Meal Timing In Fatty Liver Disease

We know that eating too much is unhealthy, right?  WHAT and HOW much you eat is important.  We know that eating too much processed food, drinking soda, and abusing substances like alcohol, tobacco and other drugs is unhealthy.

Well, it seems that WHEN you eat is also important.

There is research suggesting, at least in fatty liver disease, WHEN you eat influences the development of disease.  What is the importance of meal timing in fatty liver disease?

First let’s review what fatty liver disease is.  As discussed at Mayo Clinic’s website, fatty liver disease is a poorly-understood condition where the liver cells have droplets of fat present inside them.  Nonalcoholic Fatty Liver Disease is one of the most common liver conditions in the world, and is unfortunately getting more common.  It is linked to diabetes, high cholesterol, heart disease and the Metabolic Syndrome.  We don’t know for sure what causes it and don’t really have good treatments for it.

Scientists are furiously researching this increasingly common problem to try to identify causes and effective treatments.

Recently at the American Association for the Study of Liver Diseases annual meeting, a study was reported that suggested WHEN we eat influences the development of fatty liver disease.

It was found that skipping breakfast and lunch increased the risk of fatty liver disease by 20% and 73% respectively.  Eating between 10 PM and 4 AM increased the risk of fatty liver disease by 61%.  Eating more of the day’s calories in the morning decreased the risk of fatty liver disease by up to 21%.  Researchers adjusted for total calorie intake, age, gender, alcohol use and taking medications that are hard on the liver.

What recommendations can we give people based on this research?  These findings really reinforce the common-sense recommendations we give people all the time.

  • Eat breakfast every day
  • Eat lunch every day
  • Don’t eat too close to bedtime

What about shift workers?  What about my nurses and others that work the night shift?  It doesn’t seem to matter what time you are awake.  The liver has its own circadian rhythm and it seems that eating in the middle of the night is bad for your liver no matter when you sleep.

Since we know that night-shift workers are at higher risk for obesity and other health problems than those who work and are active during the day, this may be one way to reduce the health risks associated with night shift work. Keeping the calorie intake mirroring how day-shift workers eat may help to mitigate the risks for night shift workers.

For instance, one could eat a large “breakfast” when coming off-shift, a medium-sized “lunch” prior to sleep, a small “dinner” before heading to work, and avoid eating in the middle of the night while working.

Since we don’t have effective treatments for fatty liver disease, the main focus right now is on prevention.  Fatty liver disease is considered a “lifestyle” problem.  The main interventions are lifestyle changes like diet change, avoiding alcohol, and weight loss.

Do you already have fatty liver disease?  In addition to eating healthy and limiting calorie intake, making sure you eat breakfast and lunch daily and avoid eating too late can help make a difference in your liver’s health.

You only get one liver and replacement parts are hard to come by.  Changing when you eat is a fairly simple intervention that seems to be powerful in preventing the damage of fatty liver disease.

QUESTION:  Do you eat breakfast and lunch?  If not, do you think you’ll change your eating patterns based on this research?


Telomeres And Aging

Do you know what an aglet is?

An aglet is the little plastic cap on the end of your shoelace.  It protects the end of the shoelace and keeps it from unraveling and getting frayed.

Did you know that your chromosomes have a similar structure on their ends?  That structure is called the telomere.  It’s like an end cap that protects the chromosome from wear and tear and DNA damage.

Credit: Stanford University

Why do we care about telomeres?  Just one reason: the shorter your telomeres, the faster you are aging.  Telomeres get shorter as cells divide and reproduce and under the influence of chronic inflammation.  There is an enzyme called telomerase that lengthens and protects the telomeres.

When the telomeres shorten to a certain point the cell get old, dies and is replaced.  If this tends to happen to your cells very quickly, you age faster than if it happens slowly.

There is evidence that a number of lifestyle factors affect telomere length. (This list is NOT exhaustive, just meant to be an example.)

So what can we do to help our telomeres stay long and robust?  Obviously we want to live a healthy lifestyle and eat right, maintain a healthy weight, exercise regularly, manage our stress and avoid cigarette smoking.

What is the healthiest diet for your telomeres?  Since omega-3 fats and polyphenols seem to be protective and associated with longer telomeres, eating plenty of fresh colorful fruits and vegetables and getting omega-3 fats from cold-water fatty fish and plant sources like nuts, seeds and avocados is wise.  There is evidence that the Mediterranean diet is helpful for maintaining long, robust telomeres (see the article cited above).

