Fatty Liver Disease

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• Definition
• Introduction
• Signs & Symptoms
• Research Summary

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Executive Summary

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Write an executive summary in the form of a blog article on the topic of "Research into Chinese medicine treatment for Fatty Liver Disease" summarising the research below and using language that can be easily understood by patients and avoiding medical jargon using a professional and caring tone of voice.

Write an executive summary in the form of a blog article on the topic of "Researched Chinese medicine treatments for Fatty Liver Disease" summarising the research below in an objective and easy to understand way, and using language that can be easily understood by patients. Group the article into Chinese medicine treatments first, followed by nutrition and other treatments. Avoid using medical jargon and use a professional and caring tone of voice.

Write me a concise but easy to understand executive summary on the topic of "Chinese medicine treatments for Fatty Liver Disease" based on the following research that I will give you. Your summary should be 2 paragraphs long in Australian English spelling and include references to the studies.

A Randomised Controlled Trial published in 2023 in the journal Nutrition Journal found that Pomegranate peel extract, along with a calorie deficit diet, could improve risk factors of metabolic syndrome and reduce fatty liver in patients with non-alcoholic fatty liver disease. In the first phase, the research involved the hydro-alcoholic extraction of the peel of 750 kilograms of pomegranate using the soaking method. The second phase saw patients with non-alcoholic fatty liver disease divided into two groups - a placebo group and a pomegranate peel capsule group. Both groups followed a diet with a 500 kcal deficit for eight weeks. Aspects like intolerance to the treatment, participants' dietary intake, their lipid and glycemic profiles, blood pressure, body composition, insulin resistance indexes and changes in fatty liver disease evaluated through elastography were monitored. Further, the study reported substantial decreases in multiple indicators such as body weight, waist circumference, body mass index, body fat index, trunk fat, blood pressure, total cholesterol, triglyceride levels, LDL cholesterol, fat free mass, and fasting blood sugar in the group that took pomegranate peel capsules compared to the placebo group. Meanwhile, HDL cholesterol and liver steatosis and stiffness saw improvement. No significant differences, however, were found in the insulin and homeostatic model assessment for insulin resistance between the two groups.

A Animal Study published in 2023 in the journal European Journal of Medicinal Chemistry found that Jin Si Huang Ju tea, a traditional Chinese beverage, contains compounds that potentially reduce lipids, mitigate insulin resistance and reduce liver inflammation in vitro. The researchers identified 14 compounds in the Jinsi Huangju tea using different spectroscopic techniques, 11 of which had not been previously identified in this plant. Two of these compounds, apigenin-7-O-6″-malonylglucoside and luteolin-7-O-6″-malonylglucoside, were synthesized for the first time with a yield of 1.2% over 5 steps. In the findings, the natural compound apigenin-7-O-6″-malonylglucoside was found to inhibit the function of pancreatic lipase, reduce cellular lipid contents, and attenuate insulin resistance when tested in vitro. It was also observed to restore lipid and inflammatory profiles in plasma and the liver, as well as reduce hepatic steatosis in non-alcoholic fatty liver disease (NAFLD) mouse models. Thus, Jinsi Huangju and its active components are strong candidates for the development of drugs or functional foods that could provide a therapeutic strategy for hyperlipidaemia and NAFLD.

A Review Article published in 2022 in the journal Biomedicine & Pharmacotherapy found that Pomegranate extract and its phytochemicals can potentially inhibit severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) and improve gut microbiota, preventing obesity and diabetes. The study employs the use of in silico molecular docking methodologies to demonstrate that extract from pomegranates and their phytochemicals can serve as inhibitors of severe acute respiratory syndrome coronavirus 2's spike protein and the angiotensin-converting enzyme 2 receptor contact. These findings are further reinforced by clinical trials which suggest that pomegranates can also alleviate non-alcoholic fatty liver disease, metabolic syndrome, dental infections, and symptoms of menopause. This study has also identified numerous active compounds within pomegranates such as alkaloids, anthocyanidins, tannins, flavonoids, phenolics, proanthocyanidins, sterols, terpenes, terpenoids, xanthonoids, fatty acids, organic acids, lignans, saccharides, and vitamin C. This mixture of active compounds is believed to significantly contribute to the broad array of pharmacological activities identified within the pomegranate. This includes anti-diabetic, anti-tumor, anti-inflammatory, anti-malaria, anti-fibrotic, anti-fungal, and anti-bacterial effects. The extract from this fruit improves gut microbiota which could potentially aid in the prevention of obesity and diabetes.

