April 15, 2021

New review investigates the effects of carnitine supplementation in nonalcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) has become an increasing epidemic. It is the most common cause of elevated liver enzymes and is associated with diabetes and obesity with advanced liver disease.

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.

A few studies have shown a beneficial effects of carnitine supplementation in liver diseases, however, these results have been inconsistent. This may be due to study design, dosage, or form of carnitine administered.

According to a review published last week in Complementary Therapies in Medicine, researchers examined the effects of carnitine supplementation on clinical characteristics of nonalcoholic fatty liver disease.

This review included a total of 5 randomized placebo-controlled studies including 334 patients that investigated the effects of carnitine supplementation on liver function, body mass index (BMI), lipid profile, body weight, and HOMA-IR. These studies included a sample size between 48 and 80 individuals supplementing with a dosage of carnitine between 300 mg and 2000 mg per day over a 3 to 6-month period.

As a result, carnitine supplementation significantly decreased the HOMA-IR, AST, ALT, and triglyceride levels. On the other hand, it did not have an effect on BMI, body weight, HDL, LDL, or total cholesterol levels. Previous research has demonstrated carnitine supplementation provides a protective effect by preventing lipid peroxidation and can affect liver function by decreasing insulin resistance.

These individuals are in a chronic disease state and have increased demands then what could be obtained from the diet alone and therefore, dietary supplements should be considered to help prevent the progression as well as improve liver function. Other nutrients to consider include delta and gamma tocotrienols, phosphatidylcholine, fiber or resistant starch, n-acetylcysteine, fish oil, and probiotics.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Abolfathi M, Mohd-Yusof BN, et al. The effects of carnitine supplementation on clinical characteristics of patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med. 2020 Jan;48:102273.

New study investigates probiotic benefits on cognitive function in children and adolescents

According to a study published last month in Beneficial Microbes, researchers investigated the potential neurobehavioral benefits of probiotics through the gut-brain axis in children and adolescents.

This review included seven randomized controlled trials published between 1990 and 2018 that met inclusion criteria with an assessment of cognitive function. As a result, only one study demonstrated a positive result in patients with ADHD or Asperger syndrome. This was in a study supplementing with Lactobacillus rhamnosus at 1 billion CFUs per day. Supplementation was given to pregnant women for 4 weeks prior to delivery and was continued for 6 months after birth. ADHD or Asperger syndrome was diagnosed at the age of 13 in 17.1% of the children in the placebo group and none in the probiotic group. In addition, this study identified significant differences in commensal bacteria specifically related to Bifodobacterium between the children that later developed ADHD or Asperger syndrome and the children in the supplementation group. The 6 other studies included various strains, different lengths of duration, and the outcomes did not show a difference in cognition after probiotic supplementation.

This study demonstrates that probiotic supplementation during pregnancy and the first year of life may reduce the risk of developing ADHD or Asperger’s syndrome by its effects on the gut microbiome and commensal bacteria and via the gut-brain axis. This makes sense as the microbiome undergoes the most significant changes during infancy as well as old age and the immune system is also its weakest and most unstable during these two stages of life.

In addition, previous research suggests the presence of bacteria in the placenta, amniotic cavity, and umbilical cord suggesting the development of the microbiome may start in-utero. These factors may be influenced by type of delivery, diet, antibiotic exposure, maternal diet and microbiome as well as the environment.

It is also essential to optimize every child’s nutrient and essential fatty acid status. Previous research has demonstrated that a multivitamin can improve emotion, attention, and general functioning in children with ADHD. Addressing insufficiencies can optimize brain function as well as possibly prevent and alleviate some of the symptoms associated with ADHD without harmful side effects. Additional nutrients to consider include carnitine, choline, DHA, and phosphatidylserine. Optimal nutrition is important for brain health and this influences emotions and behavior which can impact ADHD symptoms. Gut dysfunction, food sensitivities, food dyes, processed foods, and low intake of fruits and vegetables can also play a role.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Rianda D, Agustina R, et al. Effect of probiotic supplementation on cognitive function in children and adolescents: a systemic review of randomized trials. Benef Microbes. 2019 Dec 9;10(8):873-882.

