Jay Feldman 0:12
Welcome to Episode 69 of the energy balance podcast, where we teach you how to live without constant hunger and cravings, fatigue, brain fog, poor sleep and other low energy symptoms by maximizing your cellular energy. I'm Jay Feldman. I'm a health coach and independent health researcher, and joining me again today is my good friend Mike Fave. Mike and I have been studying health and nutrition together for a long time now, and Mike also draws on his experiences from working within the healthcare industry. Today's episode is part seven of our series discussing non alcoholic fatty liver disease, and in today's episode, we'll be talking about carbohydrate deficiencies, saturated fat intake and the best diet for fatty liver disease. And as we've discussed throughout this series, the recommendations that we're making here, while some of them are very specific to fatty liver disease, most of them pertain to virtually any other chronic health issue related to a lack of energy or an energy failure. And so this information is extremely important whether you're trying to reverse fatty liver disease or any other chronic health issue. And as far as those earlier episodes in the series go, we did take some time to discuss a lot of the general mechanisms and physiology underlying fatty liver disease. So if you haven't checked those episodes out, I'd highly recommend you go back and do that. And if you are new to this podcast, then after listening through today's episode, I'd recommend going back and checking out episodes one through seven of the podcast where we took some time to build a foundation as far as the bioenergetic view of health goes. And in today's episode in particular, we'll be talking about how carbohydrate deficiencies can drive fatty liver disease. We'll be talking about the particular type of fat that you'll want to avoid if you have fatty liver disease. And you might be surprised about which type of fat this is. We'll also be discussing the optimal amount of protein, fat and carbohydrates for reversing fatty liver disease. We'll be talking about the order of dietary adjustments to make for fatty liver disease and why this order matters. And we'll be talking about whether reducing fructose intake is necessary for treating or reversing fatty liver disease. To check out the show notes for today's episode, head over to Jay Feldman wellness.com/podcast where you can take a look at the studies and articles and anything else that we reference throughout today's episode, and if you're dealing with any of these symptoms or chronic health issues we've been discussing throughout the series, whether that is fatty liver or insulin resistance or other related conditions like diabetes or heart disease, or if you're dealing with any other low energy symptoms, whether that's chronic cravings and hunger, low energy or fatigue, chronic pain or joint pain, weight gain, digestive symptoms like bloating or inflammation, brain fog, poor sleep, hormonal imbalances, or any other low energy symptoms or chronic health issues or conditions. Then head over to Jay Feldman wellness.com/energy where you can sign up for a free energy balance mini course, where I'll explain how these different symptoms and conditions are really caused by a lack of energy. And I'll also walk you through the main things that you can do from a diet and lifestyle perspective to maximize your cellular energy and resolve these symptoms and conditions. So to sign up for that free energy balance mini course, head over to Jay Feldman wellness.com/energy, and with that, let's get started.

All right. So up until now, we've talked about all these different mechanisms that are driving this pathology that we see in fatty liver disease and the progression throughout fatty liver disease. And obviously, there are a lot of factors in our environment that can cause those things. We talked about a lot of those underlying causes and how those drive the those different mechanisms in that pathology. So now let's talk about what we can do from a diet lifestyle supplement perspective, to prevent or reverse this pathology, especially in the case that somebody has fatty liver. But of course, as we've talked about, this pathology is seen in virtually every other chronic health issue, so a lot of this information would apply to virtually any other condition or issue. But we'll, we'll try to keep it a little more focused on fatty liver, especially when we talk about supplements that are, again, particularly helpful here. But as we'll get to, all of these supplements and strategies can be pretty helpful for any for any issue like they're they're working on this on this bigger picture level, so it applies to virtually everything. But with that in mind, let's start with the diet side of things. So one thing that we've discussed a little bit throughout is the role of protein and particular amino acids and fatty liver and these, for the most part, are really. Be important for the exportation of fat from the liver. And so we talked about methionine being very important there, where, if you have a methionine deficient diet, or give a random methionine deficient diet, it will substantially inhibit the ability to export fats from the liver, and that can cause an accumulation of fat in the liver. So with that in mind, making sure to get enough methionine is is an important factor to consider, and methionine is found in virtually every animal protein. You're going to have a decent amount of methionine, whether it's meat or dairy or seafood, and it's not hard to get enough methionine if you're eating a decent amount of protein. We've talked about this in the past of maybe about point six to point eight grams per pound of body weight, being a good range for general protein intake. And if you're getting that and if most of it is from animal sources, which, again, we've talked in the past, why you don't want to be getting plant based proteins, that's the whole other conversation. So we won't go into it now. But So assuming you're getting a lot of animal based protein, then it's almost impossible not to be getting enough methionine. It should be pretty easy. And when we talk supplementation, for example, this is not something you typically need to be concerned about. At least I would, I would say that most people can easily get enough methionine. But one thing that can be tougher to get, if you're not intentional about it, is getting enough glycine, and we haven't talked about glycine as much in terms of fatty liver, but glycine is is for one important for having enough methionine. It helps with the recycling of methionine, and it also has some of its own unique effects, its own unique anti inflammatory effects, its own unique effects on protecting against oxidative stress. And so with that in mind, getting enough glycine is is also extremely important, and it's been found that in the same way that having enough glycine opposes the some of the harmful effects of methionine, which is worth mentioning that you see excess methionine being an issue big picture, especially in terms of things like longevity and aging. So you don't want to be getting too much methionine. But as we've mentioned before, if you get enough glycine, it is able to counteract those effects of too much methionine, more or less. And interestingly, it's also able to counteract the effects of too little methionine, where in rats, where they're trying to create a fatty liver situation and they deplete, or they feed a depleted diet, a diet depleted and methionine, glycine is actually able to protect those rats against developing fatty liver. So with that in mind, getting enough glycine is very important, and glycine is found in the connective tissue pieces of meat, so that would be the bone and other like cartilage and tendons and things. So again, this isn't difficult to get, but you just have to make it, you know, make it a point to get it, because you're not going to be finding it in things like chicken breast or steaks for the most part. Instead, you would want to opt for a lot of the meats that you would have to slow cook, because they tend to be very tough because of this connective tissue. But if you cook them low and slow, they become very tender. So this would be your roasts, anything with a bone, like short ribs or any sort of ribs or Shanks, like lamb shanks, beef Shanks, those are all going to be very high in glycine and other protective amino acids. And as well as well as just anything with bones, like you can make a bone broth. You could also use a collagen or gelatin protein powder. And that would be, those would be some easy ways to satisfy, in this case, both your methionine needs and glycine needs.

