The world is rediscovering what holistic medicine has held for centuries, that digestive health lies at the core of our well-being. Diabetes is now also being recognized as a digestive and dietary disorder. Digestion and nutrition however does not end with the gut, and is highly dependent on the function of the liver. When I work with patients dealing with fatty or malfunctioning liver, their diabetes improves dramatically too!
While the liver carries out hundreds of important tasks for the healthy functioning of the body, here are some ways it directly impacts diabetics:
The liver is an insulin dependent organ, and diabetes is a condition where either the secretion or function of insulin is faulty. Insulin is the hormone, which signals that glucose needs to be absorbed from the bloodstream into the cells. When blood glucose is high like after a meal, so is insulin, and this informs the liver to ‘mop up’ the glucose and store it for later use. Later, when blood glucose and insulin is low, the liver understands that it needs to release stored glucose for energy. In diabetics, this two-way communication is malfunctional, either because there is not enough insulin being produced, or because the liver is not able to sense the presence of insulin. So even when blood glucose is already high, the liver will continue to release more glucose, causing a hyperglycemia (too much glucose in the blood). This is why diabetics often wake up with very high glucose levels in the morning after a night of fasting, something called ‘ the dawn phenomenon ’.
Sometimes stored glucose may be running low, while blood glucose levels are fine. The liver however misinterprets this as a need for more glucose and begins to break down stored fat into energy instead of glucose. This process results in an excess of ketones (waste products of fat) which can cause a toxic and dangerous condition called diabetic ketoacidosis.
Finally, long term diabetes often targets the kidneys first. The liver and the kidneys share the burden of removing toxins and when the liver is not able to do its job, some of its work is shifted to the kidneys, which may already have declined in function. Therefore it is particularly important for diabetics to maintain a healthy liver in order to ensure toxins are removed and to prevent diabetic nephropathy, potential further deterioration of the kidneys.
Diabetes is an independent risk factor for cardiovascular disease (CVD, or disease of the heart and arteries) and stroke. This is due in large part to atherosclerosis, which is the narrowing of arteries when plaque made of fat, cholesterol, and other substances builds up in the arteries. This is linked to levels of HDL or ‘good cholesterol,’ which is associated with lower risk of CVD, and LDL or ‘bad cholesterol’, which is associated with a higher risk of CVD. Diabetes often changes the good to bad cholesterol ratio for the worse. The liver is responsible for both the production of HDL (along with the small intestine) and the removal of LDL and excess cholesterol, and is therefore crucial in the prevention of arterial and heart disease. Lower levels of HDL are also associated with an increased risk of developing diabetes type II.
One of the first pieces of advice given to diabetics is to lose weight if they are overweight. Adding more difficulty to the task is a poorly functioning liver. The role of the liver in regulating fats in the body is even more versatile than with sugars. Bile, which is necessary for the digestion of fats is produced and secreted from the liver. When bile flow is decreased or slowed, fat is not properly metabolized and ends up being stored in fatty tissue, leading to weight gain. The hormones which are central to metabolism are also made up of fats and cholesterol, and require the liver to provide the building blocks for their synthesis. When this function is compromised, hormonal imbalances arise, which result in great difficulty to lose weight even with a healthy diet and regular exercise. Also, certain fat soluble (transported and stored only in fat) vitamins are necessary to maintain a healthy weight. Specifically, vitamin D deficiency has been linked to obesity, insulin resistance, and diabetes possibly because it is necessary for insulin secretion. It also impacts healthy function of the gut, resulting in further nutrient depletion which again results in decreased metabolism.
Non-alcoholic fatty liver disease (NFLD) is a condition of excess fat in the liver which can play a role in acquiring diabetes, or be a consequence of diabetes. The worsening of this condition can lead to cirrhosis, liver cancer, and heart disease. Maintaining a healthy weight and being able to metabolize fats plays a significant role in prevention and reversal of fatty liver and diabetes.
As always, the best way to improve health is through nutrition and physical movement. Some of the best foods and spices to ensure proper liver function are the following:
Rigorous sessions at the gym are not required for a quality lifestyle, but sitting for most of the day can cause havoc. Spending enough time standing, a daily fast paced one-hour walk or yoga (even just sun salutations) increases blood flow to the liver which enhances its, and consequently your everyday performance.
Silybum Marianum or Milk Thistle, is a plant that has been used for liver therapy for more than 2000 years. It not only has the capacity to detox the liver but to generate new and healthy cells. It is also used to decongest the liver, by increasing bile production and flow. This makes it very beneficial for diabetics by aiding in digestion and ensuring the kidneys are not overworked. Although powerful, it has no or mild side effects. A daily dose of 100-125 mg once to thrice a day serves as an excellent aid in both reversing diabetes, and preventing further complications of the disease. Please take only under the advice of a physician, after ensuring there are no contraindications.
Editor’s Note: Chronic disease reversal is all about sticking with lifestyle changes and hearing how others did it is the best inspiration!
1.American Liver Foundation. Prevention of Liver Disease. Accessed January 9, 2002
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3.Christian M Girgis, Roderick J Clifton‐Bligh, Nigel Turner, Sue Lynn Lau, Jenny E Gunton. 2014. “Effects of Vitamin D in Skeletal muscle: falls, strength, athletic performance and insulin sensitivity” in Clinical endoctrinology , vol.80 (2) pp.169-181
http://www.medscape.com/viewarticle/85012210. Smith BW, et al. Nonalcoholic liver disease and diabetes mellitus: Pathogenesis and treatment. Nature Reviews Endocrinology. 2011;7:456.
Ahmadieh H, et al. Liver disease and diabetes: Association, pathophysiology, and management. Diabetes Research and Clinical Practice. 2014;104:5312.Steven Foster Group. The Milk Thistle Silybum marianum. Accessed January 2, 2002