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Non-Alcoholic Fatty Liver Disease (NAFLD)

Treatments in Phytochemicals, Herbal

Medicines and Health Foods Perspective
By Kyle J. Norton

Nonalcoholic fatty liver disease (NAFLD) is a chronic condition caused by fat

accumulated in the liver over time, in the absence of excessive alcohol use. The
disease can be classified into the types of non-inflammatory fatty liver (NAFl)
and inflammatory nonalcoholic steatohepatitis (NASH)(1).

Nonalcoholic fatty liver disease (NAFLD) is one of the major causes of

cirrhosis and liver cancer.

According to world statistics, nonalcoholic fatty liver disease (NAFLD) is

normally known as a disease of the Western world(2). However, due to the
economic prosperity of Southeast Asian(3), the disease also was found in a
large number of population in the cities, causing concerns of many scientists in
the region(4)(6).

According to the joint assessment of the prevalence of non-alcoholic fatty liver

disease and risk factors for advanced fibrosis and mortality in the US, led by
the Stanford University School of Medicine, "The prevalence of NAFLD in the
United States (U.S.) has risen from 18% in 1988–1991 to 31% in 2011–2012.
Estimates of NAFLD prevalence for adults in Western countries is 20–30%,
with much higher prevalence in adults with obesity (80–90%), diabetes (30–
50%), and hyperlipidemia (90%)"(5).

Among the more affluent regions of China, the prevalence rate of non-alcoholic
fatty liver disease (NAFLD) is approximately 15%(6). The number may
decrease substantially if the poor rural populations where obesity is non-
existence are also taking into account(7).

The exact causes of NAFLD aren't well understood. Some researchers

suggested that certain risk factors such as long-term use of certain
medications(8), genetic preposition(8), insulin resistance(8), high cholesterol(8)
and triglycerides(8) in the blood, polycystic ovary syndrome(8), metabolic
syndrome(8), obesity(8), and type 2 diabetes(8) are associated with the onset of
the disease.
Recent studies also found that people with obstructive sleep apnea(11),
underactive thyroid (hypothyroidism(10) and underactive pituitary gland
(hypopituitarism) (9) also at an increased risk of the NALFD.

Some researchers suggested that unhealthy diet such as high-fat diet may also
have a strong implication on NAFLD(12)(13).

Dr. Jensen VS, the lead scientist in the study high-fat diet-induced non-
alcoholic fatty liver disease, wrote, "In humans and animal models, excessive
intake of dietary fat, fructose, and cholesterol has been linked to the
development of non-alcoholic fatty liver disease (NAFLD)"(13).

And, " Only HFr-fed rats developed dyslipidemia as characterized by higher

levels of plasma triglycerides compared to all other groups (p < 0.0001).
Hepatic dysfunction and inflammation was confirmed in HFD-fed rats by
elevated levels of hepatic MCP-1 (p < 0.0001), TNF-alpha (p < 0.001) and
plasma β-hydroxybutyrate (p < 0.0001), and in NASH-fed rats by elevated
levels of hepatic MCP-1 (p < 0.01), increased hepatic macrophage infiltration
(p < 0.001), and higher plasma levels of alanine aminotransferase (p < 0.0001)
aspartate aminotransferase (p < 0.05), haptoglobin (p < 0.001) and TIMP-1 (p <
0.01) compared to Control"(13).

According to the statistics, in the US, over 100 million people have non-
alcoholic fatty liver disease and the condition is more double over the past 20
years(14). The disease also is the most prevalent liver disease in children(14).

The prevalence rate of NAFLD is varied among different ethnic groups in the
US. Dr. Rich NE, the lead scientist in the investigation of the ethnicity and
NAFLD, wrote, "NAFLD prevalence was highest in Hispanics, intermediate in
Whites, and lowest in Blacks, although differences between groups were
smaller in high-risk cohorts (range 47.6%-55.5%) than population-based
cohorts (range, 13.0%-22.9%)(15)".

And, "Among patients with NAFLD, the risk of NASH was higher in Hispanics
(relative risk, 1.09; 95% CI, 0.98-1.21) and lower in Blacks (relative risk, 0.72;
95% CI, 0.60-0.87) than Whites"(15).

The progression of NAFLD and NASH led to cirrhosis, the late stage of liver
scarring are well defined, as the liver tries to heal itself by halting
inflammation(16), leading to symptoms of ascites(16)(18), swell esophageal
varices(16)(19), hepatic encephalopathy(16)(17) and complications of liver
cancer(16)(17) and liver failure(16)(17).

Most people at the early stage NAFLD are asymptomatic, however, as the
disease progression into the later stage, most patients experience symptoms of
right upper abdominal discomfort(20), fatigue(20), and/or malaise(20), and
jaundice(20) with yellowing of the skin and eyes(20).

Most patients with NAFLD have elevated levels of liver enzymes gamma-
glutamyl transferase (GGT)(21) and/or Aspartate Aminotransferase (AST)(21)
to platelet ratio index (APRI) score(21), and/or Alanine Aminotransferase
(ALT) (21) which are the markers used to predict the severity of liver disease
including the fatty liver. A blood test is required if you suspected to have
developing nonfatty liver disease.

Conventionally, as of today, there is no effective treatment of NAFLD(22)(23).

Weight loss for overweight and obese patients(22) has been recommended
through our the industry accompanied by the change of lifestyles(22) such as
moderate exercise and reduced intake of alcohol, depending on individuals.

Patients who are hepatitis virus B and C carriers are also recommended to be

Given the nature of the nonalcoholic fatty liver disease, the search for effective
treatment for NAFLD from the natural sources used over thousands of years in
traditional medicine for the treatment of liver disease has been intensified(23).
Many secondary metabolites, whole foods, and herbal medicine have been
found to be effective in vivo, vitro and small human trials(24). However, most
of them were stopped due to a simple reason. Who will spend billions to prove
the thing which has no commercial values? Secondary metabolites, whole
foods, and herbal medicine cannot be patented.

A. Phytochemicals
Phytochemicals, the natural chemical constituent, protect the plants against
diseases and form their outer's color.
Phytochemicals may be the next potential sources of a new medicine for
treatment of diseases with little or no side effects(32), including
* Secondary metabolites
Secondary metabolites produced by plants have been used as medicines,
flavorings, pigments, and recreational drugs over thousands of year in human
* Bioactive compounds isolated from plant include vegetables, fruits, and nut.

1. Triterpenoid
Triterpenoid is a various unsaturated hydrocarbon, found in essential oils and
oleoresins of plants, including Ilex, hainanensis Merr(25).

In the study to test the effect of Triterpenoid-rich fraction (TP) from Ilex
hainanensis Merr. on NAFLD with Male Sprague-Dawley (SD) fed with a
normal diet (control) or high fat diet (NAFLD model), after 4 weeks, then
orally administrated TF (250 mg/kg) for another two weeks(26), researchers
showed that TP not only improves the symptoms of the subjects but also
decreases the levels of triglyceride(26), total cholesterol(26), low-density
lipoprotein cholesterol(26), abnormality of lipid accumulation(26), levels of
inflammation(26) and infection(26) and apoptosis response(26) in the liver.

Of these results, TF is effective in protecting the liver against NAFLD by

regulating lipids metabolism(26) and alleviating insulin resistance(26),
inflammation(26) and oxidative stress(26).

