Fatty Liver & Resistant Starch

One out of three American adults, and even more and more kids, now have fatty liver.

This is no small issue, though I hear it is not taken so very seriously much of the time.

The liver is a jamming organ. The extraordinary liver does many protective things for our bodies. Excess fatty build-up inside liver cells can halt many of these protective processes.

For example, your liver processes and in this way, literally “care-takes” your many of your hormones such as estrogen, testosterone, and progesterone.

If you suffer with fatty liver, you don’t get the “best” out of your own, or replaced, hormone therapies.

A healthy liver contains a small amount of fat. In a healthy person’s liver, a cellular form of self-renewal known as “autophagy,” breaks down these fat deposits by the cell's waste disposal and recycling system, called lysosomes.

Fatty liver is when lipids, or “fat,” can be pulled out of the bloodstream by liver cells called hepatocytes. The fat accumulates in excess within structures called lipid droplets.

Fatty liver disease (steatosis) or non-alcoholic fatty liver disease (NAFLD) is a too common condition (one out of three adult Americans) caused by having too much fat build-up inside your liver cells.

It becomes a problem when fat reaches 5% to 10% of your liver's weight. (When I worked in Oklahoma, we performed ultrasounds of all patients’ liver tissue once a year, and the sonographer estimated the percentage of fat. It was highly motivating in our grateful patients).

If “fat build-up” goes on too long, then nasty tissue changes occur called fibrosis. Then the last dangerous stage, if things keep going on as they are, is scarring.

A Fibroscan is the newest and best (and not expensive) form of liver imaging, more sensitive than ultrasound. I have been using this on many of my high-risk patients for about two years.

Who is at high risk?

Those with huge guts, with weight that won’t come off, with hormones that can’t be balanced (the liver processes all hormones), those with possibly elevated liver enzymes (though not all the time), and possibly low “good” cholesterol as the liver makes this form of protective cholesterol (but not all the time), those who regularly drink too much alcohol or those who eat too much highly processed foods, especially excessive processed sugars, and/or high fructose corn syrup. (In fact, in rodent models of fatty liver, the researchers induce fatty liver by feeding these animals a high fructose corn syrup diet).

If you find out you have fatty liver, what to do?

There is a God, and this God made the liver very amenable to healing. Many botanicals and nutraceuticals and dietary improvements help.

Unless there is evidence of scarring. Scarring is irreversile.

Fibrosis is an intermediate stage, that is reversible, but requires more powerful protocols. Yet, this is not the place to go into that.

Fish oils and their omega-3 three fatty acids have been shown, in rodents induced to have fatty liver by consuming high fructose corn syrup, to help reduce the build-up of fat droplets.

In fact, when the fatty liver rodents were given probiotics along with omega-3 fatty acids they started to not want to eat high fructose corn syrup choices, and make better food choices. Wow!

This suggests that healthier food choices keep helping you make healthier food choices! Another “wow”!

Eating less is powerful. Dr. Jason Fung used intermittent fasting (IF), every other day for 24 hours, it had to be a “hefty IF”, to improve and eradicate diabetes. Even long-term diabetes.

In-depth studies demonstrate by imaging that fat literally “marches” out of the liver with IF of this type.

Thus, I have had some very motivated patients, especially to get rid of that huge belly, do this. And low and behold it works. Rather rapidly.

Resistant Starch

Now, we see another tool to "heal” fatty liver. Resistant starch.

Resistant starch is a non-digestible fiber that ferments in the large intestine, and consumption of it has previously been shown to have a positive effect on metabolism in animal studies.

A 4-month randomized controlled trial in people with non-alcoholic fatty liver disease (NAFLD) indicates that daily intake of resistant starch (twice a day) can alter gut bacteria composition and lower liver triglycerides and liver enzymes associated with liver injury and inflammation. And help heal fatty liver.

Currently, there is no approved medicine available to treat NAFLD.

