Tag: insulin

6 Key Strategies for the Prevention and Treatment of Non-Alcoholic Fatty Liver Disease

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Non-Alcoholic Fatty Liver Disease (NAFLD) is becoming increasingly common but yet remains underdiagnosed, and is the most common liver disease in Canada. It is diagnosed in women who consume less than 20g/day of alcohol and in men who consume less than 30g/day of alcohol, and other causes for liver disease are ruled out. NAFLD is on a spectrum from mild fat (triglyceride) accumulation to inflammation and scarring (non-alcoholic steatohepatitis or NASH), and eventually liver cirrhosis or even cancer (hepatocellular carcinoma)[1].

NAFLD is commonly an incidental finding on ultrasound or suspected when an elevated ALT is noted on routine lab work.

There is a strong relationship between cardiovascular diseases (CVD), particularly coronary artery disease (CAD, disease of the arteries of the heart) and NAFLD. CVD is the most common cause of death in those with this disease. Insulin resistance, diabetes, endothelial dysfunction, hypertension and hyperlipidemia are commonly found in those with NAFLD[2]. Excess caloric intake, obesity, and sedentary lifestyle create the perfect storm to develop NAFLD.

First line treatment for NAFLD includes lifestyle interventions with an emphasis on exercise and weight loss. The following are key strategies to reduce liver fat and prevent the progression of NAFLD1 [1,3]:

  1. Weight loss. 5-10% weight loss goal depending on severity, achieved by a loss of 0.5-1kg/week. Severe caloric restriction and rapid weight loss can have a detrimental impact on liver health. An activity goal of 150 minutes/week of moderate intensity aerobic activity should be achieved.
  2. Mediterranean diet. A plant-based dietary pattern provides antioxidants and helps to reduce oxidative stress and inflammation. It also helps to manage insulin resistance, and elevated cholesterol reducing risk of NAFLD as well as cvd and diabetes. Choose plant-based proteins such as beans, lentils, a variety of vegetables, healthy fats found in nuts, flax seed, and olive oil and choose more poultry and fish.
  3. Low saturated fat, no trans fats with an emphasis on polyunsaturated and monounsaturated fats. Diets high in saturated fats and trans fats increase oxidative stress, inflammation and accumulation of fat in the liver, also increasing risk for cardiovascular diseases. While healthy fats, such as those found in fish and extra-virgin olive oil, can help to reduce triglycerides, LDL, and cholesterol, reduce inflammation and fat accumulation in the liver.
  4. High fibre, whole grains. Choosing more whole grains instead of starchy and high glycemic foods will help to balance blood sugar, keep you feeling full longer and helps to reduce cholesterol. Not only that, it also helps to maintain healthy gut bacteria which is important for liver health
  5. Avoid processed foods, and foods high in fructose. Process foods are often high in saturated and trans-fat and excess sugar contributing to excess calories and accumulation of liver fat. By eliminating highly processed and sweetened foods and beverages can help you achieve your weight loss goals.
  6. Reduction/elimination of alcohol.

 

 

[1] Jeznach-Steinhagen, A., Ostrowska, J., Czerwonogrodzka-Senczyna, A., Boniecka, I., Shahnazaryan, U., & Kuryłowicz, A. (2019). Dietary and Pharmacological Treatment of Nonalcoholic Fatty Liver Disease. Medicina (Kaunas, Lithuania), 55(5). https://doi.org/10.3390/medicina55050166

[2] Arslan, U., & Yenerçağ, M. (2020). Relationship between non-alcoholic fatty liver disease and coronary heart disease. World journal of clinical cases, 8(20), 4688–4699. https://doi.org/10.12998/wjcc.v8.i20.4688

[3] Elena S George, Adrienne Forsyth, Catherine Itsiopoulos, Amanda J Nicoll, Marno Ryan, Siddharth Sood, Stuart K Roberts, Audrey C Tierney, Practical Dietary Recommendations for the Prevention and Management of Nonalcoholic Fatty Liver Disease in Adults, Advances in Nutrition, Volume 9, Issue 1, January 2018, Pages 30–40, https://doi.org/10.1093/advances/nmx007

 

 

Disclaimer: The information presented on this site does not constitute medical advice and does not replace the advice from your doctor. Always consult a qualified health care professional when changing or beginning a new health plan.