2. Curcumin
Turmeric is a perennial plant in the genus Curcuma, belonging to the family
Zingiberaceae, native to tropical South Asia(27)., used in traditional medicine
as anti-oxidant, hypoglycemic, colorant, antiseptic, wound healing agent, and to
treat flatulence, bloating, and appetite loss, ulcers, eczema, inflammations,
etc(27)(28). Curcumin is one of the natural phenols in the plant(28).

Curcumin, as an antihyperlipidemic agent, has been found to lower the “bad

cholesterol” low-density lipoprotein (LDL) and increase high-density
lipoprotein (HDL)(29), thus reducing the risk of fat accumulated in the tissues
in the liver(29).

In the support of the above, the water-soluble curcumin derivative was tested
for its efficacy against steatohepatitis which is an inflammation of the liver(30)
(31) with concurrent fat accumulation in the liver(30)(31), researchers found
that the derivative not only significantly alleviates fibrosis(30)(31) but also
decreases the grade of liver steatosis(30)(31).
3. Piperine
Piperine is a phytochemical alkaloid in the class of organosulfur compound,
found abundantly in white and black pepper, long pepper, etc.

Administration of piperine appeared to reverse hepatic steatosis (33) and

insulin resistance(33) in mice fed with high fat, probably inactivation of
adiponectin-AMPK signaling(33) associated with stimulated fatty acid
oxidation and enhance insulin sensitivity.

In other words, piperine not only inhibited hepatic steatosis and insulin
resistance by reducing the expressions of lipogenic target genes(33) associated
with insulin resistance (33) but also increased the expression of carnitine
palmitoyltransferase 1 (CPT1) gene(33) involved in fatty acid oxidation.

4. Resveratrol
Resveratrol, a phytochemical in the class of Stilbenoids found abundantly in
many vegetables and fruits as well as herbs and herbal formulas(34) including
found abundantly in skins and seed of grape wine, nuts, peanuts, etc.

According to studies, the formulas of berberine and resveratrol not only

improved a biochemical and histological change in nonalcoholic fatty liver
disease(35)(36), but also inhibited lipid accumulation(36) by up-regulating
low-density lipoprotein receptor (LDLR) expression(36), alleviating lipid
peroxidation(36), and reducing the production of inflammatory cytokines(36).

5. Carotenoids
Carotenoids are class of phytochemicals that give yellow, orange, or red fat-
soluble pigments, including lycopene and carotene, found in ripe tomatoes and
autumn leaves(38).

According to studies, in the examination of a total of 2687 in middle-aged and

elderly Chinese adults. who completed both NAFLD tests were classified into
stable, improved and progressed groups, serum carotenoids(37) are inversely
associated with non-alcoholic fatty liver disease (NAFLD)(37) by reducing
serum RBP4 and HOMA-IR(37), associated with insulin resistance(37),
triglycerides(37), and body max index (BMI)(37).

More precisely, higher levels of α-carotene, β-carotene, lutein + zeaxanthin(39),

and total carotenoids(39) have a strong impact on a significant decrease in the
severity of NAFLD(39).
6. Quercetin
Quercetin is a type of flavonoid antioxidant found in leafy greens, tomatoes,
berries, and broccoli(40). Recent studies have shown that the beneficial effects
of quercetin include the activation of mitochondrial biogenesis(41).

In Male Sprague-Dawley rats fed high-fat diet (HFD) induced alcoholic fatty
liver disease (NAFLD), quercetin intake decreased hepatic TG content by 39%,
(42) with a 1.5-fold increase in very low-density lipoproteins (VLDL)(42)
which transport hepatic lipids to peripheral tissue acquired apoC-II and apoE
from high-density lipoprotein (HDL) and exhibited the function of a protein
involved in stress response(42) compared with the HFD group.

Injection of quercetin also is found to increase the protein complex expression

of lipid transfer with a function to promote the very low-density lipoproteins
(VLDL)(42) secreted by the liver.

In other words, these findings suggested that quercetin inhibits the expression
NAFLD by increasing hepatic VLDL assembly and autophagy in hepatic lipid

Additonally, quercetin exhibited hepatoprotective activity in 30-day HFD-

induced NAFLD rats by regulating fatty acid related metabolites(43) (adrenic
acid, etc.) including the inflammation-related metabolites (arachidonic acid,
etc.), oxidative stress-related metabolites(43) (2-hydroxybutyric acid) and other
differential metabolites(43) (citric acid, etc.).

8. Anthocyanin
Anthocyanins are water-soluble pigments of colored berries, fruits, and
vegetables (44). They can protect hepatocytes against injury caused by high
glucose-induced oxidative damage(45), by improving the antioxidant status and
inhibiting the mitochondria pathways of apoptosis(45).

In male C57BL/6 J mice fed with a high fat high cholesterol (HFC) diet with or
without 200 mg/kg B.W Cy-3-G for 8 weeks, injection of cyanidin-3-O-β-
glucoside (Cy-3-G) regulated the activation of brown adipose tissue (BAT)(46)
and the expression of adipokines in BAT disrupted by HFC diet associated with
the induction of fatty liver(46).

In other words, Cy-3-G exerted the liver protective effect of on hepatic lipid
accumulation(46) via regulating the secretion of adipokines from BAT(46).
9. Epigallocatechin gallate
Epigallocatechin gallate is the ester of epigallocatechin and gallic acid,
belonging to the chemical class of flavan-3-ols (catechins) found most
abundant in green tea (Camellia sinensis L.), accounting for about 50% of its
total polyphenols(47).

In the examination of gene expression profiles with non-alcoholic fatty liver

disease (NAFLD) and associated advanced liver diseases(48), application of
Epigallocatechin-3-gallate (EGCG) inhibited the fibrosis-related genes
(48)Col1a1, Col1a2, Col3a1, and Col6a3) that have a strong impact on the
onset of NAFLD found in an independent mouse dataset (48).

In other words, EGCG protects the liver against genes related to liver

Furthermore, EGCG also exhibits multi-pronged preventive and therapeutic

activities(49), including promoted lipid(49) and glucose metabolism(49), anti-
lipid peroxidation(49) and anti-inflammation activities(49), anti-fibrosis(49),
and anti-NAFLD related tumor(49), thus contributing to the mitigation of
NAFLD occurrence and progression(49).

10. Astaxanthin
Astaxanthin is a phytochemical in the class of Xanthophylls, belonging to the
group of Carotenoids (tetraterpenoids), found abundantly in yeast, krill, shrimp,
salmon, lobsters, and green microalga(50). Astaxanthin showed to exhibit
antifibrotic effects in the liver(51).

On the steatotic liver model by giving mice a methionine and choline-deficient

high fat (MCDHF) diet, pretreatment of astaxanthin reduced levels of lipid
peroxidation(52) and reduced number of liver cells apoptosis(52) by inhibiting
the expression of inflammatory cytokines(2) and gene(52) involved oxidative
stress in the liver(32)

11. Fucoxanthin
Fucoxanthin is one of the most abundant marine carotenoids, accounting for
more than 10% of the estimated total carotenoids in nature(53).
Fucoxanthin protected the liver induced by obesity(54) by improving insulin
resistance(54) and decreasing blood glucose levels (54) through the regulation
of cytokine secretions(54).

On body weight, body fat, liver lipids, and blood biochemistry in obese, non-
diabetic female volunteers with non-alcoholic fatty liver disease (NAFLD) and
normal liver fat (NLF) content, Xanthigen (brown marine algae fucoxanthin +
pomegranate seed oil (PSO)) promoted weight loss(55), reduced body(55) and
liver fat content)(55), and improved liver function tests in obese non-diabetic

Xanthigen may be considered a promising food supplement in the management

of obesity(55).