A Animal Study published in 2022 in the journal Frontiers in Nutrition found that Cooked adzuki beans contribute notably to preventing obesity and regulating gut microbiota composition, while also alleviating systemic inflammation and metabolic disorders. The methodology involved a controlled experiment where mice were fed diets of varying lipid content: a low-fat diet or a high-fat diet. The specific twist in this experiment was the inclusion or exclusion of cooked adzuki beans to their diet, ensuring 15% of the diet comprised of this. The duration of this dietary regimen was 12 weeks. In the discussion of results, it was discovered that cooked adzuki beans provided key beneficial effects. This included a significant inhibition of weight gain and hepatic steatosis, a reduction in high levels of specific markers such as serum triacylglycerol, alanine aminotransferase, and aspartate aminotransferase, providing a counter to systemic inflammation and metabolism-related endotoxemia commonly found in those consuming a high-fat diet. Moreover, the inclusion of adzuki beans positively affected the gut microbiota composition, reducing fat-inducing bacteria and enriching the gut with beneficial bacteria to help alleviate inflammation and metabolic disorders associated with high-fat diets.

A Randomised Controlled Trial published in 2021 in the journal Phytotherapy Research found that Pomegranate extract supplement shows potential in improving glycemic indicators, serum lipids, anthropometrics, and blood pressure in patients with nonalcoholic fatty liver disease. The study involved 44 patients who had been diagnosed with nonalcoholic fatty liver disease. These individuals were randomly assigned to two groups, with one group receiving two pomegranate extract tablets daily over a period of 12 weeks, and the other a placebo. The researchers measured anthropometric values, serum lipid levels, blood pressure, and glycemic indicators before and after the intervention. In their analysis of the outcomes, the researchers found that the group which received the pomegranate extract showed reductions in total cholesterol, triglyceride levels, the ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol, fasting blood sugar, resistance to insulin, diastolic blood pressure, weight, body mass index, and waist circumference when compared to the placebo group. Additionally, an increase in serum high-density lipoprotein cholesterol was observed within the pomegranate group, indicating the potential utility of this supplement in a treatment regimen for this condition.

A Animal Study published in 2021 in the journal Journal of Integrative Medicine found that Shen Ling Bai Zhu San was found to inhibit inflammatory damage in nonalcoholic fatty liver disease, thus offering potential as a preventive and therapeutic treatment. In the study, rats were put on a high-fat diet, with or without the addition of Shenling Baizhu powder or probiotics. Assessments were made at week 16, using an echo magnetic resonance imaging analyser to examine body composition, a micro-computed tomography imaging system to measure whole body and liver fat, and a laser perfusion imager to study liver microcirculation. After this, the rats were sacrificed and biochemical markers in the blood as well as liver ultrastructure were evaluated. The expression of proteins associated with liver inflammatory signaling pathways were scrutinized via Western blot analysis alongside a high-throughput screening of 29 relevant inflammatory factors in liver tissue. The results indicated that supplementing with Shenling Baizhu powder reduced body weight, serum free fatty acid, and insulin resistance. It also improved liver microcirculation and ultrastructural abnormalities. Quantitative analyses manifested that the treatment lowered fat mass and visceral fat. Moreover, the powder reduced the expression of certain inflammatory signaling pathway-related proteins and modified the expression levels of some inflammatory cytokines found in liver tissues. Thus, indicating that Shenling Baizhu powder could inhibit the activation of inflammatory agents and suppress related expressions, making it potentially beneficial for the prevention and treatment of inflammatory damage and associated diseases.