Doctors usually say, casually without a lot of guidance, to lose weight, eat better (what does that literally mean?), and exercise more. All the while many docs don’t necessarily live that way. PS I have a really difficult time going to a doc or even listening to one at a lecture, that looks way out of health and way overweight. But we never know the back copy.

Unhealthy Gut Biome

Previous research has suggested that NAFLD is associated with perturbed gut microbiota. An unhealthy gut biome. People with early-stage NAFLD already have an altered gut bacteria profile.

A huge collaborative Chinese research team recruited 200 NAFLD patients and provided them with a balanced dietary plan designed by a nutritionist. Half, or 100 patients also received a resistant starch powder derived from maize (though I happen to really like organic green banana flour for this), while the other 100 received calorie-matched non-resistant corn starch as a control.

They were instructed to drink 20 grams of the starch per day mixed with 300 mL water (1 ¼ cups) before meals twice a day for 4 months.

This is roughly 1.5 Tablespoons of resistant starch twice a day.

After the 4-month experiment, participants who received the resistant starch treatment had nearly 40% lower liver triglyceride levels compared to patients in the control group. In addition, patients who had the resistant starch treatment also saw reductions in liver enzymes and inflammatory factors associated with NAFLD.

Importantly, these benefits were still apparent even when statistically adjusted for weight loss. Their gut biomes improved.

By analyzing patients' fecal samples, the team found the resistant starch group had a different microbiota composition and functionality compared with the control. In particular, the treatment-group patients had a lower level of Bacteroides stercoris, a key bacterial species that can affect fat metabolism in the liver through its metabolites.

The reduction in B. stercoris is strongly linked to the decrease in liver triglyceride content, and liver enzymes. This also suggests that in patients with chronically elevated triglycerides, resistant starch may be very helpful.

It makes sense to “translate” science into to-do’s! (I try to do that in this Substack!).

When the team transplanted fecal microbiota from resistant starch-treatment patients to mice fed with a high-fat high-cholesterol diet, the mice saw a significant reduction in liver weight and liver triglyceride levels and improved liver tissue grading compared with mice that received microbiota from the control group.

Your liver is a “happening” organ. It has the highest temperature in your body as it is working so hard. If it is filled with excess fat, it is no longer “watching” your physiologic back.

Be liver-friendly.

Biotics Products

My new products by Biotics have a great side-benefit beyond keeping your hormones balanced and healthfully signaling. They are liver-protective, too.

Knowledge is power.

I am older yet not so older as I have been diligently trying to live this kind of life since my teens. Many of my DES (diethylstilbesterol in-utero exposure) daughter cohorts are struggling or dead while I have the “youth” in my older age that was not possible when younger.

I remember that Dr. Bernard Jensen used to say, “A long life lived is good enough. But a good life lived, is long enough.”

I wish us all healthy and good lives. With healthy and protective liver function.

With some vitamin F added, too = FUN! Why do we want to be healthy? To be able to live out our destiny, connect with others and Nature, and have some fun.

Dr. B.

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References:

Fructose, high-fructose corn syrup, sucrose, and nonalcoholic fatty liver disease or indexes of liver health: a systematic review and meta-analysis. Am J Clin Nutr. 2014 Sep;100(3):833-49. doi: 10.3945/ajcn.114.086314

The Effects of Probiotics and Omega-3 Fatty Acids in Liver Steatosis Induced in Rats by High-Fructose Corn Syrup. Int J Clin Pract. 2022 Jan 31;2022:7172492. doi: 10.1155/2022/7172492

Resistant starch decreases intrahepatic triglycerides in patients with NAFLD via gut microbiome alterations. Cell Metabolism, 2023; 35 (9): 1530 DOI: 10.1016/j.cmet.2023.08.002

Src homology 3 domain binding kinase 1 protects against hepatic steatosis and insulin resistance through the Nur77‐ fibroblast growth factor 21 pathway. Hepatology, 2022; DOI: 10.1002/hep.32501