Liver damage with fat accumulation is very common in the United States. According to the NHANES health and nutrition surveys, in the time period 1999-2002, 8.9% of Americans had elevated ALT. Just 10 years earlier (1988-1994), the number was 4.0%. Fatty liver is a growing epidemic that currently affects roughly a quarter of Americans. Sam told me he had been trying to reverse his fatty liver for nearly a decade without success, and asked if I had any thoughts. He was not overweight, and from what I could gather, his diet was already better than most. I believe Sam knew intuitively that the right diet would improve his condition. With the usual caveats that this is not advice and I'm not a doctor, here's what I told him:
The quality of fat you eat has a very large influence on health, and especially on the liver. Excess omega-6 is damaging to the liver. This type of fat is found primarily in refined seed oils such as corn oil, soybean oil, and safflower oil... Sugar is also a primary contributor to fatty liver. Reducing your sugar intake will go a long way toward reversing it. Omega-3 fats also help reverse fatty liver if an excess of omega-6 is present. There was a clinical trial using fish oil that was quite effective. You might try taking 1/2 teaspoon of fish oil per day.On May 11, I received another e-mail from him:
The day after your recommendations, less than a month ago, I started a regimen of 1200 mg/day of fish oil concentrate.In the same e-mail, he sent me his new ALT test results. He had been getting tested since 2002. The latest result, reflecting his progress since adopting the new diet, followed the previous test by less than a month. Here's a graph of his ALT levels. Below 50 is considered normal:
At the same time, I significantly reduced or even eliminated all forms of sugar from my diet. I did have a half glass of orange juice for breakfast every few days or so, and some fruits, and maybe a taste of dessert or a small candy bar here and there. I never exceeded the 30 g/day sugar limit you suggested.
I completely eliminated any and all fried foods and avoided most oils. I also avoided high glycemic index foods to some degree, e.g. white bread and potatoes. I did eat quite a bit more protein, including red meat, eggs, fish, chicken, and pork.
The balance of my diet and lifestyle was largely unchanged. I do drink a couple of beers every two to three weeks, but never more than three drinks in day. I have been doing more yard work, simply because of the season. Other than that, I don't get much more exercise than a typical inactive office worker.
The latest test was 52, just on the cusp of normal. That's nearly 50% lower than his next lowest result over the past 7 years, in less than one month of eating well. I suspect that his next ALT test will be well within the normal range, and the fat in his liver will gradually disappear, if he continues this diet. When I asked him how he was feeling, he said: I did feel different after adjusting my diet. It's hard to describe, but overall I just felt better. I wasn't as tired when I woke up in the morning and I became a little slimmer, not a lot, maybe 3-5 pounds [note: he was not overweight to begin with]. I figured it was a placebo effect, but I think the fish oil has made a real difference.Fatty liver is a serious problem that responds readily to diet. I believe the main culprits are excess omega-6 from industrial vegetable oils; insufficient omega-3 from seafood, leafy greens and pastured animal foods; and excess sugar. The liver is your "metabolic gatekeeper", so it pays to take care of it.
Yesterday I had a few potato chips, corn chips, and some others. I didn't like it at all. Today I had half of a brownie for an afternoon snack and I completely crashed after an hour or so. I had a hard time keeping my eyes open. I no longer have much of a craving for snack food, I prefer to eat a full meal with more protein, e.g. beans, meat etc.
How to Fatten Your Liver
Excess Omega-6 Fat Damages Infants' Livers
Health is Multi-Factorial
36 comments:
Thanks Stephan.
Amazing.
I also brought my fatty liver blood markers back to normal largely through the Omega 3:6.
Pre-changing my Omega 3:6 balance I had a reasonable diet by most standards, not much sugar, but quite a lot of high sugar (unsweetened) fruit juice (eg apple), and was reasonably slim.
I have subsequently tightened my diet to try and exclude refined foods, sugars, and included seaweed and more marine foods.
Author
Omega Six The Devils Fat
www.omegasixthedevilsfat.com
A lot of the liver damage caused by “sugar” is due to the fructose component. Fructose is metabolized immediately by the liver and can easily be stored as fat in the liver. See this article that Dr. Eades referenced in one of his posts:
http://www.medbio.info/Horn/Time%201-2/carbohydrate_metabolism.htm
(Here is Dr. Eades original post as well: http://www.proteinpower.com/drmike/uncategorized/high-fructose-corn-syrup-follies/ )
The body treats alcohol almost identically to the way it handles fructose with the same bad effects.
