Jay Feldman 0:12
Welcome to Episode 70 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 eight, our final part of our series discussing non alcoholic fatty liver disease. And in today's episode, we'll be focusing on prometabolic supplements for fatty liver disease. Throughout this series, we've been discussing the general mechanisms and physiology underlying this disease process. And so if you haven't listened to the earlier episodes of this series, I'd highly recommend you go back and do so. In today's episode, in particular, we'll be discussing the optimal amount of exercise for fatty liver disease, how stress impacts fatty liver disease, and the basic ways to reduce stress, supplements that help the liver clear fat to reverse fatty liver the best supplements for raising metabolism to reverse fatty liver disease and supplements that reduce inflammation and oxidative stress in 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 are struggling with any of the symptoms or conditions that we've been describing throughout this series, whether that is fatty liver disease or insulin resistance, or other related conditions like diabetes or heart disease, or if you're dealing with other chronic health issues, maybe those are autoimmune conditions, or any other sorts of chronic health condition, or various low energy symptoms, like chronic cravings and hunger, low energy or fatigue, chronic joint pain, weight gain, digestive symptoms, brain fog, poor sleep, hormonal imbalances, and all the other symptoms that may come with that, like low libido or issues with fertility, or if you're dealing with any other low energy symptoms, 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.

So outside of diet, there are a few other factors that I think are important to focus on for, you know, resolving these issues that we've discussed revolving around fatty liver and the pathology that's underlying, and I want to focus on supplements today, because those are things that I mean, There are several that are rather unique to fatty liver, that are worth touching on and can have pretty profound effects. But I think that we also need to mention, first, the importance of exercise, which the reason I don't want to spend too much time on this is because think it's rather self evident, and something that's that's talked about, in general, we've we've talked about the issues with over exercise. But of course, it is important to make sure that somebody is exercising, or at least, I would say, moving enough on a regular basis, not being sedentary again. This doesn't mean it has to be anything particularly intense, especially if someone's dealing with, you know, severe fatty liver or something on that spectrum. That's probably a sign that more than likely, they're less fit than they could be, and so not saying, you know, go work toward running a marathon, which, you know, or anything else that's particularly stressful, which can make symptoms worse and drive a lot of stress, drive a lot of the pathology we discussed. But rather, just to work on moving on a regular basis, whether that's taking walks daily, maybe going to the gym, or picking up some sort of light activity like swimming or something like that, those would all be effective. And again, I just want to point out as well that when it comes to Exercise and Movement, the most notable effects come when you see the difference between being sedentary and being at least lightly active after that, it's more of a wash. There's, of course, certain thresholds that can vary between people, but the most important thing is just not being sedentary, and that's difficult when we spend so much of our of our time just coasting through lie like our lives. Working a ton, making sure everything's in order, whatever. So it's easy to become sedentary, and the most important thing is just being on your feet and moving on a semi regular basis for just general health, but also specifically when it comes to fatty liver, in terms of reducing stress, supporting mitochondrial respiration, increasing insulin sensitivity and increasing metabolic function. I mean, when we're looking at metabolic dysfunction and the diseases that go with it, which fatty liver is one heart disease, diabetes and insulin resistance, those all see dramatic improvements just from moving out of being sedentary.

Mike 5:37
Yeah, and I would add that I think resistance training specifically, or at least personally, can be very helpful for people with fatty liver by helping, as long as you know it's not done stressfully, right, and not saying to go out and squat 400 pounds for 20 rep sets, even just going in and just if doing a machine circuit, just to apply some resistance on the muscles, as well as maybe going for walks after the meals are helpful to, number one, increase insulin sensitivity, as As Jay mentioned. And then also to, in general, just get some lymphatic flow, some blood flow, get moving, get up. And then, I think another point that it can be really helpful for people is having a degree of, like a routine, or some type of landmark in the day where you have, you know, you have somewhere to go. So if you say, I'm going to get up at 8am and then I'm going to get into the gym by 10, that'll give you some consistency, that'll allow you to, you know, have somewhere to be, somewhere to go, if you if you don't have that currently, because whether you're not feeling well or whatnot, and, you know, have a landmark within the day to set up, you know, having your meals, I'll eat before, and then I'll eat, you know, a little bit when I come after. And then that sets, I think, can help to set people up as well. So the walks in the sun, so a resistance training session maybe three times a week or something like that. Light with machines, nothing too strenuous, and then perhaps picking up some activities of interest, martial arts, swimming, if you like, yoga, hiking, kayaking, all these types of things, I think can be very helpful just for multiple perspectives. Yeah, yeah, definitely.

Jay Feldman 7:24
And again, that'll look different for everyone. So just figuring out what works for you, but at the very least working to have some some activity on a regular basis. And yeah, and then that definitely go ahead

Mike 7:37
I was gonna say before you're gonna jump into stress, before you do that, one thing I want to say to specifically avoid, like, is running for long distances on a consistent basis over like, like, five miles a day type of thing, or whatever, to lose weight, or running on treadmills for to manage calories and this and that. Like, I think that those are more harmful than they are helpful. Because I just because a lot of I see a lot of people, that's their ideas. I want to lose weight, so I'm going to go for a run. I would generally avoid any of the long distance stuff, and like people doing like, 35 miles a week. I think that that is actually counterproductive overall. So that I would stay away from any long distance running and any extreme endurance activities, like, if it's swimming, you know, I would say leisurely stuff, go to the beach and go for a swim, or if you like swimming at your local YMCA, or whatever, whatever you have available to you. I think those are great. But I wouldn't be doing like, ridiculous numbers of laps or anything to lose weight. I think that will start digging more into a stress cascade. Um, yeah. So more like a lighter activity overall, with the dietary and other lifestyle changes that we'll discuss, yeah, yeah. I think a lot of times people are driving pretty hard into that stress side of things when they're doing the extensive, long, long distance running.

Jay Feldman 8:55
Of course, there are exceptions, but yeah, yeah,

Yeah. And so then on the stress side. So we talked, you know, specifically, in terms of psychological stress. We did mention this a little bit prior, as far as something that can drive all this underlying pathology, and it definitely can and increases the stress hormones. And that's when we were talking about it in terms of how, how directly the stress hormones drive non alcoholic fatty liver disease. So again, there are, this is a whole series on its own. It's something that we've talked about a little bit in the past in terms of other conditions and things where we don't want to ignore the impact that psychological stress has on our health, and specifically in the case of fatty liver. So it's worth mentioning there, as far as addressing it, it can be a little bit more difficult, you know, than than anything that we can mention in just a couple minutes. Of course, I think the most important thing here is just working toward doing something on that front and that can look like meditation or journaling or some sort of activity, you know, whether it's going for a walk or yoga or whatever it is that can help to reduce stress considerably, having routine. Yes, there's, there's so much that can be dug into there, but it's just worth mentioning that this is a factor that directly affects us physiologically. And considering that, we want to make sure that it is something that we're that we're addressing when it comes to metabolic health and fatty liver.

