Richard G. Petty, MD

Fast Foods, Exercise and Your Liver

We have known for many years that insulin resistance can cause non-alcoholic fatty liver disease (NAFLD). Now a new study published in the journal Gut reports that too much fast food and too little exercise can harm the liver in a matter of weeks.

In an experiment looking a lot like Morgan Spurlock’s Super Size Me, Swedish researchers selected 18 thin, healthy volunteers – 12 men and 6 women – to attempt a 5 to 15% body weight increase by eating at least two fast-food-based meals per day for four weeks. The participants in this intervention group also restricted their level of physical activity to no more than 5000 steps a day. A comparison group, matched for age and sex, ate a normal diet and maintained normal exercise levels.

The plan was to see if doubling calorific intake and increasing total body weight had any impact on participant’s liver health.

Changes in major liver enzymes, such as alanine aminotransferase (ALT), and in hepatic triglyceride content (HTGC) were used to indicate liver damage. Abnormally high ALT levels are frequently seen in people who consume a lot of alcohol or who have been infected with the hepatitis C virus. HTGC measures fatty acid levels in the liver; too much fat in the liver leads to a condition called fatty liver disease.

At the end of the four weeks, the researchers found that:

  • Fast-food consumers had put on an average of 6.5 kg (14.3 lbs.)
  • Five participants increased their weight by 15%
  • One person gained 12 kg (26.4 lbs.) in two weeks
  • Sharp increases in ALT occurred after just one week on the fast food diet
  • The average ALT level increased four-fold from 22 U/l to of 97 U/l over the 4 weeks
  • ALT rose to liver damage levels in 11 participants
  • No changes were seen in levels in the comparison group
  • The increases in ALT levels were linked to weight gain and increased sugar and carbohydrate intake. One subject developed fatty liver disease, and there was a large rise in liver cell fat content in the other participants

Although nobody should be surprised that gorging on junk food and becoming a couch potato is bad for the body, the speed and extent of the liver damage is alarming.

“Don’t dig your grave with your own knife and fork.”
–English Proverb

“I saw few die of hunger; of eating, a hundred thousand.”
–Benjamin Franklin (American Author, Inventor and Diplomat, 1706-1790)

Goldilocks and the, err, Vitamins

We are often told that we should take much higher amounts of many vitamins than the doses that are usually recommended.

The late Linus Pauling was one of the most famous proponents of the idea of using huge amounts to Vitamin C to present colds and an array of other health problems. Over the years I have heard enough recommendations to confuse anyone: and one of my degrees is in biochemistry! The only answer with so many conflicting pieces of advice is to do some good research.

Vitamin A is an important fat-soluble vitamin involved in the maintenance of many of many key systems in the body. The recommended daily allowance for vitamin A is 5000 international units (IU) for adults and 8000 IU for pregnant or lactating women.

Vitamin A deficiency is one of the major nutritional problems worldwide and it threatens the survival and health of millions of children. According to a report published in 2002, 127 million preschool children and 7·2 million pregnant women are deficient in vitamin A.

Vitamin A deficiency can cause night blindness, drying and degeneration of the cornea that can lead on to total blindness, as well as impairment of the immune system.

Children living in regions where vitamin A intake is insufficient need to receive adequate amounts of vitamin A through breastfeeding, together with improved diets, food fortification and supplementation with vitamin A.

Providing vitamin A supplementation in countries where there is a deficiency of the vitamin has been proven to decrease mortality. As a result, most developing countries have adopted a standard World Health Organization (WHO) dosing schedule for vitamin supplementation, which calls for 200,000 IU to mothers early postpartum and then 200,000 IU every 4 to 6 months. For infants, the recommendation is 100,000 IU at 9 months and 200,000 IU at 12 months.

However, in 2002 the International Vitamin A Consultative Group (IVACG) Annecy Accord recommended a new high-dose regimen for mothers and infants which includes a doubling of the initial postpartum dose for mothers, and adding 50,000 IU at 2, 3 and 4 months for infants.

An article just published in the Lancet indicates that this high dose protocol does not have any benefit over the older recommendation.

