LET’S TALK NASH MANAGEMENT

My whole life, my two brothers and I have looked to our Dad as our role model; an example of what it means to do what it takes. To always take care of the people you love. He was a provider. He somehow put three boys through parochial school, and Catholic school education was not cheap. He put food on the table, and lots of it- big Italian Macchiarola meals. But the most important thing he provided to us was himself.

My Dad sacrificed advancement in his career; he could have taken a job at the Department of Education (then the “Board of Ed”) in New York. They wanted his leadership, because he was an educator who really got the balance of development and discipline. But it would have meant leaving early in the morning and not coming home until after our dinnertime many nights.

As a teacher, he was there for us when we got home. He didn’t want to miss out on the homework time, dinnertime, bath time, and just time for being there to shuttle us around to all our activities. Three boys, you know- just a couple years apart- we had a lot going on!

But being there for us after school didn’t mean he was done for the night. A lot of times, after we were all set, he’d tutor or go out and work another job. The man sacrificed. He did what it took to be around.

At our table of five, we would get two egg rolls and he would cut them in half- him being the one to get none. If we were out for pizza, everyone had two slices of an eight-slice pie and he’d sit it out. It was his great pride to put food on the table for us and we were always encouraged to finish everything on our plates. Food was love.

Years later, when I was diagnosed with NASH (nonalcoholic steatohepatitis), I became the one who’d sit out the pizza and the eggrolls, but because of a different need. I don’t drink a lot, but my liver tells a different story. I was doing routine bloodwork when my primary physician said my triglycerides were elevated and my liver enzymes were all over the place. I needed to see a gastro (gastroenterologist). It turns out I have a rare condition. My stage of NASH looks like, on a scale from 0-4, my liver is at a 2, where 4 would be cirrhosis.

He then sent me to get a biopsy, which is a scary thing to hear you need. It’s good that I did it. My liver was a mess, and when he looked at my kidneys, their measurements weren’t alarming, but the biopsy told a different story. I needed to get clean with my eating, and fast.

I’m the Dad now, with two teenaged kids and a beautiful wife to provide for. Like my own Dad, I want most to be able to provide them with my presence. Being there for them for as many years as I can give myself.

I know I’m extra at-risk, too, because I have Type 2 Diabetes on both sides of my family and the men in my family die young. My Dad, now 75, is the second-longest-living man in my family. I had my now-teenaged twins, Michael and Claire, at 35, so I’m a little older than other fathers with kids their age. I want every minute I can have with them, like my Dad wanted with us. I get it. They’re absolutely everything to me, these two kids and my wife.

Getting the news from my gastro on a trip to Atlanta, I spent the next few days driving back to Florida eating every fatty fried food I could find. And then it was time to take action. My wife, Kris, ordered me the Arbonne 30 Days To Healthy Living and Beyond program. Shakes, teas, fizzy drinks, and foods with a low glycemic index.

I thought it sounded like a lot of sacrifice- where are the fried chicken cutlets and mozzarella? [ANYTHING] parmesan on these sample menus? I thought my wife had lost her mind, but the reality is that I’ll be 49 in August.

I used to be able to push myself working out, and I can break a sweat now and manage, but I can’t go all out anymore. It’s gotta be diet that makes the difference for me. But when the doctor says you have to make a change, and you care that you stick around for your family, you man up to do what it takes.

My gastro told me he needed to see me at 180 lbs. by August, and the Arbonne plan took me from 197 to 182 in thirty days- and that’s without extensive fitness. And my liver went from a 2 to a 1. My bloodwork showed we were in a good position. It was hard, especially as an emotional eater whose eyes wander to every other plate on the table, but it did work for me. And the progress was enough for me to say it was worth it.

My pants say it was worth it, too. They’re a 34, and I used to joke, “they just don’t make 34s fit the way they used to!” But they do actually fit the way they’re supposed to now that I’m not having to force them on.

Now, I can’t be perfect (having teenagers means there’s always some kind of junk food coming in and out of our house, or a random Snickers bar taunting me from a countertop), but I shoot for 4/7. 4 perfect days and 3 pretty good ones.