Mike 10:19
Yeah, I think the biggest thing that I've seen with the people that I've worked with is the importance of actually having a routine in the day and having a structure for their day. Now, it doesn't have to be like some of these. You know, self help gurus wake up at 530 do 1000 push ups by six and like, have every 15 minutes of their schedule absolutely booked off. But more of like your the schedule is giving you a loose template to provide structure for your day so that you can prioritize activities for your health. So for example, as I mentioned before, that's having your meals scheduled into your day, having, like, an hour for your meals where it's like in the morning I'm going to have breakfast from seven to eight, and I'm going to take that hour to, you know, sit down and eat my meal and be present with my meal. Maybe I'll read a little bit while I'm doing that or and then has, saying, doing the same thing for lunch, same thing for dinner. Like giving yourself that time to eat and and also giving yourself prep time to prepare the food to eat, I think, is extremely important, and then also giving yourself downtime. So one of the things personally for me was, when I was making a schedule for myself to handle whatever work I was doing, I would never schedule in downtime, and what will wind up happening is I'd be frustrated because I was like, not adhering to the schedule 100% because the schedule wasn't realistic, because it didn't include downtime, which was absolutely necessary time where I was just like, Okay, I'm gonna take, you know, this 2030 minutes this hour, maybe I wanna take a 2030 minute nap and just like, unwind a little bit. If I'm feeling that like I needed to take the nap, or if I was just wanted to unwind and I didn't wanna be researching something or going to the gym or doing an assignment, or CEUs for my job, whatever it was, like, just taking the time be like, Okay, I'm just going to read for right now, and that's, this is what I'm doing. Like, this is going to be productive for me. And classifying that mentally, categorizing that mentally as productive behavior, because that, like, without the downtime, you don't have the ability, or it makes the schedule difficult to follow. It makes it like an untenable plan. I think it's something that it's like trying to make, like the perfect diet, and just making it so hard to follow, regardless of how theoretically perfect it is. If you can't implement it because it's too difficult, then it's not perfect. So that was, that was those are things that I think are really helpful. Were helpful for me. Were helpful for some of the things that I've seen with my clients. And then the other thing I want to mention really quick here is that the physiology can put people in a stress state, where, if you're having that dysfunction with the liver and dysfunction in the gut, and exposure to endotoxin and energetic fit, but or not failure, but an energetic imbalance, or however you want to inter term it, you could essentially find that you'll be constantly amped up, unable to relax. You can't sit down and take that time. You can't take that nap. You have a hard time shutting down when you before you want to go to sleep. So addressing so by plugging in times to take care of yourself, sitting down, being like, Okay, this is how much protein I want to eat in a day. This is my carbs. This is my fats. I'm going to get a little exercise. I'm going to take a nap here and doing those self care activities to turn your your situation around will, in turn, allow you to relax because you've taken care of yourself, instead of just like grasping at that straws, essentially, where it's like, you're just trying to make it all the time. It's like, No, this is my structure. This is what I'm going to follow. Everything else comes after these pieces I'm going to eat like it's it's like, there's certain necessities it to function, to live. Those are eating, sleeping, human interaction, relaxation. And you know, if you have to go to the bathroom, and I say that specifically, because when I was in the hospital, you didn't have that opportunity a lot of times. But like those things are priority. Because if you want to be good at anything else you do, if you want to succeed or or function well in anything else you do, you have to take care of your basic human functions first. So it's kind of like prioritizing those first which will allow you to relax in other situations, and so you're not chasing the relaxation by default. You're able to function in relaxation because you have the energy and capabilities and resources to do so.

Jay Feldman 14:37
yeah, yeah, those are great points and and I just want to mention that it's going to look different for everybody, right? For some people, having an hour for for every meal may not be doable, might not be reasonable with their schedule, but that doesn't mean that you want to throw that idea out. It's just making a movement in that direction. Maybe it's literally just having 20 or 30 minutes that you did. Didn't have before, when before you just eat at your desk to be more productive, right? And it's just instead taking 2030, minutes to sit, or 15 minutes, whatever it is, but moving in that direction, to prioritize, as you mentioned, the self care, and trying to get rid of the idea that the longer that you work, the more productive you are, and the fewer breaks you take more productive you are, and every minute you spend away from your work means that your your miss. This is you're missing out on opportunity to do better in that regard, or to move forward or progress, when, as you mentioned, we are limited in our productive capacities, and taking breaks actually helps us recharge in a way that allows us to be more productive, whether it is in work or just being more present with our families or whatever it is that we care about. We need to prioritize that self care and this, again, the reason why I wanted, I was mentioning this in tandem with exercise, is because these things can be you can check both boxes at once, right? If you're taking a 20 minute break and you walk and you don't take your phone with you or you, you know you're also getting some sunlight and everything that can help both to reduce stress and serve as a real break while also getting some movement in. So yeah, those are all important points. We can definitely spend hours discussing the details there of what someone could do in these different situations, and I'm sure we will at some point, but yeah, let's, let's move on to supplements. Unless you have anything else to add.

Mike 16:26
No, no, that's perfect. That's that's about what I had to say,

Jay Feldman 16:30
perfect. All right, so when it comes to supplements, there are quite a few that have been shown to be protective in fatty liver, and as I've said many times throughout the series these part of the reason why I think it's so important to go through these things, whether you have fatty liver or not, is because all of these supplements happen to be extremely protective of virtually every health condition that you could imagine, and very supportive metabolically, and have a ton of great benefits. And again, I'm not saying that every single one of these supplements like that somebody should be on all of them or that using them in any dose is perfectly healthy and and that's the best route to go, but rather that these are all protective substances. They all have their place and use depending on the symptoms or conditions that someone is experiencing. And so I think it's really worth hitting on them. And they have, again, really profound effects. It's amazing to see some of the research. Again, we'll talk through some of the specific things as far as fatty liver goes, just to see how much of an impact some of these substances, substances can have here and again, in other conditions as well. So do you want to start us off with choline?

Mike 17:36
Okay, so we talked about choline and methionine as being extremely important for, I guess, phospholipid incorporation, for VLDL secretion, which is where the liver takes fat, puts it into this cold this lipoprotein particle, and then exports it out. So we and we also talked that choline can be you can get it largely from eggs certain seafood, like shrimp and liver. But if you say you wanted to take in an extra amount because of a fatty liver situation, there's a couple options you have available. You have a choline by tartrate, probably the last option I would recommend, because there's, it's it's not as well absorbed as some of the of the other ones, and it, it can be converted more easily by the microbiome into something called TMAO. I think it's trimethyl amine oxidase or trimethylamine. I think I forget what the O specifically means for it, but essentially, there's been correlations in rat studies with this compound with heart disease. Now it's the links aren't super strong, because there's other foods, like fish, that actually increase it in large amounts as well. So it's, it's kind of a contentious piece. And, you know, it's something where you see in a lot of the plant based, where it's like, Oh, you don't want to eat, you don't want to eat animal products, because a TMAO, and it's kind of like, well, peas also raised TMAO, like, pretty high in in certain populations. So, and that's like, a one of the main protein sources for quite a bit of plant based people, because peas have a the amino acid balance, and peas is decent, and this has a, like, a decent, decently digestible protein compared to some of the other plant sources. So even the plant sources are producing TMAO, and some people eggs and meat and fish. Fish was actually one of the highest so any of the the pescatarians, or whatever, avoiding meat and eggs because TMAO was well, fish was one of the better sources. But regardless, regardless of all of that, choline, by tartrate has been shown to raise TMAO l carnitine is something that does it well. It's not necessarily something we're recommending here, but the basically, the bacteria and the intestine will take these components and they will convert them into this compound, TMAO. Now the other options for choline supplementation, instead of choline by tartrate, is going to be phosphatidylcholine, or phosphatidylcholine and. And what is it, Alpha GPC, which is it's not as targeted towards the liver like a phosphatidylcholine, because the phosphatidylcholine will go into the actual the the phospholipid head of the VLDL, the out the Alpha GPC gets pushed more towards like neurotransmitter with acetylcholine, as far as for muscle contraction or for what's going on in the brain, that's kind of how they break them down. And I think Alpha GPC can be a little bit more expensive sometimes, if I remember correctly, but phosphatidylcholine would probably be the best option as far as fatty liver goes. And again, you can get a decent amount of choline from eggs, liver and seafood itself. So if you're going to do the choline supplement on top, I would do a phosphatidylcholine or maybe an alpha GBC. The other thing to keep in mind that you can combine with your choline supplement is also you could take something like a betaine HCl. The reason is because the baiting, if you remember the choline pathway we went through, you can have choline come into the pathway, or you can have some like methionine, with the pathway involved in this is, is, to some extent, is baiting and baiting, I won't go through all of the mechanisms, but it essentially, it spares Coline from having to be shunted towards the betaine pathway. So if you take a baiting HDL, it is sparing the choline that you are that you are taking in. So combining them together can have what like a synergistic effect. Now you can get betaine in food like spinach or beets, but it's kind of hard to I mean, I wouldn't make it. I wouldn't like go out of your way to eat large amounts of spinach or beets to get betaine is kind of my perspective. So the other thing is, the betaine HCL actually comes with hydrochloric acid. That's the HCl part. It's often used to raise stomach acid. With people who have fatty liver, they also tend to have issues within the small intestine taking such as small intestine bacterial overgrowth. Taking a betine HCL can help to raise stomach acid as well, and help with some of that small intestine bacterial overgrowth, if it's present, and help to improve digestion, which can be impaired with fatty liver. So it can have a dual function. They can have a dual function synergizes with the phosphatidylcholine. I would stay away from choline by tartrate and Alpha GPC can be an option, but it generally is taken more for like, a neurotransmitter effect.