Mike 8:33
Yeah, I would say the easiest way is to just get your lean at least the easiest way, in my experience, and from what I've seen working with people, is the easiest way to do is eat your lean protein sources, like your steaks, your chicken eggs, have your dairy. And then for a lot of people, it's just mixing some collagen hydrolysate into a smoothie or into some juice, and then maybe once in a while, making like a roast or some type of like slow cooked meat, so that, I would say that's the easiest intervention. The next piece to talk about would be some of the other amino acids besides glycine and methionine, and those would be your branch chain amino acids. That's leucine, valine and isoleucine. Now we have a study, I think it was in rats as well, where basically they showed that having branched chain amino acids helped to decrease fatty liver. They weren't sure of the specific mechanism, but with some of the states of fatty liver and some of the beneficial effects of and that's for branched chain amino acids, there's also other amino acids, like cysteine and glycine was important here, but also glutamate are also are the basic building blocks of the antioxidant glutathione. So having enough of those can have an antioxidant effect, as well as the branch chain fatty acids having effect on decreasing liver fat. So just getting enough amino acids and enough protein in. General, is extremely important for liver health, for those reasons, and then also that a lot of these amino acids function in some of the liver detoxification pathways. So that would be like your face, I would say, I think your Phase Two detoxification. So it's important to make sure that you're having enough protein in general to support the liver detox, to support glutathione perox glutathione production, to support anabolic processes within the liver, and then to support some of the methylation through methionine. And then also the function of methionine in producing coal, in producing choline, which is another nutrient, I guess we want to talk about that. I guess more in a supplement area, but methionine and choline are, are intimately linked. I don't know if you want, do you want me to cover it now, since they're so linked, or do you want to save that and when we get into supplements?

Jay Feldman 10:50
No, that's fine. I mean, of course we can get choline from diet as well, so it's fine to mention it now. I mean, you'll find choline and liver and eggs, those are the two main sources. They're pretty high in choline.

Mike 11:01
And shrimp is pretty good source, too. You're eating a decent amount of shrimp, those are probably the, the easiest places to get it.

Jay Feldman 11:09
Yeah, yeah. And we talked about, again, the the importance there of choline for the liver export and and being needed for that phosphatidyl choline piece that's needed in the the VLDL. So if you don't have enough choline, if you're a choline deficient, then ideally, getting it from the liver, eggs, shrimp sources would be the best. But yeah, we'll talk about supplementing and the specific types of supplements in a little bit. Yeah.

Mike 11:31
So the methionine, methionine and choline kind of go together, and then the branch chain, amino acids have their own beneficial effect, and then the glycine has its own beneficial effect. As far as protecting against methionine and choline deficiency, it also helps with bile acid conjugation, antioxidant, anti inflammatory. And then the other ones would be your glutamate, cysteine and the glycine again, which help with glutathione production. And I don't know, do you want to touch on taurine really quick while we're in protein. Or do you want to go lead that towards supplements? It's kind of in that, that category, and you can get it from some of your foods, if, if you want to...

Jay Feldman 12:11
Yeah, yeah. And it's, it is tough to get to really focus on taurine and food you're not finding, there's not too many foods that are real high in Taurus, just selfish, pretty much. Yeah, yeah. And so taurine is one. So you you've kind of alluded to these amino acids that help with the liver detox, and a lot of those are the sulfur containing amino acids. So that's the methionine, cysteine, taurine, and so those are all supportive in the liver detox. So we mentioned the methionine, you mentioned cysteine again. These are all really easy to be getting enough of from your diet. If you're getting enough animal protein. And yeah, taurine is one of those two. That's one that typically, if you're in this case, look towards supplementation. But yeah, getting enough in the diet is definitely helpful as well.

Mike 12:53
Yeah, and just for sources that could be like scallops or mussels or oysters or clams, those are kind of, those are going to be the best sources overall. But in general, I mean, you can get a little bit from meat, but it's not the same as taking a supplement. So we can kind of leave that more towards the supplement area. Just the overall picture here is that protein is important, and especially from animal sources, because of all these immune these amino acids and we we talked about in other episodes of plant stuff. So I won't cover plant proteins and why we don't specifically rely on those, but hitting that point 6.8 grams per pound of protein per day is very important. I would even shoot for the that point eight grams per pound if you're having any type of liver issues on the higher end, just because, as we're going to talk about in the next some of the modifications with um, with carbs and fats, you may want to just have a higher protein content for for a period of time. And the easiest way to meet that is, you know, your lean meats, your dairy, your eggs, organ meat, shellfish, seafood, and then supplementing some collagen, hydrolysate. Or if you're about the gourmet life, then you can do your roasts and your slow cooked meats and and what have you, all those types of options. So it's just, yeah, really important to make sure that you're you're getting adequate amounts of protein, especially if you have a fatty liver.

Jay Feldman 14:13
Yeah. And just real quick, I know you're joking about the gourmet life. I mean, in reality, those foods are much cheaper compared to something like steaks or chicken breasts, a lot of time, a lot of times, depending on the quality, of course. And yeah, I mean, I think a lot of people prefer them. And I some people have some issues with their response to things like collagen and gelatin, in which case, again, I think getting it directly from the food is is ideal.

Mike 14:37
Yep, that's definitely true. Yeah, yeah.

Jay Feldman 14:41
So moving on from protein, we've talked a lot about fats, specifically PUFA, but we've also talked about saturated fats, I mean, because of the production of them and their conversion to the monounsaturated fats. I mean, that's been a huge theme here when we're talking about fatty liver, which obviously has a lot to do with fat. So when it comes to diet, I think there are some. You know, the obvious piece here would be avoiding the polyunsaturated fats, reducing the polyunsaturated fats in your diet. We talked extensively about how these drive and amplify inflammation. They inhibit respiration, which is going to drive the production of fat in the liver. They reduce the ability to export the fat. They're, you know, all around, causing a lot of issues for the liver and driving that pathology deeper and deeper by driving the oxidative stress and inflammation. So reducing those is going to be the simplest thing we've talked about this you know more in the past. I'll link to those episodes as a real quick recap. This is the vegetable oils, nuts and seeds, fatty fish, fat from pork or chicken that's not pastured. So whether it's chicken thighs or bacon or something like that, if it's not pastured, it's going to be high in PUFA. So those would all be fats to reduce. And so in contrast to the polyunsaturated fats, we want to be favoring, the saturated and monounsaturated fats, we talked in the last few episodes about how protected the saturated saturated fats are against basically the effects of the polyunsaturated fats, especially in terms of of liver injury and damage. So that's especially noteworthy. We talked about the protective effects of saturated fats in terms of endotoxin also obviously very noteworthy. So these would be the fats that we want to focus on, and then the monounsaturated fats as well. Both of these are extremely stable. They aren't prone to oxidation, like the polyunsaturated fats. Again, I'll link to previous episodes talking about those. And then, just real quick, as far as foods go, this comes back to dairy and meat that's meat that's either chicken or pork that's raised well, or any sort of ruminant animal, like beef, bison, goat, lamb, and then low fat seafood, which is just going to be low in PUFA. So that's going to be the main sources, as well as things like coconut oil, palm oil and beef tallow, things like that. So those would be the main sources we want to focus on, just big picture wise. And then we'll talk about the specifics as far as saturated versus monounsaturated in the context of fatty liver.

