How To Reverse Fatty Liver…

Your liver is the ultimate swiss army knife of organs; it’s a detoxifier, metabolizer, and nutrient warehouse. But in today’s world of endless buffets and sedentary scrollathons, this 1.5 kilogram organ is screaming for a break. It surprised me actually to learn that non-alcoholic fatty liver disease (NAFLD) is pretty common, with 1 in 3 adults now hosting a lipid-stuffed liver.

“Fatty liver” isn’t just “a bit of fat”, it’s a metabolic cascade of unfun stuff.

First fat infiltrates hepatocytes (liver cells) followed by inflammation mediated by the immune system. The next stage involves a process known as fibrosis, where collagen patches the damage, turning liver tissue into a scarred veteran.

Saving your liver from itself

1. Diet: Antioxidant rich

• Swap saturated fats for monounsaturated (MUFA) and omega-3s. MUFA-rich diets can help reduce liver fat (think olive oil)

• Coffee (Yes, coffee): 3 cups/day lowers fibrosis risk (likely due to a combination of polyphenols in coffee and caffeine blocks TGF-β, a scarring promoter)

2. Weight loss: 

Weight loss helps to:

• Reduce visceral fat and thus steatosis (that fatty infiltration of the liver)

• Reduce inflammation and early fibrosis

N.B no crash diets, but slow and steady fat loss (if needed) improves your metabolic profile if you have NAFLD 

3. Move like your liver depends on it 

• Aerobic exercise: 150mins/week of brisk walking is associated with a reduction in liver fat

• Resistance training: Builds muscle, which soaks up blood glucose like a metabolic sponge

• NEAT (Non-Exercise Activity): Fidget, stand, pace; the extra calorie burn also contributes to improved metabolic profile 

4. Sleep: The liver’s detox shift

Chronic sleep deprivation spikes cortisol which drives increased glucose production and fat storage. Good sleep gives your liver plenty of time to do it’s spring cleaning during the REM phase.

Why does the above sort of work..!

• Insulin sensitivity: Through movement, diet and making other swaps, you help to activate AMPK, which is a enzyme that tells your liver to stop hoarding fat. Win.

• Microbiome fix: As the unofficial leader of the cult of fibre, this stuff is gold dust. Not only does it contribute to lowering LDL cholesterol (which obviously in excess can contribute to that liver fat deposition) but fibre feeds Bifidobacterium and other beneficial microbes in your gut which produces butyrate; a compound that lowers liver inflammation via the Gut-Liver axis (I spoke about this in depth on a previous newsletter!)

We’ve engineered a world where kale and chia seeds are a lifestyle choice and Netflix is a cardio substitute but don’t provoke your health anxieties just yet because reversing fatty liver isn’t about perfection and being the picture of health…it’s simply about less self-sabotage. 

Think of your liver as the canary in the metabolic coal mine: if it’s choking, so is the rest of you.

TL;DR: Eat more plants, move often, sleep deep, and treat your liver like the VIP it is. 

Try Eating Early…

You might be a morning lark, night owl or somewhere in between but in general… your gut is still a “morning person”.

Your gut, whilst pretty flexible and accommodating to the things we shove down it, definitely isn’t a 24/7 buffet; it’s a meticulously scheduled factory where timing is everything. 

Imagine your liver, pancreas, and gut microbes as shift workers: they clock in at dawn, peak by noon, and start filing out by sunset (in very broad strokes, your digestive function peaks somewhere in the early part of the day).

To elaborate on this a tad more, it’s because your digestive organs and their constituent cells actually have little “internal clocks” too which tell the time.

Ignore this schedule, and your metabolism descends into a productivity meltdown… and your reward is a higher chance of acid reflux, bloating or a slice of constipation.

The case for chrono-nutrition (i.e meal timing)

In a landmark 2023 Harvard study (PMID: 36198293), participants ate identical meals but split their calories differently:

• Group 1: 50% of calories at breakfast, 30% at lunch, 20% at dinner.

• Group 2: 20% at breakfast, 30% at lunch, 50% at dinner

Results after 12 weeks:

• Group 1 lost 10% more body fat and saw 27% better insulin sensitivity.

