NATURALLY HEALTHY: Insulin resistance can lead to fatty liver disease
In my clinic I am seeing more people being diagnosed with fatty liver or non-alcoholic fatty liver disease (NAFLD). It is a part of the spectrum of non-alcoholic fatty liver disease that ranges from fatty liver to cirrhosis. Ten-20 per cent of North Americans have this type of fatty liver without any inflammation.
NASH: non- alcoholic steatohepatitis is a part of this spectrum of NAFLD that also has inflammation of the liver. It is the most common form of progressive liver disease. NAFLD should not be treated as completely benign as it can sometimes lead to NASH which can progress to cirrhosis. In a patient whose liver enzymes keep climbing I would treat aggressively.
NASH does set the stage for liver damage and the cellular features of alcoholic or non-alcoholic liver disease are identical.
Diagnosis is made when liver enzymes are high and the following are ruled out: negative for hepatitis, don’t take medication that can raise liver enzymes such as diltiazem, corticosteroids and tamoxifen, have not had extreme weight loss, no excessive alcohol exposure and have not been exposed to organic-solvents.
Fatty liver is also diagnosed on xrays and imaging studies. A liver biopsy is the most conclusive test. Most of the patients I am seeing are like Andrew, age 55, who is obese, with elevated blood sugars and has insulin resistance which is the most common cause of fatty liver. Andrew is pre-diabetic meaning that his blood sugars are close to seven mmol/L and his fasting insulin levels are also high but his hemoglobin A1C is below 7.0. His doctor has told him that he has a fatty liver based on his blood work and an ultrasound of the liver.
Andrew’s GGT was over 100 U/L, his ALT was 75 U/L and his AST was also in the above 70 U/L. I explained that an elevated GGT has been shown to relate to the liver’s inability to make adequate amounts of glutathione in the mitochondria of the cell. Glutathione is a powerful antioxidant that helps the liver process large number of toxins from inside and outside the body. I explained that magnesium, B vitamins, cysteine, glycine and glutamic acid are some of the building blocks of glutathione that would help improve his liver function and lower his liver enzymes.
Another test that is helpful to evaluate NASH is homocysteine, a protein in the blood that becomes elevated when the body is deficient in B2, B6, B12, and folic acid. Andrew’s was at 15 and the optimal level I was looking for was between five to seven umol/L.
I also reviewed my “Foundation of Health” with him: gut health, deficiencies and diet and lifestyle. Leaky gut and flora imbalances have been found in 50 per cent of NASH patients. Deficiencies of magnesium, B vitamins and essential fatty acids promote inflammatory pathways in the liver. There are also wonderful antioxidant herbs for the liver as well as for the insulin resistance. I put Andrew on a good long term nutritional program. However, the most time I spent with Andrew was teaching him how to correct his insulin resistance. I recommended that he read “The Wheat Belly” by William Davis, MD. I have recently heard Dr. Davis speak. Particularly about how he treats the sickest of patients in his cardiovascular practice and turns them around with this diet. Getting a lot of the carbohydrates, in the form of grains, out of the diet is a wonderful way to reverse insulin resistance.
Andrew’s waist came down from 45 inches to 37 inches over a period of one year by following the recommended diet changes and nutritional remedies. Along with the weight loss came also the reduction in the liver enzymes, homocysteine and insulin.
One of the best benefits Andrew has enjoyed is much improved mental clarity now that his liver is working better. He has lost his fear of dementia for now. He has also significantly reduced his chances of having a cardiovascular event as well as preventing cirrhosis of the liver.
Dr. Ingrid Pincott, naturopathic physician, has been practicing since 1985 and can be reached at 250-286-3655 or www.DrPincott.com