Professor Andrew Prentice and a team of researchers at the International Nutrition Group at the London School of Hygiene and Tropical Medicine in London and colleagues, studied 220 women-infant pairs in an area of moderate vitamin A deficiency in Gambia. One group received the WHO recommended dose, while the other received the IVACG recommended dose.

They measured blood plasma levels of vitamin A, the incidence of Helicobacter pylori infection, how many of them had pneumococcus in the nasopharynx and the integrity of the infants’ intestines.

The problem is that too much vitamin A can also create problems, including nausea and vomiting, jaundice, irritability, anorexia, blurred vision and worst of all, increased intracranial pressure that can cause headaches, drowsiness and even death. These are not such big problems in well-nourished adults living in the Western world, but in malnourished infants, particularly if they are also being vaccinated, this can be a big problem.

There is one specific occasion when a high dose of Vitamin A can be helpful: if a child in a deficient area gets severe measles, the WHO recommendation is that two doses of 200,000 IU should be given to the child. It is easy to forget that in some parts of the world measles can be a killer.

The authors of the article, as well as an accompanying editorial suggest that we should be looking at lower, rather than higher doses of vitamin A.

The editorial is by Professor Bernard Brabin of the Child and Reproductive Health Group in Liverpool, England and he finishes by saying,

“Future trials should emphasize the importance of exclusive breastfeeding, because early feeding with formula milk might reduce potential benefits from early supplementation with vitamin A in infants.”

This story shows us once again the extreme importance of having just the right amount of a vitamin or nutrient.

If someone claiming to be an expert in nutrition or vitamin therapy tells you to “take as much as you want” of anything, please be careful.

Just remember the story of Goldilocks and the Three Bears….

Medical Correspondents

When I am at home, I have a regular Sunday morning ritual: I watch the Fox News medical correspondent while working out. It’s a fair bet that every week he will make at least one major howler that is guaranteed to increase the amount that I can bench press by 50%!

I don’t personally know the Sunday Fox medical correspondent, and he seems a nice fellow. But why oh why doesn’t he do his research before going on the air?

A few weeks ago he was endorsing “Wilson’s syndrome” that was created by E. Denis Wilson, M.D., who practiced in Florida in the early 1990s. The syndrome’s supposed manifestations include a rag bag of fatigue, headaches, PMS, hair loss, irritability, fluid retention, depression, decreased memory, low sex drive, unhealthy nails, easy and excessive weight gain, and about 60 other symptoms. Wilson claimed to have discovered a type of abnormally low thyroid function in which routine blood tests of thyroid are often normal. He claimed that the main diagnostic sign is a low body temperature that is on average below 98.6° F and that the diagnosis could be confirmed if the patient responds to treatment with a "special thyroid hormone treatment." The American Thyroid Association published a position paper about this syndrome, saying that it probably does not exist. People have paid good money to be tested and treated, and though some may have benefited, most probably have not.

It is very easy to check these facts. So why didn’t the Fox medical correspondent do so?

Then a couple of weeks ago he talked about an herbal preparation without once mentioning that the FDA had just issued a warning about potential liver toxicity.

Then today he starts discussing a preparation called Airborne, that is purported to help prevent colds. It may or may not do so. The FDA has not evaluated the claims. The problem was that the correspondent then said that it could do no harm. Yet that is quite wrong. Though I could find no published cases of harm, the possibility most certainly exist, and the public needs to be made aware of the reasons to be a bit cautious:

  1. It contains 5,000 IUs of vitamin A. If you take it every three hours as recommended, some people could overdose on it.
  2. The same with vitamin C. If you take a lot, most is quickly passed out in the urine. But some people can get bladder irritation and could conceivably get kidney stones from taking that amount over a period of time.
  3. The remedy also contains seven herbs: Lonicera, Forsythia, Schizonepeta, Ginger, Chinese Vitex, Isatis Root, Echinacea. In a couple of hours I did a literature review looking at potential toxicity of these compounds. They all look fairly benign, but there are scattered reports of side effects with a couple of them.
  4. The difficulty is that side effects can be cumulative if several herbs and supplements are taken at the same time.