 

 

New review investigates the effects of quercetin supplementation on lipids, blood pressure, and glucose levels.

Quercetin, a polyphenol, has been shown to have both strong antioxidant as well as anti-inflammatory properties. Research has demonstrated that quercetin supplementation has anti-hypertensive, anticoagulant, and anti-hyperglycemic properties, however, studies in humans have shown mixed results.

According to a review published January 6th in Nutrition Reviews, researchers investigated the effects of quercetin supplementation on lipids, blood pressure, and glucose levels.

 This review included 17 randomized controlled, cross-over, or parallel design studies including 896 individuals who consumed quercetin or a standardized quercetin-enriched extract on cardiovascular biomarkers including fasting glucose, triglycerides, HDL cholesterol, LDL cholesterol, total cholesterol, systolic blood pressure, diastolic blood pressure, insulin, and HOMA-IR. These studies included anywhere from 10 to 93 participants over a duration from two to twelve weeks and dosing ranged from 100 mg to 1000 mg per day.

 As a result, quercetin significantly lowered both systolic and diastolic blood pressure. Quercetin has effects on the autonomic nervous system having a parasympathetic effect, increases vascular relaxation, and reducing the effect of angiotensin-converting enzyme. In addition, significant changes were seen in HDL and triglycerides in individuals who consumed quercetin for 8 weeks or more. Quercetin did not demonstrate statistically significant effects on total cholesterol, LDL cholesterol, or glucose concentrations.

These results show that quercetin supplementation can have positive effects on blood pressure and improvements in plasma lipid profiles. Other nutrients to consider include delta and gamma tocotrienols, fish oil, magnesium, and taurine.

Previous research has also demonstrated improvements of metabolic features of PCOS by upregulating adiponectin and Amp-activated protein kinase (AMPK). Adiponectin signaling regulates fatty acid metabolism and glucose by activation of AMPK.

Quercetin supplementation enhanced AMPK level by 12.3% compared with the placebo group.

 By Michael Jurgelewicz, DC, DACBN, DCBCN, CNSSource: Huang H, Liao D, et al. Effect of quercetin supplementation on plasma lipid profiles, blood pressure, and glucose levels: a systemic review and meta-analysis. Nutr Rev. 2020 Jan 6.

New review investigates the role probiotics in gastroesophageal reflux disease (GERD)

Gastrointestinal reflux disease (GERD) a common digestive disorder characterized by chronic symptoms resulting from abnormal reflux of contents from the stomach into the esophagus leading to mucosal damage. The underlying cause GERD is multifactorial and can result from stress, poor diet, impaired digestion, dysbiosis, hiatal hernia, and esophageal sphincter dysfunction. Risk factors associated with GERD include smoking, alcohol, and NSAID use.

Previous research that I have shared demonstrated that the damage of the esophagus in GERD to be cytokine mediated due to inflammation and not caused directly by the acid in the stomach. 

Pharmaceutical interventions may provide symptom management but they do not correct many of the underlying factors and have side effects. Lifestyle changes and nutritional support are usually sufficient to address acid reflux. Patients should consider eat smaller portions at meals. In addition, avoid laying down after meals and avoid eating before bed. Also, alcohol and specific foods can trigger symptoms.

Although these medications may help with the symptoms, proton pump inhibitors may not be the solution. Recent previous studies have linked PPIs to chronic kidney disease as cardiovascular disease and an increase risk of a heart attack. PPIs can also lead to other problems such as dysbiosis and small intestinal bacterial overgrowth (SIBO).

According to a new review published two weeks ago in Nutrients, researchers investigated the effects of probiotics in mitigating the severity and frequency of symptoms in GERD. Benefits of probiotics are less known on supporting upper gastrointestinal health. Probiotics are associated with modulation of the immune system and accelerate gastric emptying via their action with stomach mucosal receptors.

This review included thirteen prospective studies published in twelve articles. Seventy-nine percent reported benefits of probiotic supplementation and symptoms of GERD and 45% reported benefits specifically associated with reflux symptoms. These included a reduction in regurgitation and improvements in heartburn or reflux. Five of the eleven positive studies demonstrated an improvement in dyspepsia symptoms and nine of the studies showed an improvement in upper gastrointestinal symptoms including nausea, abdominal pain, belching, gurgling, and burping. As a result, this review demonstrates the potential benefits for probiotic supplementation for patients with GERD.

