Stephanie Rivera

Internal Medicine Chief Resident @CooperIMRes I @medupr Alumn I Golden Retriever Mom

[TheLiverDoc™ @theliverdoc]

People with fatty liver disease keep asking me in my DM's for treatment advice. Here are 10 points that you can do to modify/reverse fatty liver.

1. Exercise
Three types of exercise have benefits on fatty liver. Aerobic exercise, resistance training, high-intensity interval training. Include any in your routine.
▶️https://t.co/008s2OArki

2. Diet
It is not the carbohydrates or the fat, but the calories. Low calorie dietary interventions are most effective. Low-calorie = 1000 to 1500 calories/d with deficits of 500-750 calories/d. Apart from low-calorie deficits, the only other diet intervention with proven use is Mediterranean type without alcohol.
▶️https://t.co/yP1Tabafyk

3. Sleep
Poor sleep, inadequate sleep (< 6h), non-restorative sleep and daytime napping >60 mins are all independently associated with new onset or worsening fatty liver. Pamper your liver by getting some good sleep in your routine.
▶️https://t.co/bXCm7vMdep

4. Coffee
Much to the offence and annoyance of tea connoisseurs, coffee intake has been shown to reduce fatty liver disease independent of other dietary modifications [limited evidence vs no evidence]. Ideally, it is black coffee, no sugar, no milk, a minimum of 3 cups a day, complete intake before late evening & never into the night. This dose will not affect your blood pressure, in fact may reduce it.
▶️https://t.co/7xI2f4cTpH

5. Alcohol
The most common cause of fatty liver is possibly alcohol use. The safest level of alcohol in preventing fatty liver is ZERO. Stop alcohol use and switch to non-alcoholic alcohol-like low calorie beverages instead.
▶️https://t.co/F34UKnSNEc

6. Sugar-sweetened beverages and fructose-containing processed foods
Stay away from these two. These can increase liver fat immensely and has been linked to fatty liver in both children and adults.
▶️https://t.co/qQrFJI4mvb

7. Artificial sweeteners
Artificial sweeteners are safer to use than natural sugars, even though preclinical studies have shown increased liver fat in animal models due to action on gut bacteria. Stevia is supposedly the safest bet among artificial sweeteners. In case of diabetes/obesity, speak with your specialist before you want to use them.
▶️https://t.co/LGXVH6KMem

8. Drug therapy
There are NO approved drugs for the treatment of fatty liver disease. Recommended drugs include vitamin E and pioglitazone. NO OTHER DRUGS ARE USEFUL. These are not used life long, but only until other associated risk factors are well-controlled. Drug therapy should be initiated in only those with CONFIRMED NASH (ideally biopsy proven or Fibroscan/Shearwave).
NEVER initiate treatment based on ONLY ultrasound scan fatty liver identification.
▶️https://t.co/OESXkKIWtL

9. Rational approach
Fatty liver disease is a misnomer. It is really not a disease, but an association. Treatments should be aimed at controlling causes of fatty liver disease (alcohol use, diabetes, obesity, hypothyroidism, sleep disorder, sedentary life etc.) rather than liver.
https://t.co/uylt2jyCkO [see management/updates section]

10. What does NOT work?
Ursodeoxycholic acid, milk-thistle, green tea, omega-3 supplements, detox products, yoga (because it is not aerobic), fruitarian diets, crash diets, turmeric/cinnamon supplements, shifting to honey or coconut sugars, herbal formulations, multiherbal products, any product with "liver detox" written on it & any product or advertisement with "reverse fatty liver" written on it.

[Bryan Carmody @jbcarmody]

As we countdown to Match Day, I want you to meet Dr. Kevin Jon Williams.

For nearly 20 years, he fought for - and eventually won - a student-optimal matching algorithm.

It’s one of the great stories of advocacy in Match history… and the NRMP refuses to acknowledge it.

(a 🧵)

[Cooper IM Residency @CooperIMRes]

Congratulations to our @CooperIMRes residents on a phenomenal 100% fellowship MATCH.

We are so proud of you!
🎊🎉👏
@coopermedschool @CooperHealthNJ @CooperGME

#Fellowshipmatch2022 #fellowshipmatch #Fellowship #MedTwitter #GITwitter #CardioTwitter #CCM #RheumTwitter

[Stephanie Rivera @SRiveraMD]

@StephenTrzeciak @CooperIMRes @mainlinehealth Thank you Dr. Trzeciak!

[Stephanie Rivera @SRiveraMD]

Beyond excited to have matched at #LankenauGI 💩 to continue my medical traning! Thankful for all the support from my co-residents and faculty @CooperIMRes!

[Stephanie Rivera @SRiveraMD]

What a great week at #ACG2022! Proud of @CooperIMRes and their work @AbhishekChouth1 @AndrewAlabd. Lots of learning and even had the chance to catch up with friends from @uprinternalmed.

[Stephanie Rivera @SRiveraMD]

Enjoying our time at #ACG2022 and celebrating #DiversityinGI.

@AndrewAlabd
@AbhishekChouth1
@CooperIMRes

[Stephanie Rivera @SRiveraMD]

Happy to join the Latino Medical Student Association for the virtual Residency Fair #LMSARF22 representing @CooperIMRes.
@LmsaNational

Applicants visit our booth today (10am-2pm):
https://t.co/id95KxJY53

[Stephanie Rivera @SRiveraMD]

Having a great time with my fellow @CooperIMRes future chiefs at #AIMW22!

[Jorge Rosario @JRosarioMD]

So excited to meet all our future @TempleIM residents soon! As you approach your intern year, here are some #financialwellness tips to think about. A 🧵:
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