Dr. Jennifer Stevens, MD

Why Italian women eat pasta every day and keep their livers clean

Carbs are poison for women with fatty liver. That's the first rule I learned in hepatology. I've been a hepatologist for 12 years. Sugar and starch turn straight into liver fat, and every slice of bread nudges the ALT a little higher. Low-carb is the first diet every fatty liver book in America puts in your hands. Then I went to Italy. The country where women eat fresh pasta every day of their lives. What I found there made me sick. I work at a liver clinic in the Northeast. I am not the first doctor these women see. By the time a woman reaches me, I am her 4th doctor, or her 5th, or her 9th. I am where she lands when every other doctor has run out of answers and started giving her that look, the one where he is already half turned toward the door while she is still talking. They come in carrying things. Folders. Plastic grocery bags full of old lab printouts. One woman set a 3 ring binder on my desk, heavy as a phone book, 11 years of liver panels, tabbed and highlighted in 3 colors. Before she said hello she said, "I need you to know I barely drink. A glass of wine on a Sunday, that's it." Every doctor before me had asked her how much she drinks, and not one of them believed the answer. That is how they arrive. Braced. Already defending themselves against a doctor they have not met yet. They have been on milk thistle for years. They take it exactly right. Every morning with breakfast, a full glass of water, the expensive "European" brand. They never miss. And their labs come back "slightly elevated," year after year after year, while they get worse. By the time a patient hits my office, I already know what her chart is going to say. In 12 years it has not surprised me once. It reads like the same story typed out by a hundred different doctors who just don't know better, or just don't care. Patient presents with weight gain around the middle that won't move. Doctor's notes: menopause related. Recommend dietary discipline. Cut carbs. Patient returns. Exhaustion that 8 hours of sleep doesn't fix. Needs a nap after every meal. Doctor's notes: chronic fatigue. Likely her age. Recommend exercise. Patient returns. Cholesterol creeping up the chart. Doctor's notes: borderline. Start a st*tin. Patient returns. Heart pounding going up her own staircase, the same stairs she has climbed for 20 years. Doctor's notes: deconditioning. Likely anxiety. Prescribe a beta blocker. Patient returns. Thinking through molasses. Losing words in the middle of a sentence. Falling asleep on the couch before the evening news with the plate still in her lap. ALT slightly elevated. Doctor's notes: fatty liver, mild. Lose weight, cut out the wine, recheck in 6 months. That's 5 visits over 5 years, each one with its own diagnosis and its own prescription. And by the 3rd visit somebody has handed her a low-carb diet book and told her the answer is to give up bread and walk a bit more. So she does it. She stops eating at restaurants. At her own daughter's table she shows up with a plastic container of her own food. In the grocery store she reads the back of every box under those fluorescent lights while the ice cream sweats in her cart. At dinner parties, she apologizes. She pours her anniversary wine down the sink. And at her granddaughter's birthday she turns down the cake, watches the child's face fall and says she isn't hungry. For years. And the scale never moves an ounce. Then someone finally sends her to me. I pull her chart. I look at her labs. And in less than 30 minutes I find what explains every one of those 5 visits. The thing nobody looked for, because nobody in the building is paid to look there. The bread never caused any of it. Her liver is missing the one thing it uses to clean, defend and repair itself. Your family doctor watches your cholesterol, and doctors like me watch your ALT. The problem sits inside the liver cell itself, in a molecule neither of us measures, and no one has ever been assigned to look for it. So when I got invited to a liver research conference in Florence last spring, I added 2 extra weeks to the trip. Because a question had been sitting in the back of my mind for years, quietly, the way a stone sits in a shoe. And I had finally decided to go dig it out. Here is the question. Italians eat more pasta than any country on earth. Bread at every meal, torn off a loaf still warm. Fresh pasta 3 and 4 times a week. Pizza. Focaccia. Crackers with the morning coffee. The average Italian eats close to 3 times the pasta the average American does. And Italian women outlive American women by about 4 years. In my field, 4 years is an enormous gap. They carry about a third of our obesity rate and have far fewer heart attacks. Their waists at 70 are smaller than most of my patients' waists at 45. Their minds stay sharp well past 80, still telling stories, still remembering the names of everyone's children. Based on everything I was trained to believe, those women should have the fattiest livers in Europe. They should have more of what is killing American women, not less. I needed to understand why. And I did not think the answer was going to be in a conference hall in Florence. So when it ended I rented a small car and drove south, and