I plan ahead. My health is at its best and I really feel the difference when I take care of myself. Meal planning and cooking meals at home, considering when the “cheat days” are going to happen and planning to be really good around those days or those meals.

It helps me to have changed the overindulgent habit and built a new one of making healthy choices. Cleaner and greener. And sometimes redder! On the bright side, my primary physician and my gastro told me I should drink a glass of red wine once in a while. Don’t have to tell me twice!

I do have to be careful with fatty foods because I have scarring from NASH and it could be life-threatening if I don’t take care of it. Portion control is important, too. I can’t “eat big” the way I used to- and we used to fight for scraps at the Macchiarola table. You know- the Italian household with the grandmas cooking and the sauce has been going since 6am and makes the whole house smell like heaven- you had better swipe the bottom of the dish with bread if you can.

In my house, we set an example of how to enjoy the food that was put on the table with love. When my Dad encourages my daughter to finish her plate, but she’s satisfied with half of it, I let everyone know: it’s ok to stop when you feel you’ve had enough. The love is still there. We don’t need to make ourselves sick out-eating each other to prove it.

I make the changes my doctors said to as much as I can. I’ve made them my buddies, and looking up to them helps. I might know a lot about education- and a lot about a lot of stuff- but they know this. They know what my body needs. You have to listen to your body, and you just have to do what your doctors say when you care about being around.

I know how to listen to my body. When I have sugar, I get a headache right away. And years ago, I used to be a smoker, and one day I was walking up two flights of stairs and was huffing and puffing and knew I didn’t want to feel like that anymore. So I’m proud to say that I just walked away from it right then.

And I’ve always respected doctors’ orders. You have to. You only get one body, and they’re the experts on keeping it. Back when I tore my rotator cuff, they said the whole first month I’d have to go three days a week for physical therapy. I was pissed, but I took time from work and did it. You do what you have to do.

I listened to the doctors when I took my son in at 5 years old when his stomach was protruding like he was coming back from a kegger and he wasn’t getting any better. It turns out he had celiac disease. So, we did what it took. We eat gluten free at home. He needed us to change how we were feeding him, and there wasn’t a second thought.

In a way, it prepared me to make changes I needed for myself because modifications weren’t new to my cooking. I’m used to looking at the labels and ingredients on foods, but now I look at fat and sodium levels, too. I take 1000mg milk thistle every day and a multivitamin in the morning because my body is behind, using all the vitamins I have just to keep normal functions happening.

I do need to watch the “sampling” I do when I make sure the kids are going to like what I make. I refuse to serve pizza that tastes like cardboard instead of food that tastes like food. I do what I have to do to fit in as much as I can of the good stuff. Fava beans, kale, green peppers. And actually I do like this stuff. It just has to have flavor.

After the 30 days on Arbonne I did go off the road a bit. But I’m not really in the ditch now, and I know how to get myself back to a good place. It’s about kale, red onion, lemon garlic ginger, spinach, almond milk instead of dairy… If I go off-track, I feel guilty and have to reset. My off-track is a binge at the freezer after everyone is asleep. I walk past the mirror very fast the next morning. I have a responsibility to be a role model to everyone in that house. I’m embarrassed but I have to just get back to the good habits.

Plan ahead, do the shopping, and prepare, prepare, prepare. Making the time to get meals ready we can enjoy means my family isn’t stuck with unhealthy choices. Or if, one day, my wife calls me up and says a friend of ours is selling homemade sausage- I’m not saying no to that- I can plan that the meals for the rest of the day and the next day are healthier and clean.

When I ask my Mom to cook, she feels good about it and I love to eat that food- are you kidding? There are hundreds of things she makes that are so good, but instead of the fried chicken cutlets I’ll think of all the other things she can make and I’ll pick the healthiest thing I can request.

And I like cooking! I grew up watching my mother and my Uncle Jim do their thing- they’re both excellent cooks. Uncle Jim used to put me to work peeling the potatoes and helping out, so I learned at an early age what it is to cook fresh food with good flavor. I keep their recipes in mind and I swap in ground turkey, chicken and lean pork.