• Group 2 had higher nighttime glucose spikes (↑18%) and reported more bloating/reflux

Your body processes food 25–30% more efficiently in the morning, when insulin sensitivity and enzyme activity peak. By nightfall, your gut is running on fumes, and your pancreas is metaphorically flipping the “closed” sign.

The science of chrononutrition: AKA your gut’s work rota 

1. Morning Shift (6 AM–3 PM):

   • Enzyme rush: Amylase (carb digestion), lipase (fat breakdown), and pepsin (protein shredder) peak here

   • Microbiome day shift: These little critters also are sticklers for timing and perform their peak roles during the day, i.e ferment fibre into short chain fatty acids, fueling colon cells and reducing inflammation

   • Metabolic prime time: Insulin sensitivity is highest, so glucose is swiftly shuttled into muscles, not fat cells

2. Night Shift (8 PM–6 AM):

   • Digestive downtime: Gastric emptying slows by 30%, leaving food to ferment like forgotten leftovers

   • Acid reflux roulette: The lower esophageal sphincter (LES) relaxes at night, letting stomach acid creep upward

The risk of late-night food binges

That 9 PM pizza isn’t just a “cheat meal”... it can have pretty profound impacts on general health:

• Sluggish digestion: It takes around 90 minutes from 50% of your stomach content to empty into your small intestine. Eating too close to bed means food lingers 2–3 hours longer, becoming an unnecessary snack for your bacteria who will begin to ferment this food (think feeding gremlins after dark and with more bloating) 

• Sleep sabotage: Digesting food elevates core body temperature, disrupting REM sleep (the “detox” phase for your brain)

If you want to learn more about precision nutrition, the new science of chrononutrition and gut health check out my recent podcast episode:

Breastfeeding & Endometriosis…

I was recently directed to a couple of interesting studies about endometriosis and breastfeeding… and the weird link between the two. (PMID: 34682348)

Now, before you start picturing breastfeeding as a cure-all for every female woe, let’s get one thing clarified: neither pregnancy nor breastfeeding are miracle treatments for endometriosis. In some cases they’ve been shown to be more like a temporary respite; a bittersweet intermission in the ongoing drama that is endometriosis. 

One study from 2021 showed that if you have endometriosis and become pregnant, exclusively breastfeeding for 6-8 months can give you a notable, albeit temporary, reduction in symptoms. A fleeting ceasefire in the hormonal battlefield if you will.

This study followed 123 endo patients from before pregnancy to 24 months after childbirth. On average, women resumed their menstrual cycles about six months postpartum. Interestingly, those who exclusively breastfed for 6-8 months experienced a significant drop in painful periods, with dysmenorrhea remaining below pre-pregnancy levels even 24 months later!

Chronic pelvic pain, that relentless throb, was also curbed; lasting up to 12 months post-delivery. 

So what’s driving all this? 

It appears that breastfeeding ramps up prolactin production, which in turn lowers systemic estrogen levels. Lower estrogen means theoretically less fuel for the endometrial tissue to thrive on; at least on a systemic level. (Admittedly, endometriosis can be a bit of a rebel, producing its own estrogen locally, so this hormonal tug-of-war doesn’t always play out perfectly.) 

The lasting benefits observed in the study suggest that these hormonal shifts during breastfeeding might kickstart changes in endometriosis-related pain and even shrink lesions in some cases. In fact, among 51 patients with ovarian endometriomas, 17 saw their cysts shrink by an average of 2.7 cm! Though it remains unclear whether this was due solely to breastfeeding or to pregnancy itself.

And if you’re wondering whether breastfeeding benefits extend to the little ones, you’re in luck. Another meta-analysis (PMID: 36282195) found that infants who were breastfed have about a 33% lower risk of developing endometriosis later in life. The secret sauce? Possibly the immune-boosting properties of breast milk and its subtle influence on gene expression, perhaps driven by some microbiome related changes (lots of maybes, possibly and potentiallys…but that is science!).

It seems our earliest meals might set the stage for a healthier future, even if we don’t fully understand how just yet.

Don’t Blueprint Your Life…

When I was 13 years old, I basically had to make decisions at that tender age that would go on to shape the next 20 years of my life. (Damn my desire to be a doctor… why couldn’t I be a normal kid and want to be an astronaut?!)

In the UK and probably most countries around the world you have to decide fairly early if you want a medical career and then pretty quickly decide your subject choices in school, extra-curricular activities and other major life choices well in advance.

