Archive for liver disease
How are abnormal liver function tests dealt with in primary care?
First of all, it is a shame that we still consider standard liver enzyme levels as a “liver function” test. It absolutely is NOT. With these tests, we are looking for liver damage, not function (with exception of bilirubin, which is somewhat of a functional test). True liver function tests involve what the liver DOES, such as detoxification panels. I love to see a patient come in with altered liver function, because I know there is so much that functional medicine can do for these patients.
bmj.com Abstracts: Sherwood et al. 322 (7281): 276
S-Adenosyl-L-methionine: its role in the treatment of liver disorders
When a nutrient seems to affect multiple conditions, we can assume two case scenarios. A. The nutrient is offered by a multi level marketing company and is reported to fix everything from diabetes to cancer to my bald spot. B. The nutrient affects a basic metabolic defect/deficiency that leads to many downstream conditions. SAM-e falls into the second category. SAM-e is a strong methyl donor, and methylation is an incredibly important process that is essential for many biological processes such as homocysteine conversion, protecting DNA from damage and, in this study, protecting the liver by assisting in the production of glutathione (the liver’s heavy hitter when it comes to detoxification). This would put SAM-e on the list along with milk thistle for any patients with liver problems.
AJCN — Abstracts: Lieber 76 (5): 1183S -
Supplementation with branched-chain amino acids in advanced cirrhosis
It seems like I’ve been coming across more and more patients who have or know someone close to them that has a liver that is failing. Given the increased pharmaceutical drug and over the counter pain relievers (Tylenol is now one of the top or possibly even #1 cause of liver failure) this is not surprising. Here we see branched chain amino acids protecting the liver. Add to this regimen milk thistle and N-acetyle cysteine and you’ve got some powerful tools to help retain what functional liver these patients have left.
Fatigue and primary biliary cirrhosis
And, just in case you were thinking, “so what if my liver is overburdened?” This study looked at patients with primary biliary cirrhosis–their livers were losing the ability to move things out of the body into the GI tract for elimination–and found that these patient’s fatigue may be related to brain damage from increased manganese levels. Manganese elimination is via the bile, so these patients have a reduced ability to get rid of manganese and it accumulates in the brain. Really makes you appreciate just how interactive the human body systems truly are. As a side note, manganese has been implicated in violent behavior in institutionalized criminals.
Gut — Abstracts: Forton et al. 53 (4): 587 -
Celiac disease in patients with severe liver disease
Is anyone getting tired of hearing me rant and rave about food sensitivities causing systemic problems? Here’s another article implicating celiac disease (an allergy to a protein called gluten for in certain grains) in another serious condtion that was previously of unknown origin. An elimination diet is warranted in so many different patient presentations–cerebellar ataxia, Alzheimers and other dementias and now liver failure.
Gastroenterology Online -
Paracetamol causes most liver failure in UK and US
That bottle of Tylenol looks so innocent on the shelf, doesn’t it? Ironic that Tylenol was pulled off the market for a mere week or so several yrs back when tampering was found that killed a handful of people, and yet it remains on the shelf when it is known to kill thousands more per year from untampered use. The dichotomy of our health care system is evident everywhere. A huge national uproar was raised when Tylenol was linked to several deaths from tampering, and yet barely a wimpier when it kills, on a daily basis, thousands more.
Association between Hypothyroidism and Small Intestinal Bacterial Overgrowth
Talk about the complicated web that makes up our physiology!! In this small study, it was determined that 54% patients with hypothyroidism due to autoimmune thyroiditis had small bowel bacterial overgrowth (SMBO). So what are the connections? First, we know that anti-secretory therapy for ulcers leads to bacterial overgrowth as well.
Then, we know that SMBO has been linked to fatty liver (at first seems like a stretch, but SMBO will lead to leaky gut, allowing larger molecules to get absorbed and head straight to the liver, where the liver now has to deal with the burden). We also know that a large percentage of patients with autoimmune thyroiditis have celiac disease, which further disrupts the integrity of the GI tract.