then I got on a ferry, and then I drove up into the mountains of Sardinia, on roads that got narrower and older until they were barely wider than the car. Sardinia is one of the original Blue Zones, with one of the highest concentrations of people living past 100 anywhere in the world. I arranged a homestay in a small village in the Nuoro region through a longevity research project. The woman I stayed with was named Lucia. She is 87 years old. She lives alone in the same stone house she was born in, with green shutters and a front step worn into a smooth dip by a hundred years of feet. She tends her olive trees every morning in the cool before the heat comes. She walks down to the village square in the afternoon. She cooks every single meal she eats. She has had a fatty liver for 40 years. Day 3, I am sitting at her kitchen table watching her boil fresh pasta in a copper pot. The window is steamed over. She drains it, tosses it with olive oil and tomatoes she picked that morning, sets a plate in front of me, pours us each a small glass of Cannonau, the dark red the island is known for, and then sits down across from me with the exact same plate. And my hepatologist brain is coming apart at the seams. Because I am doing the arithmetic and it will not add up. I am thinking about every woman I have ever sat across a desk from and told to throw her bread away. Every low-carb plan I ever printed out and handed over. The woman with the binder. And the one who cried in my office, a grown woman crying in a plastic chair, because I had just told her to give up her mother's lasagna, the recipe in her mother's own handwriting on a card gone soft and brown at the corners. She did it. 6 months. The scale never moved, and neither did her ALT. And she wanted me to tell her what was wrong with her. The woman in front of me has eaten pasta every day for 80 years with the exact disease I treat. Her liver should be scarred through. Her cholesterol should be off the chart. Her heart should have quit a decade ago. But she is 87. She is sharp. Her eyes are clear and quick. She has more energy at 7 in the morning than most of my 50 year old patients have all day. And when I watched her carry a full basket of olives up from the trees 2 days earlier, the thing I could not stop noticing was that she never once touched her side. I watch women with this disease all day long, every season of the year, and nearly every one of them rubs the spot under her right ribs without knowing she does it. I had stopped noticing it the way you stop hearing a clock in a room you have sat in too long. I had to ask. Her English was perfect. She had worked as a translator in Florence after the war, and again at the American embassy in Rome in the seventies. "Lucia, doesn't the pasta make your liver worse?" She stops eating. She looks at me. And she starts laughing at the earnest American doctor at her table. "Everyone worries about something. American women worry about bread and wine. We worry about something different." She wipes her hands on her apron and tells me to sit down properly, and then she looks at me the way I look at patients. Taking my measure. "You did not come all this way for an old woman's pasta," she says. "You came because something is telling you. The tiredness that sleep does not fix. A belly that will not go down no matter what you eat, and an ache here, under the ribs. The heart that pounds on the stairs. And the tests, always the tests, that say only a little high while you know you are not fine. Yes?" I nodded. And here is what I have not told my colleagues, because there is no honest way to tell this story without it. I have a fatty liver too. Diagnosed at 46. My ALT had sat in the 50s for 3 years, "slightly elevated" every time, and I had been taking milk thistle every morning for all 3 of them. My belly was hard by evening. I had put on 19 pounds I could not account for and I was asleep in a chair by 8 o'clock like a woman 20 years older. And that spring I had started to feel my own heart knock behind my ribs going up a flight of stairs I used to take 2 at a time. I told nobody. Not my husband. Not my own doctor. Because I know better than almost anyone alive what that knocking means, and I was afraid that saying it out loud would make it true. She leaned across the table and looked me in the eye, and she was not laughing anymore. "You are not crazy, and you are not lazy," she said. "Your body is telling you the truth. The doctors have not been listening. And you, dottoressa, you have not been listening to your own." She tapped the middle of her chest with 2 fingers. "And I will tell you the thing your doctors will not. You will have a heart attack. In 5 years, or in 2. The road is already under your feet. I have watched women walk it many times. I have washed their faces and buried them." I have said versions of that sentence to patients my whole career. Softened. Hedged. Wrapped in all the careful language we are trained to use so we never quite frighten anybody. I had never once had it said back to me. Plainly. Across a table. By a woman with no reason on earth to soften it. It went through me like cold water poured straight down my spine. She set her hands flat on the table. "I had a sister," she said. "Elena. 