Other nutritional supplements to consider include deglycyrrhiizinated licorice (DGL) and melatonin. DGL is a well-established anti-ulcer and mucosal healing botanical that is soothing and protective to the gastric mucosa and mucous membranes lining the digestive tract. Melatonin is often used to support sleep or for its antioxidant properties in cancer, however, the entero-endocrine cells in the gastrointestinal tract are a major source of intestinal melatonin. One of the main functions of melatonin produced by the GI tract is to protect the esophageal and gastric mucosa from stressors and irritants. Melatonin is a potent antioxidant that can influence all major functions of the GI-tract including secretion, motility, digestion and intestinal absorption. It has an inhibitory influence on gastric acid secretion resulting in an increase in gastrin release, which increases the contractile activity of the lower esophageal sphincter reducing the symptoms of GERD.

Helicoacter pylori can also contribute to gastritis. Mastic gum, methylmethionesulfonium, zinc-carnosine and vitamin C have anti-H. pylori as well as healing properties to the gastric mucosa.

An alternative approach is typically more effective than what is provided by proton pump inhibitors and does not have side effects or other complications that can be associated with them such as mineral deficiencies, bacterial infections, and dysbiosis.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Cheng J, Ouwehand A. Gastroesophageal Reflux Disease and Probiotics: A Systemic Review. Nutrients. 2020 January 2; 12(1).

New study demonstrates the benefits of resveratrol in patients with type 1 diabetes

Resveratrol is a polyphenol with powerful antioxidant and anti-inflammatory properties.  It is naturally found in nuts, berries, and grapes skin but the concentration is low. Studies have been widely publicized for its cardiovascular, anti-carcinogenic, and anti-aging benefits.  Research has also shown significant benefits in several chronic inflammatory disorders.

Resveratrol activates sirtuins, which can increase insulin sensitivity and protect against oxidative damage. Previous research with resveratrol has demonstrated improvements in dysglycemia and insulin sensitivity, however, there has been some inconsistency in results.

According to a new review published Monday in Nutrients, researchers investigated the effects of resveratrol in patients with type 1 diabetes. In this autoimmune disorder, there is a lack of insulin to regular glucose levels. Type 1 diabetes is becoming an increasing epidemic along with the many other autoimmune diseases. It is important to note that insulin treatment may not always result in the appropriate targeted glucose levels. In addition, insulin alone may not be sufficient to avoid disease related complications.

This study included thirteen patients with type 1 diabetes ranging from 12 to 45 years of age. Each patient received 500 mg or resveratrol twice daily over a two-month period. Clinical and laboratory assessment included body weight, body mass index (BMI), fasting glucose, insulin, hemoglobin A1c, insulin, HOMA-IR, HOMA-β, alkaline phosphatase, liver enzymes, creatinine, and albumin. In addition, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin 1β, total antioxidant capacity (TAC) and lipid peroxidation levels were also assessed. These were all taken at baseline, 30 days, and 60 days.

As a result, resveratrol supplementation significantly decreased fasting glucose and hemoglobin A1c levels. In addition, malondialdehyde, an oxidative stress marker, was also decreased. Total antioxidant capacity increased demonstrating antioxidant protective properties. Insulin, HOMA-IR, HOMA-β, CRP, and liver and kidney function were not affected.

These results support resveratrol supplementation as a potential strategy for improving glucose control and insulin sensitivity and oxidative damage in patients with type 1 diabetes. Other nutrients that should be considered to address dysglycemia include inositol, tocotrienols, fish oil, probiotics, and resistant starch.

Since type 1 diabetes is an autoimmune disorder, one must also investigate into the potential environmental triggers that can contribute to autoimmunity such as, food sensitivities, toxins, nutrient deficiencies, hormone imbalance, and infections. In addition, stool testing is essential to rule of bacterial infections and dysbiosis as well as assess inflammatory, immune, digestion, and absorption markers. Consider vitamin D, fish oil, curcumin, resveratrol, and probiotics to support autoimmune dysfunction.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Movahed A, Raj P, et al. Efficacy and Safety of Resveratrol in Type 1 Diabetes Patients: A Two-Month Preliminary Exploratory Trial. Nutrients. 2020 January 6; 12(1).

