloodstream when liver cells die. Normally, a certain number of liver cells wear out and die each day in the course of their normal activities.

A higher level of one or both of these enzymes means there's some sort of liver inflammation, infection, or cell injury present. In essence, your liver is greasy and sick.

Weight loss is probably the best way to treat a fatty liver. Avoid carbohydrates that will be readily converted into sugar. Stay away from most breakfast cereals, white bread, rice, and potatoes. Avoid saturated fats, fast foods, processed foods, sugared soft drinks, and alcohol.

Milk thistle extract is an interesting liver-friendly herb that has been used since Greco-Roman times. While it won't erase a fatty liver, it appears to help protect liver function and reduce elevated liver enzymes through several mechanisms: enhancing new liver-cell production; antioxidant activity; toxin blockade at the cell membrane level; and possible anti-inflammatory effects.

It really has no major adverse effects, so I support your doctor's recommendation of milk thistle extract in conjunction with a long-term healthy weight-loss strategy and regular exercise.

Q:

I am 34 years old. At 14 I was told that I have a tipped uterus. What exactly is that? All I know is that I continue to have painful intercourse despite using lubricants. What can I do? My doctor says I have a uterine fibroid tumor, but it's too small to be causing my problem.

A: A tipped uterus means the uterus is positioned toward the back rather than toward the belly. That also means the cervix (the opening to the uterus) is tipped and slightly out of its usual position. This sort of thing is actually pretty common, seen in approximately 20 percent of women.

For most women, a tipped uterus is just a variant of the normal anatomy. That was probably the case with you. For other women, a tipped uterus is an acquired condition. As a woman matures, the uterus may fail to move into the correct forward position. Childbirth can tip the uterus forward or backward. A large fibroid tumor of the uterus' muscular wall can cause a shifting of the uterus out of its normal position.

Endometriosis, a painful inflammatory condition caused by the abnormal presence of uterine tissue on various pelvic structures, can involve the ligaments that hold the uterus in correct position. If that occurs, the ligaments can become scarred and shortened.

If it's just an incidental finding on a routine pelvic exam, nothing needs to be done for a tipped uterus. It may cause difficulty getting pregnant, but never rely on it as a form of birth control.

Some women will experience backache or pelvic pain from a tipped uterus. If tipping of the uterus and cervix is causing painful intercourse, lubricating jelly won't do much good because there's a mechanical blockage. If there's a large fibroid causing not just tipping, but pain and bleeding, removal of the fibroid will correct the positioning.

Treating endometriosis will usually restore the normal uterine positioning. For those who have symptoms related to the variant positioning of the uterus and nothing else, a vaginal pessary may be recommended. There's also a laparoscopic procedure performed by gynecologists, called the uplift, that can reposition the uterus/cervix with a minimal amount of surgery.