I’ve come to realise that I’ve been following some variation of an arbitrary societal career path my entire life. What’s clear to me now is that life is less a blueprint to be followed and more a garden to be tended, where growth occurs in unexpected directions. 

Rather than planning your life with the rigidity of a machine; setting fixed paths and predetermined endpoints… it may be wiser to let your journey unfold organically, like the sprawling branches of an ancient tree. 

This tree (i.e you and your career) grows not according to a fixed plan but in response to its own inner urges, adapting to the soil, the sunlight, and the unseen forces that shape its form.

Bringing it back from the nebulous tree concept, what I mean is that we often set long-term goals as if they were immutable destinations, yet these goals should serve only as gentle guides. A goal is a tool for creating coherence in your existence, a beacon that lights the way without confining your steps to a narrow set path. 

For instance, my ambition is to educate people about health. That goal, in its simplest form, is a direction… a call to explore ideas and to express myself. The danger arises when a goal morphs into a rigid vision, when we become so fixated on the final design that we lose the flexibility to adapt to life’s unpredictable currents.

Instead… notice the little things that ignite your passion and find ways to weave them into the fabric of your daily routine.

The irony is that our education systems and society compel us to fixate on distant visions, demanding decisions about our futures with scant feedback until it’s too late to course correct (e.g. a career in medicine).

They want us to commit to a plan years in advance without knowing the intricate details of the journey ahead. Have aspirations, but hold them loosely, allowing room for recalibration as new experiences and insights emerge.

At Home IBS Tools…

Living with IBS is like one of those snowglobes. One minute, your gut is calm; the next someone has violently rattled the snowglobe and it’s a chaotic haze of gut disturbance. 

But there are evidence-based strategies you can implement right at home to reclaim a bit of order in the chaos. Here’s a mini-deep dive into a few science-backed tools for managing IBS symptoms, along with practical tips on who would benefit most from each (because again IBS shouldn’t be considered a catch all term as the symptoms can vary so much person to person!)

1. Gut-directed mindfulness 

Best for:

• Daily bloating or abdominal pain that seems tied to stress
  
  

• IBS flares triggered by anxiety
  
  

Emerging research suggests that mindfulness meditation can modulate the brain-gut axis; essentially retraining your nervous system to soothe an overactive gut. A 2021 study in the American Journal of Gastroenterology found that mindfulness-based interventions reduced IBS symptom severity by calming stress-induced gut responses. Think of it as meditation for your gut nerves, a low-key yet powerful de-stressing tool that helps you ride out flare-ups.

Tip: There are now many IBS dedicated apps which focus on the gut-brain connection or you can do it the old fashioned way. Even 10 minutes can set a calm tone for the day and help keep your gut in check.

2. Low FODMAP Diet

Best for:

• Excessive gas, bloating, or diarrhea
  
  

• Feeling like your meals leave you as stuffed as a turkey
  
  

Numerous meta-analyses, have confirmed that a low FODMAP diet can significantly reduce IBS symptoms. The strategy involves eliminating high-FODMAP foods (like garlic, onions, apples, and wheat) for 2–6 weeks, then reintroducing them slowly to pinpoint your triggers. Remember, it’s not a permanent ban; it’s a diagnostic tool that helps you learn what your gut dislikes.

Tip: Consult with a dietitian to design your low FODMAP plan. Keep a food diary to track symptoms as you reintroduce foods weekly.

3. Cognitive Behavioral Therapy (CBT) for IBS

Best for:

• IBS flares during stressful times
  
  

• Those who’re always anxious about finding a bathroom
  
  

• Individuals with health anxiety or fear around eating
  
  

CBT has been shown to disrupt the vicious cycle of stress and IBS symptoms. A meta-analysis published in Journal of Psychosomatic Research highlighted CBT’s effectiveness in reducing both pain and anxiety in IBS sufferers. By reshaping how you think about and respond to your symptoms, CBT helps you feel more in control; without needing to schedule an appointment with a therapist every week.

Tip: Try a CBT-based self-help program or guided online course. Consistency is key: dedicate time each week to practice these techniques.