What about supplements?  Do they help keep telomeres longer?  In fact, there is evidence that nutritional supplementation is protective and that those who take supplements do have longer telomeres.  Shaklee presented research showing that those who took Shaklee supplements for more than 5 years had longer telomeres than those who did not take supplements.

Because of the concerns about mercury in fish, and because mercury has a 60-day half-life in the body I am beginning to recommend that patients take high-quality fish oil capsules rather than eat fatty fish regularly.  If you eat seafood regularly, refer to this chart to choose fish least likely to be contaminated with mercury.  Also, ask your fish market or restaurant whether they sell fish that is sustainably sourced or refer to the Seafood Watch app by the Monterey Bay Aquarium.

There is also evidence that resveratrol delays aging in human cells by protecting DNA and through antioxidant mechanisms.  Resveratrol is a powerful antioxidant found in the skins of red wine grapes.  Click here to see which resveratrol supplement I take (bet you can guess!).

Telomeres are a marker of cellular aging and there’s a lot you can do to protect yours.  Clean up your diet (and think about supplementing), get out and move more, sleep more, stress less and don’t smoke.

QUESTION:  If you had to guess, would you think your telomeres are longer or shorter than the average for someone your chronological age?


Is Fasting Good For You?

What if you could lose weight and reduce the risk of problems like heart disease and diabetes by going without food a few days per week?  That’s what a lot of current diet trends promise.

As I wrote in a previous post, intermittent fasting can be a safe and effect method of weight loss.  But is fasting good for you?  Does it improve your health beyond helping you lose weight?  I found a wonderful review article published in 2014 that goes over many of the benefits of fasting.  You can find this article at this link.

There is a fair amount of evidence that fasting improves glucose tolerance and insulin resistance in normal and diabetic subjects.  Both women and men showed improvement in these metabolic markers.  Insulin resistance is central to diabetes and thought to play a role in numerous other illnesses such as heart disease, high cholesterol and fatty liver disease.

It appears that fasting is helpful in inflammatory conditions like rheumatoid arthritis and also in patients with high blood pressure.

Fasting also seems to be beneficial to cancer patients undergoing chemotherapy treatment for their cancer.  It’s thought that fasting puts healthy cells into a protected state because they have lots of ways to cope with calorie restriction but cancer cells don’t.  They get stressed and are more sensitive to chemo.

One of the most exciting lines of research seems to indicate that fasting slows the aging process.  It appears to slow the production of markers inside cells that cause the cells to age faster.  These markers are called AGE products (Advanced Glycation End Products) and sort of gum up the cells’ metabolic machinery.  Eventually the cells are damaged to the point of dying and are replaced by the body.  Fasting changes the environment both inside and outside the cells which helps clear AGE products faster.

This may also explain in part why fasting helps preserve neurocognitive function.  The vast majority of these studies have been done in animals.  However, there are small studies in humans that suggest both calorie restriction and the use of a low-glycemic diet are helpful in older adults with memory and cognitive problems.  More research is on the way!

However, fasting isn’t safe for everyone.  Children, pregnant women and frail elderly people as a rule should not undertake fasts.  Diabetics who use insulin or certain oral medications and those who are prone to hypoglycemia should definitely NOT try intermittent fasting without supervision from a doctor familiar both with their unique medical condition and with fasting as a medical intervention.

There is also one other pitfall to fasting.  As published in the Journal of Nutrition, people who fasted were hungrier after fasting and more apt to eat too much if told to eat whatever they want.  This makes sense, right?  It’s not an insurmountable problem, though.  If you’ve been fasting, make sure to eat nutritious, low-calorie-density, bulky foods like fresh fruits and nonstarchy vegetables, brown rice and whole grains as your foods of choice immediately after finishing your fast.  This will make you less likely to overeat in the day or two after your fast is complete.

There are a lot of ways to do intermittent fasting.  The first one that I recommend to people is to simply not eat for 12 hours per day (such as from 7 PM to 7 AM).  This also tends to get around people’s weakness for snacking in front of the TV late at night.

There are other intermittent fasting programs where the person avoids calories altogether or takes a very small amount of calories on some days, but eats normally on other days.  There are many popular programs which I won’t go into.

If you want to try intermittent fasting for weight loss and health benefits, first check with your doctor to see if it would be safe to do so.  Then please let me know how it works for you!