12. Glucoraphanin (4-methyl sulfinyl butyl glucosinolate)

Glucoraphanin (4-methyl sulfinyl butyl glucosinolate), the major glucosinolate
is the precursor of sulforaphane found abundantly in broccoli Brussels sprouts
and cabbages(56).

Obesity-induced insulin resistance and nonalcoholic fatty liver disease

(NAFLD), glucoraphanin, a precursor of the Nrf2 activator sulforaphane,
ameliorated obesity by enhancing energy expenditure(57) and browning of
white adipose tissue(57), and attenuated obesity-related inflammation(57) and
insulin resistance(57) and reduced metabolic endotoxemia(57).

Where nuclear factor erythroid 2-related factor 2 (Nrf2) is a key regulator of

antioxidant signaling that serves as a primary cellular defense against the
cytotoxic effects.

In chronic inflammation, insulin resistance, and NAFLD in high-fat diet

(HFD)-fed mice, Glucoraphanin supplementation attenuated weight gain(58),
decreased hepatic steatosis(58), and improved glucose tolerance(58) and insulin

Furthermore, glucoraphanin attenuated hepatic lipogenic gene expression(58),

lipid peroxidation(58), classically activated M1-like macrophage
accumulation(58), and inflammatory signaling pathways(58).

In other words, by promoting fat browning, limiting metabolic endotoxemia-

related chronic inflammation, and modulating redox stress, glucoraphanin may
have a therapeutic effect for the treatment of obesity(58), insulin resistance(58),
and NAFLD(58).

13. Sinigrin
Sinigrin is a major component of commonly consumed cruciferous vegetables,
such as horseradish and wasabi(59).

Sinigrin found in glucosinolates, a class of antioxidants has been found to

reverse of fatty liver (60) probably through indirect interaction with
mitochondrial metabolism(60) which encompasses a range of conditions caused
by lipid deposition within liver cells.

In other words, by targeting the mitochondrial metabolism, sinigrin modulates

antioxidant molecules for a potential treatment for hepatic steatosis(60).

B. Herbal medicines
Herbal medicines have been used as medicines over thousands of year in
human history.
1. Herbal Anise
Herbal anise is a flowering plant of the species of Pimpinella anisum, genus
Pimpinella, belongings to the family Apiaceae native to Egypt and the
Mediterranean region, used in traditional herbal medicine as a fragrance in
soaps, oils, and mouth fresheners and stomachic, antiseptic, anti-spasmodic

On animal with NAFLD induced by choline-deficient diet for 90 days, 30 days

treatment with hydroethanolic extract (AE) at 25, 50, 100, and 200 mg/kg/day
and essential oil (AO) at 0.125, 0.25, and 0.5 mg/kg/day, reversed plasma levels
of total cholesterol(62), low-density lipoprotein(62), and triacylglycerol(62)
and decreased in high-density lipoprotein level(62) caused by choline-deficient
diet in dose-dependent manner.

AE and AO also reduced the elevated levels of enzymes aspartate transaminase

(AST)(62) and alanine transaminase (ALT)(62) which are considered as an
indication of either liver injury or damage caused by the acute inflammation.

Additionally, anise AE and AO demonstrated a strong effect in ameliorated

lipid peroxidation induced by oxidative stress(62) indicated by elevation of
plasma level of 8-isoprostane(62) which is correlated to the prevalence of non-
alcoholic fatty liver disease (NAFLD).
2. Hawthorn Fruit
Hawthorn is shrubs and trees of the genus Crataegus, belonging to the family
Rosaceae, native to temperate regions of the Northern Hemisphere in Europe,
Asia and North America(63) used in traditional medicine to treat heart disease
and symptoms of heart diseases(63) such as irregular heartbeat(63), high blood
pressure(63), chest pain(63), hardening of the arteries(63), circulatory disorders
and respiratory illnesses(63).

Researchers at The First Affiliated Hospital of Wenzhou Medical College, in

the concerns that nonalcoholic fatty liver disease (NAFLD) is emerging as a
widespread condition worldwide, and reaffirmation of the natural treatments of
nonalcoholic fatty liver disease (NAFLD) in the traditional Chinese medicine
(TCM), launched an investigation to find natural medicines for the treatment of
NAFLD, suggested that hawthorn fruit was one the favorite herb used in TCM
for the treatment of NAFLD compared to other herbs(64).

Furthermore, the search of the database of PubMed and China National

Knowledge Infrastructure from January 1995 to June 2010 for RCTs by
comparing either traditional Chinese medicine (TCM) formulations alone or in
combination with placebo for the treatment of NAFLD, a formula containing
hawthorn normalized alanine aminotransferase(65) and disappearance of
radiological steatosis(65) in patients with NAFLD, without inducing any side

3. Sida rhomboidea Roxb

Sida rhomboidea Roxb is a shrubby weed found growing throughout India
belonging to the Malvaceae family, used in North-East India for the treatment
of hypolipidemia and diabetes properties(66).

On a high-fat diet (HFD) induced insulin resistance in C57BL/6J mice, Sida

rhomboidea ROXB. (S. rhomboidea ROXB., SR) compared to mice fed with
rosiglitazone (ROS) lowered the plasma(67) and hepatic TC(67), TG(67)
and FFA(67) in HFD+SR groups.

According to the efficient clearance of glucose in intraperitoneal glucose

tolerance test (IPGTT), Sida rhomboidea ROXB also lowered the plasma
insulin(67) and fasting insulin resistance(67) levels in HFD+SR groups.
Furthermore, in vivo, sida rhomboidea. Roxb leaf extract (SRLE)
supplementation with SRLE significantly prevented HFD induced increment in
body weight(68), plasma lipids(68) and leptin(68), visceral adiposity(68)and
adipocyte hypertrophy(68) by modulation of related genes expression(68).

In vitro, Roxb leaf extract (SRLE) decreased triglyceride accumulation(68),

leptin release(68) and glyceraldehyde-3-Phosphate dehydrogenase activity(68)
along with higher glycerol release(68) without significant alteration of the
viability of 3T3L1 pre-adipocytes(68).

4. Teucrium polium (Golden Germander)

Teucrium polium, known popularly as felty germander, is a sub-shrub and herb,
belonging to the Lamiaceae family, native to the western Mediterranean, found
abundantly in South-Western Asia, Europe, and North Africa. and used in
traditional medicine for the treatment of abdominal pain, indigestion, common
cold, and type 2 diabetes(69).

In nonalcoholic steatohepatitis induced in male N‐Mary rats by a

methionine/choline‐deficient (MCD) diet, ethyl acetate (EtOAc) extract of
Teucrium polium, inhibited inflammation(70) and ballooning degeneration by
80%(70) of the rats treated by MCD diet.

Furthermore, EtOAc extract also lowered the lipoprotein profiles(70) and levels
of liver oxidative stress(70) markers such as alkaline phosphatase(70), aspartate
aminotransferase(70), and alanine aminotransferase(70) by improving the liver
superoxide dismutase(70), glutathione peroxidase(70), and glutathione
reductase enzymes(70).

Moreover, in N-Mary rats induced NASH by methionine and choline-deficient

(MCD) diet for 8 weeks, injection of ethyl acetate fraction of T. polium orally
for 3 weeks, lowered the elevated levels of proteins(71) associated with
inflammation and malondialdehyde (MDA)(71) in the liver.

The extract increased the levels of antioxidants enzymes activities such as

superoxide dismutase (SOD)(71), glutathione peroxidase (GPx)(71) and hepatic
glutathione (GSH)(71).