Mike 17:04
Yeah. So as far as at least, it's kind of a contextual deal, right? So while you're currently having a fatty liver, while you're currently in the state of fatty liver, perhaps adjusting towards a more mono unsaturated fat dot ratio, so higher monounsaturated fat to saturated fat would be helpful to, like, relieve the liver a little bit so that the liver, if it is having a bottleneck at its ability to take those fats and create, turn them into or put them into VLDL and then to export them, yeah, to export them, but put them in VLDL and then export them out of the liver. It may be better, or maybe helpful, for a period of time to focus more in on the monounsaturated fatty acids rather than saturated it doesn't mean you have to go zero saturated fatty acids, but it's more like just increasing the ratio towards mono I would still limit polyunsaturated fatty acids as most, as much as possible. So that would be the sources for those could be something like a high quality extra virgin olive oil, a macadamia nut oil. Macadamia nuts, beef tallow and cocoa butter actually have a decent amount of monounsaturated fatty acids. So if you made a mixture of like, a like, if you were going to cook with or if you were going to put on your food, like, you cooked your food with some beef tallow, and then you added a little bit of macadamia oil. After you would actually have a very high monounsaturated fatty acid to saturated fatty acid ratio. So you could do something like that, and it's just until the liver clears out a little bit and it has an easier time processing saturated fatty acids, just because there is that nuance where they can be a little bit more difficult to process initially, especially in a pathological state. So with fats, that would be the deal. And again, the monounsaturated fats aren't really at risk for the peroxidative damage, and a lot of in studies with olive oil actually binds up being protective in some of the the inflammatory states with the liver, whereas your corn oil and your fish oil definitely aren't. And then as far as medium chain fats go with, like a coconut oil, those, those types of fats would be something that are hit or miss. And some people can be really helpful, because it can provide a quick source of energy. But in other people, it may, it could make the situation worse for them by irritating the intestine or but by adjusting the processing of liver. So those are a little bit more hit or miss. Some and some studies definitely show benefit, whereas others, it depends on, it depends on the context. So that's what I would say for for fats that would that would be my initial choice.

Jay Feldman 19:41
Yeah, and just to mention, as well, another potential reason to decrease the saturated fats a little bit does come back to the digestion where, if somebody is struggling with fatty liver, and you know, their liver is not functioning as well, their bile production might be impaired, their bile release might be impaired. There might be some gallbladder issues. And so that can make it different. Difficult to digest these fats as well. So that would be another consideration.

Mike 20:05
So the the oil nature, the fact that the monounsaturated fats are more liquid means they're a little they can be a little bit easier on digestion, whereas the longer chain saturated fats, like stearic acid or fats higher even having more carbons than that could be a little bit more difficult to digest. So focusing on the monounsaturated be helpful in that context as well. Yeah, it's definitely that's something, something I've experienced as not having a gallbladder, I feel like I can digest some of the monounsaturated fats a little bit easier. Yeah, just something to put out there. Yeah, yeah. Yeah.

Jay Feldman 20:41
And just as far as the amount of fat goes, I mean, we talked about why low fat is not just this clear answer here, or low saturated fat, right? Like, saturated fat is not the cause of fatty liver. If somebody is changing their foods in a way that is supporting their metabolism, they're using certain supplements that we'll discuss, and they're still, as you mentioned, like they're still struggling, or if they just want maybe a little bit of extra push, it might be helpful to reduce the saturated fats a bit. It might be helpful to reduce fats overall a bit. Yeah. Again, these are not first strategies from from my view, I would definitely work on adjusting the types of foods first and foremost, and maybe using some of the supplements we'll discuss prior to doing this, because you have drawbacks to decreased fat intake. So So yeah, that would be kind of like an order, order of operations. For me, it is something I would consider, if somebody is still struggling with the fatty liver situation, I would consider dropping the saturated fat down and better dropping fat down a bit as a whole. You know, sometimes we talk about like a 30 to 40% fat. Maybe they'll be going down to closer to 20% fat as far as total calories in the diet, again, all depending on the individual situation and what, you know, what that individual's experiencing.

Mike 21:59
Yeah, and I've actually, just as a personal experience, I've I've worked with people who have had fatty liver, and I've had people just switch over to a more monounsaturated fat content in the diet, and have their symptoms and presentation of fatty liver dissipate by making some of the Justin's talking about Here, making sure you're having adequate protein, taking out for some for some people, it's actually having foods that this individual kind of had a negative response, or, uh, like, kind of a allergic response to dairy. So eliminating dairy and then adjusting the fats to be more monounsaturated actually helped to clear out the liver without having to drastically drop, drop the fat content, if anything, the total amount of calories once we drop dairy and the liver started to heal a little bit increased over time. So, and that's one of the drawbacks of dropping fat really low, is that you actually, you it's hard to hit caloric intake, if you I mean, 20% isn't too low. But some people want to talk about, like, really low fat diets, and then it makes it very difficult to actually meet the number, the amount of calories you need, and to feel satiated with your diet. So, yeah, it's it. There's a spectrum of things that you're going to do. There's a there's a spectrum of things to handle, and, like, there's an order in which to try things. So maybe you just take out some sort of irritating factor, you get rid of Pollyanna as much polyunsaturated fats as possible. You move towards a higher protein diet, more nutrient dense, and you can tolerate some some of the saturated fats, no problem. Or if you're still having a little bit of issue, then you can move to more monounsaturated fats. And if you're still having some of the issue, you can lower your monounsaturated fat intake and still keep, like, the proportion of saturated, the proportion of monounsaturated fats high. So you're like 20% fat diet with with a larger proportion of that fat being monounsaturated. So there's, there's a gradation of things to try and to move through before you can just go like full boat and going full boat all the way low fat, mostly monounsaturated. Like, there's you may feel that. You may actually feel worse having the fat so low. So again, it's not always that, like, going the full way is always all the way better. Like, in some cases, for some people, may be better to, like, find that medium and what works for them. So we're trying to give a spectrum of options here.

