Insulin resistance, fatty liver, alcohol - and the hole in my bucket.

LittleGreyCat · Jul 23, 2017

A tangled web.
The "hole in my bucket" bit is because I seem to be going round in circles at the moment.

I think it started with someone saying that drinking alcohol gave you a fatty liver and someone else saying that a fatty liver was the main cause of insulin resistance.

I had been enjoying the beer and wine a little too much (plus a wee dram as a nightcap) and had put on a couple of pounds.

All this started me wondering how much effect my drinking was having on my weight and BG control.

First stage: lay of the booze for a little (but how to define little).

Second stage: research.

Which turned up this https://www.dietdoctor.com/insulin-fatty-liver-disease by Dr. Jason Fung.

With the new recognition of NAFLD, research confirmed the extraordinarily close association between obesity, insulin resistance and fatty liver. Obese individuals have five to fifteen times the rate of fatty liver. Up to 85% of type 2 diabetics have fatty liver. Even without the diabetes, those with insulin resistance alone have higher levels of liver fat. These three diseases clearly clustered together. Where you found one, you almost invariable found the others.

NAFLD being Non Alcoholic Fatty Liver Disease.

Then https://www.dietdoctor.com/low-carb-diet-best-fatty-liver.

Study after study shows a more effective weight loss on a low-carb diet. And if you reduce abdominal fat, you’re also reducing the amount of liver fat. The disease fatty liver is strongly associated with obesity and type 2 diabetes.

Not surprisingly, yet another study* shows that a low-carb diet is a good treatment for fatty liver. In only six days on a low-carb diet, the reduction in the amount of liver fat was about the same as it was for seven months (!) on a calorie-restricted diet. Furthermore, the volume of the liver decreased quickly, probably because of less glycogen and fluids (decreased swelling).

So far, then, I have that 85% of T2 diabetics have a fatty liver but a low carbohydrate diet can more or less fix that in 6 days.

I am eating (mostly) LCHF so I'm good, right?

Well, what about the alcohol?

Here we go:

For far more than you ever wanted to know, try http://emedicine.medscape.com/article/175472-overview.
Page 3 has

Several risk factors may influence the development of advanced ALD, including the following:

Minimum amounts of alcohol intake associated with an increased risk of ALD range from 40 to 80 g/day for 10-12 years; safe limits for alcohol use are not clearly defined

I did have a quote for 60g of alcohol per day guaranteeing a fatty liver but I can't find it at the moment.
However Google shows plenty of quotes which have 60g per day as persistent alcohol abuse.
https://www.dnalegal.com/blog/what-excessive-alcohol-abuse

For men, the World Health Organization defines excessive alcohol abuse as the consumption of 60g of pure ethanol (5 units) per day, sustained over the course of three months. For women, this figure translates to 40g of pure ethanol (around 3.5 units) per day, over the same time period.

Hmmmm.....

10g of alcohol is approximately 1 UK unit.
1 bottle of NZ Sauvignon Blanc has 9.4 units or 94 grams so sharing a bottle gets you 47 grams each.
A bottle of our favourite beer from Lidl has 2.5 units (or 25g)
A nice big bottle of Leffe (ocassional treat) has 5 units (or 50g)
So for example on a warm summer day, drinking 3 bottles of Lidl beer over a prolonged period takes you well into the red (over 60g).
Must have been in the red for {mumble, mumble} of the last {mumble,mumble} days.

Help!

Hang on, do I hear the cavalry?
http://www.nhs.uk/conditions/Liver_disease_(alcoholic)/Pages/Introduction.aspx

Alcoholic fatty liver disease
Drinking a large amount of alcohol, even for just a few days, can lead to a build-up of fats in the liver. This is called alcoholic fatty liver disease, and is the first stage of ARLD.

Fatty liver disease rarely causes any symptoms, but it's an important warning sign that you're drinking at a harmful level.

Fatty liver disease is reversible. If you stop drinking alcohol for two weeks, your liver should return to normal.

So two weeks off the sauce and I'm good, right?

Hang on, I'm doing LCHF which demolishes fat in the liver!

Is this 2 weeks for people eating loads of healthy carbohydrates?
LCHF should cut the time by quite a bit, don't you think?
I doubt that the studies which resulted in the 2 week timescale included people in nutritional ketosis.

Tentative conclusion; to clear any fatty liver cause by excess alcohol consumption (60g or more) I need to avoid alcohol for a period of between 0 and 14 days.

Tentative question; "Can I have a drink now, please , Miss?"

Speculation; LCHF is the boozer's friend.