In other words, the ethyl acetate fraction of T. poium effectively protected the
liver by reversing NASH(71), through its strong antioxidant(71) and anti-
inflammatory properties(71).
5. Grape seed extract
Grape Seed Extract is the commercial extracts from whole grape seeds that
contains many concentrations, including vitamin E, flavonoids, linoleic acid,
oligomeric proanthocyanidins(OPCs), and used in traditional medicine as
antioxidant, anti-inflammatory agents and to treat skin wounds with less
scarring, allergies, macular degeneration, arthritis, enhance circulation of blood
vessels, lower cholesterol(72)

In rats fed a high-fat diet to induce non-alcoholic fatty liver disease(NAFLD),

resveratrol (RSV) administration reversed the abdominal obesity(73),
NAFLD(73), and insulin resistance (IR)(73) by 10 weeks.

In vitro, RSV treatment inhibited the triacylglycerol (TG) accumulation(73) in

HepG2 cells incubated with a high concentration of glucose(73) and

In other words, resveratrol (RSV) improved NAFLD(73) and IR(73) by

suppressing the 2 lipogenesis genes(73) associated with the elevation of
NAFLD(73) and IR expression (73).

Additionally, injection of resveratrol (RSV) also found to induced production

of hepatic low-density lipoprotein(74) which has been found to process
similarly activity as high-density lipoprotein which returns cholesterol to the

6. Milk thistles
Milk Thistle is a flowering plant, in the genus Silybum Adans, belonging to the
family Asteraceae, native to the Mediterranean, used in traditional medicine for
the treatment of liver, kidney, and gall bladder problems(75).

According to the study lead by First Hospital of Jilin University in the review
of eight RCTs involving 587 patients with NAFLD, Silymarin (SIL), an active
extraction of milk thistle, significantly reduced liver oxidative stress(76)
associated with the AST(76) and ALT levels(76).

In other words, SIL improved the liver parameters(76) by reducing

transaminases levels(76) in NAFLD patients.

Furthermore, on hepatic steatosis and oxidative stress during the development

of nonalcoholic fatty liver disease (NAFLD), administration of SMO
decreased the histological injury of the liver(77) and the levels of hepatic
triglyceride(77), cholesterol(77) and free fatty acid(77) in HFD-fed mice.

Moreover, SMO administration elevated the activities of superoxide dismutase

(SOD)(77) and catalase (CAT)(77) and reduced the level of malondialdehyde
(MDA)(77) and lowered the levels of proteins(77) involved in the production
of pro-inflammatory cytokines(77) in the liver, thus preventing the onset of

7. Acanthopanax senticosus (Siberian Ginseng)

Acanthopanax senticosus or Siberian Ginseng is an oriental herb belonging to
the Araliaceae family commonly distributed throughout the North Eastern parts
of Asia, used in traditional Chinese medicine for the treatment of arthritis,
hypertension, heart disease, gastric ulcers, and tumors(78).

On 10 obesity C57BL/6J mice fed either a normal diet (10 kcal fat%) or high
fat diet (60 kcal fat%) with or without oral administration of A. senticosus
extract (ASE; 0.5 g/kg of body weight) for 12 weeks, ASE inhibited the
significantly higher low-density lipoprotein (LDL)-cholesterol in serum(79)
and higher triglyceride accumulation in liver(79), of mice high fat diet without
altering the levels of carnitine status(79).

Collectively, oral administration of ASE lowered the weight gain(79), serum

LDL-cholesterol concentration(79), and liver triglycerides accumulation(79) in
mice with obesity induced by high-fat diets.

In insulin-resistant ob/ob mice with fatty livers, 50% ethanol extract

ofAcanthopanax senticosus stem bark (ASSB) reversed the hepatomegaly(80),
by reducing the % liver weight/body weight ratio(80) in 8 weeks.

The ASSB ethanol extract also specifically lowered circulating glucose(80) and
lipids(80) and enhanced insulin(80) action in the liver and triglyceride
synthesis(80) in non-adipose tissues including liver and skeletal muscle(80).

Genes expression of glucose 6-phosphatase and lipogenic enzymes associated

with the development of hepatic steatosis(80) also were reduced by the
injection of ASSB ethanol extract.

8. Alisma Orientalis (Alismatis rhizome) or Ze Xie in traditional Chinese

Ze Xie is also known as Alisma, used in TCM as anti-pyretic, as anti-bacterial,
hypoglycemic, hypotensive, antitumor, and anti-allergic medicine(81).

On rats fed with high‐fat diet for six weeks induced nonalcoholic fatty liver
disease (NAFLD), followed by AOME for another six weeks, administration of
AOME (150,300 and 600 mg kg−1) markedly decreased the serum and liver
lipids(82), fasting serum glucose(82) and improved insulin resistance(82).

AOME lessened the lipid peroxidation(82) and activated antioxidant

enzymes(82) through inhibiting the oxidative stress in the liver(82).

Furthermore, according to the tested assays, AOME also protected the liver
against injury(82) by reducing the aminotransferase abnormalities(82) and

9. Cissus quadrangularis (Asthisamharaka)

Cissus quadrangularis is a perennial plant, belonging to the grape family, native
to India, Srilanka, Malaysia, Thailand, and Africa used in the traditional
medicine for the treatment of obesity, diabetes, and metabolic syndrome(83)

On oxidant-antioxidant balance and insulin resistance (IR) in rats fed high fat–
high fructose diet (HFFD) and free-radical scavenging property in vitro, CQEt
addition for 45 days restored insulin sensitivity (84), liver damage(84), and
oxidative changes(84), on (HFFD) rats by and bring back the antioxidants and
lipids towards normal(84).

Furthermore, CQEt protected the liver by improving the histopathology(84)of

the liver.

In vivo, CQEtin also exerted liver protective effect(84) comparable with that of
standard drug, metformin.

In vitro, CQEt exhibited radical scavenging ability(84) in a dose-dependent


In other words, dietary supplementation of CQ extract (10%) for 45 days

significantly improved insulin sensitivity(84), reduced liver damage(84),
prevented oxidative changes(84).

10. Clerodendron glandulosum

Clerodendron glandulosum is comprised of small trees, shrub sand herbs
belonging to the Verbenaceae family, native the tropical and sub-tropical
regions of the world used in the traditional medicine for the treatment of
hypertension, fever, diabetes, and abdominal pain(85).

On hyperlipidemic chronically rat fed by a high-fat diet (HL), administration

of aqueous extract of Clerodendron glandulosum. Caleb (CG) (400 mg/kg/day)
for 90 days, showed to reduce the levels of LDL-C (81.36%) (86)and VLDL-C
(43%)(86) along with an increase in HDL-C (52.84%)(86).

On alteration in lipid and cholesterol metabolism in high-fat diet fed

hyperlipidemic rats, compared to hypolipidemic drug Lovastatin (LVS),
injection of ECG exerted a strong effect in experimental hyperlipidemia(86) by
a significant alteration in plasma and tissue lipid profiles(86).

Further differentiation of the efficacy of ECG, researchers found that ECG

reduced absorption(86), improved elimination(86) and augmented
catabolism(86) of lipids and cholesterol.

11. Curcuma longa (Turmeric)

Turmeric, principal curcuminoid of the popular Indian spice, a rhizomatous
herbaceous perennial plant of the ginger family, Zingiberaceae, native to
tropical South Asia used in traditional medicine for the treatment of varies
illness, including metabolic syndrome and inflammatory conditions(87).