Jay Feldman 24:19
Yeah. Yeah, absolutely. And with that being said, I've seen people resolve severe fatty liver without taking out dairy, without taking out saturated fats, without adjusting the fat content, even at all as a whole, probably even with increasing it. So yeah, it's, as you mentioned, spectrum. Got to work through it and pick out again, lowest taking fruit and what, what sort of factors seem to be the most causing the biggest issue. And you mentioned high protein I just wanted to clarify that that doesn't necessarily mean a high protein diet, just higher than what somebody might have been doing prior low protein diets, especially in women, and I've seen it to be pretty common in people who have fatty liver or just. Is easy to come by. So a lot of people who aren't focusing on getting enough protein don't happen to get enough. Maybe they're only getting 50 to 60 grams a day. So higher meaning just adequate, not necessarily a high protein diet where you're also having low fat, low carb, that would be not a good idea. In short, yeah.

Mike 25:17
Yeah, that's what. And when I say higher, I'm talking about in our range. So when we have point six grams to point eight grams per pound of body weight per day, I'm saying moving towards the point 8.8, grams per pound of body weight per day, part of the range. And sitting there, whenever I have somebody who comes to you with fatty liver, that is the first thing that I'm going to do is put make sure that protein intake is high, high in that range, so towards the point eight, and make sure that it's eaten on a consistent basis, and it's coming from animal protein sources that are also nutrient dense. That's like number one thing to hit, right there is that protein aspect, and that's why we covered it first, and that can include using collagen protein, but it really that high protein, that that protein amount, I think, is very helpful for people. A lot of people who I've who have come to me with fatty liver, were actually under eating on a regular basis, because the liver impairment was impairing appetite to some extent, and in my experience, and then they were also the fat choices and protein choices that they're eating, like there was not eating enough protein on a regular basis, and then they had, like their even though their diet was low in total calories, the proportion of fats they were eating was higher in the polyunsaturated fatty acid. So even if, like, some of these people, were eating only, you know, 50 grams of fat a day, but they still had like 15 of those 50 grams of fat being polyunsaturated fatty acids, or even some of them only had like eight grams of fat being from polyunsaturated fatty acids. But that's still a relatively high proportion compared to what's possible. So if you're making a switch and you're going to, for example, someone like myself will eat 130 grams of fat a day, sometimes 140 grams of fat a day, but I'll keep my polyunsaturated fat and take at like eight grams. That's a very different equation than having 50 grams of fat a day, with eight grams of that being in polyunsaturated fat, and then also only eating like 60 grams of protein a day, and then filling in the rest with a whole bunch of grains and fibers and carbs, and then coming and having, like, liver issues and allergies and gut issues and all this type of stuff. That those paradigms, even though the total amount of polyunsaturated fat may have been the same, there's like other there's a whole bunch of other factors. So the first thing is always make sure there's enough protein. That's why I covered it first. And then the fats. Is a gradation approach, depending on where you're coming from. You know, you could if you're because some people will be coming from a carnivore diet, and they'll be eating, you know, a really, really high protein diet, like 300 grams of protein a day, and they'll be having maybe 80 to 100 grams of fat a day, and their liver will still be blown up. And it's related to other issues, whether that's glucocorticoid signaling, microbiome issues, and then nutrient deficiencies or like or an excess protein issues, things like that, causing issues at the liver that may not necessarily like it's, again, like it's, there's, it depends on the different context. But we're trying to give, I guess, like guidelines of like ways to go about it. So get your protein intake around this range, and then fats, this would be the stepwise approach to adjust from there.

Jay Feldman 28:30
Yeah. And in that low carb case, the carnivore case, they're probably also suffering from carbohydrate deficiencies. So yeah, yeah. So we talked about this prior about how, perhaps surprisingly, most of the fat in the fatty liver is coming from the body's own fat tissue. So the best way to cause the release of your own fat is to drive stress and to be in the fat burning state where you're kind of constantly cycling through your fat stores, fat going in, fat going out. And so a low carb diet is good way to do that and drive that. And increasing carbohydrates is the most effective way to drop those stress hormones down and reduce the release of the free fatty acids. So that's incredibly important, getting enough carbohydrates, and you know, enough to suppress stress. We've talked about this plenty of times in the past, so I'll link to those different episodes. And one thing that is especially important to highlight when it comes to Well, there's two important things to highlight when it comes to fatty liver first one has to do with endotoxin, which we've talked extensively about how huge of an issue that is in fatty liver disease, and generally the production of endotoxin is going to be driven by carbohydrates that are not well digested. And so because of that, it's extremely important to make sure that you're focusing mostly on the easily digested carbohydrates and paying attention on which ones you digest well or don't digest well, and then also addressing the cause of that male digest. Question. So which tends to be microbial in nature? It tends to be bacterial overgrowth, fungal overgrowth, or imbalances. So again, simple, like just keeping it simple here, things like ripe fruits, juices, honey, maple syrup, cooked roots and tubers, sweet potatoes, potatoes, things like that. Those are all going to be the easiest to digest, and you can dial in more specifically from there, you might not, you know, an individual might not do as well with starches. They might not be able to break down those complex chains of glucose, but maybe just the fruit juice is fine, or just ripe fruits are fine. So it's a matter of first, just making sure that you're eating a diet, in this case, eating specific carbohydrates that you digest well and aren't driving that endotoxin production. And then secondary to that, would be addressing the issue, the microbial issue that's driving that, which we'll talk about in a moment, because that's going to be more supplement based. I mean, eating the easily digestible carbohydrates will actually help to rebalance your microbiome as well, between the polyphenols in there and and also just supporting things metabolically and reducing the feeding of those harmful bacteria. So, you know, it's a multifactorial piece, but that's an incredibly important one. And then the other one I would mention is, is on the fructose side, where, for the most part, I would say this is something kind of like the saturated fats, but this is more of a secondary piece, where, if you are already doing a lot of the things, quote, unquote, right, where you have already done a lot of things to adjust your diet, to support your metabolism and support your liver health, and you've used some of these supplements, and you're still struggling, it might help to decrease the fructose intake a little bit and see if that helps, just because there might be some other factors that are inhibiting your liver capacity to oxidize it or convert it to glycogen, and so during that time, it could be helpful to have a little bit less input, a little a little bit less fuel there, again, with the acknowledgement that this is not actually solving the issue. This would just be a way to prevent it from getting worse in the short term, only, if necessary. I haven't ever found this to be necessary and people have fatty liver that being said, that that doesn't mean that it never would be. But, yeah, something to consider, again, I would definitely not be looking at that any, anytime early on in quote, unquote treatment of the issue.

