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NAFLD

Taking Vitamin D? You Need to Add This Vitamin as Well

July 16, 2015 by James Bogash

liver disease and vitamin A
bluebay2014 / Dollar Photo Club

Prediabetes is arguably more dangerous to your health than is cigarette smoking.  For the smoker who is prediabetic, life insurance is a must.

This danger to your health stems from the fact that prediabetes and diabetes attack pretty much every organ in your body.  The blood vessels get destroyed (heart attack and stroke), the DNA of your cells gets damaged (cancer), your kidneys and your brain (Alzheimer’s dementia, cognitive loss and Parkinson’s disease).  One organ that many doctors are not aware of in the line of diabetic fire is the liver.

Non-alcoholic steatohepatitis (NASH) or non-alcoholic fatty liver disease (NAFLD) are two liver conditions that are very strongly linked to being prediabetic (NASH is the more progressive of the two conditions).

The principal tool for management of prediabetes and diabetes is diet.  While exercise is important, it is not as important as diet.  Avoiding environmental chemicals like plastics, styrofoam, pesticides, Teflon and flame retardants is another pillar of diabetes prevention.

That being said, there are a handful of nutrients and supplements that have a good track record for singlehandely fighting off diabetes.  The short list includes:

  • Magnesium
  • Vitamin D
  • Fish oils and monounsaturated fats (think olive oil)
  • Alpha lipoic acid
  • Folic acid

Vitamin D is a supplement that I have written about extensively over the years.  What I haven’t been as outspoken about has been it’s related vitamin, vitamin A.  Both vitamins function as hormones, not vitamins.  They do this by acting on your DNA to change what a cell is doing.  Contrast this with a true vitamin, which will act as a cofactor to help an enzyme do its job.  The receptor for vitamin D and the receptor for vitamin A work together to change the way a cell behaves.

It is for this reason that some researchers feel that vitamin D toxicity is really a relative deficiency of vitamin A.  Kind of like how taking too much calcium without magnesium can cause heart rhythym problems.  This doesn’t happen because of too much calcium, but rather because there is not enough magnesium to counterbalance the higher levels of calcium.

There has been some controversy in the past about mixing vitamin D and vitamin A, with some experts recommending the use of beta carotene (the precursor to vitamin A) rather than preformed vitamin A.  But I have looked into this concern and just really haven’t found any solid research suggesting that we need to be that concerned (although I do reserve the right to change my opinion based on future research).

With all of this out of the way, we can talk about the results of this particular study.  In it, researchers looked at the relationship between blood levels of vitamin A and the likelihood of developing diabetes-related liver problems (NASH or NAFLD).  Here’s what they found:

  • Blood levels of vitamin A were 47% lower in patients with NAFLD (1.42 ng/mL) and 58% lower in NASH (1.14 ng/mL) versus those without these conditions (2.70 ng/mL).
  • In those without liver disease, when compared with non-prediabetic patients, vitamin A levels were 19% lower in those with “controlled” type 2 diabetes (2.87 vs. 2.32 ng/mL).
  • In those with NAFLD who were prediabetic, vitamin A levels were 20% lower when compared to those with NAFLD who were not prediabetic (1.61 vs. 1.28 ng/mL).
  • In those with NASH who were prediabetic, vitamin A levels were 21% lower when compared to those with NASH who were not prediabetic (1.35 vs. 1.07 ng/mL).
  • Under special testing done on the liver tissue, flare ups were lower in those who had higher activation of the vitamin A : vitamin D receptor complex (RXRα mRNA expression).
  • Both blood vitamin A levels and greater activation of the combined vitamin A : vitamin D receptor complex (RXRα mRNA levels) were linked to lower levels of triglyceride accumulation in the liver.

Based on this study, it is clear that vitamin A plays some type of role in protecting against both prediabetes as well as liver damage associated with prediabetes.  Given how inexpensive vitamin A is as well as how easy it is to take (much like vitamin D, vitamin A can be taken weekly).  Biotics vitamin A-Emulsion forte is the product that we use in the office.  I generally try to dose in a 1:1 ration, keeping in mind that this vitamin A has 12,500 per drop, so you’ll have to do the math depending upon how much vitamin D you are taking.

 

 

 

Filed Under: Liver Disease, Prediabetes, Vitamin D Tagged With: liver disease, NAFLD, NASH, non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, Retinoic Acid, vitamin A

NSAIDs, Prediabetes and Your Liver; Dangerous, but Not Like You Think

June 6, 2015 by James Bogash

elevated liver enzymes
creative soul/Dollar Photo Club

There is pretty much no chronic disease that prediabetes does not contribute to.  Fatty liver is on the list.

