Your liver could be an alcoholic even though you are not!
One doesn’t have to be an alcoholic to acquire liver
disease. As a matter of fact, more people in the United States are diagnosed
with Non-Alcoholic Fatty Liver Disease (NAFLD) than Alcoholic Liver Disease
(ALD). Thirty percent of the population is affected, it is often asymptomatic
and may not be detected! The clinical picture ranges from no symptoms at all to
discomfort in the area of the liver, fatigue, poor quality sleep, obesity with
abdominal (brown) fat and abnormal blood tests.
So how does this happen? The liver is the master filter of
the blood stream, pulling out toxic chemicals, extra hormones, metals and excess
sugars. It’s a complex set of processes that essentially require the liver have
a store of materials to pull from, creating the protective network that is
essential to life and health.
Risk factors abound for NAFLD. The usual suspects include
diabetes type 2 (what we associate as adult onset), obesity, high lipids in the
blood (elevated cholesterol and triglycerides) and insulin resistance/metabolic
syndrome. Other risk factors that may not be as evident can lead to the
deposition of fats in the liver as well, these include: celiac disease*, drug
use (steroids, aspirin, AZT, calcium channel blockers, synthetic estrogens and
others), surgical gastric procedures for weight reduction, a few genetic
diseases (Wilson’s, Weber-Christian), and environmental/work toxin exposure
(benzenes, toluene, styrene, hexane, vinyl chloride, and others). Stress is
often not identified as part of this inflammatory cascade, however,
adrenal-stress leading to hypercortisolemia is a potent stimulator of chemical
injury and should not be overlooked. Cortisol levels are implicated in many
neuro-endocrine disorders such as insulin resistance, inflammation and obesity,
at a minimum.
Current
belief is the progression of this pathology begins with a sensitivity to too
much sugar in the blood stream that is not accessing the cells for proper energy
usage. Excess sugars are stored in the liver in the form of fat as a reserve
for periods of starvation. Insulin levels are high in insulin resistance, the
cells are not receptive to the insulin knocking on the door of the cell wall to
deliver the glucose-energy needed for normal cell-life. Resulting fatty
storage, oxidation of fatty acids and decreased release of liver storage of
triglycerides occurs. There is increased stress in the cells causing fats to
transform into harmful bad fats, resulting in release of cytokine chemicals of
inflammation. Fat storage, inflammation, liver cell damage, scar tissue and
liver cell death ensue. Liver cell death is a normal, pre-programmed event. A
healthy liver cell lives out its life and at an appropriate time is replaced by
a copy of itself (hepatocyte). The amount of chemical-oxidative stress from
injurious substances interrupt the normal copying of a mature hepatocyte,
resulting in malformed cells that mimic healthy liver cells but actually form scar
tissue which can progress to liver/hepatocellular carcinoma.* Besides all of
this, complications with other organs can be contributors to NAFLD. Increased
gut permeability (AKA leaky gut) in infection, autoimmune inflammation, food
sensitivities/allergies, alcohol consumption and the standard American diet
(SAD) can be part of the bigger picture. Small intestine bacterial overgrowth (SIBO)
is identified as a condition debated by scientists where a specific microbiome
toxins are linked as a key player in NAFLD*. SIBO results in increased bacteria
that stimulate the immune response causing inflammation throughout the body but
more specifically local liver inflammation and damage.
Diagnosing NAFLD includes measuring alcohol consumption.
Less than 20 grams of alcohol per day is a key factor. One standard drink
contains 10 grams of alcohol, one average beer, a small glass of wine (3 ½
ounces) or a nip of spirits (1 ounce). There are conflicting reports regarding
alcohol consumption in NAFLD, although generally avoidance is recommended, “moderate
use of alcohol is thought to reduce the risk of cardiovascular disease, but not
for those with NAFLD.”* ALD, by comparison, results in hepatocyte swelling and
Mallory bodies inside the cell (alcoholic hepatitis), fibrosis of the activated
(stellate) cells and fibroblasts. This evolves slowly into alcoholic cirrhosis
of the liver. RSNA.org reports MRI imaging and CT scans show promise for
evaluating the amount of liver fat accumulation.*
Blood and serum testing include the liver transaminases (AST,
ALT, GGT), triglycerides, HDL-c, fasting insulin, C peptide, HOMA-IR, IL-6, and
serum zonulin. All of these markers are higher in the NAFLD group than in
controls according to a study done by Hendy in 2017. Salivary hormone tests for
cortisol and DHEA are useful in identifying a disruption as well as tracking
progress over time.