This sets the right example for my family, too. It’s not that we talk about it so much- my kids know about my liver in a very general sense but I don’t want them to worry. They have enough to worry about, just being teenagers. But I can still show them through my actions, “this is how we eat make healthy choices.”

I want to let both my kids know- they have my bone structure- we carry weight differently. I don’t want them to have issues or symptoms like I do. My son isn’t running track this year, but it’s important for him to have physical activity. You know, as a teenager going through a growth spurt, he eats pre-dinner, dinner, and post-dinner, but if he has my history he’ll need to watch it. So I want to model for him- he sees me eating fruits and veggies.

And my brothers- we talk; we’re pretty close. It’s always been the three of us. And when we get together, you know, we make fun of my parents! That’s what we do. We have a good laugh and it’s all out of love. But maybe we should talk about our health for real, beyond, “yeah I should probably drop some pounds” and talk about fatigue or other signs our bodies need attention. It’s important to me that we all last as long as we can.

And you just never know. I recently lost a friend at 51 years old, who was a healthy person! I can’t let that be me. So I do what I’m supposed to do.

Big scale wins are important but I can’t get caught up in it every day. I need to celebrate small wins like stocking the pantry and doing food prep. Shopping when I’m not hungry. “Today I will take milk thistle and shut down the eating at 8pm.”

Look, I’m the youngest of three, and I was always an observer. I learned what I needed to do to be like my brother here or like my other brother there; I had a lot to live up to. They’re both great guys and they were even as kids. But now, maybe it’s the competitor within me, but if I can accomplish something on my own, that means a lot to me. The scale isn’t my thing, and I’ll probably never be a 32 waist, but I can make my physicians and family proud.

As for exercise, I play softball and cut out afterwards with the kids rather than sticking around to go to some bar after and eat the wrong kind of food. When my wife and I plan a trip together, we pick a place that’ll have bike trails or hiking as part of it, rather than planning around whether there’s a fun bar nearby or something.

I have a follow-up in August with both guys- primary and gastro. I know I’ll be at the right weight by then. I’m doing the right things. I’m taking action- I really am. I have family members who complain and say “ah, I really should…” but I do actually do what I say I’m going to. I just wish there were a real treatment beyond just diet. This was all the doctors could tell me to do, and I’m doing it, but I wish more peace of mind came with it. I don’t want to keep doing biopsies.

I know it’s coming. I hear Gilead is even using machine learning to find new ways to help people with NASH. Even it’s a few years out, it feels good to know people care. If they’re reading this, let me tell you- if it helps me reduce my risk for cirrhosis and cholesterol levels and everything, I’d be willing to do almost anything for those meds. I’d take a shot, I’d take pills, I’d do weekly or quarterly blood tests, scans, anything they doctor needs me to do.

I don’t want to have any health problems, and sometimes it’s just genetics. They call it a silent disease, but it silently weighs on me. When does diet become not enough? Then what? If I do end up with cirrhosis, I’d have such fatigue, there’d be fatty infiltration everywhere, my gall bladder would be abnormal, then more meds left and right, and then my lifestyle would just be completely gone. I want to be around to enjoy life, to be with my family, and I don’t mind doing what it takes.

If you’re reading this and going through something similar, whether it’s NASH or another problem you have, the best advice I can give you is that if I can manage this, and I have a lot of responsibilities I take on in any given week, you can manage what you have going on, too. Don’t be that upset when you do fail, because the sun’s going to come up and it’ll be another day. The paperwork and numbers can be frightening. But know that you can do it. You can make changes in your diet even when it’s hard.

Communicate with your physicians. Make them your buddies like I made Dr. Blasini and Dr. Mendoza mine. If it’s not going to be about a cure- a win- at least make sure you’re working on managing it. Management is the win.

My Dad pointed out to me once that the best hitters in the world get out 7/10 times. The doctors tell me what to do, how to be 10/10, but I’m still a winner if I shoot for 10/10 and end up at a .300 like those other best hitters. Just doing my best, sacrificing when I have to, and doing what it takes to be the Dad to my kids that my Dad was to us. For as long as I’ve got.

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