Jay Feldman 22:41
Yeah, yeah. And so, just to put this in context, so the choline is necessary and helpful for the export of fats from the liver, which is that one side of the equation that we talked about really secondary side that can be impaired, especially if somebody has choline deficiency or methionine deficiency, or both. And in the case that someone has a choline deficiency, supplementing with choline can be particularly helpful in the case that somebody has other issues with the methionine pathways, that could potentially also be reason to supplement with choline or the betaine and or both. Yeah, right, right. And that's like the MTHFR mutations that people will touch on a lot. I just to mention real quick.You know, the distribution of of quote, unquote mutation there is pretty, pretty evenly spread out throughout the population. So it's not like people who have certain certain reduced capacities in their MTHFR activity. Are these outliers who have this very rare issue. I mean, most people are able to be perfectly healthy regardless of where they are on that spectrum. Depending on where you are on the spectrum, you may have some you may benefit more from somebody else more than somebody else. With some of these supplements, you might have more of a need for these things. But in general, it's, it's the reason I'm saying this is because it's such a focus, and most people don't even, aren't even aware of the different types of mutations, and that some might only impair the enzyme activity by, you know, 15% for example, as opposed to 80% on the other end. So with that in mind, there are certain places where these things might be particularly beneficial. However, it's also worth pointing out, as we mentioned earlier, it's really easy to get enough methionine from the diet, and choline is relatively easy to get from the diet as well, and unless somebody's choline deficient, I probably wouldn't be looking quite as much to the supplement. Again, if somebody has fatty liver, they could probably use some help there. But this is not something that's really addressing the underlying issues as much as it is just supporting the export of fat, which is important as well. And again, especially if someone's deficient, it would be something to look to. But beyond that, I wouldn't be it's not at the top of my list.

Mike 25:09
No. I mean, if, if you can eat adequate liver on a regular basis and eggs, I would say, you know, you're doing pretty well overall. For example, I'll eat two to three eggs every day, and then liver, bi weekly, once a month, type of deal. And the, the other thing is, as far as MTHFR stuff goes, it's you also, that also plays in with B vitamins, which I, I guess we'll talk to, we'll talk about next, but there's a whole bunch of, like, there's multiple factors going on within all of those pathways that include, obviously five, methylfolate, methyl Cobain, which is B, 12, folate is b9, and then choline, and then betaine, and then you have other things like creatine or whatnot. There's a whole host of things that can be used to help that situation, supplementally, that can make quite a big difference for people. So if you do have something like that, those are things to look into. But I would try to, like also, at the same time, reach a lot of this stuff from a dietary perspective first, and have the supplements as additions to literally, as supplements to the diet. So those are it can cause problems. There can be a big difference from the supplements the I think these can all help in fatty liver. I think a lot of these supplements can help in MTHFR mutations, which is, that's an entirely different podcast story that we'll have to do at one point. But yeah, overall, I think that they can be helpful.

Jay Feldman 26:40
Yeah, and so just, we'll just touch on those couple of B vitamins. You already mentioned them, the B 12 and b9 which is folate. Both of those are involved in the methionine cycling pathways. And we had discussed these a little bit prior when we were talking about liver ex the livers export of fat. And yes, if you have deficiencies there, they could be helpful to supplement as far as B 12 goes, similar to methionine. It's very easy to get enough B 12 if you're eating animal sources of protein. And so I pretty much never suggest that somebody supplements with that unless they aren't eating animal protein sources, which is, you know, I think generally less than ideal in and of itself. So I'd recommend doing that prior to supplementing with B 12. But if somebody's not going to do those things, then, yeah, I think you'd might want to supplement with some B 12. And then as far as folate goes, again, we should be able to get enough folate from our diets, in the case again, that somebody has an MTHFR mutation that where the activity of the enzyme is pretty heavily decreased, then yes, maybe supplementing with the methyl tetrahydrofolate form would be helpful in that context. But again, I think the vast majority of people don't really have any issues there. Again, even if they have one of the mutations, and we would have to go through all the different alleles and everything, but if you look it up, you can find out the how much the enzyme activity is reduced based on your particular mutation, and it might not be such a concern. But again, I think there's when it comes to supplementing with the folate, there's nothing wrong with supplementing with it and seeing if it makes a difference. But again, I would say that these are things that are generally helpful only if there is some sort of a deficiency or issue in the pathway, as opposed to really a broad spectrum. Yeah, exactly, yeah, yeah.

Mike 28:30
And I want to just add in here if you are having any like, significant digestive issues. For example, I had a few people I worked with who had bariatric surgeries using B 12 in those instances would actually probably be something that's helpful, right, right? So that's very but if you're eating steak or seafood or liver or eggs or any of these animal protein sources on a regular basis, B 12, like you should be able to do just fine with it, assuming that your stomach acid, pepsin, intrinsic factor production are all fine, yeah, basically, as long as you're able to absorb the nutrient is what you're getting at, yeah, it shouldn't be a problem getting us B 12, that is, yep, and there, I think so. I guess moving on a little bit, there are other B vitamins besides b9 and B 12 that can be very helpful. I don't know if you want to that. And they all these function not in methylation, but in energy metabolism. Sure go for it. That's going to be your your thiamine, your niacinamide, your riboflavin, your puredoxine, and your biotin, and I guess, your vitamin B, v5 your pantothenic acid. All these function in the utilization of substrate, carbohydrates and fats, and then, I guess protein, to some extent, which will be converted into carbohydrate as a source of fuel. They're required throughout the entire process. Making sure that you have adequate amounts of all these is vital for cellular respiration, for energy production at the cell. So any type of deficiency of that which is actually very possible, if you're coming from a poor, a nutrient poor, heavily refined diet with pathology on top of that, it's, I think it'd be pretty helpful to fill in those, those gaps with with the B vitamins in general.

Jay Feldman 30:18
Yeah, yeah. These are we've I think we talk about them quite a bit because they're so integral to the energy production pathways, and it's very easy to become deficient in them. And even if someone's not particularly deficient, adding them in tends to be very supportive. And again, you see that in terms of fatty liver, you see it pretty clearly with vitamin b3 where it's able to reverse liver pathology and non alcoholic fatty liver disease. It's able to prevent the progression of non alcoholic fatty liver disease and cirrhosis, and again, reverse the damage that's seen there. So and a lot of the ways that it's doing that is by supporting respiration, you know, reducing the NADH to NAD ratio, or increasing NAD to NADH ratio, increasing ATP production, reducing oxidative stress, reducing inflammation. And then again, the same thing would be one where you see that, and we'll talk about this later on, where there are a few studies looking at a combination of testosterone and b1 being able to reverse liver cirrhosis, which, as we've mentioned, is the most severe form, well, one of the most severe forms of fatty liver, maybe outside of cancer and Yeah, and so. So these are, again, vitamins that can have profound effects, and are, in this case, are doing so by directly supporting our ability to produce energy, which we've talked quite a bit about, why that is the key to, I mean fixing that is the key to resolving fatty liver issues. Yep. And as using them, I would just say that I would use most of these vitamins, or a lot of these, most of the vitamins and mineral supplements I would use in smaller doses more frequently, so like have a little bit with each meal. Instead of taking massive doses all at once, you'll have a better absorption, and it's a little bit more physiologic, you know, to have a smaller dose more consistently mixed in with the meal. And I think you'll have a better chance absorbing and utilizing the vitamin instead of just either passing it through your store or or or urinating a lot of it out. Yeah, yeah. Yeah. So, yeah. Anything else to add in about the B vitamins?

Mike 32:25
No, they're very general. I think, I think they're, like, pretty helpful in almost every situation. That's especially because they're used for energy production, which is so core to everything that we talk about. So, yeah, yeah. All right. So there are a few other amino acids, or a few amino acids, I think are worth touching on, that all have been shown to have some pretty protective effects in terms of fatty liver. One of them is taurine, which has some, yeah, some, some very protective effects in the liver. It's able to prevent the oxidative stress that goes on in fatty liver disease and prevent the development of fatty liver, reducing inflammation, specifically in the liver, inhibiting the inflammation response to endotoxin, preventing fat production in the liver, preventing various issues that go on with the ability to export the fat and fatty liver. So taurine is an amino acid that we can get in our diet, but it can be difficult to get it in substantial amounts. That would probably be, you know, that would be helpful in the situation of resolving fatty liver. So that's one that I think is worth considering, uh, supplementing with. And, yeah, has some really protective effects there. Yeah, I think that it also something that's helpful with taurine is that it helps with bile acid conjugation. The bile acids can help clear out dysbiosis in the small intestine. They can help enhance digestion and absorption. And then taurine overall just has like a generally antioxidant, anti inflammatory effect throughout the body. The something needs to keep in mind with that is, in some people, it can drastically increase bile acid production. So you can, like, it can be a little bit uncomfortable when you start using so just something to keep an eye out for. And yeah, again, I would split up dosing with taurine and not take massive doses, like, like five grams in a sitting like I would take smaller doses throughout the day with meals. That's something I would always recommend, is take it. Take it with meals. For me, I drop a lot of the stuff, but I'm going to use it into like my smoothie. So I'll have pineapple juice, some guava and then I'll put in because the taurine is mostly tasteless. The B vitamins are in the amounts that I use them are mostly tasteless, so I'll drop all that in and just blend it up magnesium, whatever it is, and and take smaller doses on a more frequent basis.