NoCrbs4Me · Jul 23, 2017

My opinion is completely unsubstantiated by Google or PubMed and completely made up by myself:

I think you need to consume a massive amount of alcohol for many years to do damage (cirrhosis) to your liver (e.g. a bottle of vodka or a couple of bottles of wine per day). Likewise consuming too much carbs (i.e. following the eatwell guidelines or an even worse diet) may eventually result in NAFLD, and then eventually cirrhosis.

I think the damage caused by excess alcohol is different than from excess carbs.

My own NAFLD went away pretty quickly after switching to a low carb diet.

Even 3 or 4 drinks a day is probably not enough to cause liver damage if you're on a very low carb diet.

Again, the above is completely made up by myself based on my own experience. I could be wrong.

zand · Jul 23, 2017

NoCrbs4Me said:
My opinion is completely unsubstantiated by Google or PubMed and completely made up by myself:

I think you need to consume a massive amount of alcohol for many years to do damage (cirrhosis) to your liver (e.g. a bottle of vodka or a couple of bottles of wine per day). Likewise consuming too much carbs (i.e. following the eatwell guidelines or an even worse diet) may eventually result in NAFLD, and then eventually cirrhosis.

I think the damage caused by excess alcohol is different than from excess carbs.

My own NAFLD went away pretty quickly after switching to a low carb diet.

Even 3 or 4 drinks a day is probably not enough to cause liver damage if you're on a very low carb diet.

Again, the above is completely made up by myself based on my own experience. I could be wrong.

I agree with you. So we could both be wrong.

NoCrbs4Me · Jul 23, 2017

zand said:
I agree with you. So we could both be wrong.

I hope not. I like my bourbon, rye, vodka, and gin.

Kristin251 · Jul 23, 2017

NoCrbs4Me said:
I hope not. I like my bourbon, rye, vodka, and gin.

I hope you're right!! I enjoy my vodka as well!!
And only my guess that carbs cause fatty liver is that when some of us eat them we gain weight in the abdomen. At least I do. I don't gain weight with vodka. Not calling it a health food though.

Guzzler · Jul 23, 2017

My older sister was an alcaholic. The last few years of her life were spent drinking, eating very little and chain smoking. She passed aged 59 of lung cancer and liver cancer. It was the liver cancer that saw her off but her age shows that her liver took some serious abuse before she even knew the damage she had caused.
This was a woman who would wake during the night to have a drink. The liver is a remarkable organ and very under appreciated.

LittleGreyCat · Jul 23, 2017

Thanks for all the quick responses. Please note I have now more or less finished updating the OP.

DavidGrahamJones · Jul 23, 2017

LittleGreyCat said:
Tentative conclusion; to clear any fatty liver cause by excess alcohol consumption (60g or more) I need to avoid alcohol for a period of between 0 and 14 days.

Tentative question; "Can I have a drink now, please , Miss?"

Speculation; LCHF is the boozer's friend.

Would a liver function test indicate any reversal of a fatty liver. I know the liver is a very forgiving organ but I can't help but think that 0-14 days abstention from alcohol just isn't going to do much. Who knows?

LittleGreyCat · Jul 23, 2017

I was quite surprised by the NHS website saying two weeks was enough to clear your liver.
I don't feel inclined to argue, though.

Edit:
I don't even know if I have a fatty liver (no symptoms in most people).
I don't know if I have insulin resistance or low insulin production.

Freema · Jul 23, 2017

the low carb high protein eating style seems to be able to reverse fatty liver in many diabetics... in a few month

http://www.diabetes.co.uk/news/2016...-in-people-with-type-2-diabetes-94851578.html

some kind of liver trouble is liver necrosis which is a kind of liver disease that kills of parts of the liver, many times a rsult of heavy drinking or if one has caught a liver infection a cronic liver infection this kind of liver disease combined with fatty liver is not that easy to get rid of , and may be ireversible...for some people..

just having a fat liver can in many cases be delt with by loosing aa lot of bodyfat...

Bon83 · Jul 23, 2017

NoCrbs4Me said:
My opinion is completely unsubstantiated by Google or PubMed and completely made up by myself:

I think you need to consume a massive amount of alcohol for many years to do damage (cirrhosis) to your liver (e.g. a bottle of vodka or a couple of bottles of wine per day). Likewise consuming too much carbs (i.e. following the eatwell guidelines or an even worse diet) may eventually result in NAFLD, and then eventually cirrhosis.

I think the damage caused by excess alcohol is different than from excess carbs.

My own NAFLD went away pretty quickly after switching to a low carb diet.

Even 3 or 4 drinks a day is probably not enough to cause liver damage if you're on a very low carb diet.

Again, the above is completely made up by myself based on my own experience. I could be wrong.