A Review Article published in 2021 in the journal Chinese Medicine found that With a multi-ingredient and multi-target-pathway pharmacological action, Chinese medicine compounds are compatible with the complex pathogenesis of nonalcoholic fatty liver disease to mitigate it. In the analysis of 88 herbal prescriptions screened out by Ding et al. collected from databases, the top 3 drug combinations are “Hawthorn-Rhizoma Alismatis”, “Rhizoma Alismatis-Radix Salvia Miltiorrhiza” and “Hawthorn-Radix Salvia Miltiorrhiza”, with a high frequency of over 40 in 88 prescriptions. The digestant drug Shan Zha (Hawthorn) mainly improve lipid metabolism and insulin resistance, and protect against oxidative stress in NAFLD. The damp-clearing drug Ze Xie (Rhizoma Alismatis) could alleviate lipidosis as well. Besides, it also has effects on liver regeneration, inflammation and autophagy, which supplement to the effect of Hawthorn. On the other hand, the blood-activating and stasis-eliminating drug Dan Shen (Radix Salvia Miltiorrhiza) have more effects on lipid metabolism, oxidative stress, inflammation, cell death and fibrosis. These are complementary to the effects of Hawthorn and/or Rhizoma Alismatis. As shown in Fig. 3, the combinations of three herbs play a more comprehensive role in treating NAFLD than single herb.

A Systematic Review published in 2021 in the journal Chinese Medicine found that A variety of Chinese herbal medicines have been reported to effectively prevent or treat nonalcoholic fatty liver disease by regulation of the gut microbiota and the gut-liver axis. The key roles of CHMs in the regulation of gut microbiota and the gut-liver axis along with their mechanisms (such as modulating intestinal permeability, reducing the inflammatory response, protecting liver cells, improving lipid metabolism, and modulating nuclear receptors), were well summarized. All the knowledge and information presented here will be very helpful for researchers to better understand the applications and mechanisms of CHMs for treatment of NAFLD.

A Review Article published in 2021 in the journal Pharmacological Research found that Baicalin, a Scutellaria baicalensis extract, has been found to have numerous therapeutic applications in liver and gut diseases by mediating apoptosis and immune response pathways. High-throughput screening and bioinformatics technology were utilized in the extraction and study of baicalin from the dried root of Scutellaria baicalensis Georgi, an herb traditionally used in Chinese medicine. The research sought to understand the biological action of baicalin, particularly how it affects diseases related to the liver and gut. The effects were associated mainly with downstream apoptosis and immune response pathways, which are induced by upstream oxidative stress and inflammation. In the discussion of the resultant findings, it was identified that baicalin engages various key factors during oxidative stress regulation. These include PI3K/Akt/NRF2, Keap-1, NF-κB, and HO-1, contributing to the healing effects of baicalin on non-alcoholic fatty liver disease/non-alcoholic steatohepatitis, ulcerative colitis, and cholestasis. Further, it was discovered that baicalin plays a therapeutic role in regulating inflammatory response and apoptosis pathways. This ability aids in the alleviation of liver diseases and suppression of hepatocellular carcinoma. Baicalin was also found to regulate the intestinal flora by promoting the production of short-chain fatty acids, shedding new light on the full range of baicalin's pharmacological effects.

A Animal Study published in 2021 in the journal Foods found that Traditional fermented products made from soybeans and rice, commonly consumed in the Japanese diet, show significant potential in preventing the progression of fatty liver disease. In the study, C57BL/6J mice were first acclimated for two weeks. Following this period, they were segregated into groups and fed on different diets for a duration of 20 weeks. These diets included a Normal Diet (ND), a High-Fat Diet (HFD), an HFD containing 5% of the fermented soybean and rice product (denoted as HFD+M), and an HFD with 5% of a pre-fermented form of the product (HFD+PFM). The focus was on assessing the impact of these diets on the development of fatty liver disease in the subjects. The mice consuming solely the high-fat diet developed the symptoms of a typical fatty liver, as anticipated. However, the mice fed with diets that included either the fermented soybean and rice product or its pre-fermented variety showed a substantial reduction in the progression of the fatty liver disease, notably in the female subjects. This was observed in terms of diminished liver weight. Moreover, a decrease was noted in the levels of leptin and resistin, hormones linked with obesity and insulin resistance, in the serum of these groups. The male subjects also showed resistance against fatty liver disease progression upon the consumption of these diets. This study therefore demonstrates the value of including such traditional fermented food products in the diet as possible deterrents against lifestyle-induced ailments like metabolic syndrome.