Jay Feldman 34:55
Yeah. So I'm I'm glad you mentioned that a lot of times when people are struggling with liver issues, they you might have some issues with bile secretion or congestion. Bile congestion, and the taurine can increase the release of bile. And if you are having those issues, and you take a decent amount of taurine, as you mentioned, it can cause some pain, some discomfort, it can also cause loose stools. So, yeah, I would start with a very low dose. Make sure you're having it with food, specifically a meal with some fat in it. And, yeah, small dose, maybe 200 milligrams, 250 milligrams, something like that to start, make sure you do all right with it. And I've seen that happen where somebody reacts a little bit strongly initially, maybe to the first or second dose, and then they're totally fine afterward. And they can go up to, you know, a couple grams, several times a day, and be totally fine with that. So yeah, it started with a small dose. Make sure to have it with a meal that has fat, so that if you are releasing bile, it's not just going right through it. It'll kind of be slowed down by the the fat that you're taking in.

Mike 35:57
I think that that's the best way to go about it with touring. And I've seen the same thing where it's like the first couple doses, especially when somebody wants to take, like, a large dose right away, because they read, like the beneficial studies on and it's like, oh, I'm going to do 12 grams today. So they like, do the 12 gram dose, then they start getting bile issues from it. In terms of, like, their liver starts ramping up bile production, um, so, and then you lower the dose a little bit, and then it kind of it will actually eventually dissipate. So I've definitely seen that as well. The other thing I want to mention with taurine is it has some GABAergic effects, so some slightly calming effects. So when I tend to use it with people, I tend to have them take it at night, because if you take a whole bunch of taurine in the morning, and the other amino acids we're going to touch on next is glycine, and some people you can like it will just chill you out. So you'll be getting ready to go, you'll have your morning smoothie. You get to work, and you're just like, sitting at your desk or whatever, wherever you work, you're just so relaxed and you don't want to do anything. Those are some of the side effects that you can get from some of these GABAergic compounds, taurine, glycine, magnesium, vitamin C, those all have modulatory effects on GABA. And then glycine is also an actual inhibitory neurotransmitter itself. So, yeah, I don't have anything else to add from there if you want to jump into glycine. So, yeah.

Jay Feldman 37:16
So I just wanted to say, of course, that is individual. I've had a lot of people who take it morning, you know, breakfast, lunch, dinner and are fine sometimes, yeah, concentrating it with a higher dose in the evening, or lunch and dinner is fine as well. So yeah, and the other thing too. As far as needing to start with that small dose, I would say most people are totally fine, even starting with, you know, a couple grams of Taurian. But just wanted to put a word of caution out, just especially if someone's dealing with with some significant fatty liver issues, that would be a cause for me to want to start with a very small dose. Yeah. And then, along with that as well, you kind of, I think, alluded to this, but it's also worth mentioning tugka here, which is basically a taurine conjugated bile acid and tugka specifically, has been shown to be very protective with with these non alcoholic fatty liver disease issues, and it's been shown to prevent or reduce the ER stress that the stress in the endoplasmic reticulum that we discussed previously that leads to the problems with essentially the export of fat from the liver, so it's able to prevent that. It's able to support the gut health side of things, as you mentioned, that taurine is able to as well. So that would be another one, along with taurine that would be worth considering the use of as a supplement well.

Mike 38:33
And tudka is actually a bile acid itself. So for people, if you're going to use tudka, I would 100% recommend that you take it with a fatty meal, and also be careful, more careful with your dosing with tudka, because it can actually cause bile acid diarrhea, especially if you don't have a gallbladder, which is, for example, someone like me, it's but it, it does Have, there's bodybuilders specifically use tudka because of its liver protective effects. It helps to deep so for the ER stress. It decreases er stress by inhibiting or protecting against that unfolded protein response that we talked about in some of the pathology. It inhibits nitro tyrosation, which is where, like a nitric group is added to a tyrosine on the protein that's usually in, like, a in a stressful state, and like, it's not good for the protein structure of the liver. It improves bile flow. It actually protects the liver from having the excess, like bile acids in in the liver, and like ligation studies, because the ligation meaning where they burn the bile ducts and animals so that there's no bile can't be released, and then the bile acids in the liver actually damage the liver, but the tudka is protective because it's water soluble, so it helps to protect against, like, the detergent effects of the bile acids. It actually was shown to increase liver regeneration in some models, and it can protect, like, from colitis and whole and bunch of issues. So Todd cause definitely one of the great one, a great option for people if but after these other fundamental options haven't worked because tudka is a little bit more potent. And then also, one of the things I want to talk about is it can improve intestinal integrity and improve microbiome. Situations I've had situations where people have come from being super low fat for an extended period of time and then developed gallbladder issues, and tudka helped significantly to relieve those issues. And I've also seen quite a few anecdotes for people where they had elevated liver enzymes, a, l, T, A, S, T, these are specifically bodybuilders, and they took a course of Ted cut, and it dropped the liver enzymes for them, and they were using, like, heavy duty steroids that are not good for your liver, like oral steroids, which are pretty terrible for your liver overall. And it was able to reverse some of that damage, at least based on the lab results. So TEDCO overall can be a good option, but again, it's way it's like a super potent option, and I would try the other stuff first, just because, like, the bile acid diarrhea situation is really uncomfortable. It's like, very it's actually painful, like you literally are are going to the bathroom, and it's like, acidic. So just that's one to be Be careful with, but it can also be really helpful in certain situations. So just some something to consider, yeah, yeah. And as you mentioned, being careful with the dosing is a good way to minimize those side effects. Yeah? And taking it with a taking it with a fatty meal for sure, yeah, yeah, yeah.

Jay Feldman 41:36
And so moving on to glycine, which is extremely protective amino acid we've talked about this in comparison with methionine and the, quote, inflammatory amino acids methionine and cysteine and tryptophan, in how glycine is very protective in terms of longevity, where you see the benefits of restricting things like methionine And cysteine in terms of longevity, and if you don't restrict them and just give glycine, it is able to have the same effects. And you actually see a parallel situation in fatty liver, where we know that feeding a methionine and choline deficient diet will impair the liver excretion of fat and cause fatty liver but just supplementing with glycine was able to oppose and reverse or prevent that from happening both by it has some roles in the methionine cycling pathways, so that is one factor, but it also is pretty directly anti inflammatory. It prevents all the oxidative stress that's seen when the liver is is in that pathologic state, so it's pretty protective on that front. And then also is very protective of the gut, and maintaining the intestinal barrier and keeping inflammation down in that regard. And so that would be one to consider as well, which I think we had discussed how important it would be to get glycine from the diet, as far as gelatinous meats, bone broths and things like that. But if those things are not feasible, then a collagen supplement or just a direct glycine supplement. If either somebody doesn't respond well to a collagen or gelatin supplement, or if they aren't able to get the gelatinous meats, all of those things, but glycine itself is extremely protective, regardless of where you're getting it from.