The Placebo Effect

So here’s a hypothetical situation.  You’re sick and you go to the doctor who examines you and tells you what he thinks is wrong.  He writes a prescription for some medicine which you take to the pharmacy.  You take your medicine home and take it faithfully as directed.  You get better and go on with your life.

Would it later upset you to know your prescription told the pharmacist to give you sugar pills?

It was fairly common practice in the past for doctors, when faced with an illness for which there was no treatment, to prescribe what is called a placebo.  A placebo is a treatment with no active ingredients.  Sugar pills, flavored syrup, salt solution that stings when you inject it, there are a lot of ways to make patients THINK you’re giving them medication when you’re actually not.

Guess what.  A lot of the time, the placebo works.  It works, and the patient gets better.

Sometimes it’s because the illness itself was self-limited and was destined to resolve on its own.  Often, though, it’s because the human mind is VERY powerful.  If the mind creates the right environment for healing (i.e. if you KNOW you’re getting better) often the body goes along with the program.

This placebo effect is so powerful that scientific studies of medications are nearly always “placebo controlled,” meaning the treatment being tested is compared against a placebo.  Even acupuncture trials are placebo controlled, meaning treatment is compared to “sham needling” where the acupuncturist places needles in spots that are not acupuncture points.

In medicine we often skip straight to the therapeutic effect, meaning we ask how much better than placebo is the new medication or treatment.  What we miss, though, is how shockingly large the placebo effect can be!

Here is an example:  A study published in 2015 compared a nutritional supplement to placebo in decreasing migraine frequency and severity.  There was improvement in both arms of the study!  They gave migraine sufferers (getting an average of 6+ migraines per month, yikes!) a sugar pill and their migraines improved.  Not a lot, but they improved.  As a migraine sufferer myself, this is amazing!

As amazing as the placebo effect is, I want to add a word of caution.  Like many other powerful things (think sunlight and caffeine, LOL!) the power of the mind can be used for good or evil.  The placebo effect refers to the power of the mind to achieve health and healing.

The NOCEBO effect is defined as the power of the mind to hurt you.  The mind is able to create illness and misery.

Here is a good example.  I prescribe statin drugs for treatment of cholesterol and prevention of heart attacks.  Everybody is concerned about the possibility of muscle pain and weakness with the statin drugs.  For many of my patients it’s a hard sell getting them to consider taking these drugs that will significantly decrease their risk of having a heart attack or stroke.

I looked up the research on just how often patients in the early days of statin use experienced muscle pain with the drugs.  (If you want to read the gobbledygook, LOL, you’re welcome to check this link.)  In the initial trials of this medication when Merck (the company that developed the drug Zocor or simvastatin) was asking for approval of their new drug, the risk of muscle pain for patients treated with the highest dose of simvastatin was 0.61%.  That means 6 in 1000 patients developed muscle pain with the highest dose of the statin most likely to cause muscle pain.

I do not need to poll my medical colleagues to know that the percent of patients that experience muscle pain with statin use is MUCH higher than 0.6%.  In fact, I tell my patients that in my experience about 1 in 10 patients will develop muscle pain, meaning 9 in 10 will do just fine.  I haven’t done research about that, that’s just my quick-and-dirty sense of how my patients do with these drugs.  That’s ten times the rate researchers saw when nobody knew anything about statin drugs.

My sense of the reason behind the difference is that it’s the nocebo effect.  People are aware of statins and the risk of side effects.  A long list of possible side effects is printed on your drug information that you get with your prescription at the pharmacy.  Heck, you can’t watch TV in the evening without being bombarded with a gazillion potential side effects (including death!) with every pharmaceutical commercial.

Please be aware of the power of your mind.  Your expectations and your perspective determine your reality.  If you KNOW your doctor’s treatment will help you, you are probably right.  If you KNOW the treatment will hurt you, you’re probably right about that too.

If your doctor wants you to take medication or undergo a treatment, please make sure you know exactly why that treatment is expected to help you, how likely there are to be side effects and which side effects you could reasonably expect.  Also, find out what your doctor wants you to do if you DO develop a side effect or problem with the treatment.  Be an active partner in your treatment which will reduce the risk of problems.

Your mind is very powerful.  As Uncle Ben advised Peter Parker in the movie Spider-Man, “With great power comes great responsibility.”  Make sure you are using your power for good!