Mike 32:16
Yeah. I mean, my one thing I would say is that I tend to remove honey for people when, when I first start with with any type of fatty liver or any type of bloating or any type of indication of a liver issue, just because the free fructose can cause issue for people in that state. So my preference is always for fruit juices that or any types of fruits and dried fruits that are low in FODMAPs and that are also have one to one glucose to fructose ratios, so that those sugars are entirely absorbed for the most part, higher up in the in the small intestine, and they don't reach or if you have any type of microbial imbalance, and the microbial imbalance may not necessarily have developed first with the situation, the liver impairment may have led to the microbial imbalance, or they kind of like it's kind of cyclical. It's kind of hard to know the chicken or the egg with those and it can depend on each individual's context. They got some type of liver impairment from eating foods over a period of time led to dysbiosis. Dysbiosis strengthened the process and just kind of went from there. So what I tend to push people towards, at least, to experiment with, when, when coming to me with fatty liver, any type of liver digestive impairment, is going to be those one to one glucose or fructose, and then like a safe starch, towards the ones that you mentioned, it's and it's usually going to be like a like a white potato, or maybe plantain or a banana, or for some people, white rice may be better, or sometimes it could be cassava or yams. It really depends on what you're tolerating. And that's going to come with experimentation, because some people tolerate yams fine, whereas some people just blows them up, they're going to get a lot of gas. So there's those all really depend. The most important point with the carbohydrate sources is that they have the polyphenols present because that'll that'll modulate the microbiome, and it'll allow, it'll protect you from some of the negative effects of the endotoxemia, and it also they have a protective effect on the liver directly, oxidative stress is a huge problem inside fatty liver disease, as We talked about, and the polyphenols actually can decrease that oxidative stress and restore proper energy metabolism, not only by blocking some of the effects endotoxin, but also like protecting the liver cells directly, like having it affecting the cells directly, and then making sure that those carbohydrate sources are nutrient dense carbohydrate sources, they have vitamins and They have minerals, and that the most nutrient dense sources that are the easily, most easily digested are going to be all those sources I just mentioned, grains, beans, not, not great sources, not, not really nutrient dense to a large extent, especially digestible nutrient dense, and then also come with a whole bunch of other factors. That can worsen dysbiosis and or increase negative symptoms in these states. So ideally, it'd be moving towards those more easily digestible sources. And we also we want these digestible sources so that we can start to with the carbs. We can start to move towards more carbohydrate metabolism and less oxidation, or over oxidation of fatty acids, and we also want to lower that cortisol, like glucocorticoid signaling that we talked about in fatty litter, which gets upregulated. So for carbohydrates, that's generally how I go about things. Now, one thing I want to preface here too is that, as as you mentioned, Jay, is that if you are still having issues with fructose or whatnot, I actually had a client who, at one point, was dealing with some liver stuff, and they, um, they initially didn't tolerate fructose from or they didn't tolerate fruits and fruit juice very well. It's at the start, and that's because when they came to me, they specifically had liver issues going on, like all the symptom the symptom profile indicated liver issues. I can't make a diagnosis, but I can sit there and say, I have right upper quadrantine, I have bloating, I have fatigue, my stools, or this or that, and then, you know, I'm getting these histamine reactions lit the for me, first thing is gut liver right there. That's like automatic gut liver. What's going on with that?

Jay Feldman 36:18
Those are two differentthings, by the way. This is not an organ. This is not a new organ, your gut, liver. This is your gut and liver issues.

Mike 36:25
Yeah, they're just so, like, you can't, you don't have one issue without the other. Like, they're always together. That's why I say that. Like it's, there's the connection between them is so strong that there's no way that you have a gut issue and you don't have something going on at the liver. And you don't, if you have a liver issue, don't have something going on at the gut.

Jay Feldman 36:44
it's your gut liver axis, yes,

Mike 36:47
For sure, is gut liver, your gut liver? No,

Jay Feldman 36:52
No, just like you have the this gut skin axis and the gut brain axis and this, I mean, every it's all directly interrelated. I'm not saying that there's not value in pointing out the connection between the liver and the gut, but I'm just saying you can drive those axes between all the different organ systems. It's kind of, it's kind of like, again, if you're just using it as a name to talk about the relationship between the different organ systems. It's fine, but it's just kind of a funny way to reduce this complex system that all works together to, oh, you just happen to have a relationship between these two organ systems. But not, there's not a skin, kidney axis, right? There's no way that could exist.

Mike 37:31
No, it just for me, it's just, it's easy. It's a categorization, because you always see those like, those are the main if you have these symptom profiles, like you can have, like most people who have gut symptoms or have some or have, like, serious liver symptoms, wind up getting things like rashes or hives or some type or maybe acne or or other types of skin symptoms. And then they also can't we'll get hormonal symptoms like weight gain here, water holding here. So, like, everything is, is all entirely related, but those are the areas that I'm going to specifically target in on to address the to help basically remove the blocks so I can get metabolism working in the right place. But with this particular individual, at first, they didn't tolerate juices and and fruit well, and that was fine, because what we did was we moved to starches and what, for a while they tolerated starches, and then over the period of a couple weeks, they try to reintroduce juices again. And then they found out that they like juice and fruit better than the starches, because their liver had cleared whatever the issue was going on, and their ability to process the fructose was was way better. So the problem is really the state. The state is the problem as pretty much with everything. And it's like, how are you manipulating what's going on with that state? And then what are you throwing on? Is your if you're in a healthy state, you can process fructose from fruit and juices and stuff, fine. Whereas if you have a fatty liver state, you may have an issue for a period of time just because you have that backlog and overload. So it's just, it was, again, it was just like, let's just decrease those fruits the fructose content for a period of time, and then we can reintroduce it later on, once we get the signs that the liver and gut have calmed down a little bit. And that's exactly what we did. And then it essentially just, it dissipated. It now the this individual's tolerating juices and fruit just fine. So, yeah, there's, that's the importance of context. Because in the studies, too, I don't think they talk about the context. They want to look for, like, one particular factor, and it's like, yes, you have, you're giving rats a 60% fructose diet, which causes not only rank nutrient deficiencies, but microbiome imbalances, and then you want to turn around and say, Oh, it's fructose. It's like, no, it's fructose. On top of microbial imbalance, on top of rank nutrient deficiencies, on top of a fatty liver, which is like, they're all synergizing together. It's not, it's never going to be one factor, even if you're just feeding this one thing so and. Again, that fructose is still entirely different from getting it from like a fruit juice, like if you put in a pineapple juice versus a of 60, if you put in a 60% pineapple juice diet versus a 60% High Fructose diet is going to be a world of a difference of response. So just things to keep in mind.