Mike 43:21
Yep. And I would say glycine also is involved in the conjugation of bile acids. So again, if you, if you taking taurine, and you also take glycine, and you've come from a super low fat diet, or you have something going on with the liver, you can get that like it's, it's, they don't call it bile dumping, but that's kind of the way I describe it, where you start getting this production of bile acids, and this this outflow of bile acids. And if your intestine isn't used to it, it's the combination of both can cause that, that bile acid diarrhea effect. So there's something to keep in mind with that. I'd like to use glycine, again, in smaller doses and combinations with other proteins, so like, if you have a collagen hydrolysate, what I often have people do is they'll add some into that juice or that smoothie, and if they eat, if they have that with their eggs, and you have a balance of the glycine and the methionine from the eggs, and then you also have all the benefits of the eggs and the BCAA amino acids that are coming from the eggs as well, plus the choline from the eggs, whatever It is, or if you're doing steak or seafood, same type of deal. So I like to do smaller doses in more like with with multiple meals. The other thing I want to mention here, and this is something that I saw on the forum recently, people talking about using gelatin or collagen or or these types of meat, these types of proteins as a main source of protein, gelatin or collagen hydrolysate, or any of these are not main sources of protein. They are deficient in these, these amino acids, like, what is it? Cysteine and try to fan and then they lack, or they are much lower in your BC. And your methionine. So just something to keep in mind, gelatin or collagen shouldn't be a main source of protein, at least in my perspective, it should always be a supplemental addition to the diet. And then also, if you're using the supplemental gelatin or collagens, they are very nutrient poor. So that's something to keep in mind. And I want the last piece I want to add with supplemental collagen gelatin, or even bone broth, or some of the like collagenous meats. For some people, those foods are cause digestive issues, skin issues and mental issues. I think because the actual components of the bone broth, collagen gelatin aren't digested well, and then the microbiome gets a hold of them and can cause histaminergic reactions and all types of weird reactions. In those cases, using a pure glycine would actually be better, um, even though the collagen i In theory, is better. So that's kind of where, like, you have to see what your tolerance is and adjust from there.

Jay Feldman 46:00
Yeah, yeah, yeah, absolutely. And when it comes to trying to determine what portion of your protein intake should be from collagen or gelatin, again, I come back to focusing on gelatinous cuts of meat which would have some amount of of gelatin and collagen in there, as well as the the meat from the muscle itself, which has the or the amino acids from the muscle, which have the methionine and BCAAs and everything else, which we want in moderate amounts, you get them in milk as well. I mean, these, these amino acids, are all necessary for maintaining our own tissues, you know, our own muscles and bones and everything skin, all of that. So we want to make sure we're getting all of those amino acids and just balancing them with the gelatin and collagen. And again, as you mentioned, I think it's preferable to be getting those things from the meat directly, as opposed to from the supplement. And I think it's just a matter of of adapting or just slowly shifting the types of foods. I mean, it's relatively arbitrary. You could say that we've determined that things like chicken breast and steak are the normal quote, unquote foods, as opposed to, you know, beef Shanks or Chuck roasts or, you know what, like the ribs or something. And the muscle based meats without the gelatin, aren't going to have the collagen and gelatin. And yes, you can have those and then just add in the protein powders. But I just think it's easier and more cost effective and generally more nutritious to just shift over towards some of those other meat sources.

Mike 47:41
Yeah, I mean, I think it just depends on what, what people's contexts are. For those I go on a case by case basis. Some people want to make roasts and stuff like that and and some people still want to eat their chicken breast and whatever else. And it's like, okay, we'll just, you know, just balance it, whatever works for your individual context. As far as introduce, you know, you want to do collections, cuts and roasts and stuff like that, that's awesome. Or, if you, you know, some, if you don't want to do those for cooking or whatever it is, then, you know, find, find an option that works. Do, there's kind of a spectrum there.

Jay Feldman 48:17
Yeah, of course, absolutely, it's, I'm not saying never to eat those other things. And again, if you're eating chicken and it's from a pastured source, and you have the chicken breast with the bone in it and the skin, then you'd probably be able to get a decent amount of of gel Turner collagen from that. But that's just not what most people are doing. And again, this is not a never eat chicken breast or steak or that anytime you eat them, you need to have your spoonful of collagen with it right away. Just talking about general, uh, general shifts dietary that I think are beneficial.

Mike 48:51
One of the things I want to talk about really quick before we move on to some of the antioxidant compounds, the like, more specific ones are, like the essential amino acid idea. Just briefly, these amino acids, and I just want to give an example, cysteine, for example, is required for glutathione production, which is essential in maintaining oxidative stress, or like balancing oxidative stress inside the cell, Lucy, the branch chain amino acids, which is your leucine, isoleucine, valine, are extremely important for maintaining your lean mass and and muscle protein synthesis, and a host of these other components. Tryptophan is involved in neurotransmitter production and is also involved and obviously can go to serotonin, but also involved in producing vitamin b3 in the form of niacin. And then a whole a bunch of these other amino acids, like methionine, are involved in methylation and different cycling within the body there. So I know there's this idea, at least within some of the peat sphere, where it's like these amino acids are bad. It's I want to, kind of like shift away from the idea that they are necessarily bad. It's they have a function. But there can be a cost with some of that function, because I've seen, I've seen it quite a bit recently, where it's like, oh, I'm going to eliminate these, these amino acids from my diet and make make, you know, try and limit them as much as possible. And I think that there can be issues associated with doing that. And I just want to, I want to point that out, and just to give a few examples of where some of these things are extremely important.And again, I think balancing with glycine to deal with some of the methionine is an excellent option.

Jay Feldman 50:38
Yeah, yeah, absolutely. And while we're touching on the amino acids, there's another one I wanted to mention, which was theanine, which theanine is generally known for, being found in teas, specifically green tea, and I think some in black tea as well. And it's been shown to protect against liver injury from directly caused by endotoxin and inflammation caused by endotoxin, and so that would be another one that, similarly to things like glycine and taurine, is able to increase GABA considerably. So it's often used for relaxation and for helping with sleep or decreasing anxiety, but it also has protective effects in the liver in the situation. So it's not necessarily something I'd be using in in large doses regularly. But it's, again, one of those generally protective ones that, especially if you're also looking for the relaxed, relaxation type effects, I think it would be a good one to look to.

Mike 51:32
Yep, yeah, of course. And then obviously, there are benefits to some of the teas on the liver as well. Um, the only problem with the green teas, or that that family of teas, green tea, white tea, black tea is they can accumulate fluoride and, I think, also aluminum, so just have to be careful with the source. But there is a whole bunch of studies from the polyphenols from those tea which we talked about polyphenols related to diet, which are the protective plant compounds having a beneficial effect on fatty liver. But some other herbal teas, you know from their poly, poly, phenolic content may be helpful, so maybe something like a chamomile to look into. And again, all these go hand in hand with managing that stress as well. They can easily if, like a combination glycine, taurine, DNA, magnesium and then chamomile with like a juice or something is that probably could be a pretty for some people, depending on your response to it, could be pretty powerful and in having a relaxation effect. So just, just something to keep in mind, if you want to add anything to the cocktail there, or anything, no, no. So I guess we'll jump in before we get into some of the other like, less like, I guess, more pharmaceutical or hormone based stuff, or is the the antioxidant compounds, which are or vitamin E and vitamin C, the main ones we talked about polyphenols already, just when we talked about the pathology of fatty Liver, one of the biggest portions of that was elevated oxygen oxidative stress and reactive oxygen species production. Vitamin C and vitamin E work together and work together to handle reactive oxygen species and oxidative stress. They all also work with glutathione, which is produced from the amino acids I just mentioned so making sure that you're having adequate amino acid intake for glutathione production, which is, again, is actually dependent upon having adequate carbohydrates as well through NADPH and the pentose phosphate pathway. That's a different story. We'll get into that another time. But having the adequate glucose, having adequate amino acids, specifically cysteine, glycine and glutamate, and then having adequate vitamin C and vitamin E are all important for protecting against reactive oxygen species and oxidative stress. Vitamin E is more specific towards your your your fatty it's a fatty acid oxidant or it's more it's that soluble, whereas Vitamin C is more water soluble. They do work together, so they're both, like, very important from that antioxidant perspective, which was a huge role in fatty liver and there are studies showing benefits in using them.

Jay Feldman 54:10
Yeah, yeah. When we were talking about the devastating impacts of PUFA in the progression of fatty liver disease, we talked about a study where, I think they'd given omega threes and Omega sixes, and then either gave them Vitamin E as an antioxidant or something to chelate iron, which we'll talk about in a bit. And both of those things prevented the damaging effects from the PUFA. So we see that a lot generally, the bioenergetic, pro metabolic community, vitamin E is talked about as something that can oppose the effects of PUFA, and so you see it in those sorts of situations, and you see it in the case of fatty liver, you see Vitamin E to be extremely protective, preventing the progression through fatty liver, lowering liver enzymes, preventing fat accumulation and all of those things. So, yeah, I think it's a great one to consider as far as the supplement goes. And same with vitamin C. Of course, Vitamin C is a little easier to get from the diet assuming that you're eating a considerable, a considerable amount of fruit and even roots and tubers, potentially even meat as well. There's some dehydro, yeah, that there's dehydrogenase that, yeah, that there's a fat soluble vitamin C in there.