Philip Thackray
Anyone worried about how much they drink can find comfort in the work of Amin A Nanji, for example this paper
http://jpet.aspetjournals.org/cgi/content/abstract/299/2/638
Ned
Ned, that's an interesting find.
Maybe that's why I always craved greasy bacon and eggs the next morning after a long night of drinking back in my college days.
The following was taken from the Introduction to the article posted by Ned Clack.
It's amazing how many diseases may be on the increase as a result of switching (over the past 100 years) the type of fats we cook with and found in our foods. Add fatty liver disease to the list of suspects.
"Several lines of investigation indicate that dietary fat can
modulate the severity of alcoholic liver injury (Mezey, 1998).
In experimental animals, for example, diets enriched with
saturated fatty acids protect against alcohol-induced liver
injury, whereas diets containing polyunsaturated fatty acids
promote liver injury (Nanji and French, 1989; Nanji et al.,
1989, 1994a). Saturated fatty acids have also been reported
to reverse established alcoholic liver injury (Nanji et al.,
1995, 1996, 1997b)."
I thought i remember reading either from Brad Pilon at Eat Stop Eat or Conditioning Research that intermittent fasting (even just 24 hours), can help reduce fatty livers since the liver has to burn the glycogen stored in it, and I think process other fat via lipolysis.
Alcoholic liver disease - and perhaps non-alcoholic fatty liver, I don't know - appears to be caused by bacterial endotoxins leaking from the gut. They say this in the article referenced, "The therapeutic effects of saturated fatty acids may be explained, at least in part, by reduced endotoxemia and lipid peroxidation, which in turn result in decreased activation of NF-kappa B and reduced levels of TNF-alpha and Cox-2."
The saturated fats and , especially it seems, MCTs from coconut oil and the like, stop the gut from leaking in response to alcohol; this appears to be their main method of action.
Leaky gut appears to be important in depression and chronic fatigue as well
Robert,
Thanks for sharing your experience as well.
Thackray,
I agree.
Dennis,
Very good point. Antibiotics can prevent liver damage from both alcohol and fructose. The endotoxin hypothesis is the most logical explanation. Intestinal permeability seems to be behind a lot of problems. It's an important theory. I should post on it.
Antibiotics protect against fructose-induced hepatic lipid accumulation in mice: role of endotoxin
About 10 years ago when I was beginning on my road to self-health, I first turned to Atkins, and consumed a lot of Atkins products. I drink a LOT of the Atkins canned protein shakes for about a year, often drinking 3-4 cans a day.
Then I went to a doctor and had a comprehensive blood test -- over 120 markers. Livers enzymes were part of this wide coverage. And, they were both sky high, alarming my longevity-oriented doctor. He immediately had me increase my fish oil to eight 1 gram capsules daily.
About this time, too, I started to learn that polyunsaturated fatty acids could be bad. I noticed that Atkins products almost always used soy oil, especially those Atkins shakes I had been drinking. I stopped immediately. About four months later my liver had returned to normal.
Cordain also seems to recommend fats/oils high in polyunsaturated fatty acids. This, IMO, is his greatest blind spot -- he seems to have around on saturated fats not being evil.
A powerful story!
Interesting, Scott. Yep, the Atkins dieters have fallen or fell into the same pattern the low fatters have: excess, reductionistic focus on macronutrients. I was in that place about a year ago? I appreciate Stephan's explanations as they attempt to fit the totality of evidence that we have. I went over to the low carb side for awhile (still figuring out whether more low carb is right for me) but the work of Weston Price kept me wondering.
Two years ago, if someone told me to eat foods my great great great great grandparents ate, prepared as they traditionally prepared them in order to lose weight and avoid chronic disease, and that certain foods (such as wheat, soy, vegetable oils, or refined sugar) are just plain bad, I would have thought them a pseudoscientific quack. However, that type of approach now makes so much sense to me from an evolutionary perspective. I basically started evaluating my own diet after the pet food scare made me question the healthiness of processed pet foods. Sad to say, I have a background in evolutionary biology but it never even occurred to me to question the wisdom of feeding cats and dogs grains and soy.