 

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Two Tests You Need to Ask For if You Are Prescribed a Statin

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Like any drug treatment (and even natural treatments) there are risks, but there are also benefits. Naturally our human brains tend to focus more on the negative - we are wired this way - but you can't look at one side without consideration for the other. The class of medication called statins which include the commonly known Lipitor/atorvastatin, or Crestor/rosuvastatin are one of the most prescribed classes of medications. I see patients all the time on these medication. We know those who benefit the most are those who have had a heart attack or who are at high risk for one. The benefits of statins go beyond total cholesterol and LDL reduction - they support the health of the artery lining (endothelium), support nitric oxide important for the relaxation of the arteries, act as an antioxidant and help to reduce inflammation. Not bad eh?

For those who have no known cardiovascular disease and are at a low risk for a heart attack, I like to use a more natural approach to reducing cholesterol where possible however, sometimes the best approach is a cholesterol lowering drug. Part of my role in working with patients is discussing all treatment options and advocating for the best approach for them. Not all cholesterol lowering medications or statins are the same and may pose different risk profiles. Sometimes it’s necessary to look at each person’s unique risk profile and chose an approach that will have the most benefit with the least amount of harm. What’s more is that if you need to be on a drug, we can create a strategy to reduce your risk of side effects. Two tests that help in assessing a patient’s potential for statin-related side-effects are vitamin D and insulin.

Vitamin D

Low serum vitamin levels have been associated with statin related muscle pain, and as a result, low adherence. Low serum vitamin D itself can contribute to muscle pain and so the addition of a stain medication such as atorvastatin (Lipitor) or rosuvastatin (Crestor) may increase the susceptibility of those already at risk, particularly if your serum vitamin D level is under 75nmol/L.[1]

Insulin

It is known that those who use statins are at an increased risk for new-onset diabetes than non-statin users, and seems to have a bigger impact the higher the dose and the longer duration of use. It is an even bigger concern for those who have any of the risk factors for diabetes (metabolic syndrome, obesity, impaired fasting glucose, HbA1C >6 percent).[2] [3] This does not mean that statins should be avoided. Rather an assessment of individualized risk should be done prior to making an informed decision about the use of statin, which statin to use and how to prevent future diabetes risk. It is known that elevated insulin is an early indication of metabolic dysfunction and diabetes risk and can precede changes in fasting glucose and HbA1C by years.

Any treatment plan, whether it includes pharmaceuticals or natural alternatives to drug therapy should be done with consideration of a patient’s unique risk factors. My approach when creating any heart health plan with patients involves not just targeting a few numbers in a lipid panel but involves a look at your totality of risk factors in order to achieve the best outcome for you.

[1] Michalska-Kasiczak, M. et al. Analysis of vitamin D levels in patients with and without statin-associated myalgia — A systematic review and meta-analysis of 7 studies with 2420 patients. International Journal of Cardiology. 2015. 178: 111-116.

[2] Jung Ko, M et al. Time‐ and Dose‐Dependent Association of Statin Use With Risk of Clinically Relevant New‐Onset Diabetes Mellitus in Primary Prevention: A Nationwide Observational Cohort Study. Journal of the American Heart Association. 2019. Vol 8 (8).

[3] Ridker PM, Pradhan A, MacFadyen JG, Libby P, Glynn RJ. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial. Lancet. 2012;380(9841):565-571.

 

Disclaimer: The information presented on this site does not constitute medical advice and does not replace the advice from your doctor. Always consult a qualified health care professional when changing or beginning a new health plan.

 

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