So, yeah, I mean, it's one that's generally easier to get in the diet. But again, nothing wrong with adding in some some food based vitamin C as well.

Mike 55:36
Yeah. And I just want to mention some specific besides the antioxidant effect of vitamin C. You also have the immune boosting effect, which may help with some of the endotoxin situations that you have with fatty liver. And you also have vitamin C is involved in bile acid production directly, and it's also involved in the function of the enzyme carnitil palmitoyl transferase, one which helps transports fats into mitochondria. So there's, there's a bunch of functions off targeted vitamin C besides being antioxidants. So having adequate amounts can be very helpful overall, so I would vitamin C and vitamin E are great options. Fruit specifically has the carbohydrate and the vitamin C and the minerals and the polyphenols. So overall, if you want to talk about super foods, which are like all the rage now, you know your regular pineapple juice, orange juice, grape juice, pomegranate juice, having guava or whatever, whatever fruits you're tolerating well that aren't causing digestive issues are can be very helpful for the fatty liver situation in general. And there's a ton of studies showing, you know, just extract of this fruit given to rats that are given the Western diet, which is usually corn oil, actually is protective against some of the effects. So just fruit as a supplement itself is and even the potatoes, or like sweet potatoes, or or or yams or white potatoes even show benefit in some of these situations, despite having, you know, white potatoes are evil because they're glycemic index, or whatever the idea color white man, yeah, you shouldn't eat white foods, yes,

Jay Feldman 57:22
yeah, yeah, no. White potatoes are pretty nutritious despite their color, yeah,

Mike 57:29
And the glycemic index or whatever, yeah, yeah,

Jay Feldman 57:34
yeah, those are all great points. And while we're talking about things that block the inflammation and the progression of fatty liver. Aspirin is another one that's worth mentioning as one that's effective at blocking the effects of PUFA and blocking the inflammation cascades. We talked about studies that when they did block PUFA metabolites by blocking the lox enzyme, in particular, in that one study, they were able to prevent fat accumulation as a result of high fructose intake and rats, and you know that had endotoxin issues and all of that. So considering that aspirin is helpful in that regard, it would be worth considering, and it has been shown to prevent the progression of fatty liver and non alcoholic fatty liver disease into the deeper levels of of fibrosis and cirrhosis and everything. So aspirin would be another one to consider. And again, keeping in mind some people might consider it a pharmaceutical when, which is again, semantic, but if you want to take the white willow bark version, which is where it basically came from, that would be an option, if that makes you feel like you're having more of a food instead of a chemical, a natural compound. Yeah,

Mike 58:46
One thing I want to just mention with aspirin for people is there's a wrap for aspirin causing irritation to the intestine or the stomach. Easy way to mitigate that is to take it with vitamin C, which has been shown in studies to be protective against that damage, and then also taking it with glycine has been shown to be helpful for the symptoms as well. So like a glide, mixing glycine with some vitamin C, again, vitamin C can actually be like a high quality sorbic acid, or you can take it, my preference is to take it in the form of something like a Camu. Camu, which is high in vitamin C, and also has a whole bunch of those, those beneficial plant compounds that can modulate the microbiome and protect liver from oxidative stress, or like an ascero a cherry, or you can take it with like in some orange juice, or something like that, can be helpful to mitigate some of the the irritating effects for some people of the aspirin. And I just want to point out, with aspirin, we always have to say this, but just, you know, always discuss with your doctor and yada yada yada, and we're not giving medical advice and all that, all that type of stuff. Yeah, with all these, all this, yeah, with everything, yeah, yeah.

Jay Feldman 59:59
Yeah.

So another, another thing that I mentioned earlier was the chelation of iron being able to prevent liver damage and progression through fatty liver disease. And one compound that might be worth considering for doing that would be lactoferrin, which also has the ability to decrease inflammation, as well as a lot of anti inflammatory type effects and some antimicrobial effects as well. And it's been shown to prevent the liver injury and damage that goes on in response to alcohol. It's been shown to prevent metabolic dysfunction and fatty liver progression and increase insulin sensitivity and and prevent fatty liver from developing by removing iron and reducing oxidative stress. That is a, you know, that the excess iron would cause. So that might be another supplement to consider from that regard.

Mike 1:00:55
Yeah, that's definitely, I think it's definitely a possible one to use. I think a lot of people there's in these states, in some of these inflammatory states, you kind of get into this sticky situation where you have a lot of iron bound up in ferritin, which is the storage form. And I don't know if I think I may have touched on this earlier, but in this series, it's been so long. I don't remember exactly everything we've covered, but the the ferritin will, the body will increase iron, I guess, mobilization into ferritin under states of inflammation or chronic type, any type of chronic infection state, because the bacteria will try to sequester the iron, and then the iron is also is very likely to oxidize in these inflammatory states. So ferritin essentially protects the body from the effects of that iron. And iron is absolutely essential for quite a few functions in the body, but in excess of the iron can be very problematic. So any if you do have like in some of these states, looking at a liver panel, and then for some people, actually looking to see if you have, which is relatively rare, hemochromatosis, which is an iron genetic disorder where you store excess iron that could also directly be leading to fatty liver and liver impairment, diabetes through oxidative stress. So that's something to consider as well. And if you do have an excess of iron in the system, or you're actually anemic, but your ferritin levels are high, if you have the excess iron, getting rid of it black can help, but also maybe some some phlebotomy, like blood donations, can help if you but if You have a high ferritin, and you're actually anemic. Blood donation doesn't necessarily solve that. What solves that is redistribution of the iron by lowering whatever the inflammatory or infective stimulus is. So if you have the chronic endotoxemia coming from the gut, you would have to adjust that rather than do venipuncture or phlebotomy. If you did phlebotomy, you would actually make the situation worse, because your your active iron would would possibly be low, with a lot of it bound up in ferritin. And with that said, that brings me to something to address as well, is the adjusting or manipulating the microbiome in fatty liver with with an antimicrobial as well as with the change in diet, antimicrobial could be like an herbal one, like an oregano oil or a cinnamon oil, or any, any, any, some of these herbal compounds could be helpful to manipulate the microbiome, possibly wipe out any pathogens, and with the change of diet, be able to sustain it. And some of the studies, they actually were able to do this directly. I think one of the studies we talked about, they were actually able to change the people, people who had obesity and fatty liver, changed their diet. They lost the weight in the liver fat when as well. So, and that was through manipulations in the microbiomes for these individuals, as well as obviously decreasing oxidative stress. They weren't we don't know which was the chicken or the egg, but the whole situation was able to adjust by the dietary change. And helping that along could be modulating the microbiome with some type of herbal antimicrobial. That's a possible option, especially if SIBO is present,

Jay Feldman 1:04:13
yeah, yeah. Or potentially a pharmaceutical one as well, depending on the situation, potentially in a lower dose. Again, all of that is, there's a lot of factors that can go into navigating that situation we've talked about in a few previous episodes. So I'll link to those because there's, yeah, it's it's a there's a lot there, as far as the different antibiotic, antifungal, anti parasitic compounds that can be used, whether they're herbal or or pharmaceutical, but if there is a microbial issue that is not being improved by restoring effective digestion and restoring uh metabolic function to the extent that it can be and eating digestible foods, if it still seems to be an issue that is a limiting factor, a bottleneck, then it's generally worth working to resolve it with some sort of an antimicrobial.

Mike 1:05:10
Yep, yeah, for sure. And again, I would you know, under the supervision of a trained medical professional and all and your doctor, whoever it is.