On C57BL/6 mice fed an HFD for 16 weeks, daily oral administration (os) of
the NDS inhibited steatosis (88), aortic lesions(88) or carotid artery
thickening(88) induced by the HFD.

Furthermore, NDS inhibited dyslipidemia(88) compared to untreated animals.

In other words, NDS prevented the onset of NAFLD and atherogenesis(88) by

modulating the expression of different genes(88) involved in NAFLD.

According to the double-blind randomized controlled clinical trial conducted

on 46 patients with NAFLD (21males and 25 females) aged 20-60 years old
and body mass index (BMI) between 24.9 and 40 kg/m2, turmeric group (n =
23) given six turmeric capsules daily for 12 weeks with each capsule contained
500 mg turmeric powder (6×500 mg) showed the decreased serum levels of
glucose(89), insulin(89), HOMA-IR(89), and leptin(89) compared to the
placebo group without affecting the weight, BMI and liver enzymes.
Collectively, turmeric supplementation inhibited NAFLD complications by
improving glucose indexes(89) and serum leptin levels(89).

12. Ginkgo biloba (Maidenhair Tree)

Ginkgo biloba is the oldest living tree species, genus Ginkgo, belonging to the
family Ginkgoaceae, native to China, from the temperate zone to subtropical
zone and some parts of North America, used in traditional herbal medicine in
treating impotence, memory loss, respiratory diseases, circulatory disorders,
and deafness as well as preventing drunkenness, and bedwetting(90).

In vivo, on Male Wistar rats divided into 4 groups (the control group, GBE
group, high-fat diet [HFD] group, and HFD + GBE group) researchers
examined the effect of Ginkgo biloba extract (GBE) on nonalcoholic fatty liver
disease (NAFLD).

According to the experimental results, GBE reduced the elevations of hepatic

triglyceride contents(91) and the increased hepatic fatty acids(91) in rat livers
caused by HFD.

Furthermore, GBE also enhanced the expression palmitoyltransferase I (CPT I)

and total activity of the fatty acid β-oxidation rate-limiting enzyme, in the
regulation of whole-body metabolism, inflammatory vigor, and pathogenesis of
nonalcoholic fatty liver disease(91).

The effects of GBE was attributed to its chemical compounds and ingredients,
quercetin, kaempferol, and isorhamnetin which work synergistically to decrease
the cellular triglyceride content(91) and promote the expression and total
activity of CPT1A(91) in converting fat to energy.

Based on the finding, researchers wrote, "The triglyceride-lowering effect of

GBE on the HFD rat liver is closely associated with the increased expression
and activity of CPT1A, and the flavonoid ingredients are the major contributors
of GBE".

13. Linum usitatissimum (Linseed/Flaxseed)

Flaxseed is native to the region of the eastern Mediterranean to India and also
known as common flax or linseed. Flax is an erect annual plant, it can grow to
1.2 m tall. The leaves are 20–40 mm long and 3 mm broad, used in traditional
medicine for the treatment of constipation(92).
A double-blinded, randomized, and placebo-controlled study in moderately
hypercholesterolemic men suggested that oral administration of SDG (20 or
100 mg) decreases the level of blood cholesterol(93) and liver disease risk
factors(93) induced by hypercholesterolemia in humans.

In a study of 30 men with total cholesterol levels of 4.65 to 6.21 mmol/L (180-
240 mg/dL), SDG exhibited a significant reduction in the ratio of low-density
lipoprotein/high-density lipoprotein cholesterol(93) compared to baseline at
week 12.

Furthermore, injection of SDG also showed a significant percentage decrease

in the levels of glutamic pyruvic transaminase(93) and γ-glutamyl
transpeptidase(93) associated with liver injury markers related to the levels at
the baseline.

In other words, daily administration of 100 mg SDG may be effective in

reducing the levels of blood cholesterol(93) and hepatic diseases risk(93) in
moderately hypercholesterolemic men.

In the testing of 7-d diets including a low-fiber control diet (Control), a diet
with flaxseed fiber drink (3/day) (Flax drink), and a diet with flaxseed fiber
bread (3/day) (Flax bread), researchers found that compared to control, Flax
drink lowered fasting total-cholesterol and LDL-cholesterol by 12 and
15%(94), respectively.

Fecal fat and energy excretion increased by 50 and 23% with Flax drink
consumption compared to control(94).

In other words, Flax drink decreased plasma total and LDL-cholesterol(94) and
increased fat excretion(94).

14. Nelumbo nucifera (Lotus)

Nelumbo nucifera (Lotus) is a perennial plant belonging to the Nymphaeaceae
family produced individual leaves and flowers directly from the root system
and used in traditional medicine for the treatment of respiratory, hepatic,
digestive, and reproductive diseases(95).

On 3T3-L1 preadipocytes and high-fat diet (HFD)-induced obese SD rats,

injection of N. nucifera leaves extract, N. nucifera alkaloid (NNA) decreased
cell population growth of 3T3-L1(a cell line derived from (mouse) 3T3 cells
used in biological research on adipose tissue) preadipocytes(96) and increased
the apoptotic cells(96) in a time- and dose-dependent manner and reduced the
body weight(96), the lee's index(96), adipose tissue weight(96), and plasma
lipid levels((96) in HFD-induced obese rats.

In vivo, C57BL/6 mice induced obesity by a high-fat diet (HFD), oral

administration of NLFE reduced the body weight(97), body lipid
accumulation(97), and activities of fatty acid synthase (FAS)(97), glutamic
oxaloacetic transaminase(97), and glutamic pyruvic transaminase(97)
associated with the risk of NAFLD.

Additionally, NLFE efficacy in the attenuation of body lipid accumulation(97)

and prevention of obesity(97) was associated with the inhibition of lipid-
regulated enzymes involved in synthesizing lipids right in the cell(97).

C. Healthy foods
Eating a healthy diet with high vegetables and fruits knowledged by health
experts is the best way to prevent diseases including non-alcoholic fatty liver
disease, particularly in older adults.

1. Olea europaea (Olive)

Olive fruit also called the olive and the source of olive oil. Olea europaea L is a
small tree, belonging to the family Oleaceae, native to the coastal areas of the
eastern Mediterranean Basin and south end of the Caspian Sea(98).

In the evaluation of oxidative stress induced non-alcoholic steatohepatitis

(NASH) on hypertensive/NIH-corpulent rats fed a diet of AIN-93G with or
without olive leaf extract (500, 1000, 2000 mg/kg diet, and control; 5 rats each)
for 23 weeks, oleuropein, the active constituent of olive leaf, exhibited
antioxidative stress(99) by enhancing the levels of antioxidant(99) against
hepatic fat accumulation(99).

In other words, a diet of AIN-93G containing more than 1000 mg/kg olive leaf
extract had a preventive effect on the occurrence of NASH(99) by improving
the levels of thioredoxin-1 expression(99) and decreasing the levels of 4-
hydroxynonenal expression(99) associated with hepatic lipid
peroxidation(99) in rat with NASH.

Where overexpression of thioredoxin-1 expression is a marker of liver disease.

Based on the findings, researchers said, "olive leaf extract may help prevent
NASH,... through its anti-oxidative activity.".

Also, on rats fed a cholesterol-rich diet for 16 weeks, administration of

polyphenol-rich olive leaf extracts significantly lowered total cholesterol (TC)
(100), triglycerides (TG)(100) and low-density lipoprotein cholesterol (LDL-C)
(100) and increased the serum level of high-density lipoprotein cholesterol

Furthermore, administration of polyphenol-rich olive leaf extracts was found to

lower the levels of thiobarbituric acid reactive substances (TBARS)(100), a
byproduct of lipid peroxidation upon the injection of in liver, heart, kidneys,
and aorta significantly.

