Nonalcoholic fatty liver disease.
Here's what to do.
Hi. I'm Dr. Chris Masterjohn of
chrismasterjohnphd.com.
And this is Chris Masterjohn Lite, where
the name of the game is
"Details? Shmeetials. Just tell me what works!
And today we're going to talk about
nonalcoholic fatty liver disease,
a topic that I've done a lot of research
on because when I did my PhD, my
laboratory specialized in this
particular condition, and I actually have
some papers on it. So, nonalcoholic fatty
liver disease afflicts an estimated 70
million Americans, and it's especially
common in obesity and overweight and in
both type 1 and type 2 diabetes. The only
way to diagnose it is with ultrasound or
a more advanced imaging technique.
Ultrasound is the least invasive. Liver
enzymes are not useful in diagnosing it,
and if you're not going to get an
ultrasound or a more advanced
imaging technique, then it makes more
sense to assume you have fatty liver if
you are obese or have diabetes than to
assume you don't simply because the
probability is that high. So, if we have
fatty liver, what are we going to do
about it? I believe the foundation for most cases
should be what I would call a
choline-boosting modified fast. And I'm borrowing
this name from a concept that this is
very loosely based on called a
protein-sparing modified fast, where the idea is
to have a strict restriction of calories
while providing protein, vitamins, and
minerals to prevent muscle wasting.
In this case, we absolutely do want to cause
as much weight loss as we can get away
with causing, but we want to focus not so
much on muscle wasting, but we want to
focus on providing a lot of choline,
whether in the diet or that you
synthesize within your liver because
choline is the primary most important
factor for getting fat out of the liver.
The basic principles involved here are
assuming that fatty liver is all about a
fat in versus fat out equation. The factors
that influence fat into the liver are
free fatty acids that are circulating in
your blood, especially free fatty acids
that are derived from the visceral abdominal fat
pad, because your visceral
abdominal fat empties free fatty acids
directly into your liver. Fat can also
wind up in your liver because of the
food that you eat. Out of the possible
foods that you could eat, fat is the
thing that is most likely to contribute
fat going into the liver. This should be
reduced the most. The second most likely
thing to generate liver fat is fructose.
There's fructose in any form of sugar
whether you're talking about table sugar
or you're talking about high-fructose corn
syrup that's in your sodas, all of that
sugary stuff is a lot more likely
to contribute to liver fat than protein
or starch, even though fat is more likely
to contribute to liver fat even than fructose.
So, what we're trying to do is we're
especially targeting fat and we're
especially targeting fructose, and then
we want to make most of the diet be
protein and starch. In terms of protein
and starch, the protein is most important
because the protein is providing, is not
only helping you preserve your lean mass
while you're losing weight, but the
protein is also helping you make choline.
Choline is the principal thing that gets
fat out of your liver. Any protein
will help you make your own choline, but
animal protein is about twice as good at
helping you make protein as plant
protein is. Additionally to make your own
choline and to help preserve the choline
that does come into your diet, we want a
lot of vitamin B12 and folate. Then we
also want just lots of choline coming into the
diet as well. The starch is basically
filling the calories that are left over,
and how much starch should be included
in the diet is largely going to be
determined by to what degree do you need
to cut your calories. The last
principle that we want to incorporate is
we want antioxidant protection.
And that's because oxidative stress or
oxidative damage in the liver can
actually hurt the ability of the liver
to export fat. And it doesn't
matter how much choline we're getting in to
help us export fat. If that process is
being damaged by oxidative stress, it's
not going to work properly. So, what would
a diet look like that would achieve this?