I have nothing at all against the Sunday Fox Medical Correspondent: he seems an affable and quite knowledgeable fellow. Neither do I have anything against Airborne. If it helps people, all well and good.

The trouble is that we have had at least three occasions in the last couple of months where advice has been given that had clearly not been checked. I think that unfortunate. Before I post any article I spend hours checking and re-checking. Even with all that checking, I’m quite sure that something could slip through, and if an error occurs, I shall be delighted if someone picks it up, so that I can correct it.

I only wish that everyone who writes or speaks about things medical would do the same kind of obsessive checking.

I really do believe that readers, listeners and watchers deserve nothing less.

Reversing the Irreversible

When I am analyzing current medical research for you, I focus on findings that are relevant to our underlying theme of Integrated Medicine.

One of the most important of all is the evidence for “spontaneous” remissions of otherwise fatal illnesses, and the reversal of diseases that are usually thought of as irreversible. It is exciting when we can show that arteriosclerosis and some neurological disease may be reversible, though most physicians still do not know that good news.

Two years ago I was asked to comment on a remarkable clinical problem. A 28-year old woman had seen a neurologist about some odd symptoms, which included quite severe visual disturbances. On MRI and electrical she had clear evidence of demyelination, the hallmark of multiple sclerosis. All of which has resolved after just one month of complete withdrawal from her diet of the sweetener aspartame. Multiple sclerosis is a disease that comes and goes, but the point of this case is that there was clear evidence that it went away completely. The neurological lesions in the brain that should have stayed forever, just melted away. I’ve looked at thousands of brain scans and this is extraordinary. And clinically the young woman is just fine.

Cases like this must be very rare: the FDA has determined that aspartame is safe, though on a future occasion I’ll say a bit more about the pros and cons of sweeteners. Discussions about artificial sweeteners usually generate more heat than light, but there is a lot of very helpful data to guide us.

Now let’s look at another condition that is supposed to be irreversible: cirrhosis of the liver. The liver is a remarkable organ. It has almost unique regenerative abilities. I’ve often wondered if the Ancient Greeks somehow knew about that remarkable attribute of our largest solid organ. When Prometheus was chained to a rock, an eagle came every day to eat his liver, which had re-grown by the next day.

The trouble is that if the liver keeps getting damaged and trying to re-grow, it produces a lot of fibrous scarring, the hallmark of cirrhosis. For more than a century, every expert has said that this fibrosis is irreversible. Now some first class research has shown that it isn’t true. An inexpensive medicine can reverse the fibrous changes in the liver.

The medicine is called sulfasalazine (sulphasalazine in the UK) that is normally used for treating inflammatory bowel diseases and some kinds of inflammatory arthritis. A team of scientists lead by Professor Derek Mann has recently moved from Southampton to Newcastle University has made a series of ground breaking discoveries. One of the most exciting is that sulfasalazine can reverse fibrosis in the liver.

The results were published in the journal Gastroenterology. A second and third papers published in Apoptosis, that describe the – then – Southampton group’s collaboration with chemists and oncologists to produce novel and more effective derivatives of sulphasalazine.

The researchers believe that, subject to further research and clinical trials, sulfasalazine could potentially be used to treat types of chronic liver disease – like cirrhosis – that are currently considered untreatable. Sadly because of greater alcohol consumption, especially binge-drinking, and obesity, liver disease is rising dramatically.

And if a simple medicine can reverse something previously believed to be irreversible, the final question that we have to ask is whether other the non-invasive methods may also help? Since most of the non-invasive methods work at deeper and more subtle levels of the organism, the answer to that one is, “Highly likely.” But it is going to have to be tested scientifically, just as every other hypothesis has to be tested.

Black Cohosh and Liver Damage

After discovering that some of the Black Cohosh sold in the United States contains precious little of the active ingredient, we now learn that that may not have been such a bad thing.

In 2004, a Conference sponsored by National Center for Complementary and Alternative Medicine and Office of Dietary Supplements, National Institutes of Health indicated that Black Cohosh appeared to be safe. However, earlier this year, the regulatory authorities in Australia issued a policy statement about adding warnings about liver toxicity to all herbal products containing Black Cohosh. The European and British regulatory authorities followed suit.

