Tag Archives: liver disease

Sugar and Alcohol: Your Liver Can’t Tell The Difference

Dr. David Unwin, Fellow of the Royal College of General Practitioners (FRCGP) together with fellow researchers recently completed a study showing low carb diets significantly reduce fatty liver, weight and blood sugar. Trialing a low carb approach over a year, they found rapid improvements in liver function among other positive effects.

“My interest in abnormal liver, and particularly GGT blood results began when I noticed that in our family practice of 9,000 patients well over a 1,000 had an abnormal GGT result,” said Dr. Unwin. “I could predict which patients would have lost weight -before they came into my consulting room from the improvement in GGT blood results alone- so began to wonder about raised GGT levels, Diabetes and non-alcoholic fatty liver disease (NAFLD): Was dietary carbohydrate a link?”

Before we get to the summary, let’s breakdown some of the statistics.

  • Approximately 30 million children and adults have diabetes in the United States. Out of that number, nearly 95% have type 2 diabetes according to the American Diabetes Association.1
  • The National Conference of State Legislatures (NCSL) reports obesity affects more than one-third of adults and 17% of youth in the United States. This equates to 78 million adults and 12 million children suffering from the obesity epidemic. As adopters of the Paleo diet well know, obesity increases risk for heart disease, type 2 diabetes, and cancer among other debilitating health conditions, like non-alcoholic fatty liver disease (NAFLD).2
  • The American Liver Foundation reports (NAFLD) affects up to 25% of Americans, where risk is directly correlated to being overweight or obese, having diabetes, high cholesterol or high triglycerides.3

As the cost of health care continues to skyrocket, Dr. Unwin has decreased his prescribing budget £15,000-£30,000 a year by prescribing a low carb diet to patients who in two years’ time decreased average blood sugar by 10% and is now below the national average in the UK4 and US.

“I would say sugar is definitely rather like alcohol for the liver, and would point out that starchy foods like bread and pasta are a rich source of glucose,” said Dr. Unwin.

Well, thankfully the Paleo diet is devoid of breads, pastas, grains, pseudo grains, and processed sugars. When we focus upon lean meats, fish, poultry, veggies, and fruits, nuts, and seeds in moderation, a Paleo prescription is the best, cost effective investment you can make for your health.

Summary* presented ahead of publication in Diabetes in Practice September 15, 2015.

Unwin DJ1, Cuthertson DJ2, Feinman R3, Sprung VS2 (2015) A pilot study to explore the role of a low-carbohydrate intervention to improve GGT levels and HbA1c. Diabesity in Practice 4 [in press]

1Norwood Surgery, Norwood Ave, Southport. 2Department of Obesity and Endocrinology, Institute of Ageing & Chronic Disease, University of Liverpool, UK. 3Professor of biochemistry and medical researcher at State University of New York Health Science Center at Brooklyn, USA.

Working title: Raised GGT levels, Diabetes and NAFLD: Is dietary carbohydrate a link?  Primary care pilot of a low carbohydrate diet

Abnormal liver function tests are often attributed to excessive alcohol consumption and/or medication without further investigation. However they may be secondary to non-alcoholic fatty liver disease (NAFLD). NAFLD is now prevalent in 20-30% of adults in the Western World. Considering the increased cardiovascular and metabolic risk of NAFLD, identification and effective risk factor management of these patients is critical.

Background Excess dietary glucose leads progressively to hepatocyte triglyceride accumulation (non-alcoholic fatty liver disease-NAFLD), insulin resistance and T2DM. Considering the increased cardiovascular risks of NAFLD and T2DM, effective risk-factor management of these patients is critical. Weight loss can improve abnormal liver biochemistry, the histological progression of NAFLD, and diabetic control. However, the most effective diet remains controversial.

Aim We implemented a low-carbohydrate (CHO) diet in a primary health setting, assessing the effect on serum GGT, HbA1c levels (as proxies for suspected NAFLD and diabetic control), and weight.

Design  69 patients with a mean  GGT of 77 iu/L (NR 0-50) and an average BMI of 34.4Kg/m2 were recruited opportunistically and advised on reducing total glucose intake (including starch), while increasing intake of  natural fats, vegetables and protein.

Method Baseline blood samples were assessed for GGT levels, lipid profile, and HbA1c. Anthropometrics were assessed and repeated at monthly intervals. The patients were provided monthly support by their general practitioner or practice nurse, either individually or as a group.

Results After an average of 13 months on a low-CHO diet there was a 46% mean reduction in GGT of 29.9 iu/L (95% CI= -43.7, -16.2; P<0.001), accompanied by average reductions in weight [-8.8Kg (95% CI= -10.0, -7.5; P<0.001)],and HbA1c [10.0mmol/mol (95% CI= -13.9, -6.2; P<0.001)].

Conclusions We provide evidence that low-carbohydrate, dietary management of patients with T2DM and/or suspected NAFLD in primary care is feasible and improves abnormal liver biochemistry and other cardio-metabolic risk factors. This raises the question as to whether dietary carbohydrate plays a role in the etiology of diabetes and NAFLD, as well as obesity. Over the study period and given a choice not a single patient opted to start antidiabetic medication, losing weight instead. This helps explain why our practice is the only one in the Southport and Formby CCG to have static diabetes drug costs for three years running.

*Note: The summary displayed above is not the official abstract from Diabetes in Practice.

David Unwin | The Paleo Diet

David Unwin is the senior partner and GP trainer at the Norwood Surgery, Southport, a seaside resort in the North West of England. He is an expert clinical adviser in diabetes for the Royal College of General Practitioners, and has a special interest in the Solution Focused psychological approach to the consultation. David lives on a farm with his wife, son and their sheep, turkeys, hens -and a very large pig!