3 years younger. We were born in this house, in the room over our heads, in the same bed I still sleep in. When we were girls we did everything together. And then she grew up restless. She wanted America. At 22 she married a man from New York, and she left." She turned her coffee cup a slow quarter turn on the table. "Our mother stood at that door with a cup of warm whey from the morning's cheese, the way she had every morning of our lives, and put it in Elena's hands. And Elena set it back down on the table by the door and said, Mamma, in America there are real doctors. This is old fashioned. Then she kissed her and she went. 62 years ago, and I can still see her hand setting that cup down. "She had the same sickness I have. From our mother, both of us. And in America she did everything her doctors told her, and she was proud of doing it. She took her pills every morning for 30 years and never missed one day. And when a doctor told her the bread was her enemy, she was pleased to be modern about it. She threw out the flour. She gave up the thing she had loved most at every table since she was a child. "Every year she was heavier and more tired, and every year they gave her one more pill. And the tests always said she was only a little high. "She died in her kitchen in New Jersey at 64. Making coffee. On an ordinary Tuesday morning. Her husband was in the next room and heard the cup break. Her doctor told the family she was just getting old." She looked up at me. "She gave up the bread and she kept the disease. She starved herself of one small joy at her own table for 30 years and it bought her nothing. Nothing. Because the bread was never the problem. And you, dottoressa, you are walking my sister's road right now. Unless you turn, you will end where she ended. On the floor. With the coffee still warm on the stove." Then she got up, slowly, one hand on the table, and walked to the cool stone pantry in the corner. She came back with a clay jug, a small cup worn smooth from years of hands, and a brown pharmacy bottle with the label rubbed soft. What she poured was thin and pale, like water with milk clouded into it. I could smell it from across the table. Sour and sweet, like fresh cheese in a cold room. "Your doctors give you the thistle," she said. "The thistle only tells the liver to make one thing." She put her hand low on her own right side, just under the ribs, right over her liver. "The liver cleans itself. Here. Not in your stomach. Not in your blood. Here. And it cleans with its own soap, which it must make fresh every day." She let that sit. "The thistle tells the liver to make the soap. But the soap is made from something, and the thistle does not bring it. After 20 years of this sickness, the liver has nothing left to make it from. Quietly. It does not hurt. It does not show on the tests they run. It only slows. And when the liver cannot make its soap, 2 things go wrong at the same time. The fat is no longer cleared away, so it sits inside the liver and burns, and the liver scars a little more each year. And the liver begins pouring cholesterol into your blood, so it climbs, and climbs, and settles into the walls of the very heart you are so frightened for. Every hour. Every day. For years. "So the belly stays, and the cholesterol climbs, and one day the heart stops. That is what kills you. Not the bread. Never the bread." She set the cup down in the middle of the table between us, the way you place something into someone's hands. "This is what my mother gave us. The whey from the cheese. It gives the liver a little of what it makes the soap from. For my mother, one cup every morning was enough." Then she set the brown bottle next to it. "For me it was not. At 47 my belly swelled and I could not walk up this hill. The old doctor in Nuoro told me the cup is too weak once the liver has nothing left. He gave me these. 2 every day. 40 years now." Then she turned and pointed out the kitchen window, up the hillside behind the house, gold in the morning light. "You see the sheep on the hill, grazing between the tall thistles with the purple crowns? There are more sheep on this island than people. Every morning the shepherds make the cheese, and every morning the women drink what is left in the pot. The thistle tells the liver what to do. The whey gives it something to do it with. God put both outside our door. My mother taught me. Her mother taught her. Her mother before her, further back than anyone can count. For 700 years the women of this village have drunk this same cup. "Every woman here who lives past 90 with our sickness drinks it, and the ones whose livers got tired take the pills too. Every one of us. We do not worry about the bread. We worry about the liver. So the bread does not matter." I sat there and stared at her. Then I picked up the bottle and turned it to the light. Acetilcisteina. N-acetyl cysteine. NAC. I knew it the second I saw it. The same molecule I learned about in medical school, the one every ER uses when someone comes in with a liver failing from an acetaminophen overdose. I had only ever thought of it as the drug that saves a liver in one night. I had never once thought to use it on a liver failing slowly over 20 years. I have a medical degree. 