A Review Article published in 2021 in the journal World Journal of Acupuncture-Moxibustion found that Chinese medicine formulas for nonalcoholic fatty liver disease were superior to antioxidants in alanine aminotransferase normalization. Seven systematic reviews were ultimately included. All systematic reviews were conducted based on randomized controlled trials and published in the last decade. According to the AMSTAR 2 tool, one systematic review was judged as having a moderate confidence level, whereas the other studies were rated as having a low or extremely low level of confidence. The ROBIS tool showed that the included systematic reviews all had a high risk of bias due to insufficient consideration of identified concerns. According to the GRADE system, only two outcomes were determined as high quality; namely, TCM formulas with the HuoXueHuaYu principle were better than conventional medications in ultrasound improvement, and TCM formulas were superior to antioxidants in alanine aminotransferase normalization. Other outcomes were downgraded to lower levels, mainly because of heterogeneity among studies, not meeting optimal information sample size, and inclusion of excessive numbers of small sample studies. Nevertheless, the evidence quality of extracted outcomes should be further downgraded when applying to clinical practice due to indirectness.

A Systematic Review published in 2021 in the journal Chinese Medicine found that Traditional Chinese medicines might have various beneficial effects for non-alcoholic fatty liver disease such as improving TCM syndrome score, liver function, and body lipid profile. A total of 53 RCTs involving 5997 participants with NAFLD were included in this review. Each included RCT tested a different TCMs giving a total of 53 TCMs identified in this study. Based on the evaluation of the RCT results, TCMs might have various beneficial effects such as improving TCM syndrome score, liver function, and body lipid profile. A range of non-serious, reversible adverse effects associated with the use of TCMs were also reported. However, no conclusion about the efficacy and safety of TCMs in NAFLD can be made. The quality of reporting was generally poor and the risks of bias was mostly uncertain in all trials. There is some evidence from RCTs that supported the effectiveness and safety of TCMs for NAFLD. However, no conclusive recommendations can be made due to the questionable quality of the RCTs. Improvement in the RCT protocol, the use of a larger sample size, a setting of multicenter, and a more focused approach in selecting TCMs are recommended for developing high quality evidence about the use of TCMs in managing NAFLD.

A Systematic Review published in 2021 in the journal Chinese Medicine found that Traditional Chinese medicines such as Shenge formula, Shugan Jianpi Huatan decoction and Heze lipid lowing oral liquid decoction might have positive effects on NAFLD by improving TCM syndrome scores, liver function, and body lipid profile. A total of 53 RCTs involving 5997 participants with NAFLD were included in this review. Each included RCT tested a different TCMs giving a total of 53 TCMs identified in this study. Based on the evaluation of the RCT results, TCMs might have various beneficial effects such as improving TCM syndrome score, liver function, and body lipid profile. A range of non-serious, reversible adverse effects associated with the use of TCMs were also reported. However, no conclusion about the efficacy and safety of TCMs in NAFLD can be made. The quality of reporting was generally poor and the risks of bias was mostly uncertain in all trials.

A Review Article published in 2020 in the journal The Journal of Nutritional Biochemistry found that Catechin-rich green tea extract (GTE) exercised anti-inflammatory activities can be beneficial in managing Nonalcoholic fatty liver disease (NAFLD) by reducing liver injury and gut-derived endotoxins. The research is built around the study of the anti-inflammatory properties of catechin-rich green tea extract (GTE). The primary analytical interest is its effects on inflammatory responses that contribute to Nonalcoholic fatty liver disease (NAFLD), specifically nonalcoholic steatohepatitis (NASH). The extraction focuses on inhibiting the activation of the hepatic nuclear factor kappa-B, which is known to exacerbate liver injury. The results have shown positive contributions of GTE to management of NAFLD. Itn was observed that the extract limits the activation of the hepatic nuclear factor kappa-B and in turn, reduces NASH-associated liver injury. Additionally, green tea extract was found to contain hepatic-level benefits that attenuate intracellular redox distress and pro-inflammatory signaling. It was also found to improve the gut barrier function, limit the translocation of gut-derived endotoxins, and exercise prebiotic and antimicrobial effects on the gut microbial ecosystem. These results can potentially contribute to managing NAFLD-associated morbidity.

