### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hello Dr. I am 60 yr/old male and have been diagnosed with fatty liver disease approximately 30 years ago. my weight fluctuates between 220 lbs and 26% body fat to 325 lbs. and 48% body fat over a repeating 3 or 4 year cycle. I am Bi-Polar; and my weight fluctuates depending on what medications I am able to take and the amount of sleep I am receiving, due to severe sleep apnea ( I have a Bi- Pap unit but only within the past 9 months (new model) in the past 10 years have I been able to use it due to nasal and palate restriction in my airways complicated with central sleep apnea. I do not have any history of even moderate alcohol use and I have never done drugs. Should I be looking for a more aggressive treatment for protecting and or helping my liver to regain any potentially lost function. When I take Liv 52 4 caps per day my liver functions (ALT AST) come back normal; when I don t they are elevated. my weight is currently on the losing curve and I am down to 269 lbs and 36% body fat. I am fairly stable with 1 amitriptyline 25mg and 1 2mg klonopin a day. Is metadoxine a possibility. Thank You

### output:

HelloWelcome to Chat Doctor Dear patient, since you have never consumed much alcohol, so your fatty liver is least likely to be related to alcohol consumption, however it may be related to your weight as your body fat ranges from 35% to 48% and more over you are having OSA for which you are using BiPAP, which is again related to your obesity. So in your case metabolize which is given for fatty liver due to alcoholism will not be of much benefit, you better concentrate on losing weight by avoiding high fat and high Carrie diet, doing regular exercise especially aerobic exercises and avoiding any alcohol and smoking and hopefully when you lose weight your fatty liver as well as OSA will improve wish you good luck thanks Chat Doctor. 