Of course, it makes even more sense when you learn about the biochemistry of these foods and how they wreak the havoc they do on human metabolism.
Unfortunately both the low fatters and the low carbers (i.e. Weight Watchers and Atkins types) advocate prepackaged processed foodstuffs that are supposed to somehow work magic because they omit a macronutrient... I think some of these mistakes are honest ones, but the truth needs to out.
This site has helped me a lot, to build my own thinking about food.
I believe that we should care about those nutrients that our ancestors were getting and we don't get, ie Vitamin D3, K2, Magnesium, and Iodine. Zinc, B12, and possibly others for vegetarians.
Maintaining a balance of n3:n6 oils is very necessary, which would require supplementation. n3 greater than n6 would actually be better than a n6 greater than n3, but not by too much.
I don't think we need to supplement anything else as long as we are keeping these stable.
Proteins are necessary, for building and maintaining muscles. But we should not focus at them for energy. Energy can be either from Fats or Carbs as long as we don't have insulin resistance.
Some Saturated and Mono-saturated fats are anyway required, so it is a good idea to keep the fats as the major source of energy.
If we are having things like Fructose, or some lectins, then we can get insulin resistance, and that makes carbs bad as an energy source.
I am substituting D3, K2, and Omega3. I still have to find some source of magnesium and iodine. I have reduced wheat, fructose, and refined oils almost completely. Giving up on grains or legumes completely is not possible, in a mostly vegetarian lifestyle.
I am seeing a lot of benefits for me, following this lifestyle. I have lost more than 5Kgs over the past few months. I had already lost about 10Kgs in the last year, by exercising, and controlled diet. I think I still have to lose about 5 Kgs more. Fasts will help me reach there.
So in reference to Amin Nanji's article ...
is it the PUFA that is aggravating the damage or the ethanol itself?
sounds like the ethanol could be damaging the PUFA (yet another way to damage PUFA!), but SFA, being more stable is not vulnerable?
Stephan. You may want to chenk this blog for link into new study related to yor theoury on polysat 6/3 ratio and poly sat./sat fat ratio and coronary health.
http://drbganimalpharm.blogspot.com/2009/06/benefits-of-high-saturated-fat-diets-in.html
WBR : JVAS
to address the work of Amin Nanji-- this would end up being a gem if it were able to show 2 more things.
1: 1 group with a fat like olive oil added after 6 weeks.
2: that the effects of ethanol weren't just damaging the polys as mtflight mentioned. as saturated fats would be be pritty much immune to that effect.
the animal pharm blog put up a decent post today:
http://drbganimalpharm.blogspot.com/2009/06/benefits-of-high-saturated-fat-diets-in.html
what i wish people to know however is that the high saturated fat diet still had an almost 1:1 ratio of saturated fats to monounsaturated fats-- people on the saturated fat bandwagon may go overboard and suggest a 2:1 or 3:1 saturated to monounsaturated ratio and this "may" not lead to the same type of benefits. we know keeping polys low is beneficial-- the other ratios however are less certain!
another interesting tidbit about the study is that the diets were composed of fish oil and ethanol prior to the switch to palm or mct oils.
fish oil has more unsaturated bonds (EPA:5, DPA:5, DHA:6) than linoleic (2) or other n-6 PUFAs. Would've been interesting to see "corn oil-ethanol" vs "fish oil-ethanol."
Another possible explanation is that ethanol damages PUFAs, regardless of whether they're n-6 or n-3... the way that sugar glycates them.
IIRC palm oil has high vitamin E content, which would help the PUFAs avert damage, but being mostly saturated it's just gravy.
group 5 (fish oil and dextrose)... hmmm would've been interesting to add ethanol to it. or ethanol-fructose, but the researchers would go to hell for being so cruel to the test subjects.
Stephan,
Any comments on Ray Peat's take on fish oil?