It goes by many names: non-alcoholic steatohepatitis (NASH), fatty liver, non-alcoholic fatty liver disease (NAFLD).  It can start with just a mild elevation of liver enzymes on a routine blood work panel.  This may prompt your doctor to order a viral hepatitis panel just to make sure that hepatitis is not at work.

When the virus panel comes back normal you just get kind of a mention of it not being anything significant and that we’ll just keep an eye on it.

This is how it starts (I’ve covered this concept in a previous blog article that can be read by clicking here), but it can progress to something far more severe with time, leading to scarring of the liver (fibrosis, cirrhosis) and liver transplants.

Currently, there is a rather large amount of research being published on this topic because this elevation of liver enzymes is on the rise.

As always, the answer comes down to that condition that about half of the Westernized world has prediabetes.  There are some very, very strong links between the diabetic progression and NASH.  It boils down to the accepted fact that the diabetic process pretty much pisses off the liver cells, ultimately killing them off slowly (leading to the elevation in liver enzymes in the blood).  Inflammation that is generated by the diabetic lifestyle likely plays a pivotal role as well.

This means that living an anti-diabetic lifestyle is the ONLY real answer (despite the rush to try to develop a drug for this condition).

(While it is beyond the scope of this article, feel free to check out my Diabetes eBook for a complete outline of the necessary lifestyle changes to combat diabetes by clicking here.)

Or at least, an anti-diabetic lifestyle was the only thing that USED to be on the list.  This particular article adds another aspect to this condition.  In it, researchers looked at the relationship between the activation of the enzyme cyclo-oxygenase 2 (COX2) and the development of fatty liver.

You may recognize the name of the enzyme because COX1 and COX2 are the enzymes that are blocked by the use of non-steroidal anti-inflammatory drugs like ibuprofen and naproxen.  And we can’t forget the Vioxx debacle, a drug that was designed to block only COX2, along with Celebrex and Bextra.

Vioxx was pulled off the market because it greatly increased the risk of heart attacks, causing at least tens of thousands of heart attacks in the time it was being prescribed.

Why?  Because, while we know that COX1 and COX2 produce inflammatory chemicals in our body, they also do things like thin the blood via the enzyme prostacyclin.  The problem is that we don’t find out about these other enzymes functions until we block it in large numbers in a brand-new-to-the-market blockbuster drug.

Here’s some interesting things that the researchers found:

  • Adult liver cells do NOT turn on the COX-2 enzyme when the rest of the body is in an inflammatory state.
  • This lack of expression of COX2 may leave liver cells vulnerable to the development of insulin resistance / prediabetes.
  • If the baseline production (constitutive) COX-2 in liver cells is forced (in the lab in mice), they found that this protects these cells against adiposity, inflammation, and, hence, insulin resistance.
  • This increased production of COX2 leads to decreased fatty liver, adiposity, triglycerides and free fatty acids, increased adiponectin-to-leptin ratio (an anti-diabetic marker), and decreased levels of chemical involved with inflammation.
  • As an added benefit, these mice who produced more COX2 enzyme activity burned more fat.

So, just like most everything else that has to do with human physiology, we really don’t have any idea how things work.  We THINK we know what enzymes do.  COX2 produces inflammation.  We block that with a drug and we’ll stop pain.

Until you cause a heart attack.

And here we see yet another aspect of what this enzyme does.  This leads to the very reasonable possibility that drugs like the NSAIDs and the selective COX2 inhbitors (Celebrex is still available although Vioxx was pulled off the market) may contribute to fatty liver.

Although it has always been known that these drugs damage the liver, it was thought to occur by a different mechanism; one that had not been previously thought of.  At least until now.

(Just in case you’re a little rusty on your ibuprofen side effects, feel free to check out my eBook on the topic by clicking here)

This is not, however, the direction the researchers were looking.  Rather, the conclusions stated that drugs that INCREASE the expression of COX2 in the liver may be a new route of research into drugs used to treat NAFLD.

Yep.  I’m sure it’ll be a blockbuster.  At least until it starts killing patients left and right.

 

Filed Under: Fatty Liver, NSAIDs Dangerous Tagged With: fatty liver, ibuprofen, NAFLD, NASH, NSAIDs dangerous, prediabetes, steatohepatitis

THE NUMBERS OF PREDIABETIC PATIENTS JUST SHOT UP!!