So, we end up with an upregulation of the immune system as a result of the leaky gut, increasing our likelihood of an autoimmune condition. This can be a perfect example of a feed forward cycle, where an initial disruption in physiology leads to other problems, with these “other problems” feeding back into the cycle and making the initial disruption worse!!
I’m floored. Look at the outcomes in this study. It’s sickeningly scary. And we’re worried about vaccinating our healthy kids for the flu. Ten years ago we never even heard about NAFLD, let alone in children. This is really only the tip of the iceberg. As our children get heavier and heavier and more insulin resistant we will see increasing prevalence of NAFLD. This is scary. These are just children. The parents and the pediatricians should both be strung up and beaten (the pediatricians for not illustrating the contribution of poor lifestyle to the condition, the parents if they don’t adopt the changes if the pediatrician recommends them). Sorry to be so strong on this one, but I’m sick of seeing toddlers being fed Coke and chicken fingers…
Fractures, calcium, and the modern diet
WOW!! How refreshing for an article in a major medical journal to cut through the PR from the dairy industry and lay some truths bare. Osteoporosis is NOT a disease of calcium defiency. It is a result of a Westernized lifestyle. From a physiological viewpoint, the body wants to keep us alive for right now and that involves keeping pH and calcium levels of the blood in very tight levels. When a more acid-producing diet is eaten (i.e. more animal protein based) the body buffers with bicarbonate and calcium, causing the calcium levels in the blood to fall. The blood needs to get levels back to keep us alive for right now and where is the best source of calcium in the body?? Bone. Years of this pattern weakens the structure of bone. AJCN — Abstracts: Hegsted 74 (5): 571 http://www.ajcn.org/cgi/content/abstract/74/5/571
Site-specific differences in the fatty acid composition of abdominal adipose tissue in an obese population from a Mediterranean area: relation with dietary fatty acids, plasma lipid profile, serum insulin, and central obesity
Quite a long title…This study begins to identify why abdominal fat is the type of fat that increases risk of certain diseases as opposed to peripheral fat. Abdominal fat contains higher levels of omega-3 fatty acids, generally considered to be anti-inflammatory and protective against all sorts of diseases known to man. AJCN — Abstracts: Garaulet et al. 74 (5): 585http://www.ajcn.org/cgi/content/abstract/74/5/585
Cocoa and dark chocolate on LDL oxidative susceptibility
Great news for chocalate lovers!! It does appear that the polyphenols in chocolate do have some protective effects. However, this article does not take into effect the affect of stearic acid in the chocolate that are believed to have adverse effects of lipids. AJCN — Abstracts: Wan et al. 74 (5): 596 http://www.ajcn.org/cgi/content/abstract/74/5/596
Maternal Epidural Use and Neonatal Sepsis Evaluation
Articles like this may one day illuminate the fact that ANY substances given to the mother while she is pregnant and breastfeeding will have an effect on the infant, no matter how late it is administered. How could substances given at levels to affect a much larger human not affect the tiny infant?? Pediatrics — Abstracts: Goetzl et al. 108 (5): 1099
Genetic variation in aldosterone synthase predicts plasma glucose levels
This article is more of an FYI for those of you who may be interested. Keep in mind that this may indicate that proper adrenal cortex function may be essential for managing glucose levels. Keep an eye on this as research develops. PNAS — Abstracts: Ranade et al. 98 (23): 13219 http://www.pnas.org/cgi/content/abstract/98/23/13219
Preventive Strategies in Chronic Liver Disease
This is a review article that touches on the superficial ways to address improper liver function. Of interesting note is the long list of very common drugs that are hepatotoxic. We need to start viewing pharmaceutical drugs for what they are–toxic substances that, while having limited beneficial effects, can have a broad range of side effects that can be worse than the condition originally treated. Although the list of herbs in this same category is also long, the herbs listed are not very common. Also of note is the author grudgingly supporting milk thistle. Research and anecdotal information supporting the use of milk thistle to protect and restore the liver is abundant. Preventive Strategies in Chronic Liver Disease – November 1, 2001 – American Family Physician http://www.aafp.org/afp/20011101/1555.html
Classic Presentation of Celiac Disease Is Not Most Common
This interesting portion of this article is that one third of patients in this study were originally identified as having irritable bowel syndrome. Most patients had seen three physicians before the correct diagnosis was made. Celiac disease is an allergy to one of the proteins found in certain grains, principly wheat. The take home message here is that any patient with IBS (and any GI complaints in general) needs to be put on an elimination diet devoid of the common allergens wheat, dairy, corn and soy.
