Dr Raese Khan Gastroenterologist and Hepatologist.

20/12/2025

FATTY LIVER !

when you see a fatty liver on USG report , your radiologist compares the brightness /echogenicity of your liver

with respect to your spleen , kidney , diaphragm and then reports it as grade 1- 2 or 3 Fatty liver.

This grading is not specific and we need to know the exact grade of fatty liver by Fibroscan.

The common misconception is that fatty liver means our liver gets covered with fat.

There are Liver cells called hepatocytes and when more than five percent liver cells have fat in them -

it qualifies for the definition of fatty liver.

Suppose there are 100 liver cells , if more than 5 cells get filled with fat globule/ droplet it defines fatty liver.

Grade 1 - means 5 to 30 liver cells having fat droplet in them.

Grade 11– means 30 to 60 liver cells having fat droplet in them.

Grade 111— means more than 60 liver cells having fat droplet in them.

The question remains why should we worry about this fat droplet in our liver cells ?

The liver cell one presumes is like a small pea !

When it is filled with fat droplet this pea size it may remain like this or the

liver cell swells up and becomes like a grape!
🍇 ( this stage is called steatohepatitis ).

When this swelling persists long enough, this grape like swollen liver cell starts shrinking
and becomes like a green raisin ( kismish)

- the one with some moisture in it !

( this stage can be compared to early fibrosis F1-F2 stage) .

When the cell remains like this without any intervention in the form of life style modification and medication-

This green raisin like cell further progresses to the stage where it gets further shrunken and become like a dead / dry( raisin )

A stage compared to F3-F4 fibrosis!

At this stage we say that cirrhosis liver has developed and here it is irreversible!

Once cirrhosis liver sets in - it may remain compensated for years and finally decompensation starts-

Decompensation features are :

1. Fluid in abdomen ( ascitis).

2. Vomiting of blood or blood in stool( red or tar coal like ).

3. Yellowish eyes ( jaundice).

4. Recurrent drop in consciousness ( encephalopathy)

5. Drop in hemoglobin/ WBC and Platlets ( pancytopenia)

Therefore the goal is not to start treatment on ultrasound findings of Fatty liver.

But to check if it is simple fatty liver ( pea type liver cell with fat droplet) or

The liver cell with fat droplet has swollen like a grape 🍇

Where swelling can be reversed by lifestyle changes and medcine.
Or

It has progressed to the stage where this grape like swollen cell has shrunken to green moist raisin.

Or

This green moist raisin has further progressed to the stage of dry dead raisin ( F3- F4)

19/12/2025

GOAT or SHEEP MEAT !

Is it the time to shift from the Sheep to Goat meat. ?

GOAT MEAT :

Fat Content: Leaner, typically 3-7g per 100g.

Calories: Lower, around 110-130 kcal per 100g.

Good For: Weight loss, leaner protein intake.

Sheep Meat :

Fat Content: Richer, often 9-18g or more per 100g.

Calories: Higher, around 200-240 kcal per 100g.

Good For: Weight gain, rich flavor, heartier meals.

18/12/2025

STOMACH ULCER!

Unlike Duodenal ulcer- stomach ulcer once diagnosed needs to be

checked again after 8 to 12 weeks with repeat endoscopy.

There are some percent of stomach ulcers that turn into cancers later on.

We have to follow patients very closely after diagnosis stomach ulcer.

This patient is as diagnosed with stomach ulcer in 2022 and was given H Pylori treatment.

He was advised to repeat endoscopy after 8 to 12 weeks.
Since he improved he stopped following the doctor.

Now this month he is diagnosed with stomach cancer at the same site where these ulcers were seen in 2022.

16/12/2025

PUMPKIN 🎃!

Boiled pumpkin and garlic strained for few hours !

Mixed with curd , honey , almonds , cumin , raisins.

Excellent for GUT health !

15/12/2025

15/12/2025

FATTY LIVER and LFT

Upto two-thirds of patients with fatty liver , including those with advanced fibrosis

or cirrhosis, have normal serum aminotransferase levels.

Serum ALT levels do not correlate well with the histological severity of fatty liver.

There is a poor correlation between LFT and severity of Fatty liver disease.

Therefore If you have a fatty liver on ultrasound or you are a diabetic don’t be happy that your LFT is normal.

Check whether your liver is having simply fat in the cells or there is stiffness ( swelling) or fibrosis.

There are many clinical parameters to check this
Like APRI - AST /ALT ration and many othe parameters.

You just need a Google calculator to check your liver health 👇👇👇

14/12/2025

COST - EFFECTIVE investigation !

Always make a clinic assessment of positive predictive value of the investigation you advise!

Be specific and relevant!

Always convey what you want to know by ordering the investigation!

Clinical judgement saves money , time and efforts of your patient!

14/12/2025

GROW your own food —

Growing your own food is like printing your own money.

13/12/2025

FATTY - LIVER !

12/12/2025

Staying in Kashmir during winters !

Why we leave for warm places !

Is winter too bad ?

Nothing grows in a comfort zone except fungus and mould !

Comfort brings decay !

Cold weather is not our enemy it is the nature’s mechanism to overall us !

Body exposed to some degree of cold weather is actually reinforced to trigger stress and protective mechanism!

Our body starts upregulation of Cold - Shock proteins ( cSP)

Moderate amount of physical stress in the form of cold weather throws our body into survival mode!

It induces the production of brown fat - a health fat to protect against the cold climate !