A Review Article published in 2020 in the journal Frontiers in Endocrinology found that Many clinical and experimental studies suggest that Chinese herbal formula are effective in reducing fatty liver disease, and revolving inflammation via many mechanistic pathways. The NAFLD pandemic implies an increase number of patients diagnosed with NAFL, NASH, liver fibrosis and HCC in the near future. Although the interpretation and diagnosis of NAFLD in Chinese medicine are different from those in western medicine, many clinical and experimental studies suggest that Chinese herbal formula are effective in reducing hepatic steatosis, and revolving inflammation via many mechanistic pathways. Some Chines herbal formulae also target at the gut–liver axis in NAFLD, while the adipose tissue–liver axis emerges to be a therapeutic approach for the treatment of NAFLD. More clinical and in-depth mechanistic investigations may help to validate the roles of these Chinese herbal formulae for the treatment of NAFLD. Application of the modern technology can also help to discover novel herbal-based therapeutics for the treatment.

A Systematic Review published in 2020 in the journal Phytotherapy Research found that Green tea influences liver enzymes differently based on an individual's health status, reducing levels in patients with Nonalcoholic Fatty Liver Disease, but slightly increasing levels in healthy subjects. The researchers initiated a comprehensive review and analysis of randomized clinical trials relating to green tea supplementation's effects on liver enzymes. This analysis included forms of green tea supplementation, such as catechin. The information to support this examination was sourced from four medical and health databases and included all trials examining the influence of green tea or its derivatives on specific liver enzymes, including Alanine Transaminase, Aspartate Aminotransferase, Alkaline Phosphatase, and Bilirubin. Altogether, fifteen trials were considered for inclusion in this research. The study found that while the overall effect of green tea on liver enzymes was nonsignificant, further analysis showed that the impact of green tea on liver enzymes varies depending on an individual's health status. Notably, the use of green tea reduced liver enzyme levels in participants diagnosed with Nonalcoholic Fatty Liver Disease. However, in contrast, a small but statistically significant increase in liver enzyme levels was observed in healthy subjects. These findings suggest that the therapeutic potential of green tea may differ significantly based on an individual's health condition.

A Experimental Study published in 2019 in the journal Nature Communications found that Pu-erh tea was found to lower triglyceride and total cholesterol levels more significantly than green, oolong, or black teas. Comparative studies using rodents treated with Pu-erh tea, green tea, and black tea provided supporting evidence that fully fermented Pu-erh tea is more effective in causing hypolipidemic and hypocholesterolemic effects compared to other partially fermented and non-fermented teas.

A Systematic Review published in 2019 in the journal Journal of Functional Foods found that Consumption of virgin avocado oil, rich in monounsaturated fatty acids and bioactive components, may help manage chronic diseases like hypertension, diabetes, and lower cardiometabolic risk. The research paper is a review that explores various extraction methods developed for producing virgin avocado oil (VAO) and the oil yields for these methods. It additionally details the physicochemical composition of VAO, focusing specifically on its high concentration of monounsaturated fatty acids and bioactive components, such as α-tocopherol and β-sitosterol. The results discussed indicate that VAO, which is mainly composed of oleic, palmitic, and linoleic acids, can be utilized as a functional oil offering potential health benefits. In particular, the intake of avocado oil could aid in managing conditions like hypercholesterolemia, hypertension, diabetes, and fatty liver disease, taking advantage of its rich composition. Furthermore, it was noted that the oil could also reduce cardiometabolic risks and exhibit properties that can combat microbial activity.

A Systematic Review published in 2018 in the journal The Journal of Internal Korean Medicine found that Acupuncture relieved hepatic steatosis and reduced total cholesterol and triglyceride in non-alcoholic fatty liver disease patients. From the 8 included trials, the values of the following examinations were extracted: liver ultrasonography, liver CT, body fat CT, aspartate transaminase (AST), alanine transaminase (ALT), gamma-glutamyltransferase (GGT), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, fasting blood sugar (FBS), hosmeostatic model assessment for insulin resistance (HOMA-IR), weight, body mass index (BMI), waist hip ratio (WHR), obesity degree, body fat mass, body fat rate, leptin, malondialdehyde (MDA), and super oxide dismutase (SOD). In the 4 outcomes, cure rate in liver ultrasonography (RR=1.56; 95%CI=1.05~2.31; P=0.03), cure rate in liver CT (RR=2.23; 95%CI=1.33~3.72; P=0.002), TC (MD=-0.78; 95%CI=-1.41~-0.15; P=0.02), and TG (MD=-2.05; 95%CI= -3.88~-0.21; P=0.03), acupuncture was more effective than the control intervention.

