Liver disease can be from many causes, but when there is no cause for liver disease it is called NASH, nonalcoholic steatohepatitis, or nonalcoholic fatty liver disease. The liver is a major source of detoxification in the body and when burdened will start to develop fatty deposits, a sign that it is stressed. When alcohol abuse, medication toxicity and infections have been ruled out, what then could be the cause for liver disease?
NASH is a growing condition in western culture. Those with NASH often have comorbidities including blood sugar management issues, elevated cholesterol, specifically triglycerides, and obesity. It is diagnosed by imaging studies, most often an ultrasound of the liver, revealing enlargement and fatty deposits on the liver. Often liver function studies through blood work are elevated, indicating the liver is having a hard time keeping up with demand and is inflamed. In some cases, a liver biopsy is required to rule out other causes of fatty liver disease.
Symptoms of NASH are often subtle if any at all including fatigue, pain in upper right abdomen, or fullness in right upper abdomen. Severe cases can lead to abdominal swelling, red palms and jaundice or yellowing of the eyes and skin. The good news is that the liver is very regenerative and can start to heal itself if the insult is removed and support provided. Ideally, you want to start working to reverse NASH right away, the longer the liver is inflamed increases the risk of cirrhosis of the liver. Cirrhosis is a process where more permanent scaring starts to develop on the liver rendering it unable to function. Luckily, only 20% of those with unmanaged NASH will go on to develop cirrhosis.
Traditionally, patients with NASH are encouraged to manage the comorbidities of NASH through diet and exercise to maintain a healthy body weight, improve blood sugar and correct cholesterol abnormalities. This is often difficult to do without direction. Naturopathic doctors utilize a plethora of modalities to support liver function to treat NASH from dietary alterations to supplementation to IV therapies. While each person is an individual and we treat each patient uniquely, the following are often staples in a treatment plan for NASH.
Balance the Blood Sugar
Insulin resistance is found in almost all who suffer from NASH. Insulin is needed to shuttle glucose, energy, into the cells of the body. Insulin resistance is a condition when the cells in the body become resistant to insulin, making it difficult to get glucose into the cells for energy. It has been found that insulin resistance may increase free fatty acid delivery to the liver, therefore increasing liver fatty accumulations.1 While the exact mechanism of how ineffectual use of insulin and NASH are linked is not fully understood, what naturopathic medicine knows well is how to balance blood sugar and improve insulin sensitivity.
Intermittent fasting is a dietary regimen that directly affects your body’s ability to use glucose for energy. The idea behind intermittent fasting, fasting for 14-16 hours in the day including overnight hours, is that during that time of calorie restriction your body will use fatty acids in the body for energy. Hence less fatty acids being shuttled to be deposited on the liver. Not only dose intermittent fasting encourage fatty acid utilization in the body but it does encourage calorie restriction. Overeating and lack of exercise is a recipe for excessive fatty acids to be deposited on the liver.
Intermittent fasting has also been shown to improve insulin sensitivity making it a favorable implantation in type II diabetics dietary recommendations. The World Journal of Diabetes published a study on the effect of intermittent fasting on health markers for those with type II diabetes. The results from the pilot study was that it was a well-tolerated and overall safe intervention.2
We have been taught to eat breakfast every morning and to eat every couple of hours to improve our metabolism, however, recent research is starting to show the contrary. Intermittent fasting is not for everyone and needs to be altered to fit each person individually based on work schedule, family meal times, etc. The idea is overall calorie reduction and to encourage the body to use its own fatty acid storage for energy, this can be obtained through other means as well but diet is the first place to start.
There are many vitamins and herbal supplements that have been shown to help to support liver detox and to relieve stress and inflammation of the liver. The following is not a comprehensive list but can be used at varying doses and in varying combinations to support an individual with NASH.
- SAMe- S-adenosylmethionine- A naturally formed molecule in the body, that when supplemented serves as a precursor for cysteine, an amino acid, that protects against free radicals, or toxic stresses, that can enter the body including alcohol, pesticides, environmental pollutants. 3 The liver is the first place these free radicals are neutralized and can become overwhelmed, making SAMe a great addition to protect the liver.
- NAC- n-acetyl-cysteine-This is a molecule that encourages the production of glutathione, the livers most potent endogenous detox supporter. NAC has been shown to reduce the stress on the liver, as shown in liver enzyme testing blood work. The dose of NAC depends on the person, however, has been shown to be a safe and effective adjunct in those with NASH. 4
- Vitamin E-Supplementation with vitamin E has been shown to improve inflammation and fatty deposition on the liver. Vitamin E is a natural anti-oxidant helping to neutralize oxidizing effects of toxins on the liver, protecting it from further damage and allowing healing. 5
- Glutathione- A super power molecule that is vital to support detoxification and protection of the liver among many other important roles in the body. Glutathione can be supplemented orally with advantageous benefit to liver function studies of patients with NASH. 6 Oral supplementation of glutathione can become costly and may not be as absorbed as well as an intramuscular injection of glutathione or IV push of glutathione. Both have been shown to prove advantageous to improve your liver enzyme profiles. 7
If you are struggling with what to do for a diagnosis of NASH consider a consultation with a Naturopathic Doctor as we have a variety of treatment modalities to encourage liver and overall health.
- Journal of Clinical Endocrinology & Metabolism | Oxford Academic. OUP Academic. https://academic.oup.com/jcem/article/91/12/4753/2656230. Published December 1, 2006. Accessed January 28, 2018.
- Arnason T, Bowen M, Mansell K. Effects of intermittent fasting on health markers in those with type 2 diabetes: A pilot study. World J Diabetes. 2017;8(4):154. doi:10.4239/wjd.v8.i4.154.
- CS L. S-adenosyl-L-methionine: its role in the treatment of liver disorders. – PubMed – NCBI. Ncbinlmnihgov. 2018. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12418503. Accessed January 28, 2018.
- Manouchehr Khoshbaten F. N-Acetylcysteine Improves Liver Function in Patients with Non-Alcoholic Fatty Liver Disease. PubMed Central (PMC). 2018. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270338/. Accessed January 28, 2018.
- Pacana T, Sanyal A. Vitamin E and nonalcoholic fatty liver disease. Curr Opin Clin Nutr Metab Care. 2012;15(6):641-648. doi:10.1097/mco.0b013e328357f747.
- Honda Y, Kessoku T, Sumida Y et al. Efficacy of glutathione for the treatment of nonalcoholic fatty liver disease: an open-label, single-arm, multicenter, pilot study. BMC Gastroenterol. 2017;17(1). doi:10.1186/s12876-017-0652-3.
- Dentico P, Volpe A, Buongiorno R et al. [Glutathione in the treatment of chronic fatty liver diseases]. Europepmcorg. 2018. Available at: http://europepmc.org/abstract/med/7569285. Accessed January 28, 2018.