12 years of practice. Hundreds and hundreds of charts behind me. And a woman who never saw the inside of a university had just described to me, at her own kitchen table, in words a child could follow, the thing it took me 15 years of journals to half understand. The soap she was describing is glutathione. Your liver makes it every day and uses it to clean up the damage inside every liver cell, and to defend and repair itself. Your liver makes glutathione from 3 ingredients. 2 of them are easy to get. The 3rd, cysteine, is the one your body is always short on. Without enough cysteine, your liver cannot make enough glutathione, no matter what you eat. Milk thistle, the silymarin in it, tells your liver to make more glutathione. That is all it does. It gives the liver no cysteine, so the liver gets the order and has nothing to make it with. That is why it never moves the numbers. A liver carrying fat for 20 years uses up glutathione faster than it can make more. Slowly. Quietly. It does not hurt. It does not show on a standard panel, because nobody orders a glutathione test. And nobody catches it, because the family doctor is watching the cholesterol and the hepatologist is watching the ALT, and the liver cell sits right in the middle doing the one job neither of them thought to ask about. So the milk thistle goes in every morning. The liver gets told to clean up. The lab prints "slightly elevated." And the cells never get what they need at all. That is the whole thing. It explains the belly that will not go down, because a liver choking on its own fat stores more than it burns. The cholesterol climbs no matter what she eats, because a fat-clogged liver pumps more of it into the blood. And the heart pounding on the stairs is the part that matters most. Most people with fatty liver never die of their liver. They die of heart disease, years before the liver would have gotten them. It is in the journals, and almost nobody tells the patient. Whey has a little cysteine in it. That is why the village tradition worked for women whose livers were still healthy. NAC is cysteine in its simplest form. Your liver takes it and makes glutathione with it. That is why Lucia's doctor gave her the pills when the cup was no longer enough, and it is why the ER uses it when a liver is about to fail. The answer had been sitting in Lucia's pantry for 40 years, right next to the jug of whey. I spent the rest of that week talking to every old woman in that village. Her neighbor is 92 and has drunk her cup of whey every morning since she was 18. She took me out to see her tomatoes, bent to pull a weed without a second thought and straightened up just as easily. Lucia's cousin Anna, late 80s, same disease, same brown bottle on the same kind of pantry shelf, takes her 2 pills after breakfast the way you would wind a clock. None of them on a st*tin or a beta blocker. Every one of them eating bread and pasta at every meal of their lives. The healthiest livers I have examined in 12 years, and I found all of them on one hillside, and not a single one of those women has ever counted a carb. And Lucia's village is not alone. In the 1700s and 1800s, people traveled to Swiss mountain spas for weeks-long whey cures. Icelanders drank the whey left over from skyr for centuries. In India, a glass of buttermilk after lunch is still a daily ritual in millions of homes. These places never spoke to each other, across continents and centuries, and they all landed on the same cup. In medicine, when separate traditions arrive at the same conclusion with no contact, we take that very seriously. The morning I left, Lucia walked me out to the car. She put a wrapped loaf on the passenger seat, still warm through the cloth. Then she held my hand and did not let go. "Do not be like Elena," she said. "She thought the old thing was a small thing. Feed the liver, dottoressa. Every morning. And come back and see me." I cried in a rental car on a mountain road in Sardinia, and I am not a woman who cries. I started that night in my own kitchen, still jet lagged, with plain NAC pills from the pharmacy, the same kind as Lucia's. A month later my ALT had not moved one point. Lucia had 40 years of whey and pills behind her. Her liver had never gone without. Mine had gone without for years, and plain NAC barely gets into the body. Stomach acid destroys most of it. Only about 6 to 9% reaches your blood, and each pill was 600mg, half the dose used in the research. I did not have 40 years to wait. So I switched to the full 1,200mg, in a form made to get past the stomach. And I switched scared, not hopeful. Because I had just spent 2 weeks being told by an 87 year old woman that my heart was on a clock, and the worst part was that everything I know about medicine said she was right. Week 1. On day 5 I noticed my waistband at 7 PM. 3 years of quietly unbuttoning my pants under the dinner table. I stood in my own kitchen pressing on a stomach that was soft for the first time in years, like it belonged to someone else. Week 2. No nap after lunch, and energy at 4 in the afternoon for the first time in years. I unloaded the dishwasher after dinner instead of going straight to the chair. My husband asked me twice if something had happened at work. Week 3. This is the week that matters, and I braced for it. Every drugstore supplement I have