How did you treat your NAFLD and how long did it take?

zaaku

The prevalence of NAFLD is already widespread and only increasing. The liver is central to metabolism and probably one of the hardest organs to heal.

RP: "The liver, to the extent that it's injured, will ruin the whole organism. It's the chemist for the whole organism."

pikeypilled on X posted their liver score (ALT+AST+GGT) and it was a whopping 36. For reference, mine is 113 and I struggle with bouts of hypoglycemia every 2 hours.

So what did you do to bring your enzyme levels down, improve glycogen storage, and ultimately raise metabolism through the supercharged conversion of T4->T3?

war4512

@zaaku A very specific question, but a lack of specific information. How much do you weigh? Do you have abdominal obesity? What are the proportions of macronutrients in your diet? Do you consume an adequate amount of choline and vitamin B12? What supplements do you take, and what are your levels of triglycerides, cholesterol, TSH, cortisol, insulin, and other relevant metabolic markers? A general recommendation for treating NAFLD is weight loss.

zaaku

@war4512 I was hoping to crowdsource ideas to try myself but personalized suggestions are great too.

I've tried to answer all the questions below:

I weigh 203 pounds (92kg) at 5 feet 10 inches (178cm). I'm overweight and abdominal fat is slightly higher than the rest of the body, but not overly so. I have a little more muscle than a slender person as I used to lift weights.
Till a week ago, I consumed 2800-3000 calories a day with a 64/15/21% C/P/F ratio (448g/100g/64g). I dropped my T4 dose from 50mcg to 25mcg and increased my T3 dose to 20-25mcg almost 3 weeks ago which has led to a decrease in appetite. So this week I've consumed 2300-2500 calories per day in a similar ratio. I'm physically sedentary apart from a 45 minute daily walk. A decent amount of mental work though.
I was consuming 500mg choline via eggs and milk, but added an extra egg 2 days ago to reach 700mg choline per day. 10-11mcg B12 per day.
The past several months I was only taking thyroid, 2-5000 IU vitamin D, and 2mg vitamin K (every few days). This past week I added 300 IU vitamin E and 200mg aspirin daily.

Blood work

Triglycerides:      48mg/dL
Cholesterol, Total: 184mg/dL
Cholesterol, HDL:   68mg/dL
Cholesterol, LDL:   107mg/dL
TSH: 0.05µIU/mL (Used to be 2.3 before thyroid supp)
ALT: 27U/L
AST: 34U/L
GGT: 52U/L
Albumin: 5.06g/dL

I have outdated prolactin, DHEA etc measurements that I should get tested again.

Overall I feel significantly better than I used to and I think treating liver + glycogen storage is the final step for me. Sleep is deep and sound, though I wake up once in the middle to replenish sugar. Digestion is smooth with 1 BM per day (sometimes 2). I'm calm and patient and at peace pretty much all the time though I avoid excursions or putting myself in challenging situations because I know I become hypoglycemic. Even the daily walk with my dog leads to a little hypoglycemia midway through so sometimes I want to, sadly, cut it short.

RP on a diseased liver: “Eliminating all PUFA would be the most important thing, and having lots of orange juice, other sugars including honey, and milk and gelatin. Cytomel, aspirin, acetazolamide, and progesterone all protect the liver and help to slow cancer growth. Some people use extremely large amounts of aspirin, which require supplements of vitamin K, to prevent bleeding. Fibrous foods such as bamboo shoots and laxatives such as cascara help to reduce the absorption of bowel toxins that promote cancer and burden the liver.”

I reread this quote by Peat recently and put more emphasis on the gelatin, cytomel, and aspirin. I was already doing everything else. Found some papers which demonstrate direct effects on liver health in NAFLD – T3 sheds fat and promotes synthesis of glycogen in the liver. Gelatin, Vitamin E, and Aspirin papers here.

Would appreciate any more suggestions.

evan.hinkle

@zaaku on the old forum @haidut had a thread where he mentioned using caffeine to clean out the liver. I myself used this method using 1200mg/day split into three doses of 400mg at breakfast, lunch, and dinner. The effect on glycogen storage is unmistakable in my opinion. After two weeks at this level I’m able to tolerate black coffee on an empty stomach, (a test for glycogen storage) and I can go longer between meals without blood sugar issues.

When I feel my liver function needs a leg up, I do this again. I’ve done it twice, (once a year for the past two years).

zaaku

@evan-hinkle That's great news. Found the thread.

A few questions:

Did you work your way up to 1200mg/day?
How much sugar?
Did you make any changes to your diet during this time?
Did you use any other supplements? B1, K2, magnesium, aspirin, thyroid, etc?
After the two weeks, do you stop caffeine completely or settle at a baseline?
Did you lose or gain any weight during this time?

war4512

@zaaku said in How did you treat your NAFLD and how long did it take?:

Triglycerides: 48mg/dL
Cholesterol, Total: 184mg/dL
Cholesterol, HDL: 68mg/dL
Cholesterol, LDL: 107mg/dL
TSH: 0.05µIU/mL (Used to be 2.3 before thyroid supp)
ALT: 27U/L
AST: 34U/L
GGT: 52U/L
Albumin: 5.06g/dL

Well, it’s likely that your NAFLD is already in an early stage. Continue with a high-carbohydrate diet—your very good triglyceride levels suggest a state of carbosis (preferential and highly efficient carbohydrate metabolism). The area for improvement is definitely excess weight, which you can reduce with an appropriate calorie deficit, leading to a genuine regression of NAFLD.