"In declaring EPA and DHA to be safe, the FDA neglected to evaluate their antithyroid, immunosuppressive, lipid peroxidative (Song et al., 2000), light sensitizing, and antimitochondrial effects, their depression of glucose oxidation (Delarue et al., 2003), and their contribution to metastatic cancer (Klieveri, et al., 2000), lipofuscinosis and liver damage, among other problems. "
In declaring EPA and DHA to be safe, the FDA neglected to evaluate their antithyroid, immunosuppressive, lipid peroxidative (Song et al., 2000), light sensitizing, and antimitochondrial effects, their depression of glucose oxidation (Delarue et al., 2003), and their contribution to metastatic cancer (Klieveri, et al., 2000), lipofuscinosis and liver damage, among other problems.
Sorry,
Meant to post the link:
http://raypeat.com/articles/articles/fishoil.shtml
Scott,
Great story, thanks for sharing.
Anand,
Nice work. So you're eating a mostly plant-based diet?
Alex and Aaron,
I think at least part of the mechanism has to do with the intestinal flora. You can suppress fructose-induced fatty liver by feeding mice antibiotics. The idea is plausible that ethanol by-products like ethaldehyde could damage PUFA, I don't know if there's any direct evidence of it.
Sverlyn,
I disagree with Peat's take on fish oil. Although we aren't actually that far off from one another. I say take a little if necessary, he says take none.
Sverlyn
Peats argument that fish oil can contain Vitamin A D etc depending on how it is refined, and A and D also impact on health is a valid one. You would have to look at the fish oil used in the trial to see if it contained vitamin A or D.
As far as this goes
"In declaring EPA and DHA to be safe, the FDA neglected to evaluate their antithyroid, immunosuppressive, lipid peroxidative (Song et al., 2000), light sensitizing, and antimitochondrial effects, their depression of glucose oxidation (Delarue et al., 2003), and their contribution to metastatic cancer (Klieveri, et al., 2000), lipofuscinosis and liver damage, among other problems. "
It does not tie up with the mass of the evidence I am reading.
Yes there are isolated concerns but the bulk of evidence suggests Omega 3s are protective at many levels including against a wide range of western conditions, that they are antiinflammatory and do not in normal use give rise to damaging oxidation.
Should we get the nutrients we need from our diet preferably - of course - but our ancestors diet was more nutrient dense varied and . . .
Metabolism of alcohol
One method for disposing of alcohol oxidises fats and preferentially PUFAs.
This removes DHA from the brain and other organs.
The trial in rats looked at the liver but not the brain. Brains need DHA to function.
It would have been more interesting to look at a high Omega 6 intake rather than a fish oil intake.
Other trials suggest moderate Omega 3 intake is liver protective. The intake of Omega 3 in this trial was very high.
Yes Omega 3 DHA is more susceptible to oxidation than saturated fats, but the wider picture in a more normal diet is more complex, as oxidation of Omega 3s produces anti-inflammtory products.
To reiterate your brain eyes and reproductive organs do not function optimally without adequate DHA. Alcohol depletes Omega 3s. Most in the west have lamentably low DHA intakes.
Author Omega Six The Devils Fat
www.OmegaSixTheDevilsFat.com
Stephan,
Are you aware of the chronic infection/dormancy hypothesis and the patents for its treatment?:
Using antibiotics and endotoxin support to treat chronic bacterial infections.
It is the work of a rheumatologist, Dr. Michael Powell.
It is consistent with your other comments and connected to the fructose/liver findings.
Art
Art,
Thanks for the link. Peter over at hyperlipid has written about the connection between gut flora and autoimmunity as well, it's fascinating.
Stephan,
Just to be clear, the article and patents are not about gut flora and autoimmunity, but rather about system-wide microcolonies of bacteria that perturb the associated tissue into a physiology similar to that in hibernating organisms. The infections are persistent and cryptic, perhaps like fibromyalgia, CFS or even some forms of cancer. Chronic inflammatory degenerative diseases also. The upshot is that they are treatable with persistent use of antibiotics, but that results in dangerous inflammation, cytokine storm? So, treatment for the inflammation is also needed until the endotoxins clear. That is my understanding. I thought you would find in a natural extension of some of your other comments.
Art
Art,
Ah, that's what I get for skimming. I read a bit more on the site, I suppose a lot of us have Cpn infections in white blood cells. I didn't see anything that convincingly linked it to pathology though. I'll keep this in mind.
Stephan,
I am on a mostly plant based diet. I am married to a committed vegetarian (not really a religious one), which reduces my options.
I still take as much animal fat as possible.
