Dietary Treatment of Nonalcoholic Steatohepatitis (NASH) or Non Alcoholic Fatty Liver Disease (NAFLD)

The condition – Nonalcoholic steatohepatitis (NASH) is increasing in prevalence, in tandem with the obesity epidemic, in both children and adults. Identifying specific dietary components that drive NASH is important for successful management of this disease.

Nonalcoholic fatty liver disease (NAFLD) encompasses a range of liver diseases. Simple steatosis, or fatty liver, is now found in up to 31% of adults[1] and 16% of children.[2] Of those with steatosis, approximately 5% will develop nonalcoholic steatohepatitis (NASH), in which steatosis is accompanied by inflammation and fibrosis.[3] Up to 25% of NASH patients will progress to cirrhosis. NASH is the third leading indication for liver transplantation in the United States and will become the most common if current trends continue.[4] Therefore, understanding its pathogenesis and treatment is of utmost importance.

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RA – Bacteria, Diet and Hormones a Fixable Mix?

Rheumatoid arthritis! – these are not the words anyone wants to hear when they start to experience joint discomfort. It quite naturally engenders fear and worry as the tretaments offered are in themselves a challenge in most cases and avoiding effective treatment can predispose an individual to a shortened and miserable life.

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16% of Cancer Described as Avoidable! – What About The Rest?

The research, published in Lancet Oncology and carried out at the International Agency for Research on Cancer, studied international data for 27 cancers in 184 countries in order to identify the factors which contribute to the development of the diseases. The results suggest that 16% of all cancers are a result of infections, and of that sub-set 80% occur in less developed regions.[1]

The WHO another data crunching megalith estimates that 6% of cancers in wealthy nations and 22% in low- and middle-income countries are caused by infectious agents: viruses such as HBV, HPV and hepatitis C virus (HCV), bacteria such as Helicobacter pylori and waterborne parasites.

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A Nutritional Proposal For Improving “Mental health” with a focus on depression

At present no chronic disease has a greater drag on global function than mental illness.[1] A remarkable 40% of the European population is affected in any given year with depressive symptoms, and these numbers are rising.

Core symptoms include depressed mood, anhedonia (reduced ability to experience pleasure from natural rewards), irritability, difficulties in concentrating, and abnormalities in appetite and sleep (‘neurovegetative symptoms’). In addition to mortality associated with suicide, depressed patients are more likely to develop coronary artery disease and type 2 diabetes. Depression also complicates the prognosis of a host of other chronic medical conditions. The chronic, festering nature of depression contributes substantially to the global burden of disease and disability.

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Food and Our Bacterial Mix – Can we really change them both?

A few weeks ago (June 2012), a paper in Nature by a group of researchers suggested that despite the vast geographical and nutritional differences in the human population, that just three predominant bacterial clusters (referred to as enterotypes hereafter) could explain all of our gastric microbial mixes.[1] This they suggest indicates the existence of a limited number of well-balanced host–microbial symbiotic states that might respond differently to diet and drug intake.

Each of these three enterotypes are identifiable by the variation in the levels of one of three genera: Bacteroides (enterotype 1), Prevotella (enterotype 2) and Ruminococcus (enterotype 3). These enterotypes are not as sharply delimited as, for example, human blood groups; they are, in contrast, densely populated areas in a multidimensional space of community composition. They are nevertheless likely to characterise individuals, in line with previous reports that gut microbiota are quite stable in individuals and can even be restored after perturbation.[2]

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Microbes Are What You Eat

Most nutritional therapists and others that regard the role of the bacterial populations in the human gut as being a significant part of our capacity to operate and function in health or otherwise, understand that food choice has an effect.

A recent study on mice published in Science raises some very interesting early observations.[1] The same group published an earlier study exploring the same strategy.[2] Aware that food choices alter bacterial colony ratios and may favour certain bacterial species over others, mice were impregnated with a small number of commonly found human bacteria (10) and then were fed, via human pureed baby food concentrations of 4 commonly consumed ingredients. The researchers state that some 60% of the variation in species is attributable to dietary food choice.

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Vegas, Pregnancy, Immunity and Allergy Prevention!

The saying is ‘what happens in Vegas stays in Vegas’, or if you are English ‘what happens in Blackpool….’ but the same cannot be said about what happens in utero, as increasing evidence supports the understanding that the maternal nutritional environment and early feeding affects the health of the foetus beyond infancy and into adulthood.[1],[2] An article in Nature’s Mucosal Immunology this month explores some of the key events in foetal and neonatal immune management.[3] It stimulated a revisit to the area of what to consider for parents to be and mums of young children when they ask ‘is there anything I can do to prevent or reduce the risk of allergy or atopy in my child’.

The first moments, weeks and months of life can determine the health outcomes of an individual over the duration of their lifetime and this knowledge represents a significant choice for prospective parents. Fortunately the remarkable adaptability of the immune and central nervous system means that there are numerous opportunities in the early years of life to positively influence health outcomes even if the early stages were less than optimal.

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Fat – I’m Not To Blame Its My Bugs!

A trial to see if the ingestion of a probiotic bacterium enriched drink might have a beneficial impact on central obesity was funded by Snow Brand Milk Products company in Japan and the results were published in the European Journal of Clinical Nutrition this June 2010. [i]

Whilst it may seem a stretch that bacteria can influence our body mass, (I have written a previous review) it is an area of growing interest and investigation as bacteria have previously been implicated in the metabolic storage of fat. Studies in mice have shown up to 30% greater fat storage in mice with gastrointestinal colonies of commensals rather than their skinnier counterparts operating with sterile guts.

One proposal for this is that certain bacteria (Bacteroides Thetaiotaomicron is one likely contender) are able to manipulate energy to be stored in adipocytes through a pathway that involves microbial regulation of the intestinal epithelial expression of fasting-induced adipocyte protein (Fiaf), a circulating inhibitor of lipoprotein lipase (LPL).[ii]

The microbiota can then, based on this and other studies be viewed as a metabolic “organ” exquisitely tuned to our physiology and performing functions that we have not had to evolve on our own.

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Neurological/Dietary Control Over the Immune System – The Role of Fats

The immune system in humans and animal is complex, all the more so because it crosses over all tissues. The traditional view has been that the immune system keeps itself in check, and that is mostly the case. However, for some years there has been a development of a neural feedback loop comprehension that helps to answer some of the complex mechanisms and remarkably ties in the role of a nutritional strategy for immune management. This is known as the inflammatory reflex.

The inflammatory reflex, a prototypical neural circuit that modulates innate immunity, is activated by the presence of cytokines or other inflammatory products in tissues that triggers afferent (a nerve that passes impulses from receptors toward or to the central nervous system) action potentials travelling in the vagus nerve. The ascending information is relayed to brainstem nuclei that control efferent (nerves that convey nervous stimulus from the brain to other parts) neural signals in the form of action potentials transmitted back to the periphery via the vagus nerve.

Whilst this may sound complex – few subjects that combine neurology and immunology aren’t… the outcome suggested meets simple strategies, based on complex mechanisms.

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Butyrate Improves Bowel Transit

Problems such as poor transit or constipation are common, and can produce significant misery for the individual compromised in this manner. Butyrate is a short chain fatty acid, manufactured in the gut by the anaerobic fermentation of dietary fibres by resident microbiota. It is proposed that apart from its already well understood properties that it has another remarkable effect – the ability to increase the neuronal concentration of the Enteric Nervous System.[1]

Butyrate-generating foods and supplements might become an effective and simple option to prevent or treat functional gut disorders via modulation of enteric neuroplasticity.

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