Cold exposure has been shown to reduce chronic inflammation, enhance antioxidant defenses, and improve metabolic health by activating brown adipose tissue.!

Cold exposure increases energy expenditure

and whole body glucose and fatty acid utilization !

lower fasting glucose and insulin levels and improve dietary fatty acid handling !

At the biochemical level, whole-body exposure to cold triggers a release of neurotransmitters

such as serotonin, cortisol, dopamine, norepinephrine, and β-endorphin

These play a crucial role in emotion regulation , stress regulation and reward processing !

Chronic exposure to cold conditions induces structural and functional adaptations in the vascular system,

including increased vascular wall thickness and improved endothelial function,

which enable more effective regulation of blood flow and blood pressure !

Acute cold exposure can increase the risk of myocardial infarction and stroke!

However, Prolonged cold acclimation has been associated with significant cardiovascular health benefits —

adapting to cold environments enhances cardiac pumping efficiency and vascular elasticity,

thereby reducing the risk of cardiovascular diseases —lower resting heart rate and blood pressure

Cold shock proteins induced by exposure to cold weather repair cell membrane damage and oxidative stress !

One of the major mechanisms for weight loss is bathing in cold water!

Athletes who train by swimming in cold water have to increase their calorie intake by many times to maintain their body weight !

COLD is not our enemy- it is the nature’s way to throw our body into the protective mechanism which is overall beneficial for us!

Remember Less is more — avoiding overexposure to cold — slow , graded exposure to make our body adapt to the cold weather is the key !

One can start with a graded exposure by covering face in order to avoid breathing in cold air and start exposing gradually himself to cold environment.

Comfort brings decay ! Leaving Kashmir for warmer places is not the solution!

Our ancestors survived ice age —— we share their genes and gene memory—

We only need to remind our genes Who we are.

12/12/2025

VITAMIN - E ——— in fatty liver !

You prescribe vitamin E when you see patient’s ultrasound showing fatty liver!

Ask yourself why you prescribed it ??

Do you want to remove this fat from liver cells by giving vitamin E to patient ?

If yes —— How long will you tell patient to continue it ?

Do you expect vitamin-E to take out fat from liver cells?

If yes - then how long will you tell patient to continue it - what is the End point of your treatment?

How much money is the patient going to spend on this treatment to remove fat from liver cells?

And is that much of spending worth it?

Vitamin E is indicated in fatty liver only when we have confirmed that it is not a simple fatty liver !

But there is swelling of liver cells ( Steatohepatitis) !

The goal is to reduce this swelling by adding vitamin E !

Don’t prescribe Vitamin E for simple fatty liver on ultrasound!

👇 this patient was prescribed vitamin E and each 10 tablet strip costs 500 rupees

12/12/2025

LEG MUSCLES — are the key !

They are the largest muscle group of our body.!

If your legs are strong - you will be protected against dementia in old age!

Leg muscles will regulate your blood sugar and protect against diabetes !

Strong legs protect you against fall and fractures in old age !

Good Muscle mass helps early recovery from infections like pneumonia!

After 40 years of age - muscles get infiltrated by fat and there Is reduction of muscle mass every year !

And by 60 years of age we are left with little muscle mass !

therefore susceptibility to infections, fall , fractures , memory loss etc !


How to maintain Strong Legs 👇👇

Don't STOP WALKING.

There are many experts who attribute walking to weight loss.

This is a paradoxical attribution.

They make people believe that the only reason a person should walk it to lose weight.

Let me clear some issues here.

Walking is not synonymous with weight loss.

If your weight is normal , WALK .

if you aren’t losing weight , WALK, don’t stop walk.

Sedentary lifestyle is an independent factor for mortality, therefore one should not stop walking if either weight is normal or not decreasing.

Many individuals whom I observe have stopped walking

because they found that their weight isn’t decreasing and they think it is futile to continue it.

They aren’t at fault ,

the actual blame is on experts who feed them that walking is an activity for weight loss.

Sarcopenia ( loss of muscle mass) is an independent risk factor for poor health and mortality.

Walking irrespective of weight loss strengths our muscles especially the large muscle groups of body (LEG and BACK.)

Walking improve GLUCOSE homeostasis ,

muscles are able to take up glucose from blood thereby decreasing the blood sugar levels.

Walking stimulates our body muscle , increasing glucose utilisation and decrease the dose of Medciine required.

Walking decrease BLOOD PRESSURE.

Walking is a shield against osteoporosis .

Sedentary lifestyle decrease bone mass , hastens osteopenia leading to premature osteoporosis.

We all know that with age our muscles are infiltrated by FAT , this reduction of muscle mass is harbinger for disease and debility.

Walking tones up our muscles , reduces fat infiltration, maintains muscle mass.

Walking decreases the levels of STRESS hormone ( cortisol).

Walking promotes the release of ENDORPHINS from brain , the chemicals which acts as antidepressants.

Endorphins are natural opioid chemicals , they elevate our mood and help in relaxation.

So Next time experts tell you , WALK to reduce Weight

and you feel you aren’t losing weight despite walking

just Chill and continue WALKING.

There are enormous benefits other than a weight loss

The concept of MORNING/ EVENING WALK is obsolete now.

There is no specific time , whenever one is free just start walking.

Ideal physical activity is 300 minutes walk per week.

Plan a long walk on Sundays ,

for rest of the days walk for 10 , 15 , 20 or 30 minutes a day either continuously or in phases as per your convenience.