ever recommended to a patient quits at week 3. The small lift fades, the symptoms come roaring back, the bottle goes into the cabinet with all the others. Nothing faded. Nothing came back. The flat stomach held. The energy held. My liver was finally getting what it needed. Week 4. Down 11 pounds without changing one thing I eat, most of it from my middle. The dull ache under my right ribs, the one I had been rubbing for 3 years, was gone. I took the clinic stairs 2 at a time and my heart stayed where it belonged. First night in a year I did not lie in the dark listening to my own chest. A colleague stopped me in the hallway and said, "Did you do something different? You look younger." Week 8. ALT down 31 points, back in the normal range for the first time in 3 years. My own doctor read the panel twice and asked me what I had changed. The number I have spent my whole career watching, moved by 2 capsules at dinner. And my mind stayed sharp through a full clinic day for the first time since my 30s. I sat in my office with my own results on the screen and I thought about the woman with the 3 ring binder. Before you go trying to put this together yourself, please don't. I tried. I am a doctor with access to everything and I could not do it. The whey protein powder at the grocery store is heated during processing, and the heat wrecks the cysteine in it. What you are drinking is a milkshake with a label on it. And the plain NAC on the pharmacy shelf is what I wasted my first month on. The one I use now is a small company called Orvia Labs. One ingredient. 1,200mg of NAC, the full dose the research uses. Not the 600mg in the drugstore or on Amazon, and not a blend of a dozen liver herbs and fillers at token doses. Liposomal, which means every dose is sealed inside a thin layer of fat, the same material your own cell walls are made of, so it gets past your stomach acid and is carried to the liver. Made in the USA and third party tested for potency and heavy metals. 2 capsules with a meal. That is the entire routine. No phases, no meal plan, nothing to count. And before you do anything else, hear this part. You keep taking your medication. This did not replace anything my doctor prescribed and it should not replace yours. Your st*tin, your M*tformin, your blood pressure pill: each one handles its own job, and does it well. The job nobody has been handling is the one inside your liver cells: giving your liver what it needs to make glutathione, the soap it cleans with. Your medication does its part. This lets your liver do its own. They work together. You keep your prescriptions. You add 2 capsules with a meal. That is it. Try Orvia for 90 days. Weigh yourself every Sunday morning and measure your waist at the belly button. Ask your doctor for a liver panel at day 60 and put it next to your old one. If you don't see the change on the scale, in your energy or on that panel, you get every dollar back. No questions, no fight. They run up to 40% off on the bundles and the 90 days covers all of it. Now here is what makes me furious. Fatty liver sits in roughly 1 in 3 American adults. It raises the risk of a heart attack, and most of the people carrying it have no idea. If a disease that common were killing people in a way anyone could see, there would be national campaigns. Insurance would cover a yearly liver scan for everyone over 45. Cardiology guidelines would be rewritten every year. But this one is quiet, and it happens to people who have been told they are only "slightly elevated." So instead we tell her to give up bread, to try low-carb for 6 months, to lose weight, to consider an antidepressant. We hand her a diet book and tell her to come back in 6 months while her liver keeps falling further behind. There are pills I can adjust for her cholesterol, her blood sugar and her blood pressure. There is not one standard protocol anywhere in mainstream liver medicine for giving her liver what it needs to make glutathione again. Not one. We don't even test for it. I am done with that. And if you have spent a decade being told that cutting carbs would fix what is wrong with you, and it hasn't, you should be done with it too. Your labs say "slightly elevated," you still feel sick, and every doctor tells you it's your age. Your belly has grown no matter what you eat. You have already given up bread and sugar and wine and 7 other things, and you still feel terrible. Your cholesterol creeps up at every annual visit, your heart pounds on 1 flight of stairs, and the ache under your right ribs has become something you just live with. You have stopped looking at photographs of yourself. And it has cost you more than energy. Mother's Day, too tired to even go for a walk. The grandkids on the go all afternoon while you watch from the couch. The jeans you stopped trying on, and the dinners you sit through with a plastic container. Waking up after 9 hours in bed and wanting to crawl back in. Most days you do not feel like yourself anymore, and you are starting to wonder if you ever will. Listen to me. You are not crazy, and you are not lazy. The exhaustion, the belly that will not go down, the pounding on the stairs, the thinking through molasses: every bit of it is real. Your liver has been told to clean itself this whole time with nothing