Non Alcoholic Fatty Liver Disease - Part 2

NAFLD - Part 1

In Part 1 a few causative factors were discussed. In part 2 we are looking at 15 nutrient considerations, along with diet and lifestyle recommendations.

While insulin dysfunction is the key foundational causative factor it's not alone. When It comes to treatment options you need to first uncover what other factors are also relevant for you. 

This is where testing can help.

Some women discover they have NAFLD by accident when they have a standard check-up and others go looking for it if they are experiencing symptoms. The main symptom is pain in the upper right quadrant. While the other symptoms are quite generic and include things like fatigue, and weight gain.

Basic testing generally starts with looking at liver enzymes. If they are elevated this generally progresses to an ultrasound image of the liver. 

Most doctors would also order more bloodwork including things like fasting insulin levels, lipid panel, uric acid levels, and inflammatory markers. BP is normally also assessed. 

It's also worth considering SHBG, DHEA, Testosterone, Estrogen, Homocysteine, and the nutrients mentioned below.

As soon as I see raised liver enzymes I want to know what ferritin is doing. Ferritin is the stored form of iron and the liver is one of its favourite places to hang out. In the case that’s also elevated, reducing this would become a treatment priority for me. 

There are so some other nutritions we need to consider, let's start at the beginning with

VITAMINS

• Vitamin A. Women with NAFLD are generally Vitamin A deficient. Did you know the liver is the primary storage site for Vitamin A and when it starts storing fats, it releases its store and loses its ability to hold this vitamin? Vitamin A, is a key anti-oxidant, with a role in modifying glucose and lipid metabolism in the liver.  Without adequate regular amounts of this nutrient, it can lead to the progression of liver damage. Vitamin A is found in organ meat, eggs, butter, ghee, and cheese or you may prefer to supplement.
• Next is B vitamins. They are all important but 3 of them stand out.
  • Vitamin B3 - is significant in lipid metabolism.
  • Vitamin B9/folate deficiencies can promote fat accumulation in the liver via the homocysteine pathways and are linked with the development of NAFLD-related co-morbidities including diabetes and obesity.
  • B12 is a mitochondrial regenerator, unfortunately, your mitochondria are innocent victims in the development of fatty liver, hence the symptom of fatigue.  Luckily B12 helps here. But unluckily your liver is also the primary storage site of vitamin B12 so regular consumption of B12 food sources or supplementation may be warranted. I did find a study suggesting that B12 deficiency may be an independent predictor of disease progression. This is a really good vitamin to ask your doctor to test for.
•  Vitamin C. This is another vitamin deficiency that can lead to disease progression. Vitamin C is an antioxidant and may improve mitochondrial function by reducing free radical damage and its resulting inflammation.  It may also play a role in improving lipid and glucose metabolism and suppressing central obesity. Adding additional food sources Vitamin C and supplementation may improve liver health.
• Vitamin D. A deficiency here may increase liver inflammation and disease progression. Vitamin D also plays a role in insulin-sensitizing and blood sugar regulation. Please make sure you have tested this vitamin and work towards optimizing it.
• Vitamin E. This vitamin is another anti-oxidant, it can lower liver inflammation and liver fibrosis and it has a unique ability to reduce the liver's capacity to store fats. Its supplementation is recommended by both the American Association for the study of liver disease and the United Kingdom Institute for Health and Care Excellence. They both found Vitamin E supplementation to be the only intervention that leads to a mortality rate drop and transplant-free survival amongst patients with NASH - a progressive form of NAFLD.  

MINERALS

• Chromium is a very important mineral when it comes to metabolic health and healthy insulin levels. In a clinical trial, it had been found to balance the metabolic markers contributing to the development and progression of  NAFLD
• Copper deficiency may have a role to play in the development of obesity, metabolic syndrome, and heart disease. Without adequate levels of this mineral lipid metabolism can be disrupted and this may play a role in the development of NAFLD.
• Magnesium helps reduce insulin resistance and metabolic syndrome. Higher intakes of this mineral is associated with a low risk of developing fatty liver and pre-diabetes. The scary thing is almost everyone is deficient in this mineral that I call the master menopause mineral, as it can also help with so many menopausal symptoms such as sweating, insomnia, stress, moods, headaches, muscle cramps, and more. Please make sure you are getting enough. One of my favourite ways to top this nutrient up is with an Epson salt bath.
• Manganese is a potent anti-oxidant, and a key component of manganese superoxide dismutase, which is the principal anti-oxidant inside your mitochondria. Higher levels of this mineral is considered to be protective against the development and progression of NAFLD.
• Potassium deficiency has been associated with the development of NAFLD and its related metabolic dysfunction. With lower levels being linked with more weight gain and higher insulin resistance.
• Selenium may reduce the development of fatty liver by acting as an antioxidant and anti-inflammatory agent. This is another nutrient that needs to be well balanced as both elevated levels and deficiency may be contributing factors to consider.
• Zinc is an anti-oxidant involved in the metabolism of glucose, lipid, and protein. Inadequate levels of zinc can be implicated in the development of insulin resistance, diabetes, dyslipidemia, obesity, hypertension, and the development of a fatty liver.

OTHER NUTRIENTS

• Phosphatidyl choline is by far the first and foremost nutrient that springs to mind when I think of fatty liver. What is really promising is the research looking at NAFLD regression with this supplement. Some studies have shown really promising results including liver enzyme reductions and the reduction of fatty infiltration in the liver.
• Ubiquinol is a mitochondrial fuel source that has also been found to help reduce elevated liver enzymes, reduce inflammatory markers and improve lipid parameters. 

Please do not go out and take all 15 of these nutrients. Where available test and see if you have adequate levels, or high levels that need reducing, or low levels that could benefit from increasing. 

If you need to increase you may like to start with food sources or with supplementation. Before you start supplementing it is best to seek professional help as all supplements and medications have cautions, interactions, and contraindications and you want to get this all checked before potentially throwing a few things together.  But even before this, I would like to recommend you consider your diet.

The Mediterranean diet has been found to be the most beneficial when it comes to NAFLD. It contains a good amount of beneficial fats especially olive oil, which has been found to play a protective role for the liver. A good amount of animal protein with a complete amino acid profile. If you eat animal protein you don’t need to supplement with amino acids but if you are vegan you may need to consider adding these amino acids, methionine, glycine, glutamine, taurine, leucine, isoleucine, and valine. The Mediterranean diet also contains an abundance of fibre and polyphenolic carbohydrates, in the form of fruits and vegetables. Polyphenolic foods are anti-oxidants, and anti-inflammatory, they may help improve insulin sensitivity, are heart healthy, and improve the health of your digestive system.

On the lifestyle front, stress management and movement are key. It's even better if you can do them together with activities such as yoga, walking, or swimming.

Please know that your liver is a fairly resilient organ capable of rejuvenation in most cases.

If you would like a hand to develop a treatment plan taking into account your individual needs please consider booking a consultation