 

 

New study demonstrates the effect of riboflavin supplementation in patients with Crohn’s disease

Inflammatory bowel disease (IBD) is an autoimmune condition where in most cases there are multiple triggers chronically stimulating the immune system over a long period of time in multiple ways and the immune system gets into overloaded, overwhelmed state and loses its ability to function leading to chronic inflammation causes symptoms such as diarrhea, abdominal pain, and other debilitating symptoms and anemia.

According to a study published last Tuesday in the Journal of Crohn’s and Colitis, researchers investigated the effect of riboflavin supplementation in patients with Crohn’s disease. Riboflavin has antioxidant, anti-inflammatory, and modulatory effects on the microbiome.

This was a prospective clinical intervention study consisted of 70 patients with Crohn’s disease with varying disease severity. Each patient received 100 mg of riboflavin daily for a 3-week period. Clinical and laboratory assessment included the Harvey-Bradshaw Index (HBI), inflammatory and antioxidant biomarkers, and comprehensive testing of the gut microbiome at baseline and at the end of the study.

As a result, riboflavin supplementation significantly decreased inflammatory markers as well as the Harvey-Bradshaw Index. In addition, IL-2 levels decreased in patients with low fecal calprotectin and C-reactive protein decreased in those with high fecal calprotectin levels at baseline. An overall reduction of systemic oxidative stress was demonstrated as free thiols significantly increased after supplementation. Riboflavin supplementation also led to a reduction of Enterobacteria in the patients with low fecal calprotectin levels. This data demonstrates the potential anti-inflammatory and antioxidant effects of ribloflavin supplementation in patient with Crohn’s disease.

One must also investigate into the other potential environmental triggers that can cause inflammation such as, food sensitivities, toxins, and molds. Also, stool testing is essential as one can rule of bacterial infections and dysbiosis as well as assess inflammatory, immune, digestion, and absorption markers.

High dose probiotics, fish oil, curcumin, glutamine, and mucilaginous botanicals are helpful in immunomodulation and for their anti-inflammatory properties. Other common deficiencies include magnesium, vitamin D, and iron. A specific carbohydrate diet (SCD) or elimination diet may improve gastrointestinal function and decease disease activity.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: von Marteis JZH, Bourgonje AR, et al. Riboflavin supplementation in patients with Crohn’s disease (RISE-UP study). J Crohns Colitis. 2019 Dec 24.

New review evaluates several dietary approaches for the treatment of nonalcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) has become an increasing epidemic. It is the leading cause of abnormal liver enzymes and is associated with diabetes and obesity with advanced liver disease being one of the leading causes of liver transplantation.

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 week in Nutrients, researchers evaluated dietary approaches for the treatment in nonalcoholic fatty liver disease.

This review included six randomized controlled trials including 317 patients with NALFD. Each study ranged from 12 to 98 patients with 50 patients being the average. These studies ranged over a period from 6 weeks to 6 months. The primary outcome of interest was a reduction in hepatic steatosis based on imaging or biopsy. In addition, other outcomes investigated were changes in hepatic fibrosis, reduction in liver enzymes, and weight reduction. Five out of the 6 studies evaluated the effects of a Mediterranean diet, and the other study investigated modified alternate-day calorie restriction, which is a type of intermittent fasting. These were compared to other dietary interventions including a low fat diet, low carbohydrate diet, and usual care. Hepatic steatosis was assessed by magnetic resonance spectroscopy or ultrasound in 5 of the 6 studies. Liver stiffness was measured using shear wave elastography in 4 of the 6 studies.

A significant reduction in hepatic steatosis was seen in 3 of the 5 studies following a Mediterranean Diet and the one study evaluating a low-carbohydrate diet. Two study arms included a low-fat diet, however, only one of these reached a significant reduction in hepatic steatosis. The study with an intermittent-fasting arm also demonstrated a significant improvement in hepatic steatosis. Four studies evaluated liver stiffness with 2 of the 3 Mediterranean diets showing a significant improvement. All six studies evaluated the impact on liver enzymes but only half of these studies showed a significant improvement. It is important to note that patients achieved weight loss in all of these studies with significant weight loss in 5 of the 6 studies.