I have met a lot if people who have literally hammered their body with booze. I am not condoning it or saying that they were in complete good health. But I have seen some completely turn things around and seem to get completely better as well. Our bodies are fragile and also extremely adaptable and self repairing! I

NoCrbs4Me · Jul 23, 2017

These are Prof. Sikaris' indicators of NAFLD from blood tests. My results from the tests (except for the fasting insulin, which I didn't have done) are why I think I had NAFLD before I was diagnosed with type 2 and that now I don't.

DavidGrahamJones · Jul 24, 2017

LittleGreyCat said:
I was quite surprised by the NHS website saying two weeks was enough to clear your liver.

So, Alcoholic Related Fatty Liver Disease can be reversed by two weeks abstention. I can see that's what several articles that I googled say, including some by the NHS. I'll put my neck out and say that it's incorrect, I found several articles where the wording was identical, cut and paste job maybe.

Edit: Just found another opinion by Merck Pharmaceutical.

"If people stop drinking and no fibrosis is present, fatty liver and inflammation can be reversed. Fatty liver may completely resolve within 6 weeks. Fibrosis and cirrhosis often cannot be reversed."

I like the use of the word "may". Also it's about the only time you can lose fat from a particular place. LOL

LittleGreyCat said:
I don't know if I have insulin resistance or low insulin production.

I've always found it surprising that our GPs seem reluctant to do the tests that will show poor insulin production (c-peptide) and insulin resistance, probably money comes into it. I found it valuable to know that my pancreas produces normal amounts of insulin and I have high insulin resistance.

LittleGreyCat · Jul 24, 2017

It all makes Dry January seem like a good idea.

One month in 12 to give your liver a rest.

LittleGreyCat · Jul 24, 2017

DavidGrahamJones said:
<snip>
I've always found it surprising that our GPs seem reluctant to do the tests that will show poor insulin production (c-peptide) and insulin resistance, probably money comes into it. I found it valuable to know that my pancreas produces normal amounts of insulin and I have high insulin resistance.

Yes, I think this can be very important information.

Given that some of the reading around this thread suggests that a fatty liver is almost always associated with insulin resistance, that there are people who are slim and fit who still have a fatty liver and insulin resistance, and that the Newcastle Diet specifically targets a fatty liver, results showing normal insulin production but insulin resistance could be used to target specific treatment such as short term very low calorie diets.

This could also hold out the hope of reversal/cure.

I assume the liver could also be scanned to confirm/deny fat deposits, perhaps with ultrasound?

Well, yes, https://www.liverdoctor.com/how-to-know-if-you-have-a-fatty-liver/ starts out with some helpful information but then drifts off into possibly less scientific areas.

I don't recall having any tests for liver enzymes in my regular check ups, which look to be a useful indicator.

So possibly liver enzymes and c-peptide could build a picture, and an ultrasound scan might give visible evidence.

It would probably make a big difference to patient motivation.

Edit: posted in stages because the web site is being unhelpfully constipated at the moment.

DavidGrahamJones · Jul 24, 2017

LittleGreyCat said:
Edit: posted in stages because the web site is being unhelpfully constipated at the moment.

Know what you mean.

While we're on livers, fatty or otherwise, I took a drug called Rosiglitazone, no longer available, which affected my liver function which has never been the same since, although in January 2016, after taking Milk Thistle for 6 months, my GP announced that my liver function was fine. Sadly, January 2017, it's not so good again so perhaps I should get back to the Milk Thistle.

ickihun · Jul 24, 2017

zand post: 1515733 said:
I agree with you. So we could both be wrong.

I agree. So that's 3 of us.

Avocado Sevenfold · Jul 24, 2017

NoCrbs4Me said:
I hope not. I like my bourbon, rye, vodka, and gin.

I though you avoided everything plant based

Dark Horse · Jul 24, 2017

Some sobering statistics:-

If you drink around 5 or 6 units of alcohol (two to three pints of lager) each day for around ten years then your chances of developing cirrhosis double. By the time you are drinking around 8 units every day (1 bottle of wine, or 3 pints of Stella each day) then your chances of developing cirrhosis go up ten times. Approximately 1 in every 20 people in the UK is currently drinking at this level, and about half of them are likely to get serious liver problems at some stage.
http://www.drinksafely.soton.ac.uk/AboutYourLiver/

There is a calculator -the DRINKULATOR - which assesses whether your drinking habits put you at risk:-
http://www.drinksafely.info/Drinkulator

NoCrbs4Me · Jul 24, 2017

Avocado Sevenfold said:
I though you avoided everything plant based

Plant based food, not medicine.

Insulin resistance, fatty liver, alcohol - and the hole in my bucket.

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