4. Magnesium supplementation

Best for:

• Those battling constipation
  
  

• Individuals who also struggle with poor sleep or heightened anxiety
  
  

Magnesium plays a crucial role in muscle function, including the smooth muscles of your gut. Research indicates that magnesium oxide can gently support daily regularity, while magnesium citrate offers a bit more oomph for tougher cases of constipation. Moreover, magnesium has been associated with improved sleep and reduced anxiety, making it a multi-tasker in your IBS toolbox.

Tip: Start with a low dose (e.g., 200-300 mg of magnesium oxide) daily, and adjust as needed. Always check with your healthcare provider to ensure it’s right for you.

5. Soluble fibre (e.g., Psyllium Husk)

Best for:

• Those with mild constipation or diarrhea
  
  

• Individuals who bloat when taking other types of fiber
  
  

• If your bowels feel erratic and you crave consistency
  
  

Soluble fibers like psyllium husk absorb water and form a gel that can help normalize bowel movements. A well-cited study in the American Journal of Clinical Nutrition demonstrated that psyllium improves bowel regularity and reduces IBS symptoms. It’s gentle on the system and, if taken in the right amount, can provide stability without causing excess gas.

Tip: Mix a teaspoon of psyllium husk in water or your morning smoothie, and follow up with another glass of water. Consistency is critical to see lasting benefits.

6. Peppermint oil

Best for:

• Those suffering from cramping, spasms, or sharp abdominal pain
  
  

• Individuals with diarrhea-predominant IBS (IBS-D)
  
  

• If you want natural pain relief without reaching for medication
  
  

Peppermint oil has long been recognized for its antispasmodic properties. A systematic review in the Journal of Gastroenterology and Hepatology found that peppermint oil can significantly reduce abdominal pain in IBS patients by relaxing the muscles in the gut. It’s a natural remedy that works by soothing your digestive tract, providing relief without the side effects that some medications carry.

Tip: Try enteric-coated peppermint oil capsules with meals; start with one dose per day and increase as tolerated. They can be an effective, natural way to reduce cramping.

How Much Protein You Need According To Your Age…

Over the last 10-15 years it seemed the entire world slowly became initiated into the cult of protein. Protein in chocolate bars, cereals and even sauces! 

I think whilst our protein tunnel vision has some downsides (namely we could risk losing focus on other important nutrients like fibres), I think the awareness of eating more protein is a net positive….BUT

…and there's always a but. Nutrition isn’t fixed and your protein requirements change as you age. The people who need it the most are the ones who are skimping on protein are the ones who need it the most. 

Whilst the youth turn protein into a religion by slinging bars, shakes, and powders like it’s a holy sacrament; older adults are somehow missing the mark. 

Why does this matter? Well, protein isn’t just a nutrient; it’s the raw material for our body’s repair and renewal. As we age, our bodies become less efficient at transforming the protein we eat into the building blocks of muscle; a phenomenon known as anabolic resistance. Essentially, your body’s protein factory starts to run on old, outdated machinery, meaning that simply eating the same amount you did in your twenties won’t cut it anymore.

And not forget the sneaky specter of sarcopenia; the natural, and often accelerated, loss of muscle mass that creeps in with age. To put it bluntly: as we grow older, our muscles and strength take a hit, especially after menopause when hormonal shifts (think lower testosterone and estrogen) kick into high gear. 

Muscle loss in older adults can be dramatic; sometimes over three percent per year…leading to a vicious cycle where low muscle mass increases the risk of falls, which then lead to surgeries, hospital stays, and even more muscle loss.

So, how much protein do you really need? The baseline is around 0.75 grams per kilogram of body weight per day; roughly 50 grams for someone weighing 65 kilograms. But let’s be honest: that’s just enough to avoid outright malnutrition. 

Young adults tend to chow down around 1.2 grams per kilogram daily, and as we age, the requirement goes up. Middle-aged and elderly individuals often benefit from around 1 to 1.2 grams per kilogram, with some experts suggesting as high as 1.5 grams per kilogram for those at risk of muscle loss and for those engaging in resistance training wishing to build muscle. For a 65kg person, that means nearly 100 grams of protein a day.

The issue here is that a well-distributed protein intake throughout the day might be even more beneficial. While most people cram most of their protein into that heavy, late-night dinner, the morning meal is where we chronically under-deliver. Instead of a bowl of cereal or a slice of toast, imagine starting your day with a protein-packed breakfast…you’re setting yourself up for sustained muscle health throughout the day.