66th Annual Scientific Meeting of the American College of Gastroenterology The classic presentation of celiac disease, severe malabsorption symptoms beginning in childhood, is actually not the most common presentation, according to study findings presented Monday at the 66th Annual Scientific Meeting of the American College of Gastroenterology. Dr. Robert D. Zipser, from Harbor-UCLA Medical Center in Torrance, California, and colleagues surveyed 1032 patients with biopsy-proven celiac disease to determine the most common presentations. The median age at diagnosis was 46 years and 14 patients were over 80 years when first diagnosed, the investigators note. Only 12% of patients were diagnosed before 10 years of age. Most patients had normal weights at diagnosis. While diarrhea was a common initial symptom, a few patients presented with constipation. Anemia, fatigue, flatus, bloating, and abdominal pain were also frequent presentations. Five percent of patients were asymptomatic. Most patients saw three physicians prior to being diagnosed. More than a third of patients were initially diagnosed with irritable bowel syndrome, the investigators report. The median time from initial presentation to biopsy-proven diagnosis was 1 year. However, 19% of patients had symptoms for more than 10 years before being diagnosed. “The goal of the study was to help physicians recognize celiac disease,” says Dr. Zipser. “Physicians often think of it as a rare malabsorptive disease limited to childhood,” he said. “However, the current findings indicate that celiac disease usually presents in adulthood with symptoms mimicking those of irritable bowel syndrome,” he added. While the findings indicate that adult onset is common, Dr. Zipser pointed out that for a small minority of patients the disease was probably missed during childhood. “Many symptoms which are typical of the childhood form are relatively uncommon in the adult form,” Dr. Zipser stated. For example, “weight loss is common in the childhood form, but uncommon in the adult form,” he noted. In fact, he added “some of the patients were actually obese,” he added. While all of the patients in the current study underwent small bowel biopsy, Dr. Zipser noted that it is now quite easy to diagnose celiac disease. “A simple blood test can determine whether antibodies to wheat products are being made,” he explained.
Unrecognized Fructose Intolerance and Unexplained GI Symptoms
This is another factor to look for with IBS symptoms. Fructose is found in many fruits as well as high fructose corn syrup used as sweetner in just about every processed snack and drink.
66th Annual Scientific Meeting of the American College of Gastroenterology Many patients with unexplained gastrointestinal (GI) symptoms have fructose intolerance, according to study findings presented Monday at the 66th Annual Scientific Meeting of the American College of Gastroenterology. Unexplained bloating, flatus, and distension are common GI complaints. While much attention has been paid to lactose intolerance as a potential cause, fructose intolerance has received relatively little attention. Dr. Young K. Choi and colleagues from the University of Iowa in Iowa City administered a fructose breath test to 219 patients with unexplained GI symptoms. The patients were also given a symptom questionnaire and assessed for irritable bowel syndrome (IBS). Nearly 80% of patients had a positive breath test, the researchers note. Furthermore, the fructose given during the test reproduced the GI symptoms of 58% of patients. Based on questionnaire results, 130 of 159 patients met ROME I criteria for IBS. “We were quite surprised to find such a high prevalence of fructose intolerance,” says Dr. Choi. “The results also suggest that many people with IBS have underlying fructose intolerance,” he added. However, “the patients we studied were referred to us by outlying centers, so it is hard to know the actual prevalence of fructose intolerance.” “The fructose breath test is probably not performed at most community hospitals,” Dr. Choi noted. “The test is somewhat time-consuming, but relatively simple to perform.” Further studies are needed to better characterize the problem, he said. Until then, it is important for physicians to recognize the problem because institution of a low fructose diet may improve symptoms.