A Experimental Study published in 2017 in the journal Food & Function found that When combined, Silibinin and Pu-erh tea extract prove more effective in preventing non-alcoholic fatty liver disease than when used individually. The research used obese mice (ob/ob) and fed them a high-fat diet along with the oral administration of Silibinin, Pu-erh tea extract, or both, over a six-week period. Concurrently, lean mice were used as a control group, consuming a regular diet. The blood chemical index and histopathological evaluations were analyzed to determine the effects of Silibinin and Pu-erh tea extract on the mice, particularly in terms of weight, blood lipid levels, fat metabolism, and inflammatory response. The results showcased that in comparison to the group of mice suffering from non-alcoholic fatty liver disease, the groups which received either Pu-erh tea extract, Silibinin, or a combination of both exhibited significant reductions in weight and blood lipid levels. Furthermore, both Silibinin and Pu-erh tea extract, whether used alone or in tandem, were found to improve fat metabolism and decrease the inflammatory response to a certain extent. The combined group, however, displayed the strongest efficacy in adjusting fat metabolism and inhibiting oxidative stress. They also revealed the drugs' ability to inhibit fat synthesis and improve cholesterol homeostasis by regulating the expression of specific genes. The combined effect was superior to that of individual usage.

A Experimental Study published in 2016 in the journal Food Science and Human Wellness found that Pu-erh tea water extracts could potentially enhance liver health and reduce oxidative stress in rats on a high-fat diet. In this study, fifty SD rats were split into five distinct groups and subjected to a high-fat diet. Their body weights were noted daily. Researches measured the serum levels of malondialdehyde (MDA), glucose, catalysts such as alanine aminotransferase and aspartate aminotransferase, nitric oxide synthase, and pyruvate kinase. Besides, hepatic glycogen levels were assessed, along with the activity of liver enzymes like total superoxide dismutase, catalase, and glutathione peroxidase. These measurements were consistently undertaken for a duration of 12 weeks. The findings showcased a decrease in the body weight and fat index of rats after the administration of Pu-erh tea extract. The reduction in body weight and fat index was accompanied by a decrease in malondialdehyde and nitric oxide synthase levels. Interestingly, there was also a noticeable increase in the activities of hepatic total superoxide dismutase, catalase, and glutathione peroxidase. These findings suggest that the Pu-erh extract might reduce the oxidant stress state, inhabit lipid peroxidation, and protect liver health in rats. Simultaneously, the extracts seemed to boost the production of liver glycogen, enhance the activity of pyruvate kinase, and decrease glucose levels, thereby possibly safeguarding the liver from diseases linked to Type II Diabetes.

A Systematic Review published in 2012 in the journal Molecular Biology Reports found that Traditional Chinese medicines had a better effect on the normalization of alanine aminotransferase and disappearance of radiological steatosis in the treatment of non-alcoholic fatty liver disease. RCTs comparing either TCM formulations alone or in combination with placebo, ursodeoxycholic acid, insulin sensitizers, lipid-lowering drugs, or antioxidants were included. The category of most usually used herbs in the treatment of NAFLD was also calculated. Five thousand nine hundred and four patients from 62 RCTs were included for meta-analysis and 25,661 patients from 419 clinical studies were for TCM formulation analysis. Comparing with western medicines mentioned above, TCM had a better effect on the normalization of alanine aminotransferase and disappearance of radiological steatosis in the treatment of NAFLD. Furthermore, 246 kinds of Chinese herbs were included in our present study, with an average of 10 herbs (range 1–31) in each formulation. Hawthorn Fruit (321 times in 17,670 patients) was the most often used herb in the treatment of NAFLD. In conclusion, TCM is of modest benefit to the treatment of NAFLD.

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