Jay Feldman 1:05:21
Yes, but in talking about both polyphenols and general antimicrobials, things that are anti inflammatory and things that reduce iron absorption, or the amount of iron that we take in caffeine and coffee come to mind, as well as and also, specifically fat with fatty liver. And we did an episode, or, I think it was part of a Q A, where we discussed coffee and caffeine, so I'll link back to that. But caffeine and coffee are incredibly protective of liver health. They protect against the effects of endotoxin, they reduce inflammation, they have antimicrobial effects. They're able to lower liver enzymes and reduce liver pathology, prevent fibrosis, prevent cirrhosis, and they also prevent mortality from these things, or reduce mortality from these things, not prevent and the important thing here as well is that beyond being generally anti inflammatory and protective of the gut, coffee is also Coffee, or the compounds in it, including caffeine, are also effective at stimulating and supporting respiration, meaning the amount of energy we're producing. So something that is helping, on that fundamental level, to then resolve all these issues, and I think that's a major reason why you see such a wide array of benefits from it. And interestingly, as well, the liver's ability to to metabolize the caffeine can also be a measure of its function, which can also mean that some people who are dealing with liver pathology might not be able to to to tolerate caffeine effectively, because, because they aren't clearing it well, potentially, or they're not able to handle the stimulation, because there there are too many blockages along the pathway. If that is something that someone's experiencing, then I would not suggest taking in a lot of coffee or caffeine or any necessarily. You want to make sure that you're able to handle that stimulus well without and without driving any stress so or driving minimal amounts of stress, or really opposing stress. So that's something to keep in mind there as well.

Mike 1:07:26
Yeah, coffee is definitely one. I think that's based on, on individual tolerance in these in these situations. I've seen it help people. I've seen some people love it and do well in it, but I've also seen some people not do so not do so hot with with coffee or caffeine? Yeah, and that's really going to be one of those things again, where you got to just experiment and see how you feel. One thing I would say is, if you're going to do coffee, a lot of people like to wake up and have it black. I would not recommend that. I recommend if you're going to do coffee, take it with a meal. Have it with breakfast. Give some eggs, some some fruit juice, some some fruit a smoothie, whatever it is, have have some coffee with that. Um, I think that's probably one of the better ways to go.

Jay Feldman 1:08:09
Yeah, yeah. And there are a few other nuances there. I'll just refer back to that previous episode, because I think we discussed all of that and how, yes, a lot the way that a lot of people are using coffee is not supportive metabolically or of liver health for that matter.

Mike 1:08:22
So no more it's used more like a like a stimulant, than an actual metabolic aid, where it's just like you're just stimulating that, that adrenal response, that adrenaline production and sympathetic activity to get you going, rather than using it to drive energy production. Yeah, that. And that's a big nuance with with caffeine consumption. And the other thing I want to point out here really quick is that tolerance to caffeine is can also be contextual and change over time for an individual. So that's something if you start out and you're not doing well with it, make some of these other changes first, address your liver health in general, a whole host of these other situations, and then you may be able to find, oh, now I can tolerate half a cup or a cup of coffee in the morning, and I'm fine. So, like, it really depends on on the individual with that.

Jay Feldman 1:09:09
Yeah, absolutely. So it was funny what you were mentioning as far as using coffee as a way to drive stress, where a lot of people are actually using it as an aid to help them with their fast, or to help them with their really intense exercise that they're doing fasted, where, again, you were just further driving that stress, you know, even deeper. So in that case, definitely not an ideal situation. But yes, considering all that tolerance is definitely individual, and there's a lot of factors to consider there. So yeah, but definitely wanted to that I think is worth looking into for this situation. One other one that I wanted to mention before we talk about some of the prometabolic hormones is inosine which has been shown to be protective in fatty liver situations by directly increasing the amount of energy available, directly increasing ATP. And in situations where ATP Production has been impaired, it's able to restore that production and reverse the pathology, which is, you know, some of these studies, they're looking specifically at the liver ability, or capacity, to export the fat through the VLDL, and that process gets impaired, as we talked about, with oxidative stress as well as a lack of energy. And so the intestine is able to reverse that situation and restore the energy availability. So that's another one that is not used or not discussed as often, just in general, as a supplement, but I think can be a pretty protective one in terms of the liver and and also in other regard, just considering that, it's pretty good at increasing ATP, increasing energy and decreasing the stress hormones as well through that mechanism.

Mike 1:10:47
I think it just goes to the general pathology that we're talking about was actually like an energetic or ATP deficiency at the cell. So correcting that with inosine could be something that would be helpful. So, yeah, not too much more to add. Um, yeah, unless you want to jump into to thyroid here, because just like thyroid being kind of the thyroid hormone being the basis for the other steroid hormones, because thyroid hormone is what is driving the other steroid hormone production. But I guess we'll start at the top of the pyramid here, I guess, which would be with thyroid hormone, which has a whole host of possible beneficial effects in in fatty liver.

Jay Feldman 1:11:31
Yeah, yeah. And again, looking at the the broad, general mechanisms and causes underlying fatty liver, when we're considering metabolism, and, you know, and thyroid, of course, there's going to be a pretty strong relationship there. And you see it, you see an association, good association, between low thyroid activity or hypothyroidism and non alcoholic fatty liver disease, and, of course, every other metabolic issue. And that's because our thyroid is, is basically the general governor of our metabolism. So you see, you see that relationship, and you also see that using thyroid hormone helps to decrease the fatty liver pathology. Of course, it is not as simple as just everyone should be using thyroid hormone. We want to be supporting our metabolism and thyroid function with everything that we've discussed as far as diet and lifestyle goes. But thyroid hormone can be helpful, adjunct to those things when used properly, which, again, is a whole episode in and of itself. But it's just worth mentioning this relationship and that thyroid hormone should be something that's that's considered. I mean, just anytime there's metabolic dysfunction, I think it's, it's not surprising considering what goes on as far as the medical industry and pharmaceutical industry. However, I think you could probably make the argument that prescribing thyroid hormone in place of many of the other medications that are prescribed for various metabolic diseases like diabetes and heart disease would be more effective. Yeah, statins, Metformin, all of those things, prescribing thyroid hormone would be a much better route for for actually helping to reverse the pathology there. So, yeah, you see that here as well.

Mike 1:13:11
It's just not patentable. I think that's the biggest problem, right? That's why the like the study that I looked at for this, because they looked at at thyroid hormones, effect, specifically in fatty liver. And they talked, there's I have some notes here on it. It actually prevented and reversed hepatocytosis so fatty liver. It decreased liver weight, decreased serum triglycerides, decreased lipid peroxidation, decreased liver injury, lowered AST and alt, which are the liver enzymes, and then it increased mitochondrial biogenesis, which is the formation of new mitochondria. It increased Mito fad g of or mitophagy, however you want to pronounce it, of damaged mitochondria, which is something that we talked about at one point in the pathology, where, when there's not enough energy in the cell, the cell can't, like, break up those, those damaged mitochondria and then build new ones because, because of that energetic deficit. So the they were talking about all these benefits of thyroid hormone, and it was like, oh, we need this synthetic thyroid hormone analog that only works on one specific thyroid hormone receptor. It's like, or you could just use thyroid hormone. That was kind of like that was when, after I read the study, as well as things like, you could just use regular thyroid hormone. But I also want to touch on here with the thyroid hormone in the fatty liver or or, I guess in fatty liver in general, you see that up regulation in triglycerides, and you see the we talked about, the need to export the fats from the liver in the form of VLDL, which eventually becomes LDL. The LDL receptor that's expressed on tissues is directly upregulated by thyroid so what that means is those cells and tissues are going to pull in or take some of the fats that's stored in that VLDL and LDL, and then thyroid hormone pushes the cholesterol. All that those cells take up, and the fats that those cells take up, and then the carbohydrate that those cells take up into energy metabolism. So it's going to cause the cells to burn, to increase beta oxidation, increase glucose oxidation, and take the cholesterol and turn it into steroid hormones. So it does it by upregulating LDL receptor and also upregulating this protein called Star steroid acute regulatory protein, which functions with the, I think, the retinoid X receptor as well, which is dependent on vitamin A, and takes that cholesterol with the glucose vitamin A, and then it turns it into a steroid hormone. This is directly shown or discussed in multiple levels of the research, and this is also something that both Danny, Roddy and Ray have, like, outlined for people. I think Danny has a, like, very nice graphic on it, but so if you're having elevated cholesterol, elevated triglycerides, and the thyroid hormone will allow will push it and allow the cells to use it, but at the same time, like you want to be able to make sure that the liver is able to export the fats and cholesterol that is producing. So it's important to have adequate choline, and you also want to make sure that the cells have adequate B vitamins to be able to oxidize the substrate. So that's why thyroid hormone isn't just like a cure. It has to be in the context at this, at least from my perspective, in the context of a solid diet with solid nutrition and supplements to if you require those supplements to rebuild nutrient stores so that you can adequately use the thyroid hormone. Because if you just hop on thyroid hormone and you still have a trash diet, you actually may be causing yourself more harm overall, because, because you don't have the nutrients to process the fatty acids to glucose, to turn the hormones into the cholesterol, into steroid hormones, to move the fat out of the liver through VLDL, you're at your deficient in choline, whatever it is the it's or you have a glucose deficiency, right? Like you're not eating enough carbohydrate. You want to use thyroid hormone on a low carb diet, it just doesn't make too much sense. So just all things to keep in mind that the diet and the nutrient, having enough nutrients and macro and micronutrients pushes your fat, your carbs, your proteins, your vitamins and your minerals, having all of those as the baseline, and then running something like thyroid hormone on top would would be ideal. Wouldn't be just take thyroh hormone solve all your problems, although thyroid hormone can be very helpful.