Moreover, the also extracts also increased the serum antioxidant potential(100)
and the hepatic CAT(100) and SOD activities(100).

Collectively, polyphenol-rich olive leaf extracts protected the liver against the
onset of NASH(100) by inhibiting parameters(100) involved in the production
of oxidative stress(100).

2. Punica granatum L. (Pomegranate)

Pomegranates is a fruit-bearing small tree, genus Punica, belonging to family
Lythraceae, native to Iran but has been cultivated in Asian since ancient time.
Pomegranate flower (PGF) has been used in traditional medicine for the
treatment of hyperlipidemia, insulin resistance, and diabetes(101).

In glucose-fed hyperglycaemic and alloxan-induced diabetic rats, oral

administration of aqueous-ethanolic (50%, v/v)extracts of pomegranate led to
significant lowering the blood glucose(101)with a maximum dose up to 400
mg/kg, b.w.

On streptozotocin (STZ) induced diabetic rats, Punica granatum aqueous

extract (PgAq) restored parameters of diabetes(103) including blood glucose
level(103), total cholesterol (TC)(103), triglycerides (TG)(103), low-density
lipoprotein cholesterol (LDL-C)(103), very low density lipoprotein (VLDL)
(103), and improved antioxidant profiles(103) including glutathione-S-
transferase (GST)(103), superoxide dismutase (SOD)(103) and catalase (CAT)
Additionally, the extract also elevated the levels of HDL-C(103), compared to
the diabetic control group.

In other words, Punica granatum aqueous extract (PgAq) processed anti-

chronic diseases including NASH associated with atherogenic lipoprotein
profile(103), aggravated antioxidant status(103), and impaired glucose

3. Zingiber officinale (Ginger)

Ginger (Zingiber officinale) or ginger root is the genus Zingiber, belonging to
the family Zingiberaceae, native to Tamil, used in traditional and Chinese
medicine to treat dyspepsia, gastroparesis, constipation, edema, difficult
urination, and colitis(104).

On streptozotocin (STZ)-induced type I diabetic rats, oral administration of

juice of Z. officinale (4 ml kg-1, p.o. daily) for 6 weeks showed a significant
increase in insulin levels(105) and a decrease in fasting glucose levels(105).

Treatment with Z. officinale also decreased serum cholesterol(105), serum

triglyceride(105) and blood pressure(105) in diabetic rats.

Based on the findings, researchers said, " (The) potential antidiabetic activity of
the juice of Z. officinale in type I diabetic rats, possibly involving 5-HT

In vitro, Zingiber officinale Roscoe was found to reduce the elevation of rat
plasma triacylglycerol(106) levels 1 and 2 h involved in hydrolysis(106) after
oral administration of a lipid emulsion containing corn oil by interfering the
intestinal absorption of dietary fat.

In vivo, mice fed the high-fat diet containing 3% aqueous extract of Z.

officinale Roscoe compared to controls fed the high-fat diet significantly
reduced final parametrial adipose tissue weights(106) associated with fat

4. Green tea
Green tea contains more amount of antioxidants than any drinks or food with
the same volume, and is the leaves of Camellia sinensis, undergone minimal
oxidation during processing, originated from China(107).
On male ZF rats fed a high-fat diet (HFD) for 2 wk then treated with GTP (200
mg/kg) or saline (5 mL/kg) for 8 wk, GTP intervention showed a decreased
weight gain(108) and a significantly lowered visceral fat(108).

GTP treatment not only significantly reduced fasting serum insulin(108),

glucose(108), and lipids levels(108), but also attenuated the levels of pro-
inflammatory cytokines(108) in rats fed a high-fat diet (HFD) by regulating the
pathways associated with fat metabolism(108).

Furthermore, GTP treated rats also was found to involved with hepatic
lipogenesis(108) and triglycerides outflux(108) from the liver.

SlimTrym®, a formulated product composed of

citrus polymethoxyflavones (PMFs), green tea extract, and lychee extract, in
male C57BL/6 mice fed a normal diet (ND), high fat diet (HFD) or HFD
containing 0.1% or 0.5% SlimTrym® for 16 weeks, significantly reduced
weight gain(109) and relative perigonadal(109), retroperitoneal(109),
mesenteric fat weight(109) as well as the size of the adipocyte(109).

Moreover, SlimTrym® supplementation also effectively inhibited the hepatic

steatosis(109) and the elevated serum levels of enzymes(109) associated with
liver injury or damage, such as glutamate oxaloacetate transaminase (GOT)
(109), glutamate pyruvate transaminase (GPT)(109).

Observation of the adipose tissue and liver after injection of SlimTrym®,

researchers found that the formula SlimTrym® exerts its anti-NASH(109) and
obesity(109) effect by inhibiting the receptors(109) involved in
lipogenesis(109) and lipid accumulation(109).

5. Wolfberry
Wolfberry is the fruit of plant Lycium barbarum of the family Solanaceae, used
as a famous drug or supplement by traditional Chinese medicine for the
treatment of liver and eyes problems(110).

On C57BL/6N mice by feeding with MCD diet for 6 weeks, accompanied by

the 1 mg/kg Lycium barbarum polysaccharides (LBP) intragastrically fed on a
daily basis with or without MCD diet lasting from the 4th to 6th week, LBP, a
major bioactive constituents of wolfberry attenuated the hepatic injury(111) in a
non-alcoholic steatohepatitis (NASH)(111) induced by methionine-choline-
deficient (MCD)(111) in mouse model.
Additonally, LBP normalized the increased serum ALT(111) and AST
levels(111), hepatic oxidative stress(111), fibrosis(111), inflammation(111), and
apoptosis(111) in a mouse model fed with MCD diet.

Furthermore, LBP injection also attenuated the overexpression of proteins(111)

in facilitating the production of pro-inflammatory cytokines(111) involved in
lipid peroxidation(111).

Based on the findings, researchers suggested that the reduction of hepatic injury
during the progression of NASH by therapeutic LBP treatment is attributed to
the inhibition of proteins and protein receptor associated with proinflammation
and inflammatory diseases(111), respectively.

Moreover, on a high-fat diet (HFD)-induced NAFLD mice model and C57BL/6

mice fed a normal control diet, high-fat diet (HFD), HFD supplemented with 2
g/kg LRE, or HFD supplemented with 5 g/kg LRE, LRE markedly decreased
the levels of triglycerides(112), total cholesterol(112), aspartate
aminotransferase(112) and alanine aminotransferase(112) in the serum of mice
fed an HFD, and improved glucose metabolism(112) and insulin
sensitivity(112) in NAFLD mice.

Also, treatment with LRE significantly decreased the expression level of

proteins(112) involved in the transcriptional regulation of lipid
metabolism(112), energy balance(112), and inflammation(112) in the liver
tissues through enhancing the hepatic AMPK pathway(112) associated with
liver lipid accumulation and insulin resistance.

6. Garlic
Garlic, or Allium sativum, is a species in the onion genus Allium, native in
Asia, Egypt, and the Mediterranean regions, used popularly in traditional and
Chinese medicine for the treatment of common cold and flu to the plague,
blood pressure cholesterol levels, natural antibiotic(113).

