Non-alcoholic fatty liver disease (NAFLD) is an increasing epidemic in the U.S. and the rest of the world. It is the leading cause of abnormal liver enzymes and is associated with diabetes and obesity.

At this time there are few guidelines for diagnostic and follow up methods and limited proven treatment options. Previous research of pharmacological agents to treat nonalcoholic fatty liver disease were performed with poor results.

Insulin resistance is one of the key factors in the development of NAFLD, however, the gut-liver axis plays a significant contribution as well. Gut dysbiosis and intestinal hyperpermeability lead to liver damage by proinflammatory responses.

According to a review published last month in Therapeutic Advances in Gastroenterology, researchers investigated the effect of synbiotics in nonalcoholic fatty liver disease.

This review analyzed 10 randomized controlled trials including 634 patients with NALFD. The studies were conducted between 2014 and 2020 with a duration between 8 weeks and 28 weeks. These patients were diagnosed with ultrasound and/or biopsy. The prebiotics consisted of either inulin or fructo-oligosaccharides (FOS) and the probiotic dosing was between 1 to 4 billion CFU.

The results demonstrated that supplementation synbiotics significantly reduced the level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyl transferase (GGT) in NAFLD patients. In addition, synbiotic supplementation was shown to significantly reduce the level of total cholesterol and low-density lipoprotein (LDL) cholesterol and increase the level of high-density lipoprotein (HDL). Furthermore, synbiotic supplementation significantly reduced liver stiffness measurement indicator and controlled attenuation parameter indicator in NAFLD patients.

The gut microbiome imbalance is a risk factor in contributing to the development and progression of NAFLD. The ability of synbiotics to reverse gut dysbiosis has led to significant interest in synbiotics for patients with NAFLD. This study found that symbiotic supplementation significantly improved liver function, adjusted lipid metabolism, and delayed the progression of NAFLD.

In general, synbiotic supplementation demonstrated a significant decrease in liver enzymes compared to placebo groups. In addition, synbiotics have also shown to have a synergistic effect with metformin on liver enzymes in patients with NASH.

Several studies have assessed synbiotics on hepatic steatosis, fibrosis, and liver stiffness. Ultrasound imaging assessing these parameters have shown positive clinical outcomes with synbiotics. There has also been some novel MRI testing that has demonstrated similar beneficial effects of synbiotic supplementation.

Synbiotics restore the gastrointestinal barrier function, modulate the immune system, and inhibit the proliferation of harmful bacteria. Synbiotics have been shown to reduce liver fat and improve liver enzymes. Synbiotics are likely most effective by preventing bacterial translocation and reducing the effects of the intestinal microbiota on the liver.

These individuals have established disease and increased demands then what could be obtained from the diet alone and therefore, dietary supplements should be considered to mitigate to help reduce the progression and improve liver function in patients with NAFLD.

Other nutrients to consider include, delta and gamma tocotrienols, fish oil, carnitine, coenzyme Q10, berberine, and milk thistle.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Cai J, Dong J, et al. The effect of synbiotics in patients with NAFLD: a systematic review and meta-analysis. Therap Adv Gastroenterol. 2023 Jun 22;16:17562848231174299.



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