These individuals have established disease and increased demands then what could be obtained from the diet alone and therefore, dietary supplements should be also considered to help reduce the progression and improve liver function in patients with NAFLD. Nutrients to consider include, probiotics, delta and gamma tocotrienols, fiber, resistant startch, fish oil, coenzyme Q10, berberine, and milk thistle.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Saeed N, Nadeau B, et al. Evaluation of Dietary Approaches for the Treatment of Non-Alcoholic Fatty Liver Disease: A Systemic Review. Nutrients. 16 December 2019, 11(12), 3064.

 

 

New review demonstrates the benefits of resistant starch in patients with type 2 diabetes

Metabolic syndrome and insulin resistance are a significant health care problem in the United States. Type 2 diabetes affects more than 300 million people.

Insulin resistance is preventable and reversible through lifestyle changes, proper nutrition, supplements, exercise and stress management. Weight loss and exercise are the best treatments for restoring the body’s ability to respond to insulin.

Previous research has shown a variety of health benefits from resistant starch including preventing obesity, lowering cholesterol, preventing constipation, and producing short chain fatty acids in the gut.

According to a new review published last week in Lipids in Health and Disease, researchers investigated the effect of resistant start supplementation on mitigating insulin resistance in patients with type 2 diabetes and obesity.

This review consisted of 14 randomized clinical trials including 515 patients published between 2006 and 2017. All these studies took place over a 4 to 12-week period with the exception of one study lasting one year. There were 6 studies for obesity without type 2 diabetes and 8 studies for patients with type 2 diabetes. Six of the studies for diabetes had obesity and the other two that had diabetes and did not have obesity.

The research team found a better effect from resistant starch supplementation in patients with type 2 diabetes who were obese. The dosage of resistant starch can have different effects. A higher dose of 30-40 grams per day decreased fasting glucose levels, however, 10 grams per day was effective in lowering fasting insulin levels.

A high fiber diet leads to the production of short chain fatty acids (SCFAs) in the gastrointestinal tract. SCFAs can increase insulin sensitivity, improve glucose tolerance, and reduce B-cell apoptosis by modulating the gut microbiome.

Other research has indicated that obesity has a microbial component that alters the caloric extraction from ingested food. For example, if one has more Bacteroidetes bacteria, the individual tends to be leaner. High Firmicutes:Bacteroidetes ratios have been known to increase the caloric extraction from food and these individuals tend to be more obese. This also ties together the importance of dietary fiber, prebiotics, and weight loss.

Resistant starch should be considered for patients with obesity, insulin resistance, dyslipidemia, and metabolic syndrome. It can also be a great substitute to regular starch in baked goods, which lowers the caloric density and glycemic index of food products. Other nutrients to consider include curcumin, tocotrienols, fish oil, magnesium, vitamin, and glycine.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Gao C, Rao M, et al. Resistant starch ameliorated insulin resistant in patients of type 2 diabetes with obesity: a systemic review and meta-analysis. Lipids Health Dis. 2019 Nov 24;18(1):205.

 

 

New review demonstrates the impact of sleep duration and metabolic syndrome

Insulin resistance is preventable and reversible through lifestyle changes, proper nutrition, supplements, exercise and stress management. Metabolic syndrome and insulin resistance are a significant health care problem in the United States.

Sleep disruption is commonly associated with type 2 diabetes and obesity due to the effect of dysglycemia. This altered glucose metabolism is associated with not only poor sleep but also shorter sleep duration and an increased risk of sleep apnea.

According to a review published last month in Nutrients, researchers investigated the association between sleep duration in metabolic syndrome in the 2013/2014 National Health and Nutritional Examination Survey (NHANES).

This review was a cross-sectional study including 2,737 individuals. Assessment models analyzed the relationship between metabolic syndrome disease severity and sleep duration. As a result, the lowest average disease severity score was associated in individuals sleeping 7 hours per night. Shortened and longer sleep durations were associated with a higher disease severity as well as a higher risk of metabolic syndrome.

