Gut Health & Fatty Liver Disease

What differences do you see compared to the first one?

You can see that the mucus layers have been eroded, allowing bacteria and toxins to be in contact with the intestinal cells. As a result, this disrupts the intestinal wall, leading to bacterial toxins (known as endotoxins) such as LPS leaking to the other side of the intestinal wall and blood stream. This is known as intestinal hyperpermeability, or leaky gut. This triggers the immune system, leading to irritation, or inflammation, not just in the gut, but in other parts of the body too.

This occurs due to a reduction in beneficial bacteria which no longer provide the fuel for the cells to produce mucus, and also due to direct impact on the intestinal wall. These disruptions could occur due to e.g. a poor diet, antibiotics and other medications, stress and poor sleep, pesticides and alcohol intake.

So what does this have to do with MASLD and MASH?

Well, blood from the intestines is circulated to the liver via the hepatic portal vein. So in a healthy gut environment, the liver will receive nutrients following the digestive process. However, in a leaky gut state, endotoxins will be circulated to the liver as well. The endotoxins will trigger the liver immune system, leading to liver cell inflammation, insulin resistance, and eventual fatty liver.

Interestingly, we saw earlier how SCFAs are beneficial to gut health. However, if they are not in the right balance e.g. if there is too much acetate and propionate being produced in comparison to butyrate due to an imbalance in gut bacteria, this could contribute to fat build up in the liver too.

A nutrient called choline is important for the transport of fats out of the liver. However if there are less favourable bacteria in the gut, the choline can be converted into something called trimethylamine (TMA), which reduces choline levels. Additionally, TMA can then be converted into something called TMAO, which can increase the risk of cardiovascular diseases.

Another contributing factor can be bile, or more specifically bile acids. Bile is a liquid produced by the liver and stored in the gall bladder, and has functions such as helping in the digestion process of fats in the diet, and getting rid of bilirubin (a yellow pigment), cholesterol, toxins, medications and hormones. Bile is made up of various components including water, bile salts (made from primary bile acids), cholesterol, amongst other things. It is released by the gallbladder into the small intestine, and in order to not put too much strain on the liver to produce more bile salts, a lot of these are reabsorbed from the gut and taken back to the liver. However, if there are less beneficial bacteria in the gut, the bile salts can be converted into secondary bile acids, which differ from the primary ones made by the liver. These secondary bile acids can lead to increased fat build up in the liver and reduce fat breakdown, and can cause liver inflammation and damage to liver cells, leading to NASH.

So, is there anything we can do to prevent, improve and even reverse MASLD/MASH? Yes!

The key thing is to maintain, improve or rebuild a healthy gut environment by ensuring a diverse range of beneficial bacteria, healthy mucus layers, and a strong gut lining. How can we do this? Here are some tips:

• Feeding good bacteria to allow them to thrive is key. Beneficial bacteria feed on fibres, in particularly prebiotic fibres, which are found in fruits, vegetables, whole grains, legumes, nuts and seeds. The SCFA balance as a result will contribute to a strong gut lining and protective mucus layer. Additionally, these food sources contain plant nutrients (phytonutrients) which good bacteria also benefit from. So a diet rich in a diverse range of whole plant foods is important
• Include choline rich foods such as cruciferous vegetables and legumes
• Reducing/minimising processed foods, fast foods, animal products is also important, as these foods can imbalance bacteria in the gut, eventually contributing to a leaky gut, inflammation and disease
• Eating as organic as possible is important, as pesticides can also impact good gut bacteria levels. For more guidance on the must buy organic foods, please take a look at https://www.pan-uk.org/dirty-dozen/
• Be mindful of alcohol intake as this can also impact on gut and liver health
• Only use medications such as antibiotics and ibuprofen if really necessary and under the guidance of your doctor, as these can impact on the diversity of beneficial bacteria and the intestinal lining
• Manage stress, as chronic stress can contribute to a leaky gut. Meditation, yoga and vagus nerve exercises are a few ways to help you relax more. Additionally, magnesium supplements or salt baths, chamomile tea and L-theanine can aid relaxation
• Ensuring good sleep is vital in order to help the body regenerate, and again to reduce the risk of excess stress chemical exposure. Relaxation methods as mentioned above, reading, lavender essential oil, avoiding/limiting caffeine, not eating too late, minimising blue light exposure from screens by using blue light filters, and doing anything that helps you wind down can help with good sleep.
• Regular exercise can help improve beneficial bacterial diversity, strengthen the gut lining, reduce inflammation and increase SCFA levels
• Supplements such as probiotics, prebiotics, polyphenol plant nutrients, butyrate, omega-3, curcumin (from turmeric), vitamins and choline can play a role in rebuilding and improving gut and liver health.

And there you have it – an understanding of the importance of the gut in liver health, and strategies to help protect the liver and improve its health.

If you or anyone you know is affected by fatty liver, or any other health problems, then please book a your 15 Minute Discovery Call with us to see how The Green Doctor to see how we can help you.

Book your discover call here: Consultations – The Green Doctor