 

 

REFERENCES

[1] //www.diabetes.org/diabetes-basics/statistics/infographics.html?loc=db-slabnav

[2] //www.ncsl.org/research/health/obesity-statistics-in-the-united-states.aspx

[3] //www.liverfoundation.org/abouttheliver/info/nafld/

[4] //diabetesdietblog.com/2015/07/15/you-only-need-one-arrow-dr-unwin-proves-it-again/

Are Sugary Drinks Killing Your Liver? | The Paleo Diet

Everyone knows that increased sugar intake increases your risk for type 2 diabetes and obesity. The consumer market competes daily on how to cater to the average individual’s sweet tooth. In a society that loves the indulgence of super-sized drinks, it becomes easy to fall prey. Given the metabolism and breakdown of sugar takes place in the liver, it is no surprise excess sugar intake can lead to major liver problems.

According to a recent study conducted at Tufts University, and published in the Journal of Hepatology, drinking sugary drinks daily puts you at risk for non-alcoholic fatty liver disease.1 This condition can eventually lead to liver cirrhosis, just like with alcohol, in some cases liver cancer, and have the individual needing a liver transplant.2

In the study, 2,634 self-reported dietary questionnaires from mostly Caucasian middle-aged men and women enrolled in the National Heart Lunch and Blood Institute (NHLBI) Framingham Heart Study’s Offspring and Third Generation cohorts were analyzed. The sugary beverages listed on the questionnaires comprised of caffeinated and caffeine-free colas, other carbonated beverages with sugar, fruit punches, lemonade or other non-carbonated fruit drinks. Afterwards, a computed tomography (CT) scan was carried out on the participants to determine the quantity of fat in the liver and the authors of the current study used a previously defined cut-point to identify NAFLD.

Among the participants who drank sugar sweetened beverages, those who drank one or more sugar-sweetened beverage per day experienced a higher prevalence rate and had a 60% greater risk of NAFLD compared to people who said they drank no sugar-sweetened beverages. This association was still evident even after controlling for possible confounders, which could affect the results, such as age, sex, body mass index, calories and other risk factors. Basically, the more sugary beverage the people drank, the greater the risk. An estimated two thirds of the participants drank at least some fruit, cola or other sugary beverage, and over 10% drank the sugary beverage daily.

Between mislabeling, misleading advertisements, and chronic sugar addiction, it’s easy to understand why Dr. Cordain advocates eating your fruit whole rather than drinking commercial juices, which may be loaded with sugar.

About 20-30% of people living in the US has nonalcoholic fatty liver disease (NAFLD)3. The primary cause behind this condition remains relatively unknown. With NAFLD, in about 25% of the cases, there are no symptoms, with the fat accumulation in the liver only found from imaging results, when the liver has pretty much lost the sugar battle. Researchers have shown obesity increases a person’s risk for NAFLD, as well as a correlation between NAFLD and heart disease and type 2 diabetes.4 In other words, keep drinking that sugary beverage daily, and not only may you need a heart transplant, but you could have also traded in your heart and received a free serving of type 2 diabetes as well. Clearly not a fair or even worthy exchange.

The problem may lie in a part of sugar used in the beverages, known as fructose, and how it is processed within the body. When taken alone, fructose is poorly absorbed from the gastrointestinal tract, and it is almost completely cleared by the liver. While regular glucose blood concentration is with 5.5 mmol/L , that of fructose is about 0.01 mmol/L in peripheral blood.5

Both fructose and glucose follow different paths for absorption in the body. While glucose results in the release of insulin from the pancreas, fructose is unable to do so. Many cells lack the type of sugar transporter that takes fructose into the cell, unlike glucose. The breakdown of fructose mainly takes place in the liver, through a process known as phosphorylation, which avoids the rate-limiting phosphofructokinase step.6 While your body uses up glucose, for example the brain for energy, hepatic metabolism of fructose leads to the free fatty acids (FFAs), VLDL (the damaging form of cholesterol), and triglycerides, which get stored as fat. So, think of drinking that sugary beverage like you are drinking fat, because essentially that is what it ends up as.

Here in the Paleo world, it is safe to understand why we stay far away from commercial products such as sugar sweetened beverages. Not only do they provide empty calories, but there is the possibility of leaving your body in worse shape than imagined. Care for a liver transplant? I’ll pass, that refreshing glass of cold water sounds even better.

 

REFERENCES

[1] Ma, J; Fox, CS; Jacques, PF; Speliotes, EK; Hoffmann, U; Smith, CE; Saltzman, E; and McKeown, NM. (2015, June 5). Sugar-Sweetened Beverage, Diet Soda, and Fatty Liver Disease in the Framingham Study Cohorts. Journal of Hepatology.

[2] Ibid.

[3] Ma, J; Fox, CS; Jacques, PF; Speliotes, EK; Hoffmann, U; Smith, CE; Saltzman, E; and McKeown, NM. (2014, April). Sugar-sweetened beverage intake is associated with fatty liver in the Framingham Offspring Study (267.3).  The FASEB Journal. 28(1).

[4] Cassidy, S., Hallsworth, K., Thoma, C., MacGowan, G., Hollingsworth, K., Day, C., . . . Trenell, M. (2015, Feb 13). Cardiac structure and function are altered in type 2 diabetes and non-alcoholic fatty liver disease and associate with glycemic control. Cardiovasc Diabetol, 14(23). doi:doi: 10.1186/s12933-015-0187-2.

[5] Bray, G. (2007). How bad is fructose?1,2. Am J Clin Nutr, 86(4), 895-896.

[6] Ibid.

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