There are some possible mechanisms involved. Growth hormone release takes place during stage 3 in sleep. This is considered the most important stage of sleep as numerous activities such as, fat burning and general regeneration and repair take place during this time. In addition, the longest part of stage 3 occurs prior to midnight. Therefore, individuals going to sleep later, would suppress growth hormone. Furthermore, advanced glycation end products (AGEs) are significantly in individuals with chronic sleep disturbance. This increases inflammation and sympathetic nervous system activity.

Previous research also demonstrates how sleep disruption increases amyloid beta and tau proteins. It is highly unlikely that there is an overall increased risk of developing cognitive decline simply from a few nights or a week of poor sleep.  Amyloid beta and tau protein levels will go back down after the next good of sleep, however, the main issue is those that have chronic sleep issues. This can lead to chronically elevated amyloid levels leading to increased risk of cognitive decline.

It is important to address the environment to promote restful sleep. It is important limit use of screens at bedtime although it is very hard to today’s society. If necessary, I would recommend using apps like Night Shift (smartphones) and f.lux for laptops. Blue light blocking glasses may also be beneficial. In addition, it is important that people go to sleep around the same time every night. When the timing of one’s sleep is shifted even if the duration of sleep is the same, it’s not going to be as restorative. Caffeine and other stimulants can keep you up and interfere with sleep. It is best to avoid these four to six hours before bedtime. Finally, try to get your workout in earlier in the day. Exercise increases cortisol and can make hard trying to fall asleep. If not possible, consider phosphatidylserine post workout. Other nutrients to consider to help restore sleep include magnesium l-threonate, valerian root, passionflower, lemon balm, melatonin, and phytocannabinoids.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNSSource: Smiley A, King D, Bidulescu A. The Association between Sleep Duration and Metabolic Syndrome: The NHANES 2013/2014. Nutrients. 2019 Oct 26; 11(11).

New review demonstrates the role of probiotics in nonalcoholic fatty liver disease

Fatty liver disease and Non-alcoholic steatohepatitis (NASH) are 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. Long term hyperglycemia causes an increase in the synthesis of fatty acids and triglycerides in the liver leading to fatty liver.

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 (NAFLD) 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 new review published on Monday, researchers investigated the role of probiotics via the gut-liver axis in nonalcoholic fatty liver disease.

An increasing body of research has demonstrated that dysbiosis can negatively impact immune and metabolic processes. One study showed increased intestinal permeability as well as small intestinal bacterial overgrowth in 35 consecutive patients with NALFD proven on biopsy. These abnormal findings correlated with disease severity. In addition, an imbalance in the ratio of Bacteroidetes and Firmicutes has been reported in obese patients with NASH.

Other recent research suggests the presence of a gut microbiota-derived signature, which predicts the presence of advanced fibrosis in NAFLD patients. Researchers analyzed the bacteria composition of 86 biopsy-proven NAFLD patients in which 72 had mild fibrosis and 14 had advanced fibrosis. As a result, they identified 37 different bacterial species where they could distinguish mild and advanced fibrosis by an increase of Proteobacteria and Escherichia coli and decrease in Firmicutes.

There have been some recent promising findings for probiotics in NALFD and cirrhosis. A study including 30 adults with NASH demonstrated a reduction of liver enzymes with Lactobacillus acidophilus compared to the placebo, however, probiotics delivered in multi-strain formulas have shown better clinical outcomes in randomized trials. A triple blinded trial including 64 obese children with NALFD received a probiotic including Lactobacillus acidophilus, Bifidobacterium lactis, Bifidobacterium bifidum, and Lactobacillus rhamnosus over a 12-week period. As a result, there was a significant reduction in liver enzymes, lipid profile, and intrahepatic fat compared to the placebo group.

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

It is also essential to encourage a restricted carbohydrate diet and exercise to support weight loss in these individuals. 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, coenzyme Q10, berberine, and milk thistle.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Meroni M, Longo M, et al. The Role of Probiotics in Nonalcoholic Fatty Liver Disease: A New Insight into Therapeutic Strategies. Nutrients. 4 November 2019, 11(11), 2642.