My breakfast is 3 eggs in butter and 1/2 litre milk.
Lunch is small amount of industrial chicken (about 100gms including bones, from the cafetaria) + vegetables cooked in mustard oil + low sweetness fruits and raw vegetables (eg cucumber and tomato).
Dinner is a traditional vegetarian fare. I do avoid wheat as much as possible. We also ferment the wheat. We also indulge in a lot of south indian dishes which are essentially made from fermented rice and lentil batter, eg dosa and appam. I don't like idly that much, with more vegetables, than traditional.
I also undergo fasts intermittently. There is no schedule, whenever I think that I am not getting anything good I take a fast ;-). Sometimes when eating out I will only take a grilled chicken, there by being low carb once in a while.
Its really tough to convince people of this diet. I am hoping that changes in me will help other people realize that it indeed is good. But I am somehow not that sure that people will actually see reason. Only time will help I guess.
Even my wife is very reluctant, but at least she has agreed to the fish oil in capsules. I guess when she notices the positive changes from D3 and K2, she will understand that this diet makes sense. She is noticing that after the increased fat in the diet she feels less hungry.
Your site has been the source of most important information. It has told me that starch in themselves are not bad. They just need to be managed. Other low carb sites don't distinguish between grain, starch, and sugar.
Anand,
It sounds like you're doing well. Many people have constraints on their diet other than health, as do I. Actually, my situation isn't that different from yours. I live in shared housing and most of the common food is vegetarian. I prepare meat for my lunches, but I eat vegetarian or nearly so for breakfast and more than half my dinners. I just stick with traditionally-prepared whole foods like eggs, potatoes, dosas, dairy, coconut oil, etc, and it works out just fine. I avoid gluten and processed foods, but I don't mind eating vegetarian sometimes.
I know this is an old post, but I just found this website and my attention was really caught by your article on ALT.
I am 52 years old and was diagnosed with high cholesterol when I was around 40. My drug pusher - oh, I'm sorry, I mean my doctor - kept pressuring me to take a statin, but I insisted on trying to correct the probem through diet and exercise, none of which worked for me. My total cholestertol through this period was around 250 with an LDL around 180. When I was 48, my doctor informed me that my ALT enzymes were elevated at 80. They were not supposed to be over 50.
At this time I chose to visit a new doctor, who although an M.D., practices "functional" medicine, whom I hoped to be more interested in finding the cause of the problem, rather that just suppressing the symptoms. She suggested that my liver probem and cholesterol problem were interconnected and diet related. She convinced me to go on a "low-glycemic, non-inflammatory" liver cleanse. For 3 weeks, I eschewed all gluten, dairy, corn, fatty meats, alcohol and caffeine. I supplemented this with a diet of shakes mixed with "Opticleanse" powder provided by a company called Xyogmen.
At the end of three weeks my cholesterol had dropped from 250 to 180, my LDL from 180 to 100, my triglycerides from 180 to 150 and my ALT enzymes from 80 to 30. They have remained that way for the last 4 years. I conducted a brief 6 month experiment and returned to my old diet and all of the numbers, except the liver enzymes returned to the previous bad levels.
Thank you for sharing your story Daryl.
First, let me say that right as I was about to post this comment, I saw one from a "Daryl" right above. LOL... that's my name, and I use the same spelling. Thought I'd been sleep-posting for a minute...
I had elevated liver results for well over a decade. Upon being diagnosed with Type 2 diabetes in December 2007, I began eating under 30 grams of carbs a day, per Dr Richard Bernstein. All subsequent liver tests have come back perfectly normal, not to mention that my blood glucose is now normal, and I've lost right at 100 pounds.
Daryl #1: "My drug pusher". Ha, ha, I love it.
Daryl #2: Those are amazing results. One of my parents is diabetic type II and I'm trying to avoid it myself.