Jay Feldman 40:19
Absolutely, yeah, and I did want to mention, so you mentioned honey as being something that you often take out. I've also seen situations where somebody has some very noteworthy symptoms in relation to digestion, and virtually any type of carbohydrate will trigger them, but honey will be totally fine, and that's maybe one of the very few foods that they can digest without an issue, and it won't drive endotoxin production or anything. So again, just saying that it's all individual. Some people might do better with with without honey, due to the amount of fructose in there. But for other people, it might be totally fine. Again, it's just variable. And as you're saying, there might be a place for starting with more on the starches. Again, it's these are all things that that we would work to sort out depending on symptoms and how somebody responds, which is a huge part of it, when we're talking about these dietary things, these dietary strategies, is we're keeping the larger context in mind of what's driving the pathology and how we can best oppose it, and then within that, you're considering how you respond to making certain changes and adjustments, and then adjusting accordingly. I mean, that's, that's what most of it comes down to, I guess, after you have those, those foundational pieces in place, or the foundational understanding in place of what's driving the problem. Yeah, that's that.

Mike 41:38
That's the thing, though, because it's always, there's always nuance. And that's why it's hard to be ever be a guru about something, because there's so much nuance involved with everything that, like a lot of times, somebody will ask me, Well, why is this going on? And it's like, I can give you a hypothesis based on what I understand currently as to why something's going on, but the only way we're going to know, like, what intervention is going to work for you, is we're going to just have to try it, and we're going to have to put it in an experiment, intelligently, hypothesize, intelligently about what that specific issue is and what that specific causes. So, yeah, it's it's always going to be this nuanced approach. It's always going to be a an organic, evolving approach, and being open to trying different strategies within the context of certain principles, you know, based on these understandings. And so like, for example, a great example, this is the fructose and honey situation. So like, even when you look at the studies people, some people can only tolerate five grams of five free grams of fructose in excess of glucose at a meal, whereas others can go up to 50 or 100 so maybe the individual you were working with was more in that 50 grams of free fructose in excess of glucose, glucose range. So the amount of honey they were eating in that in that meal wasn't enough to push them over their saturation point for their intestine, whereas someone like myself, it's like, if I have, you know, 10 grams more fructose, like, I'm going to have a problem. So it's that's where that nuance comes in, and the flexibility to be like, Okay, what are we seeing in your symptoms, and how are we going to address it from there? And so, like, that's something, I think, what is helpful for people to understand when they even when they're like, when they're working with their own situation, and trying to figure it out is really looking at what like, what is my perception of my experience? What like? It's really, raise, perceive, think, act, right? So like, what am I experiencing? What am I perceiving? And then thinking about it from there, and then doing it, performing an experiment, and seeing how you respond from it, rather than having the ideology first ignoring the perception and then trying to perform the experiment, you have to go off of really how you're feeling and what's going on with you.

Jay Feldman 43:52
Yeah, definitely. And I do want to say, just to add in with the with the honey portion, there is more free fructose than than free glucose. It's about 7% more. So just to put that in context, I know we've done this before, it would take almost 100 grams of honey to get I mean, if you took 100 grams of honey, of carbohydrate from honey, which is more than 100 grams of honey, you would end up with seven grams more of free fructose than free glucose. So even if somebody is on the low end of that fructose digestion spectrum, it would still take a ton of honey to get there, and there are other carbohydrates in the honey that are more glucose based, so it ends up being similar, depending on the digestion and all of that. But there are other components of the honey too that can be harder to digest, so and it can vary between honey. So there's a lot of factors here, but yeah, it's something to consider, just like a lot of the other foods, as far as certain unique characteristics about them that can make them a little tougher, a little easier. There was an episode where we dug into a lot of the specifics of different types of carbohydrates. So I'll link back to that one.

Mike 44:53
Yeah, I think that the fructose to glucose ratio of honeys adjust by honeys as well. Sure. Yeah. I. So you can have some that are higher than others, because I know some people will tolerate some. Like, when with my experience, I was tolerating Clover honeys, fine, but I wasn't tolerating other honeys. And so, like, it really depends, and like, my symptomatology from the honeys were legitimately like, like, what I have, if I have other FODMAPs, bloating, gas, sometimes, depending on the amount, like a like a diarrhea, or anything like that. So again, this is it. That's why it's important to figure out, you know, what's working for you, and and, and go from there.

Jay Feldman 45:31
yeah, yeah. And so in that case, it could be other carbohydrates that are hard to digest from the honey. Might not even have been the fructose for you, even in the different types, but it's hard to know you know?

Mike 45:41
Yeah, it's it comes down to experimenting, right?

Jay Feldman 45:48
Yeah, definitely. And there's a couple other things I think that are important to keep in mind when it comes to carbohydrates. Also, one thing that you said, I wanted to come back to you were saying it's hard to be a guru, because we were talking about the importance of experimentation and individuality, and I just want to clarify you weren't saying that we're trying to be gurus, but rather just that the idea of being somebody who knows exactly what will work and what won't in every situation is virtually impossible and shouldn't be something that you aspire to. But rather just understanding the principles so that you can apply them to different situations and then see what the outcomes are and adjust accordingly, because there is no way to to part of the you know, of course, the more experience you have with different sets of of expressions of of symptoms and things, the easier it is to navigate. But there is so much individuality and so much uniqueness between even, as you said, different types of honey, for example, that experimentation becomes a huge, a huge piece of the puzzle, yeah.

Mike 46:44
Yeah. I definitely it. And everything, everything we do with people, I think, is largely like his preference, too, is like, this is an experiment. Yeah, we're gonna, we're gonna see how this goes based on this hypothesis, and then adjust accordingly, exactly, and then continually adjust, Yep, yeah, yeah.