According to the study by the Huazhong University of Science and Technology,

a traditional Chinese medicine formula including resveratrol, Lycium barbarum
polysaccharides, dioscin, bergamot polyphenol fraction, capsaicin, and garlic-
derived S-allylmercaptocysteine, garlic-derived S-allylmercaptocysteine,
inhibited the progression of NAFLD(114) by exhibiting the liver
In other words, the formula protected the liver against the onset of NAFLD by
inhibiting insulin resistance(114), dysfunctional lipid metabolism(114),
endoplasmic reticulum stress(114), oxidative stress(114), inflammation(114),
and apoptosis/necrosis(114).

Furthermore, in a clinical trial including 110 subjects with NAFLD were

randomly assigned to the intervention or the control group, with the
intervention group received two garlic tablets (containing 400 mg of garlic
powder) daily while the control group received placebo tablets, 400 mg
of garlic powder showed a significantly greater reduction in body weight(116)
and fat mass(116) compared to controls.

7. Uncontaminated fish oil

Uncontaminated fish oil is derived from the tissues of oily fish, excluding fish
which are contaminated and at the top of the food chain(117).

Fish do not actually produce omega-3 fatty acids, but instead, accumulate them
from consuming microalgae that produce the fatty acids.

Compared to the 10 male Sprague-Dawley rats fed a control diet (CON),

a Western-style high-fat and high-cholesterol diet (WD), or a WD diet
containing fish oil (FOH) for 16 weeks respectively, researchers found that fish
oil significantly ameliorated WD-induced dyslipidemia(118), transaminase
elevation(118), hepatic steatosis(118), inflammatory infiltration(118), and
fibrosis(118) induced by the Western diet by correcting the expression levels of
genes(118) involved in fatty acid and cholesterol metabolism(118).

Additionally, fish oil also inhibited the expression levels of pro-inflammation

genes(118) such as Mcp1, Socs2, Sema4a, and Cd44(118) compared to the WD

Collectively, researchers said, " fish oil protects against WD-induced NALFD
via improving lipid metabolism and ameliorating hepatic inflammation".

On male Sprague-Dawley rats fed with a lab chow (CON), high-fat high-
cholesterol diet (WD), or WD supplemented with fish oil (FOH), respectively,
fish oil modification of hepatic lipid metabolism(119) and signaling
transduction(119) through the alternation of hepatic miRNAs(119)
including rno-miR-29c-3p, rno-miR-30d-5p, rno-miR-33-5p, rno-miR-34a,
and rno-miR-328a-3p, compared to differentially expressed miRNAs (DEMs)
between FOH and WD groups.

By comparing different expression of miRNAs (DEMs) between FOH and WD

groups, researchers said, (The result) reveals that fish oil supplementation alters
hepatic expression of miRNAs, which may contribute to fish oil amelioration of
NAFLD in rats".

8. Flax seeds
The seeds of the flax plant (Linum usitatissimum) contained both omega-3 and
omega-6 fatty acids.
Its oil used as a supplement generally contains 50% of the omega-3 fatty acid -
alpha-linolenic acid and 25 % of the omega-6 fatty acid linolenic acid, 15 % of
mainly monounsaturated oleic acid and trace amounts of palmitoleic acid and
eicosenoic acid(120).

In the aged laying-hens-a novel and more physiologically relevant model of

human disease induced NAFLD, supplemented with whole flaxseed (WFX)
reduced steatosis(121) and hepatocellular ballooning(121).

Furthermore, the serum AST(121) associated with liver injury or damage(121)

also was reduced in hens provided with WFX and defatted flaxseed meal

Compared to other group fed with flax seeds, FXO supplementation showed a
greater effect in the modification of transcript abundance of genes(121) linked

Based on the findings, researchers said, "These findings demonstrate the

potential use of whole flaxseed for the treatment and prevention of NAFLD in

In a two-arm randomized open labeled controlled clinical trial was conducted

on 50 patients with non-alcoholic fatty liver disease (NAFLD), assigned to take
either a lifestyle modification (LM) or LM +30 g/day brown milled flaxseed for
12 weeks, researchers found that at the end of the study,
flaxseed supplementation exhibited a significantly greater reduction on body
weight(122), liver enzymes(122), insulin resistance(122), and hepatic
fibrosis(122) and steatosis(122) compared to LM group.
Flaxseed supplementation also reduced the levels of hepatic markers(122)
compared to the control group.

Researchers wrote in the final report, "flaxseed supplementation plus lifestyle

modification is more effective than lifestyle modification alone for NAFLD

9. Coffee
Coffee, a popular and social beverage all over the world, particularly in the
West, is a drink made from roast bean from the Coffea plant, native to tropical
Africa and Madagascar. Chlorogenic acids (CGA) are the most abundant
phenolic compounds in green coffee beans and have been suggested to mitigate
several cardiometabolic risk factors(123).

On ApoE-/- mice fed an atherogenic diet without (vehicle) or with water-based

standardized green coffee extract (GCE) by gavage (equivalent to 220 mg/kg of
CGA) for 14 weeks, GCE showed to improve metabolic parameters(124),
including fasting glucose(124), insulin resistance(124), serum leptin(124),
urinary catecholamines(124), and liver triglycerides(124), without affecting the
atherosclerotic lesion progression(124) or plasma lipid levels(124).

GCE also reduced weight gain(124), decreased adiposity(124), lower

inflammatory infiltration(124) in adipose tissue(124), and protected the liver
against damage(124) and induced the shifts in favor of good gut
microbiota(124), compared to vehicle group.

The levels of liver pro-inflammation cytokines(124) also were decreased by the

injection of GCE.

In a study of patients with metabolic syndrome (Mets) randomly allocated to

consume 400 mg GCE or placebo capsules twice per d for 8 weeks with both
groups were advised to follow an energy-balanced diet, injection of GCE
supplementation significantly reduced systolic blood pressure (SBP)(125)
compared with the placebo group.

Furthermore, the GCE treatment group showed a significantly reduced fasting

blood glucose (FBS)(125), waist circumference(125) and insulin
resistance(125) compared to placebo.

Based on the findings, researchers said, "GCE administration had an

ameliorating effect on some of the Mets components such as high SBP, high
FBS, and Mets (metabolic syndrome) main aetiological factors including
insulin resistance and abdominal obesity.

10. Broccoli
Broccoli is a mustard/cabbage plant, belonging to the family Brassicaceae. The
vegetable has large flower heads, usually green in color and the mass of flower
heads surrounded by leaves and evolved from a wild cabbage plant on the
continent of Europe(126).

On adult 5-wk-old male B6C3F1 mice received a control diet (AIN-93M) or a

Western diet (high in lard and sucrose, 19% and 31%, wt:wt, respectively), with
or without freeze-dried broccoli (10%, wt:wt), mice group treated with broccoli
exhibited lower hepatic triglycerides(127) and NAFLD scores(127).

Additionally, compared to the control group, mice group treated with broccoli
decreased liver injured or damaged markers(127) and protected against liver
inflammation(127) and slowed the initiation and progression of a hepatic

In the sum up, researchers said, "Long-term consumption of whole broccoli

countered both NAFLD development enhanced by a Western diet and hepatic
tumorigenesis induced by DEN in male B6C3F1 mice".

On mice exposed to the hepatocarcinogen diethylnitrosamine (DEN),

sulforaphane from broccoli exerted significant liver protection against NAFLD
and liver cancer.

On male 15-day-old C57BL/6J mice given DEN and placed on a Western or

Western+10%Broccoli diet from the age of 4 weeks through 7 months,
researchers at the end of the experiment showed that dietary broccoli decreased
hepatic triacylglycerols(128), NAFLD(128), liver damage(128) and tumor
necrosis factor(128) by month 5 without changing body weight(128) or relative
liver weight(128), and slowing down the carcinogenesis(128), seen in 100% of

In other words, broccoli, a good source of sulforaphane, is a good candidate to

slow the progression of hepatic lipidosis(128).

