Threats to Your Liver – Health and Wellness Clinic in Carmel IN
Blog by -Dr. Bruce Thomas, MD at Health and Wellness of Carmel IN.
When you think of your liver, the most famous detox organ of the body and what might hurt it; the things that may come to mind are alcohol and hepatitis. But fatty liver aka hepatic steatosis really tops the list. That affects approximately 25%-35% (1) of the general population.
But wait, doesn’t fatty liver come from alcohol?
Yes, it can.
But 25-35% of the general population? That’s lot more than have trouble with alcohol. When people have fatty liver and it’s not from alcohol, that’s called Non Alcoholic Fatty Liver Disease (NAFLD).
Most people who have it don’t know it because usually there are no symptoms or they have nonspecific symptoms like fatigue. While it can elevate liver enzymes, it doesn’t always. The most common test for it is a liver ultrasound. This test can give a good estimate of whether a person has it or not.
But it doesn’t do a good job telling if a person’s liver is scarred, if it has fibrosis. If it does, then the new name is Nonalcoholic steatohepatitis (NASH). Transitionally knowing this has required a biopsy but there is a new test called a Fibroscan, which is an even better ultrasound that can estimate what a biopsy might show.
Between 5% and 12% of people with NASH will progress to cirrhosis.
As it is this common, surely there’s some drug that can help, right?
Actually there are no FDA approved medicines for this.
The traditional advice is avoid alcohol, lose weight and do whatever you can to treat diabetes and reverse metabolic syndrome (three of fasting glucose > 110, high triglycerides, abdominal obesity, low HDL and elevated blood pressure).
Doing these things is good but that’s all we have for something this common?
Well we may not have FDA approved drugs, but there are quite a few other things that seem to help.
Vitamin E has gotten a lot of press for this, but the studies seem to be mixed on it. As it turns out Vitamin E is a mixture of 4 components called tocopoherols and 4 more components called tocotrienols. Marilyn Arguillas, a gastroenterologist with a particular interest in fatty liver cites research to support the tocotrienols. She cites a study in which 200 mg of mixed tocotrienols lead to complete resolution in 56% of patients with fatty liver compared to 23% of controls (2).
L Carnitine known to holistic doctors as a taxicab that shuttles fatty acid to the energy factories of the cell has also shown to help in a clinical trial (3)
Lecithin in the form of DLPC in combination with SAMe has also shown promise through this was animal research (4).
Researchers have found other things beyond these that seem to help the disease process here. Why doesn’t the average doctor know these things? These things are natural and can’t be patented so while the initial studies seem impressive, they don’t always make it as far down the road to the enormously large trials that pharmaceuticals do because the deep pockets that fund those trials know they can’t make money off the research. Further, there are no drug companies sending drug reps to doctors and TV commercials to patients about these things. So the research gets buried amongst the > 800,000 papers published per year.
Lifestyle changes are critical, but this is the most common liver disease and we need more things to fight it. Holistic medicine will be your best option. Call and make an appointment today.
- Dr. Bruce Thomas, MD
2 Enrico Magosso,1 Mukhtar Alam Ansari et al . Tocotrienols for normalisation of hepatic echogenic response in nonalcoholic fatty liver: a randomised placebo-controlled clinical trial ‘Nutr J. 2013; 12: 166
3 Malaguarnera M1, Gargante MP et al L-carnitine supplementation to diet: a new tool in treatment of nonalcoholic steatohepatitis–a randomized and controlled clinical trial. Am J Gastroenterol. 2010 Jun;105(6):1338-45. doi: 10.1038/ajg.2009.719..
4 Qi Cao, Ki M. Mak, et al The Combination of S-adenosylmethionine and Dilinoleoylphosphatidylcholine Attenuates Non-alcoholic Steatohepatitis Produced in Rats by a High-Fat Diet Nutr Res. 2007 September ; 27(9): 565–573.