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I’ve sat in classrooms listening to bombastic lectures from so many boring professors that rigor mortis was starting to set in. The most impactful didactic occasions I’ve been subject to have been anecdotes. Real life experiences; stories, basically. I’ve included a couple “case studies” in the Fatty Liver Disease articles and I want to tell you about another.

Pooty Bottum established care with me February 1, 2021. He did not drink alcohol and exercised in an enjoyably varied manner 5 days a week. He had a few years of waxing and waning belly pain and bloating. And indeed, he described one of the worst cases of bloat I’ve encountered. First of all, bloat is code for massive flatus. If passing flatus was a sport, he could easily have gone pro. Acquired endorsements and likely have enjoyed modest fame and a comfortable living. He started his morning with 16 ounces of soda and consumed a large amount of carbohydrate throughout the day. His weight was 191.2 pounds which correlated to an overweight BMI of 26.8. He had developed abdominal obesity, with a circumference of over 41 inches. Liver function tests were moderately elevated at 38 and 28, strongly indicating some element of Fatty Liver Disease. Triglyceride (fat in blood, formed by the liver from carb) very elevated at 193, and HDL (good cholesterol) 32. Under 40 is an independent risk factor for heart disease. I also checked for a severe gluten allergy called Celiac Sprue. These tests were also very abnormal. I’m not sure what all the numbers mean but there sure is a lot of red:

He also had gout and had taken the medication allopurinol for decades.

It's a good thing people don’t die of crappy lab results or I would’ve called a Code Blue on the spot (“Everyone remain calm! What’s the number for 911?! Where’s that defib thing kept?!) Abnormal blood work can imply distorted metabolism, and people sure die of that. In droves.

Pooty did not want to undergo an endoscopy procedure, with biopsies of the small intestine. This is how Celiac Sprue is definitively diagnosed. Instead, he decided to stop soda, reduce all starch and eliminate gluten.

I saw Mr. Bottum the other day. It had been a year. It’s not unusual for patients to not come back for a long time, if ever, after they’ve met me. His body habitus had changed. He was lean. He was down to 169 pounds, with a BMI of 23.7. Abdominal obesity cured, with a circumference of 36 inches. Abdominal cramp and bloat GONE, professional opportunity dashed. Triglycerides down to 103, HDL up to 45, liver improved to 30 and 21. He weened down his gout medication and was able to stop it completely. And he felt terrific.

Focusing on gas, weight gain, and crappy blood work is futile unless you (yes, YOU) learn what is causing the issue. Hint, it’s usually diet. Abnormalities and symptoms are just the voice of distorted metabolism. Sugar is not a benign substance. The opposite is true. Carbohydrate is a survival food. Learn to live and enjoy sugar as a rarity and starch as a garnish. It worked for Pooty.

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