@zaaku said in How did you treat your NAFLD and how long did it take?:

Overall I feel significantly better than I used to and I think treating liver + glycogen storage is the final step for me. Sleep is deep and sound, though I wake up once in the middle to replenish sugar. Digestion is smooth with 1 BM per day (sometimes 2). I'm calm and patient and at peace pretty much all the time though I avoid excursions or putting myself in challenging situations because I know I become hypoglycemic. Even the daily walk with my dog leads to a little hypoglycemia midway through so sometimes I want to, sadly, cut it short.

Hypoglycemia, simply put, is a stress response. If possible, perform an OGTT (Oral Glucose Tolerance Test) and consider testing C-peptide levels to assess insulin secretion. To improve glycogen storage, you can supplement with creatine and more carefully control selenium intake by increasing the amount of seafood in your diet, especially those rich in copper.

During a walk or any other physical activity, try to consume easily digestible carbohydrates to prevent a stress response.

I also recommend Masterjohn's article. A very valuable tip.

https://chrismasterjohnphd.substack.com/p/start-here-for-fatty-liver-disease-0a3

CrumblingCookie

@zaaku said in How did you treat your NAFLD and how long did it take?:

I was consuming 500mg choline via eggs and milk, but added an extra egg 2 days ago to reach 700mg choline per day.

Consider three to four times as much daily choline.

Consider TUDCA and monoterpenes and CoQ10.
Consider a cholagogic of your choice like sylibine, chlorogenic acid (coffee), coffeine, emodine, artichoke leaf extract, gold coin grass, liquorice.

@zaaku said in How did you treat your NAFLD and how long did it take?:

increased my T3 dose to 20-25mcg almost 3 weeks ago which has led to a decrease in appetite.

Consider the possibly detrimental and exacerbarting impact of additional T3 on an already burdened liver.

zaaku

@war4512 Thank you so much.

zaaku

@CrumblingCookie said in How did you treat your NAFLD and how long did it take?:

Consider three to four times as much daily choline.

Is this recommendation from personal experimentation or from a study? If it's from a study, could you please share it? I couldn't find it.

@CrumblingCookie said in How did you treat your NAFLD and how long did it take?:

Consider TUDCA and monoterpenes and CoQ10.
Consider a cholagogic of your choice like sylibine, chlorogenic acid (coffee), coffeine, emodine, artichoke leaf extract, gold coin grass, liquorice.

Awesome, thanks.

@CrumblingCookie said in How did you treat your NAFLD and how long did it take?:

Consider the possibly detrimental and exacerbarting impact of additional T3 on an already burdened liver.

In my understanding from reading Peat's work and some papers T3 is helpful in energizing the liver. Did you mean T4?

war4512

@zaaku said in How did you treat your NAFLD and how long did it take?:

Is this recommendation from personal experimentation or from a study? If it's from a study, could you please share it? I couldn't find it.

https://chrismasterjohnphd.substack.com/p/does-choline-deficiency-contribute

@zaaku said in How did you treat your NAFLD and how long did it take?:

In my understanding from reading Peat's work and some papers T3 is helpful in energizing the liver. Did you mean T4?

Reply

At low glucose levels, T3 shifts its metabolic effects, promoting catabolic processes. T3 increases glucose utilization, which can result in chronically low glucose levels, leading to the suppression of glycogen synthase expression.

Low glucose levels, in turn, lead to elevated glucagon levels.

Low blood glucose is a precursor to a stress response, further amplified by neurotransmitters and stress hormones.

Compensatory intake of more carbohydrates throughout the day can be highly beneficial, provided that the root cause of all problems is not excessive neurochemical signaling; treating this process will require time.

zaaku

@war4512 said in How did you treat your NAFLD and how long did it take?:

At low glucose levels, T3 shifts its metabolic effects, promoting catabolic processes. T3 increases glucose utilization, which can result in chronically low glucose levels, leading to the suppression of glycogen synthase expression.

Low glucose levels, in turn, lead to elevated glucagon levels.

Low blood glucose is a precursor to a stress response, further amplified by neurotransmitters and stress hormones.

Compensatory intake of more carbohydrates throughout the day can be highly beneficial, provided that the root cause of all problems is not excessive neurochemical signaling; treating this process will require time.

Oh yeah. Being careful with the dosing of T3 (<3mcg per hour or two) and consuming enough carbohydrates seems to be working okay right now. I think T3, alongside the rate of glucose oxidation, also increases the efficiency of glucose oxidation. I've experimented with dosing ~1-2mcg T3 between meals and noticed it increased the amount of time I can stay euthyroid. But I mostly swallow instead of chew the T3 as chewing leads to too fast an increase in metabolism which can make it harder to dose, and prefer to have it with meals.

CrumblingCookie

@war4512 Good replies!

@zaaku said in How did you treat your NAFLD and how long did it take?:

[Consider three to four times as much daily choline.]
Is this recommendation from personal experimentation or from a study?

Own experimentations after having read the available studies. The RDIs and AIs for choline are lamentable.

@CrumblingCookie said in B12:

Without choline, supplementation of B vitamins eventually leads to liver damage (Biskind).