Jay Feldman 47:02
There's a couple other things I wanted to mention, as far as carbohydrates, I think you you mentioned it, but I just wanted to say so part of the reason why they're so helpful in decreasing the stress hormones and supporting the prometabolic hormones. And as you mentioned, reducing glucocorticoids is huge when it comes to liver pathology. We talked about that, we'll talk a little bit about the importance of supporting thyroid activity and other hormonal pro metabolic hormonal activity, so they do all that, and the reason why they do that, and again, we've talked about this in the past. I'll link to those articles, and the articles I wrote about it in the episodes where we discussed it, is that carbohydrates are very they're favorable for supporting the rate of mitochondrial respiration. They increase the rate of energy production compared to fatty acids. And because of that, if you're trying to, for example, reduce fat production at the liver, kind of like an overload, quote, unquote, even though it's it's not caused by the excess substrate. Carbohydrates are essential for that. If you're trying to run on fats, you'll end up, quote unquote, burning through much less fuel, much less substrate than if you're running in carbohydrates. So that's really what a huge piece of this comes down to, as well. Outside of the gut is driving mitochondrial respiration, driving energy production at a faster and more efficient rate that allows for more substrate to be converted to ATP with less oxidative stress, which the oxidative stress slows down that that energy production. So that's just huge, a huge piece there. The other thing that you had mentioned was the polyphenols, which have effects in protecting against endotoxin. They have effects in reducing the type of bacteria that are going to produce endotoxin and other toxins, and you know, bacterial agents or fungal agents. So they have those kind of antimicrobial or bacteriostatic effects, and they preferentially support certain microbial populations, and I also certain polyphenols also have direct anti inflammatory and anti oxidative stress effects, antioxidant effects, again, particular ones do, and we talked about that piece of the pathology in liver disease, or fatty liver disease. So they are also all important from from then that standpoint as well.

Mike 49:22
Yep. So, I mean, besides the polyphenols that you would get from the carbohydrate sources that you mentioned, they'd also come with large amounts of vitamin C. And they also can come with large amounts of minerals. Those minerals will also come from the protein sources that we mentioned, minerals being zinc, copper, iron, and, you know, adequate amounts manganese. All these are important for antioxidant function as well. The minerals specifically take part in some of the important enzymes we mentioned these in other episodes, superoxide dismutase, catalase, glutathione peroxidase. These enzymes help with the antioxidation. Function at the liver cell. So if you're having oxidative stress, you can start to deplete these minerals in these pathologic states. So having adequate amounts of those extremely important that's where you hear, like Ray's famous quotes on are you getting enough, like getting enough oysters, or having your weekly liver or something like that, is to replace those minerals. The muscles are also really high in manganese, which you can actually be kind of hard to get in some on some parts of the diet, or depending on how you set up the diet, and pineapple juice was behind manganese so.

Jay Feldman 50:31
And grapes and maple syrup, right?

Mike 50:35
Yeah. So basically, those would optimizing for these foods. And essentially, what I would say is really, I would put your diet into chronometer, so you can see what micronutrients you're getting on a regular basis. And then also you could see your macronutrients. You could see if you're hitting those protein targets that we talked about. And then you can adjust your your carbs and your fats, and you can see, you know, your fatty acid ratio. So how much monounsaturated fats am I eating versus saturated. What's my polyunsaturated fatty acid content? And once you this is not something you do forever, but it's once you solidify a diet for yourself. The chronometer can serve as a general template and let you know that you're hitting all your or most of your micros. Some of them are hard to are hard to hit, like vitamin E, can be difficult from diet if you're eating a lot of low polyunsaturated foods, because it tends to come with those. So yeah, I would plug those in. And then, as far as other components that are helpful from some of the fruits, is what I mentioned before, is vitamin C, which is actually a cofactor, or required for proper carnitine, carnitine palmitoyl transferase, one function. So that's the the protein that will or the enzyme that'll transport fats into the mitochondria to be oxidized. So it's helpful in the state where you're trying to Oxford, the liver is oxidizing some of these excess fats. And it also helps with the production of bile acid. So having adequate, adequate vitamin C is important, basically adequate nutrients in general. And that's going to come from all these sources that we mentioned. If you plug in a specific diet, you basically will see that you can hit almost all of your micronutrients, whether that's vitamins and minerals, and then in and macronutrients. With these foods, like, you'll be you'll be in, like, in doing a huge service for yourself in general. And it's quite easy, something you could do, like, right now, like, while you're on this podcast, look up chronometer, you can start plugging in the things that we talked about and start making those changes. So, yeah, that we're gonna, we'll, we're gonna dive more into some of the specific supplements you can use. But I would say this first strategy would always be to try and get this stuff from from food, and then use the supplements after or on or on top of what you're getting from food. That's kind of the best way to go.

Jay Feldman 52:50
Yeah, yeah, definitely. I think those are all important pieces. The one last thing I wanted to mention when it comes to non alcoholic fatty liver disease is alcohol. So we talked about how alcoholic liver disease and non alcoholic liver disease are really not all that different. It's just that alcohol is incredibly effective at driving the pathology that we see in fatty liver disease. So you can attribute in somebody who's drinking a lot of alcohol, you can attribute those effects largely to the alcohol. However, in somebody who is not drinking a lot of alcohol is drinking, let's say, a moderate amount or less than that, but is still dealing with fatty liver disease. I would still, and this is going to be a typical, even conventional, recommendation as well, to basically avoid alcohol. And I think it's just worth emphasizing. We talked about how alcohol drives this, this pathology. It depletes ATP, it depletes the NAD to NADH ratio, or decreases NAD to NADH ratio, driving inhibited respiration, driving oxidative stress, driving fat accumulation and on from there, you know, impairing the ability to depleting B vitamins. Yep, absolutely. So the short piece there is to minimize alcohol intake. It makes a huge difference for liver health. And so I just feel like that should be mentioned if somebody is to drink alcohol. We mentioned this before. Fructose is effective at protecting against the effects of alcohol and at increasing the clearance of the alcohol from the liver, so that is at least, again, protective, but from the fatty liver disease standpoint, or just liver health standpoint, it still would not, you know, alcohol is still not ideal, yeah.