Well, I think for protein you want to
focus on lean animal proteins, and you
want to get one gram of protein for
every pound of body weight, and you can
roughly double that if you measure your
weight in kilograms. Although you want
most of that protein coming in the form
of lean protein, I would include three or
four eggs a day because they're a very
rich source of choline. I would also
include one or two servings of liver per
week for the same reason. That liver is
also an excellent source of vitamin B12
and folate, and if you really hate the
taste of liver, then I would use a
high-quality liver supplement. For example the
Ancestral liver capsules that I
advertise in this show, six to nine of
those a day would be a great source of
the nutrients that we've just been
discussing. In most cases the person with
fatty liver is going to have a lot of
weight to lose. If you're going to pursue
a rapid weight loss approach, then I
would recommend getting three to six
cups of dark green vegetables a day and
primarily as steamed or raw vegetables,
and that's going to contribute a lot of
folate, and it's also going to take up a
lot of volume. As long as the person can
handle it without GI problems, then it
goes a long way towards filling up the
plate. After that I would provide most of
the rest of the volume of food as
low-calorie, low-carbohydrate vegetables
without added fats. Many factors are
going to influence someone's ability to
adhere to strict caloric restriction, and
so for someone who can't handle the
level of caloric restriction, or for
someone who's fairly close to their
ideal weight, then it makes sense
to replace some of those vegetables with
starches. In particular reducing the dark
green vegetables and replacing them with
legumes is a great way to maintain high
levels of folate in the diet. For someone
who cannot handle the digestion
of greens or legumes, then the best thing
to include is starches that they can
digest. In that case you want to make
sure that you're providing supplements
of methylfolate to replace the loss of
the primary food sources in the diet.
For a person who cannot handle the digestion
of the greens and the legumes and who
cannot handle the carbohydrate load of
the starch due to blood sugar problems,
then I do think that it is advisable to
include sources of fat that round out
the calorie needs of that person.
It's just that fat isn't the ideal
choice to do that from the perspective
of fatty liver. At the end of the day, the
final calorie intake needs to be adjusted
according to what is a sustainable
degree of weight loss that the person
can handle. If the person is very close
to their ideal weight, which is not the
usual case in fatty liver, then they
shouldn't be on a very steep caloric
deficit. If the person psychologically
doesn't do well with a very steep
caloric deficit, then you need to round
it out to what they can handle. But this
is going to be a balance of is the
person motivated by the rapid fat loss
to continue with the
rapid fat loss and achieve the goal
quickly, or is that person so burdened by
the rapid fat loss that they need
something more moderate. In that case you
round out the calories. Again, the top
choice is going to be with greens and
legumes where the legumes are the main
source of extra calories, and then you go
down the ladder to other starches and to
fats on an as-needed basis depending on
what that person can handle digestively
and metabolically.
This episode is brought to you by
Ancestral Supplements living collagen.
Our Native American ancestors believed
that eating the organs from a healthy animal would
support the health of the corresponding
organ of the individual.
Ancestral Supplements has a nose-to-tail
product line of grass-fed liver, organs,
living collagen, bone marrow, and more.
All in the convenience of a capsule.
For more information or to buy any of their products,
go to ancestralsupplements.com.
This episode is brought to you by Ample.
Ample is a meal in a bottle that takes
a total of two minutes to prepare,
consume, and clean up. It provides a
balance of fat, protein, and carbs plus
all the vitamins and minerals you need
in a single meal. All from a blend of
natural ingredients. It's available in
original, vegan, and keto versions
portioned as either 400 or
600 calories per meal. I'm an advisor to
Ample, and I use it to save time when I'm
working on major projects on a tight
schedule. It keeps my brain going while I
power through the day never letting food
prep get in the way of my productivity.
Head to amplemeal.com and enter
the promo code: CHRIS15
at checkout for a 15% discount off your
first order.
For ad-free versions of these episodes
with transcripts that you can read and
getting early access to the episodes
often weeks or maybe even months
ahead of time, you can sign up for the
CMJ Masterpass at
chrismasterjohnphd.com/masterpass.
And use the code: LITE10
to get 10% lifetime discount.
The audio of this episode was enhanced
and post-processed by Bob Davodian of
Taurean Mixing You can find more of his work at
taureanonlinemixing.com.
All right, I hope you found this useful.
Signing off, this is Chris Masterjohn of
chrismasterjohnphd.com. This is
Chris Masterjohn Lite.
And I will see you in the next episode.