Jay Feldman 1:17:26
So, yeah, yeah, I agree, and I think we've talked about that relationship in the past, and I'll link back to those episodes. But yeah, it, uh, it is not going to make up for poor diet, poor lifestyle, all those things. When those things are in place, it can help to speed along the process of of healing and regeneration. I did want to mention so you talked about the mitophagy and and also, thyroid hormone has been shown to restore autophagy as well in in liver pathology. And I know I've talked about how we don't want to be stimulating those things, you know, in terms of hormesis and all of that, which is still the case, and the fact that, basically what we're seeing is that when there is pathology, when things are dysfunctional, we cannot carry out these adaptive processes that are happening in response to damage. So these things, we want them to be able to happen in response to damage, but we don't want to be doing the things that increase them, which is the damage and insult and inflammation in the first place, so that's the important piece to have. And then if we are causing those that dysfunctional situation, we want to be able to adapt effectively with things like autophagy and mytophagy, and we can't do those without enough energy. So the thyroid hormone helps to restore those adaptive processes. But again, we don't want to have to do that. But if you're in a situation of of fatty liver disease, then you're already at that point, and you can reverse it. But when you're in that situation, you'd rather be able to properly adapt to that, to that issue.

Mike 1:18:55
What I the the mitophagy and autophagy that you're seeing there, from my perspective, are you like when you have this elevated reactive oxygen species in the fatty liver situation, and you start damaging the mitochondrial membranes and mitochondrial structure and all of its components having mitophagy, which is the destruction of these damaged mitochondria to recycle some of the components that are left, I think, is ideal in this state, because you have a you have a it's like having a broken house. You want to be able to go and fix that house, or having a broken generator, whatever it is you take out, you're going to take out the parts that you can still use by the structure of the house, and you're going to replace the other broken parts that all requires energy that's all important. Thyroid hormone is helping this process along. It's not just stimulating my toffee G for the sake of stimulating mitophagy. It's like you have this pathology, this issue going on, and thyroid hormone is allowing you to effectively undergo this process, to adapt to that problem. Now that's an entirely different process. Of I'm going to go blow up the house. I'm going to go blow up my mitochondria so I can have mitophagy. It's like very be different. It's like, you have the damage, we're gonna fix it, versus I'm gonna create damage so that I have to fix it.

Yes, yeah. That is a good way to put it, which is what the people in favor of hormesis are suggesting, that you want to create the damage to fix it,

yeah, to some extent, yes, yeah. I don't think they know. They're they, they're seeing it through that lens. But that is kind of where we're like, yeah, that's kind of what you're saying,

Jay Feldman 1:20:22
yeah, yeah, yeah. And so beyond thyroid, there is some research looking at or there's a decent amount of research looking at testosterone in terms of fatty liver. We talked about Vitamin E earlier, and there's quite a few studies looking at testosterone in combination with Vitamin E being able to reverse fibrosis in fatty liver disease and restore insulin sensitivity. Of course, this is what the drug that they're trying to patent in the certain combination. But that is noteworthy, as well as also I alluded to these earlier, as far as the studies looking at testosterone and vitamin b1, thiamine, in combination, being able to reverse liver cirrhosis, which is that very severe form of fatty liver disease. And they this is, this is research from I think, the 60s, and was something that they were looking at as something that was basically curing the situation and so this is, this is this does not mean that we just want to be taking in large amounts of testosterone, rather a that we want to do the things to support testosterone production on its own, just like we talked about with thyroid, again, you have all the same issues, but also using certain supplements, including supplemental hormones that can increase testosterone production or androgenic activity could also be protective Things like pregnenolone DHEA and some other steroid hormones would also potentially be effective in creating these same in creating the same healing, regenerative, protective effect.

Yeah, and DHEA, by itself, has also been shown to have some benefit. But all of the idea would like, I think, a lot of the the low testosterone state, which you often see in fatty liver, like some of the low steroid hormone states, are pathologies caused by the endotoxemia. So they have, uh, I think it's, there's, there's a couple studies. They're like the gelding studies, which is like, it was like gut derived endotoxin, I forget the specific, like definition of the acronym, but they are just basically showing that endotoxin from the gut could directly lower steroid hormone production through like, multiple mechanisms. So the question is, why are these steroid hormones low? Not, not like, Oh, they're low. Let's just replace all of them now, the the and there's a difference, right? Because your pregnant alone and your DHEA aren't going to, in most situations, based on the research, aren't going to completely shut down all of your steroid hormone production, whereas taking large amounts of testosterone, what it there's very likely you're going to shut down your own steroid hormone production. So these things can be helpful. Of course, the question is, just, why are they not there? And then how to use them in a way where you're not shutting down your own production and minimizing the side effects to exert the beneficial effects from them? And again, thyroid hormone is like the primary hormone driving the production of these steroid hormones, and then also lowering glucocorticoids is also key in in allowing for the adequate production of these steroid hormones and minimizing stress, minimizing gut drive endotoxin and optimizing sleep. All of those are key for lowering your glucocorticoids and raising thyroid function and raising these other adaptive, or catatoxic, they're not adaptive, the catatoxic or the steroid hormones, which are which are generally protective. So it's like addressing the underlying issues underneath is the always, I think should be. The first key is like, Why? Why is my testosterone low? How can I go about fixing that? Do I have a deficiency? Do I have endotoxemia? Whatever's going on? Are my glucocorticoid super high? Is my sleep ad, addressing those factors and then considering okay if I used a little bit of DHEA and pregnenolone, if I was able to access a doctor and get smaller amounts of testosterone, would that be helpful? Would using thyroid hormone help me along to recovering from these situations. That's where, like, I would come from adding some of those things in, not from, like they're low, replace them. It's a very it's nuanced, but I think it's a very big difference overall.

Absolutely. Yeah, I wanted to add in one other feature there that would decrease the production of the steroids, which would also be oxidative stress. Of course, that goes with the inhibited respiration and all of that. But we pointed it out in the past how Vitamin E can protect against that effect, for example, with testosterone, specifically in the testicles, which can allow for testosterone production when it's inhibited by oxidative stress.

Mike 1:24:57
Yeah, and we also talked about and other podcasts as well that having high amounts of polyunsaturated fatty acids present in the test in the testicles and testicular structure decrease testosterone via oxidative stress testoxone production. So not only is it causing that damaging effect at the fat at the liver, it can also be causing the damaging effect at the testicles and God knows where else in the body, the vasculature, the heart, the brain, for all these different pathologies, whether it's heart disease, asperosis, heart attacks, Alzheimer's, there's associations and possible mechanisms involved, or there's oxidative stresses implied in all of them. But as far as the polyunsaturated fatty acids. I mean, there you can't talk about oxidative stress without really talking about those. Yeah, yeah, yeah, yeah. And that all comes back down to again, establishing that diet, first, making sure you're having that solid diet, changing the lifestyle, and then addressing and filling in the gaps with supplements. So it kind of all works together, but that foundation is extremely important with diet lifestyle.

Jay Feldman 1:26:05
Yep, absolutely. All right. And before we wrap up this episode, I did want to clarify as far as what we meant when we were discussing the use of thyroid hormone, where there are multiple different thyroid hormones, but in general, we recommend using a combination of t3 and t4 hormones, either synthetic or natural, desiccated thyroid products that contain both hormones. Of course, before using any hormones like that, definitely consult with a medical professional, and that is going to wrap up this non alcoholic fatty liver disease series. If you did enjoy it and this episode, 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 conditions that we've been discussing throughout this series, whether that is fatty liver disease or insulin resistance, or other related conditions like diabetes or Heart disease, or if you're struggling with any low energy symptoms, like chronic cravings and hunger, low energy or fatigue, chronic joint pain, weight gain, digestive symptoms, brain fog, poor sleep or hormonal imbalances. Or if you're dealing with any other low energy symptoms or chronic health issues, 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, I'll see you in the next episode.