This highlights a problem with which we’ve struggled before: are the reports of hepatotoxicity due to a “bad batch?” Adulterated perhaps, or collected incorrectly? Yet that highlights both the strength of natural remedies and also their Achilles’ heel. We have so little information about the purity of individual products.

The standardization of herbal medicines is difficult, particularly since herbals usually contain complex mixtures of constituents, some of which are active, and some not. We often do not know exactly which component of an herbal medicine is responsible for clinical effects. There are often also differences in the composition of herbal preparations among manufacturers and lots. There are also enormous variations in the identification of plants by the manufacturers, how they are handled and the presence of other chemicals. Just think of the variations in the taste of different types of coffee, and you will see the point.

This variation has important consequences in clinical trials, many of which have failed to address the question of whether the herbs that they were using were of high quality.

The information on the label does not always reflect the actual content of the preparation and it is difficult to give one standard dose for an herbal medicine.

I thought that I should give you the wording from The European Medicines Agency (EMEA) and the Committee on Herbal Medicinal Products (HMPC)”

“Following review of all available data, the HMPC considered that there is a potential connection between herbal medicinal products containing Cimicifugae racemosae rhizoma (Black Cohosh, root) and hepatotoxicity.

The EMEA therefore wishes to give the following advice to patients and healthcare professionals:

Advice to patients:

— Patients should stop taking Cimicifugae racemosae rhizoma (Black Cohosh, root) and consult their doctor immediately if they develop signs and symptoms suggestive of liver injury (tiredness, loss of appetite, yellowing of the skin and eyes or severe upper stomach pain with nausea and vomiting or dark urine).

— Patients using herbal medicinal products should tell their doctor about it

— Advice to healthcare professionals:

— Health care professionals are encouraged to ask patients about use of products containing Cimicifugae racemosae rhizoma (Black Cohosh, root).

— Suspected hepatic reactions should be reported to the national adverse reaction reporting schemes."

Insulin Resistance, Diabetes and the Timing of Meals

At a meeting of the American Diabetes Association in June 2006, Professor Markus Stoffel from the Eidgenossische Technishe Hochschule in Zurich and Rockefeller University in New York, received the Outstanding Scientific Achievement Award for his extremely interesting and important research on the molecular mechanisms involved in the developmental insulin resistance.

This may sound as interesting as watching paint dry, but in actual fact the research is supremely practical, and may lead to a complete re-working of some commonly used dietary strategies.

Many physicians have not yet been taught that the liver is the key organ involved in the genesis of insulin resistance and of type 2 diabetes mellitus. Up to 90% of the glucose circulating in your blood has come from your liver. As the liver becomes less sensitive to the actions of insulin, it starts producing more glucose, particularly after meals. This in turn causes blood glucose to rise and with it insulin levels. One of the other consequences of insulin resistance is that the liver stops storing triglycerides, which then start circulating, while at the same time storing other types of fat, leading to what we call, not surprisingly, fatty liver. Or in the dog Latin that doctors use to confuse the general public, hepatic steatosis.

When we are fasting, the liver switches on banks of genes that produce the enzymes responsible for oxidizing fatty acids to produce fuel.

The main objective of a balanced diet is to maintain balance: we want to avoid sudden swings in glucose, fatty acids or insulin: it is these sudden changes that can cause inflammatory changes in blood vessels and in the liver and may lead to some of the circulatory problems that are such distressing complications of diabetes. We want to try and keep our insulin levels smooth and low. The best way not to do that is to have frequent high calorie snacks and to eat late at night. The best way is to follow the plans that I’ve talked about before. Eat little and often, keep the balance of nutrients just right, and be aware of the exact times at which you eat. Nothing except a little protein in the 2-3 hours before you retire for the night, and go very easy on alcohol, which can wreck your metabolism.