Mike 54:41
So it'd be like having, like, your having mixing your vodka with some pineapple juice would be a good idea, yeah? Orange juice, yeah, or orange juice, or grape juice, or whatever it is, what I actually have people do a lot, if they really like red wine, is, I'll just say, what if you tried just having some grape juice at night with your dinner? Instead of a glass of red wine, some people like it. Some people say it's not the same. That's tangential. But another thing I think is important is, if any number one, the ultimate goal would be to stop drinking altogether. But you know, in casual situations, whatever, it's going to be social, like I get it, it's important for for those circumstances. So, you know, having it mixed with some type of fruit juice. And then also, if you had something like chocolate available while you were having it, the polyphenol, as long as you tolerate chocolate, the polyphenols and the fats in the chocolate are actually protective against the damage from the alcohol. So that could be helpful. And then making sure that you have adequate, like, you know, people having their hangovers and whatnot, having adequate amounts of B vitamins can help with the processing of the alcohol, making sure you're having the adequate, uh, protein, and then, as in, as Jay said, adequate fructose from fruit juice, carbohydrates in general, can all be very helpful to process the alcohol while minimizing the damage that can occur from it. And so, you know, I'm sure you've seen this too, like, I've had people like, I'm still going to have my drink, and it's like, that's completely fine. I'm not going to fight with you over your drink. How are we going to minimize the damage from that drink? Like, what's the next best strategy? And it's the same thing, I guess. You know, in general, with with these pathologies, the goal is to avoid all of the things that are making it worse. So that's going to be your fast food, that's going to be your polyunsaturated fats, that's going to be your alcohol, that's going to be any type of, you know, toxic ingredient at as an additive into your industrial food, whether your chips or whatever that is and like it. The goal is to first stop doing harm. So that's removing all of those things. And then the the what you would do is you would replace them with these options that we placed here that not only don't do harm, they reverse that harm because they provide nutrients, because they and that's macro and micronutrients, protein, carbs, fat, vitamins, minerals, they're providing all of those things, and they're not. They're also not causing microbial imbalances, all this type of stuff that's that's essentially what the strategy is, and the supplements are like additive or synergistic on top of that. But the first strategy is always, always, stop doing harm and then replace with things that are going to reverse that. And that's why we were focusing on diet first, because I think in a lot of circumstances like you may you, I think it's very likely that you can reverse your fatty liver without having to really touch a supplement. You can probably do it entirely through diet. Supplements may just speed up the process, help things along into a better state, and allow you to get where you want to be faster. But in most of these cases that I've seen in people that I work with, that initial beneficial period, like within the first two weeks of change. If you really change things around, change things around, and make the effort, you're going to feel better right away. It's just getting rid of, like, some of the more ingrained damage and pathways can take a little bit more time. And the biggest barrier my experience to this is commitment to, like, maintaining this and maintaining a newer paradigm, making that change and accepting this is like it's not just a diet you're doing to get rid of your fatty liver. It's like this is more of the new lifestyle that you're adopting for yourself. That's those are, I think, more the hurdles that I see. Um, yeah, go ahead. Go ahead. I know you have some things you want to add to that.

Jay Feldman 58:20
No, I agree with all that. The only thing I wanted to add was, in relation to the alcohol you were talking about these protective factors, and it's funny that things like fructose and saturated fats, which are blamed for causing fatty liver disease, happen to be the things that are most effective at protecting against alcoholic liver injury, and then also polyphenols, which those are less argued over. But yes, those help as well. So yeah, all good things to consider. And I think, as you mentioned, the diet piece here is huge lifestyle as well, which we'll get into, as far as stress and exercise too. And as you said, supplements too. But the this is, these are the foundational things that are going to matter, especially in the long run, more than anything else. And you and as much as the supplements can help, they can't out perform or reverse a bad diet. You know, this is a fundamental piece that more or less has to be there in some you know, more it has to be there. You can't, you can't make up for a poor diet with supplements.

Mike 59:20
That's what I'm trying to get at, yeah, and sometimes, sometimes taking the supplement on top of a poor diet can actually make things a little worse for you. Because, like, if you're going to use thyroid or and you have B vitamin deficiencies, or you're going to throw B vitamins on to situation you don't have added carbohydrates, all that can make things worse. So it's diet and then subs. That's, I mean, and that's the process I'll generally go to. And I think it's kind of the same on your end until, um, unless, there's like, some, like, severe issue.

Jay Feldman 59:48
Yeah, yeah, diet and other lifestyle factors and, yeah, and lifestyle, yeah, it's a complex loop, right? I mean, supplements can be held because, as you mentioned, there are pieces here that are not just. Simple as just change your diet. You know, there's a lot of impediments that can go on and obstacles, and sometimes supplements can help you get to a place where adjusting the lifestyle is easier. So I don't like to to put it also as, as always, diet first, or or supplements bad, or anything like that. They're obviously incredibly helpful. It's just that you at least have, you know, in order to get long term to where you need to be, checking the box for diet is a necessary one. Checking the box for supplements is not necessarily a necessary one. That's how I would think of it. All right. I hope you enjoyed that episode. We'll be wrapping up this series in the following episode, in part eight, where we'll discuss supplements to help reverse fatty liver disease, as well as the impact of exercise and stress on fatty liver disease. If you did enjoy today's episode, then please leave a like or comment. If you're watching on YouTube and if you're listening elsewhere, please leave a review or five star rating on iTunes. All of those things really do a lot to help support the podcast, and are very much appreciated. To check out the show notes for today's episode, you can head over to Jay Feldman wellness.com/podcast you can take a look at the studies and articles and anything else that we referenced throughout today's episode, and if you are dealing with any of the symptoms or chronic health issues that we've been referring to throughout this series or throughout today's episode, whether that's fatty liver or insulin resistance or related chronic health issues like diabetes or heart disease, or if there's other low energy symptoms, whether that's chronic fatigue or chronic cravings and hunger or joint pain, or maybe that's weight gain or various digestive symptoms like bloating or slow motility, or any other digestive inflammation. Maybe that's brain fog or poor sleep or insomnia. Maybe that's hormonal imbalances or various other low energy symptoms or chronic health issues. If you are dealing with any of those symptoms or chronic health issues, then head over to Jay Feldman wellness.com/energy, or you can sign up for a free energy balance mini course where I'll explain how these different symptoms and conditions are really caused by lack of energy. And I'll also walk you through the main things that you can do from a diet and lifestyle perspective to maximize your cellular energy and resolve these symptoms and conditions. So to sign up for that free energy balance mini course, head over to Jay Feldman wellness.com/energy, and with that, I'll see you in the next episode.