February 4, 2015 by James Bogash

THE NUMBERS OF PREDIABETIC PATIENTS JUST SHOT UP!!  If you’re a regular reader of my updates, you know that a large chunk of the population is prediabetic.  Probably well over 50%.  That number is about to get much larger based on this study.  It is well established that being prediabetic is bad for the liver and induces a condition called non-alcoholic steatohepatitis (NASH).  That mild elevation in liver enzymes that your doctor can’t find a reason for and just says it must be genetic?  Yup.  Prediabetes.  But it gets worse.  This study finds that our normal range (usually 2-60) is not even close to good enough.  In men, >22 and women > 10 is a strong predictor of developing diabetes in the next few yrs.  Wow!!  These are some pretty harsh numbers!!  So, next time your doctor calls and tells you your labs are “normal,” make sure you get a copy of them yourself so you can double check the numbers.
Read article here

 

Filed Under: Fatty Liver, Prediabetes Tagged With: ALT, aminotransferase, AST, fatty liver, liver enzymes, NAFLD, NASH, prediabetes

NORMAL LIVER ENZYMES LINKED TO DIABETES?

February 4, 2015 by James Bogash

NORMAL LIVER ENZYMES LINKED TO DIABETES?  I remember early on in practice not recognizing this for what it was.  I had a few patients with mildly elevated liver enzymes (AST, ALT).  They would just comment that they’ve always been elevated.  Usually their doctor had run a barrage of liver tests looking for viral hepatitis.  But, with time, I’ve come to understand that prediabetes is very damaging to the liver, just like every other organ that is affected by this condition. I’ve even come to recognize that high normal values, when combined with other factors (abdominal obesity, elevated cholesterol / triglyerides, elevated uric acid, etc..) are a strong sign of prediabetes.  Something else to consider here…we view AST and ALT as “liver function” tests.  What we’re really looking at here are cells that are dying off and spilling their enzymes into the blood stream.  Doesn’t really sound like a test of “function” but rather a test of “dead…”
Read more here

 

Filed Under: Fatty Liver, Prediabetes Tagged With: ALT, aminotransferase, AST, fatty liver, liver enzymes, NAFLD, NASH, prediabetes

GGT, A MARKER OF LIVER OR GALL BLADDER DYSFUNCTION – (11-07-05)

August 19, 2012 by James Bogash

gamma-Glutamyltransferase as a Risk Factor for Cardiovascular Disease Mortality

GGT is normally thought of as a marker of liver or gall bladder dysfunction (it is called a liver “function” test, but is actually looked for dead cells spilling more of the enzymes into the bloodstream–hardly a marker of “function” if you ask me…), but has been gaining increased popularity as a marker of CVD and insulin resistance. So, chalk yet another marker up for risk of insulin resistance and CVD. One thing I have not seen mentioned, however, is whether the relationship is direct or indirect.

Insulin resistance is known to cause an elevation of liver enzymes and non-alcoholic steatohepatitis (or called non-alcoholic fatty liver disease- NAFLD). So, is this just another marker of the damage that insulin resistance is doing, or does the GGT have a direct relationship to CVD? And does it matter??

Read entire article here

Filed Under: Fatty Liver, Heart Disease Tagged With: bloodstream, CVD, Glutamyltransferase, NAFLD

DON’T WORRY ABOUT DIABETES–CANCER WILL GET YOU FIRST

May 19, 2011 by James Bogash

The beauty about not taking good care of ourselves is that every aspect of our physiology goes to hell in a handbasket.  There’s no need to worry about focusing on a single organ system or medical specialty.  Just assume that everything bad is happening.  See?  No need to needlessly focus on your cardiologist and worry about your GI doc finding something.  They will, don’t worry.

On the plus side, this is why positive lifestyle changes can be so profound.  They don’t just improve what you are shooting for (weight loss, lower cholesterol, etc..), but improve everything.  Massive bang for your buck.

In this particular study, authors looked at patients with non-alcoholic steatohepatitis (NASH or NAFLD).  This is prediabetes.  Period.  Bad enough news.  But they looked for the presence of colon cancer and found a massive 534% higher risk of having advanced cancers in those with NAFLD.

Now maybe you can understand why I get frustrated when a new patient comes into my office and proudly states that their doctor is “keeping an eye on” their progression to diabetes.  As if there is no concern until one crosses that magical barrier of blood glucose to be called diabetic.  If you are prediabetic (too much weight in the abdominal region, ANY lipid / cholesterol problem, PCOS, high blood pressure, gout, sleep apnea, etc..) then understand that your single goal is to make lifestyle changes to pull back from the progression.  Anything less is signing an early death war

Filed Under: Colon / Colorectal Cancer, Diabetes (Type 2), Fatty Liver, Prediabetes Tagged With: colon / colorectal cancer, diabetes, NAFLD, NASH, prediabetes

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