Is slow the best speed for fatty liver weight loss?

Dr. Keith Roach M.D.

DEAR DR. ROACH: I have had fatty liver for the past 10 years. To reverse it, I am trying to lose weight. Now I am 116 kilograms. I have heard that if someone has fatty liver and wants to lose weight, they should not lose more than 1.5 kg per week. This week, I lost 3 kg. What is your advice? -- A.A.

ANSWER: The advice against too much weight loss too quickly was based on an observation that some people rebounded their weight after losing it. Newer studies have not confirmed that. In fact, people with large amounts of weight loss (more than 2 kg in the first four weeks) have been shown to have a better chance of keeping the weight off. If you are losing weight due to healthier diet and exercise, I would advise continuing those behaviors and not worrying about losing too much too quickly.

Any kind of weight loss can temporarily increase the risk of gallstones. Having some sources of healthy fat in the diet (such as nuts or avocados) will decrease this risk.

Early on in the first few weeks of weight loss, especially in people using a higher fat diet, much of the apparent weight loss is by loss of water associated with glycogen stores.

DEAR DR. ROACH: What is an epiretinal membrane? My doctor says I have this but it is not bad enough to be treated. I am 86 years old, and my vision is blurry. How would this be treated? -- T.V.

ANSWER: An epiretinal membrane, also called a macular pucker, is a thin layer that forms over the retina at the back of the eye. It is semi-translucent, and as such can cause loss of vision or visual distortion. They are common and occur more frequently in older individuals. Most of the time, they do not require treatment. They can form for no particular reason, and these are usually asymptomatic. However, an epiretinal membrane can form after certain eye conditions, especially retinal detachment. It's possible for it to attach to and pull the retina, causing distortions in the vision. It may also decrease vision when it is thicker and interfering with the function of the retina.

The only treatment is surgery. The decision to perform surgery is made by how much the vision is affected. Although surgery is relatively safe and usually effective, there are possible complications. Most eye doctors do not rush to surgery, except in less-common cases where there is swelling in the most critical part of the retina (called the macula) for central vision. People whose epiretinal membrane gets worse, or who have the kind that can pull the retina out of shape, may also require surgery.

DR. ROACH WRITES: A recent column on pneumonia vaccines contained an error: I said that the 13-valent conjugate vaccine, Prevnar, was a 2-dose series. It is a single dose. Many people get both the 23-valent polysaccharide vaccine, Pneumovax, as well as the 13-valent Prevnar, but my column misstated this. I appreciate my sharp-eyed colleagues who wrote in to correct this.