At home, a simple waist circumference test could indicate
storage of the visceral (bad) fat accumulation on the frame. Measuring at the
waist level where the naval would naturally be (not when it has dropped in an
obese form) will inform as to whether the healthy woman is less than 35 inches
and man is less than 40 inches.
The good news is that the liver has an uncanny ability to
repair and regenerate, given optimal circumstances! Of course, there is always
the chance one has waited too long, is un/mis-diagnosed, is unable to implement
adequate lifestyle changes. The opportunities for restoring health requires an
intimate conversation covering all the facts in the case and the resources
available for change. The two primary approaches include avoiding alcohol and/or
other liver-offending substances and implementing the Mediterranean Diet plan.
In 2015 Malhotra discovered that a diet low in high fructose corn syrup decreased
fibrous tissue changes of the liver, and subsequently others (Jensen,
DiNicolantionio and Chen) found NAFLD is driven by HFCS and sugar. Monosodium glutamate
induces liver fatty changes and the viscera*.
Treatment considerations point to reducing inflammation which
causes cellular injury, correcting the insulin resistance and repairing the
gut. Naturopathic medicine and Functional medicine approaches healing the cells
by changing the diet and lifestyle. Addressing the vis, the core energy
creating healthy and well cellular activity, incorporates mindfulness, dietary
habits, appropriate levels of physical activity, nutritional supplementation
and reducing environmental exposure. Weight loss, normalizing blood fats and
sugar via the diet, stress management and supplementation have the greatest
impact of all and offer solutions to nearly everybody without investing in
expensive interventions.
- A slow, steady weight loss
not exceeding 3 ½ pounds a week for adults to reach a total of 10%
reduction of body weight is the first goal.
- Avoidance of alcohol, added
sugar, fructose, soda/pop, artificial additives and preservatives.
- Food choices within the
Mediterranean Diet fit the program, generally, although some may need to
modify this diet, such a Celiac eliminating wheat/gluten. It is felt that
the NAFLD individual is better off eliminating all gluten and grains as
well as starchy vegetables. A high protein and vegetable diet with a low
glycemic load and frequent small meals seems to work best.
- Nutrients to correct
glucose, insulin and fat in NAFLD: alpha lipoic acid, B complex, Chromium,
Zinc, Magnesium, Manganese, Vanadium, Betaine HCl, N-acetyl Cysteine,
Vitamin E and probiotics (order ProBio SAP on https://us.fullscript.com/welcome/drnancydoreo). Robust antioxidant levels are beneficial. Vitamin
D levels, when low, can cause poor response to treatment or increased risk
of fibrosis.
- Herbs to support liver
function: Green Tea, Black Tea,
coffee. Herbal choleretics and addressing
the cortisol/DHEA levels are also crucial factors. Mahonia, Cynara,
Silybum, Taraxacum, Cichorium and Curcuma longa. Mixed carotenoids
(lycopene, beta carotene, alpha carotene and phytoene/phytofuene).
Addressing chronic disease is a big project and requires support
and direction. Please research, learn and make informed decisions in your
health care. After all, no one knows you better than you!
Are you looking for some help with NAFLD? Contact Dr. Doreo
for a consultation to see if you are a fit for the scientifically natural approach
she uses in restoring health through Science-based Nutrition.
Yours in Health and Wellness,
Dr. Doreo
Resources for nutritional supplements: https://us.fullscript.com/welcome/drnancydoreo
https://drdoreo.metagenics.com/ https://klaire.com/
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