to clean with, and your body has been paying for it every day for years. Cutting carbs will not fix that, and neither will cutting fat or sugar or wine. Your family doctor will not find it, your ALT will not explain it, and milk thistle and normal liver supplements will never fix it. I spent 12 years proving all of that, and I proved the last part on myself. You were doing everything almost right. One step was always missing. You are standing at a crossroads. I have watched hundreds of women stand exactly where you are standing. One road. You keep the milk thistle. You keep giving up foods that were never the problem. You watch the belly grow anyway. The st*tin arrives when the cholesterol goes up, a beta blocker follows when the pulse climbs, and an antidepressant comes when the exhaustion finally breaks something in you. 20 years of collecting bottles and food rules while the actual problem never once gets touched, and every test says you are only a little high, right up until an ordinary morning in your own kitchen with the coffee still on the stove and someone you love in the next room. The other road. You take care of the one thing nobody has been watching. You give your liver what it needs to make its own soap again. You wake up after a night's sleep and actually feel rested. A waistband that fits at 7 PM, and clothes that fit sitting down. The word you were reaching for, right there when you need it. Stairs that are just stairs. A pulse under your own fingers that does not scare you. Energy left at 9 PM after a whole day out on your feet. The bread we all love, back on the table again. Photographs you don't flinch at. And finally, the feeling of being yourself again, full of life, the way you were before anyone told you it was just your age. I chose the second road. Your family doctor is not looking inside your liver cells, your cardiologist is not looking at your liver at all, and nobody has ever tested your glutathione. Every day without this is another day the fat sits and burns, the cholesterol piles up and your heart does the extra work. The heart attack at 64 scares me. The 10 years before it scare me more. Every month you wait, the fat sits in your liver for another month, the scarring creeps further, and the things you were saving for "when I feel better" quietly stop being options. The trip you keep putting off. The dance at your granddaughter's wedding. Being the grandmother down on the floor playing, instead of the one watching from the chair. Those grandkids are going to grow up either way. The only question is whether you have the energy to be in the middle of it. Lucia is 87 years old. She is boiling pasta this morning in a copper pot in a stone house on a hillside, alone, sharp as a blade, with the same disease you and 1 in 3 Americans have. She is never going to die of a heart attack at 64, because she takes care of the one thing every grandmother in her village has known about for 700 years, and an American doctor had to fly across an ocean to be told it. You do not have to fly anywhere. You just have to stop giving up the bread and start giving your liver what it needs. Your next blood test is already on the calendar. Give your liver 60 days of what it needs before then, put the 2 panels side by side, and watch your doctor read it twice. You can start with tonight's dinner. One last thing. Orvia Labs is a small company and they don't sell on Amazon. There are listings on there borrowing their name. If you want the real one, order from the link below. Check if it is in stock 👉: https://orvialabs.co/products/nac-liposomal P.S. A waistband that fit at 7 PM by day 5, after 3 years of unbuttoning under the table. Down 11 pounds by week 4 without changing a thing I eat. ALT down 31 points at week 8, the number I have spent my career watching. And a pulse I can finally take without being afraid of it. Your body will run its own timeline. But it cannot start one until you do. P.P.S. My patient Patricia started 4 weeks after I did. She is 58, 9 years with fatty liver, 3 years strictly low-carb, and her doctor had started using the word "FibroScan" the month I got back. At her last visit her ALT was down 28 points, her doctor asked her what she had been doing, and "recheck in 6 months" had become "see you next year." She said, "3 years without bread, and my liver was starving the whole time." She ate pasta at her granddaughter's birthday last month, first time in 3 years, and she sent me a picture of the plate. Neither of us is ending up on a kitchen floor at 64. Neither should you. P.P.P.S. Whether you never touch alcohol or enjoy a glass of wine with dinner, this still applies. Most of my patients drink little or nothing. The fat in your liver uses up glutathione either way. P.P.P.P.S. If you have a husband, a father or a brother with a fatty liver, this works the same way for him. My own husband takes his 2 capsules at dinner with me. The mechanism does not care how the fat got there. P.P.P.P.P.S. I am 53 years old. I am a hepatologist with 12 years of practice and this disease myself. The face in the mirror this morning is the face I had at 41. If you have spent the last decade giving up food after food and watching your liver numbers climb anyway, I am writing to tell you it was never the food.