Just catching up on old posts from this awesome blog... Kelly
As a physician (MD), it was encouraging to read this blog and the testimonials regarding increased ALT and in particular “fatty liver”. For two years, I have had borderline to somewhat elevated liver enzymes, especially ALT. At my most recent physical examination, my AST was 41 and my ALT was 101 (the last two years the numbers were similar, with the exception of an ALT rise from 65 in 2008). My internist told me that the next step would be a liver ultrasound and additional laboratory tests should the numbers not come down. On review of the formal medical literature, I could not find much about lowering ALT and treating a fatty liver with the exception of stopping all alcohol, losing weight, and exercising. I am 5’10” and 185 lbs. – slightly overweight, but certainly not obese, and I do not have diabetes. As with another patient’s discussion, I do not regularly exercise (as I should) because of my work schedule and two young children that take up the rest of my free time.
For a two week period, I followed much of the advice that I have read in this blog:
1) I limited alcohol intake to 1 glass or less of wine per day (before < 2 drinks per day)
2) I stopped taking Pepcid and Tylenol (metabolized by the liver)
3) I stopped drinking diet soda and drank more water, tea, and V-8 juice (was drinking 3+ Diet Cokes/day - Aspertame)
4) I increased raw vegetables (salad) and cut back on fatty red meat (no fast food)
5) I started taking 1200 mg of fish oil/day twice daily
6) I took a daily supplement called Livatone (mostly milk thistle and B vitamins) as well as a garlic pill
My repeat liver enzymes after only two weeks of this regimen were AST 20 and ALT 60 (down from 41 and 101 respectively). I would anticipate continued improvement with time.
Clearly, there are too many confounding variables to determine which of the above has helped with the numbers, but I did not completely abstain from alcohol, and I doubt I have lost much weight over this short time frame. This is definitely not an add for milk thistle supplements, but I did see it on the internet, and didn’t think it would hurt.
- Tim
Tim:
Wow, it sure says a lot when an MD has to resort to the blogosphere for sound treatment for what I believe is a disease of modernity.
Well, at least you've come to the right place. I and many others have been huge fans of Stephan's pretty much since the day he began blogging.
Anyway, in case you stumbled on this entry via a Google search or some other, there's two additional, subsequent posts here on fatty liver reversal that should interest you:
http://wholehealthsource.blogspot.com/2009/06/another-fatty-liver-reversal.html
http://wholehealthsource.blogspot.com/2009/09/another-fatty-liver-reversal-part-ii.html
Keep us updated.
Hi Tim,
Glad to hear you've had success treating your NAFLD. I'm getting the impression that it's easily reversed with a few diet changes.
Thank you thank you!!!!!!!!!!!!!! I am new to this whole paleo thing. I have been worried about my liver. My doctor told me that my enzymes were up . He never said how much. He told me to take an herb,Milk Thistle. I feel like I have hit the jack pot today in finding your blog. I have cleaned out all my cabinets. I bought a grass fed cow, He is in the freezer. I have a whole dear also. Now I know what to do. You have given me a map to follow. I appreciate the ti me you took to post this and I will be sure to read the rest of your blogs. Thank you again.
I've been treading this blog with interest whilst researching my NAFLD, (caused by wrongly thinking fructose would be better for me than table sugar) but I'd really appreciate a few answers to my queries! Thanks in advance!
Is soya milk (unsweetened) GOOD or BAD for NAFLD?? Is low fat cow's milk better? What about for women trying to avoid cow hormones?
What about glucose instead of other types of sugars with my morning (raw) oatmeal? I've tried it without any sweetness but eeewww...
Surely white bread/pasta/rice aren't honestly healthier than their brown counterparts, due to the sucrose inherent in the bran and the germ according to http://www.diet.com/g/fructose-intolerance
I too have NAFLD, am aged 48 , office worker not obese but little fat at middrift.
Two scans over 5 years show a bit of fatty liver. ALT is only enzyme consistently raised over 5 years - 120, 72, 62, 48, 102, 60.
Exercise 2-3 tiimes per week for twenty minutes.
Drink lots of water each day (with lemon slice to cleanse where possible), take milk thistle, southern ginseng, flaxseed, cod liver oil. Eat chicken and fish mainly, pasta etc, but do like occasional pizza or curry and 2 beers once at weekend.
I am confused about what is bad?
All bran cereal
Wholemeal brown bread
Soya milk or skimmed best?
100% all fruit marmalade
And the biggest bugger of them all is spreads for my breakfast toast....I buy dairy-free margarine but it still has vegetable oils. Is there a good substitute?
Stephan - what if your ALT is normal, even on the low side, and you still have a fatty liver?
Post a Comment