“The secret of life is balance, and the absence of balance is life’s destruction.”
–Hazrat Inayat Khan (Founder of the Sufi Order of the West, 1882-1927)

Technorati tags:

A New Way of Looking at – and Treating – Inflammation

Diseases of both large and small blood vessels are two of the biggest problem facing people with diabetes. Not only is it a huge clinical challenge, but also nature sometimes does our experiments for us. The high rates of coronary and peripheral vascular disease in diabetes can be seen as a kind of experiment of nature: a recognizable set of chemical abnormalities that might shed light on vascular diseases in general. It was those twin factors: a huge clinical problem, and an experiment of nature, that lead me to pick the topic of my research doctorate. 

When I was working on my research doctorate in the mid 1980s, I came across a lot of old research that seemed to show links between inflammatory and autoimmune conditions like systemic lupus erythematosus and rheumatic fever, and the eventual development of coronary artery disease. There was also a lot of old and largely forgotten research about the link between some viral infections and the development of coronary artery disease and acute coronary artery occlusions, because some infections can make blood more “sticky.” Inflammation evolved as one of the body’s defence mechanisms.

So I made the proposal – revolutionary at the time – that diabetes, coronary artery disease and a range of other illnesses might be inflammatory rather than degenerative. I soon found inflammatory markers in people with diabetes, that helped predict when someone was running into trouble with their eyes, kidneys or heart.  Even with stacks of data, I had to spend a lot of time defending that position, because it also implied that some illnesses thought to be irreversible might not be.

With the passage of time, it has tuned out that I was probably correct. Chronic inflammation, wherever it starts, mat have long-term effects on the body and on the mind. Chronic inflammation increases the risk of diseases of many blood vessels, as well as causing anemia, organic depression and cognitive impairment. Here is a partial list of common conditions in which inflammation is a prominent factor:
1.  Rheumatoid arthritis
2.  Systemic lupus erythematosus
3.  Fibromyalgia
4.  Chronic infections
5.  Insulin resistance or metabolic syndrome
6.  Arteriosclerosis
7.  Diabetes mellitus
8.  Hypertension
9.  Asthma
10. Inflammatory bowel disease
11. Psoriasis
12. Migraine
13. Peripheral neuropathy
14. Alzheimer’s disease
15. Autism
16. Gingivitis
17. Cystitis

The reason for raising the issue is not to say “told you so!”

It is instead that we need to think about inflammation a little differently. There is a mountain of information about the physical aspects of inflammation. We can stop at the simple description of inflammation as a condition in which part of the body becomes reddened, swollen, hot, and usually painful, or we can look below the surface: we can examine inflammation not only as a physical problem, but also as a psychological, social, subtle and spiritual problem. Why bother? Because the deeper approach allows us to understand and to treat and transcend inflammation as never before.

I am going to write some more about specific ways to address inflammation and what it means in future articles. I would also like to direct you to the book Healing, Meaning and Purpose, in which I talk about specific approaches in more detail.

But I would like to start with this.

In Ayurvedic and homeopathic medicine, inflammation is a sign of an imbalance in the vital forces of the body, and the traditional Chinese system agrees: here inflammation is usually a manifestation of an excess of Yang Qi, or a deficiency of Yin Qi. Most of our lives are seriously out of balance: Yang Qi is like a rampaging lion that has been stimulated by:
Acidic foods;
Environmental toxins;
Unwanted sexual stimulation:
Discordant music:
Constant demands from others:
Toxic relationships;
Years spent in front of television sets and limitless multi-tasking.

It should be no surprise to learn that all of these inflammatory conditions are increasing rapidly throughout the Western world. Not because we are getting better at identifying them, or we are living longer, but genuinely increasing.

It is wrong to put all the blame on poor diets or inadequate exercise. The problem is more subtle and is a reflection of distorted Information being fed to our bodies, minds, relationships, subtle systems and spiritual relationships.

The great news is that this simple conceptual shift gives us a whole load of new tools for handling these problems, and for using them as catalysts to growth.

In the next few weeks, I am going to drill down and give you some specific guidance that ties into the material in Healing, Meaning and Purpose and the next two that are on the launch pad.

Fasten your seat belt!

Technorati tags:  

logo logo logo logo logo logo