Many thanks for your question regarding your client who is now finding it difficult to shift additional weight although I note the improvements he has already experienced following you advice. In view of the recent liver results I wonder if more attention needs to be given to his liver health and insulin sensitivity which may in turn assist with weight loss.
I also agree with you that this client may benefit from a more plant based diet and one that includes plenty of soluble and insoluble fibre with care not to include foods that may aggravate the diverticulosis such as seeds and pips etc. Fatty liver disease has multiple interrelated causes. Primary mechanisms include obesity leading to steadily increasing insulin resistance coupled with an overabundance of circulating fatty acids. These factors fuel one another in a destructive cycle. Together with advanced glycation end-products (AGEs), these events lead to increased oxidant stress and ultimately inflammation, cell death, and fibrous destruction of liver tissue
Younossi ZM. Review article: current management of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Aliment Pharmacol Ther. 2008 Jul;28(1):2-12. http://tinyurl.com/y7m8r3fl
An overload of fatty acids and abnormal lipid profiles factor so heavily in the onset of NAFLD that they’re now referred to as “lipotoxicity” because of the ways they directly poison liver tissue
Musso G, Gambino R, Cassader M. Nonalcoholic fatty liver disease from pathogenesis to management: an update. Obes Rev. 2010 Jun;11(6):430-45. http://tinyurl.com/ydbz422l
And as fat builds inside liver cells, they begin churning out a storm of fat-related cytokines known as adipokines, which fan the inflammatory flames of the metabolic syndrome and NAFLD
Polyzos SA, Kountouras J, Zavos C, Tsiaousi E. The role of adiponectin in the pathogenesis and treatment of nonalcoholic fatty liver disease. Diabetes Obes Metab. 2010 May;12(5):365-83. http://tinyurl.com/y8om3jfc
Ongoing inflammation aggravates the body’s ability to utilise insulin which in turn could make it difficult to lose weight. Of particular relevance is the amount of fructose in the diet. Fructose promotes formation of new fat molecules in the liver, blocks breakdown of existing fats, stimulates free radical production, and promotes insulin resistance. An increasing number of studies are linking increased fructose consumption with NAFLD, and even with its deadlier consequence, non-alcoholic steatohepatitis (NASH)
Keeping fruit to a minimum and limiting to low fructose fruit, no fruit juices, smoothies, squash etc would therefore be appropriate
Abdelmalek MF, Suzuki A, Guy C, et al. Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease. Hepatology. 2010 Jun;51(6):1961-71. http://tinyurl.com/y882h6xu
One of the most effective interventions to consider is vitamin E. One study provided the first evidence that vitamin E can prevent NAFLD before it develops, largely by reducing oxidative stress, inflammation, and liver cell death by apoptosis. Another study demonstrated a vitamin E-related reduction in oxidative damage and tissue levels of the inflammatory mediator TNF-alpha, while beneficially reducing PPAR-gamma activity
Raso GM, Esposito E, Iacono A, et al. Comparative therapeutic effects of metformin and vitamin E in a model of nonalcoholic steatohepatitis in the young rat. Eur J Pharmacol. 2009 Feb 14;604(1-3):125-31. http://tinyurl.com/y6wabhfc
I would also consider the use of fish oil. Increasing the amount of unsaturated fats like omega-3s in cell membranes is associated with improved insulin sensitivity. And supplementation with omega-3 rich fish oil results in activation of the important metabolic sensor, called PPAR-alpha, in liver cells, suppressing production of new fat molecules.
Omega-3s also contribute to improved insulin sensitivity, a reduction in serum triglycerides, and stimulation of fat utilization in liver tissue and skeletal muscle
Ukropec J, Reseland JE, Gasperikova D, et al. The hypotriglyceridemic effect of dietary n-3 FA is associated with increased beta-oxidation and reduced leptin expression. Lipids. 2003 Oct;38(10):1023-9. http://tinyurl.com/yao8l44x
Larter CZ, Yeh MM, Cheng J, et al. Activation of peroxisome proliferator-activated receptor alpha by dietary fish oil attenuates steatosis, but does not prevent experimental steatohepatitis because of hepatic lipoperoxide accumulation. J Gastroenterol Hepatol. 2008 Feb;23(2):267-75. http://tinyurl.com/ya785wgp
A long-term human trial, using 1,000 mg per day of omega-3, revealed significant decreases in serum markers of liver cell damage, triglyceride levels, and fasting glucose. Most impressively, supplemented patients display improvement of their livers’ appearance and blood flow on ultrasound exams, providing graphic evidence of the supplements’ benefits
In addition, constant exposure to oxidant and toxic stresses makes liver cells especially vulnerable to depletion of glutathione and therefore a supplement such as NAC may be helpful.
Capanni M, Calella F, Biagini MR, et al. Prolonged n-3 polyunsaturated fatty acid supplementation ameliorates hepatic steatosis in patients with nonalcoholic fatty liver disease: a pilot study. Aliment Pharmacol Ther. 2006 Apr 15;23(8):1143-51. http://tinyurl.com/yaabsovl
Supporting insulin sensitivity may be also something to consider and watching overall fat intake particularly saturated fat and switching more to oily fish, monounsaturated fat such as olives and avocado would be beneficial. Clearly if there is a thyroid imbalance and / or adrenal imbalance then this may need specific attention based on test results.
The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
KappArest (BRC) take 2 with each meal
EFA-Sirt Supreme (BRC) – take 2 three times daily – http://tinyurl.com/h3czc9x
NAC Enhanced Antioxidant formula (ARG) take 1 twice daily
Tocomin SupraBio Tocotrienols (ARG) take 1 twice daily
Glucofit (ARG) take 1 20 minutes before each meal http://tinyurl.com/gwwkcnk
Glucobalance (BRC) take 2 with each meal http://tinyurl.com/jfhvyum
I hope this helps with your client
Registered Nutritional Therapist Helen Perks is collaborating with Clinical Education to bring you the first-ever Functional Medicine book club for Practitioners.
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