#58: Jeffrey Fine, MD- Balancing the Gut-Liver-Axis Through Nutrition and Lifestyle Changes

 

About Dr. Jeffery Fine

Dr. Jeffrey Fine is the Chief of Gastroenterology for the Medical and Surgical Clinic of Irving.  He is a board certified gastroenterologist with over 20 years of medical experience. Dr. Fine specializes in the diagnosis and treatment of digestive and liver diseases, gastrointestinal endoscopy, hemorrhoid treatment and food sensitivities.

Connecting with Dr. Fine

Website  http://www.drfoodsensitivity.com/

Link Discussed

Drug-Induced Liver Injury Network  http://www.dilin.org/

Show Notes

02:08 Dr. Fine’s Integrative Journey: One day he had an epiphany and realized that as a gastroenterologist, he was a food sensitivity specialist. Even before medical school, Dr. Fine had a personal interest in food sensitivities. He is lactose intolerant, taking probiotics and staying primarily lactose free for over 20 – 30 years. Because he takes the probiotics, he can have lactose, but he chooses not to. He tells his patients that they need to keep their gut bacteria happy, because they have us outnumbered 100 to 1. As a gastroenterologist in an allopathic world, he must think outside the box as he looks at the evidence and utilizes his experience.

07:02 Prevalence of GI Disorders: Dr. Fine deals with the area from the esophagus to the liver. Liver disease constitutes 10 to 25% of his practice. He treats anything from fatty liver to Hep C, Hep B, Hep A, genetic disorders like hemochromatosis, and autoimmune liver diseases. The most common liver disease he treats is fatty liver.

08:25 Fatty Liver: When those of us with a genetic susceptibility take in too much sugar, the fatty acids are deposited in the liver in the form of triglycerides. Fatty liver is the quadrafecta of glucose intolerance, fatty liver, hyperlipidemia, and heart disease. Diabetics have a 5x greater incidence of Alzheimer’s disease.  Many times this can be reversed, but, sadly, many do not do the work to make it happen.

11:23 Recommended Testing: The traditional Liver Function Test does not test liver function.  Generally, Dr. Fine looks at the AST/ ALT ratio and totals, albumin, total bilirubin, alkaline phosphatase, GGT, and also the complete blood count because the white and red blood cell count and platelet count are important. Optimal number results are different for women and then they are for men. If he suspects more advanced liver disease, he checks coagulation profiles. He may also look at fasting insulin levels and have an abdominal ultrasound done. They may also do a body impedance analysis and a body composition to illustrate to the patient just how much fat they have.  Not only is there fat around and inside the organs, but the organs are being crushed by the surrounding fat.  Sometimes the only way to relieve pain is to lose weight. When patients have elevated liver enzymes, they are checked for genetic diseases, viral diseases and other things. Anyone with cirrhosis is screened for liver cancer and they do an upper endoscopy to check for esophageal varices. Thirty to 50% will have varices (bleeding) and a good number of them will require intervention.  At least 30% of diabetics have liver disease.

23:39 Liver Functions: The liver is in charge of glycogen storage, lipid metabolism, and cholesterol metabolism. Cholesterol is the precursor for all hormones and vitamin D. The liver detoxifies the blood. It clears blood by 2 liters per minute. Those of us with more advanced liver disease; a poorly functioning liver sends poisons to the brain. It is called hepatic encephalopathy and causes altered mental status. According to the Drug-Induced Liver Injury Network, some cases of liver failure comes from supplements.

26:16 Liver Disease Lifestyle Protocols: Liver disease often does not have overt symptoms. It is often discovered during the exploration for other health issues. When liver disease is discovered, we need to stop drinking alcohol. Only red wine shows a beneficial effect on the brain, on lipids and potentially cardiac benefit. When alcohol is metabolized, it becomes toxic to the liver. Women absorb more alcohol and have less of the enzyme to metabolize it. Research shows that drinking 2 cups of coffee per day decreases the risk of liver cancer and liver disease.  Only 20% of those of us who chronically over-consume alcohol become cirrhotic. For those of us who consume alcohol while we have compromised liver function, and we take Tylenol, we can end up with Tylenol-induced liver failure. The antidote within a few hours is IV acetylcysteine.

33:34 Gut/Liver Axis: There have been a few cases where they thought that a person was drunk, but instead, their gut microbes were making alcohol. They ferment carbohydrates and making alcohol to the point of autointoxication.  Which microbes were responsible is unknown.  The best remedy is to modify the diet and replenish our microbes. Dr. Fine recommends Probio Defense.

36:34 Pancreas Dysfunction:  Sometimes Dr. Fine sees fatty pancreas, but more often he sees pancreatic inflammation.  As the pancreas ages it becomes atrophic. The pancreas is unforgiving “Don’t piss off your pancreas.” It is a dual organ. It is an endocrine organ that is responsible for glucagon and insulin metabolism, as well as a neuroendocrine organ. It is also an excocrine organ that makes digestive enzymes. When the pancreas becomes inflamed, it starts to autodigest itself.  A severe case can be fatal. Chronic pancreatitis can lead to pancreatic cancer. It is caused by high fructose corn syrup, smoking, and alcohol. Unless the pain is severe, a doctor may not realize that a patient has pancreatitis. It may not be visible on a CT scan, but it may be visible on the endoscopic ultrasound.

42:11 Optimizing Gut, Liver and Pancreas Health: Limit your carbohydrate intake to 40 grams/day. Limit sugar to less than 20 grams per day. Take a Probio Defense (Xymogen) twice per day. Try to eat a high fiber diet with 4 servings of salad and other green leafy vegetables. Eat lean protein. Dr. Fine takes Lipocol and does high intensity and weight training, as well as plays tennis. Consuming medium chain fatty acids, like unsweetened coconut can be beneficial as well.  Drink lots of filtered water. Dr. Fine recommends that we take about 2,000 iu of vitamin D. Turmeric is also good for fatty liver.

45:52 Dr. Fine’s Favorite Supplement:  Dr. Fine’s most important supplement is NRF2. It helps to maintain our internal antioxidant environment.

46:54 One Health Benefit for America: We should all eat right and exercise. It is simple and no extra cost. Supplements are called supplements because they only supplement. The foundation of your health is your diet and exercise.