11. Walnuts
Walnut tree is one of the Genus plants belonging to the family Juglandaceae
about 30–130 ft cultivated for its nut and kernel and for the commercial
purpose all over the world(129).

On male C57BL/6J mice fed a rodent chow or HFD (45% energy-derived)

±walnuts (21.5% energy-derived) for 6 weeks, before injection of walnut, mice
fed with HFD showed a significantly elevated fat accumulation(130).

Mice fed a rodent chow or HFD (45% energy-derived)±walnuts (21.5% energy-

derived) compared to HFD group prevented HFD-mediated alteration of the
levels of key proteins involved in lipid homeostasis(130) in the induction lipid
accumulation in the liver(130).

Furthermore, walnut protected the liver against the overexpression of pathways

that elevate oxidative stress-induced lipid peroxidation(130) as well as the
proteins associated with programming liver cells apoptosis(130) caused by

Researchers based on the findings wrote, "The beneficial effects of dietary

walnut likely result, at least partially, from its antioxidant ingredients and
attenuating HFD-induced hepatic steatosis, nitroxidative stress and apoptosis".

Also, on male C57BL/6J mice fed either a regular rodent chow or HFD (45%
energy-derived) with or without walnuts (21.5% energy-derived) for 20weeks,
dietary walnuts significantly decreased the amounts of hepatic triglyceride
(TG)(131)compared to HFD-fed mice.

Similar to the aforementioned results, additional walnuts significantly altered

the levels of proteins(131), involved in the hepatic lipid homeostasis(131).

Moreover, in the examined the adipose tissues isolated from mice fed the
HFD+walnut diets, researchers found that walnut significantly decreases levels
of proinflammatory cytokines(131) compared to those significantly elevated in
mice fed HFD alone without affecting the significantly alter HFD-induced
peripheral glucose intolerance(131) or insulin resistance(131).

Researchers wrote in the final report, "the protective effects of walnuts against
HFD-induced hepatic TG accumulation in mice are mediated, at least partially,
by modulating the key proteins in hepatic lipid homeostasis and suppression of
the genes related to adipose tissue inflammation and macrophage infiltration as
well as prevention of adipocyte apoptosis".
12 Avocado
Avocado is a commercially valuable fruit cultivated in tropical climates
throughout the world. The fruit is a green-skinned, pear-shaped fruit that ripens
after harvesting and native to the Caribbean, Mexico, South America, and
Central America, belonging to the flowering plant family Lauraceae(132).

On male Sprague-Dawley rats fed high-cholesterol diet for four weeks to

induce hypercholesterolemia, followed by the VAO (450 and 900 mg·kg-1
·day-1 ) and simvastatin (10 mg·kg-1 ·day-1) given orally while maintaining
the high-cholesterol diet for another four weeks, according to the assessment of
urinary metabolomics using NMR, oral administration of VAO partially
recovered the metabolism dysfunction(133)) induced by hypercholesterolemia
mainly via lipid, energy(133), amino acid(133), and gut microbiota(133)

On Streptozocin-induced diabetic mice, before treatment of avocado oil, a rich

source of C18, diabetic mice elicited a noticeable increase in the content of
docosahexaenoic acid (DHA)(134) found in the mitochondrial peroxidizability
index(134) and higher levels of lipid peroxidation(134).

Furthermore, mitochondrial respiration(134) and activity were impaired in

diabetic rats by a significant increase in reactive oxygen species (ROS)

Additional avocado oil not only restored all the alternative parameters(134) in
the diabetic mice except by the changes in mitochondrial fatty acid
composition(134) but also normalized the hyperlipidemia(134).

However, avocado oil showed no effect on the prevention of hyperglycemia


Based on the findings, researchers said, " These findings might have also
significant implications in the progression of NAFLD in experimental models
of steatosis".

D. Summary
Taken altogether, phytochemicals, herbal medicines, healthy foods found in the
research paper may be considered remedies for the prevention and treatment of
non-alcoholic fatty liver disease, pending to large sample size and
multicenter human study.
Natural Medicine for Fatty Liver And Obesity Reversal - The
Revolutionary Findings To Achieve Optimal Health And Lose Weight

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Contrary To Professionals Prediction, Floaters Can Be Cured Naturally

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Author Biography
Kyle J. Norton (Scholar, Master of Nutrition, All right reserved)
Health article writer and researcher; Over 10.000 articles and research papers
have been written and published online, including worldwide health, ezine
articles, article base, health blogs, self-growth, best before it's news, the karate
GB daily, etc.,.
by Named 50 of the best health Tweeters Canada - Huffington
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as
international journal Pharma and Bioscience, ISSN 0975-6299.

(1) Histopathology of Nonalcoholic Fatty Liver Disease and Nonalcoholic
Steatohepatitis by G. Thomas Brown, M.D., Ph.D., and David E. Kleiner, M.D.,
Ph.D. (PMC)
(2) Non-alcoholic fatty liver disease in 2015 by Monjur Ahmed. (PMC)
(3) The Global Pattern of Urbanization and Economic Growth: Evidence from
the Last Three Decades by Mingxing Chen, Hua Zhang, 2 Weidong Liu, 1 and
Wenzhong Zhang. (PMC)
(4) Non-alcoholic Fatty Liver Disease in South Asians: A Review of the
Literature by Sital Singh,1 Gabriela N. Kuftinec,2 and Souvik Sarkar. (PMC)
(5) Prevalence of non-alcoholic fatty liver disease and risk factors for advanced
fibrosis and mortality in the United States by Michael H. Le,1 Pardha Devaki,2
Nghiem B. Ha,3,4 Dae Won Jun,5 Helen S. Te,6Ramsey C. Cheung,4,7 and
Mindie H. Nguyen. (PMC)
(6) Epidemiology of non-alcoholic fatty liver disease in China by Fan JG1,
Farrell GC. (PubMed)
(7) Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an
exponential increase in the burden of disease by Chris Estes, 1 Homie Razavi,
1 Rohit Loomba, 2 Zobair Younossi, 3 and Arun J. Sanyal. (PMC)
(8) Symptoms & Causes of NAFLD & NASH by NIH
(9) Nonalcoholic fatty liver disease in adult hypopituitary patients with GH
deficiency and the impact of GH replacement therapy. by Nishizawa H1, Iguchi
G, Murawaki A, Fukuoka H, Hayashi Y, Kaji H, Yamamoto M, Suda K,
Takahashi M, Seo Y, Yano Y, Kitazawa R, Kitazawa S, Koga M, Okimura Y,
Chihara K, Takahashi Y. (PubMed)
(10) Non-alcoholic fatty liver disease and thyroid dysfunction: A systematic
review by Ahad Eshraghian and Alireza Hamidian Jahromi. (PMC)
(11) Obstructive sleep apnea syndrome and fatty liver: Association or causal
link? by Mohamed H Ahmed and Christopher D Byrne, (PMC)
(12) Diets and nonalcoholic fatty liver disease: The good and the bad by
Mohamed Asrih, François R. Jornayvaz. (El Sevier)
(13) Dietary fat stimulates the development of NAFLD more potently than
dietary fructose in Sprague-Dawley rats by Jensen VS1,2, Hvid H2, Damgaard
J2, Nygaard H2, Ingvorsen C3, Wulff EM4, Lykkesfeldt J1, Fledelius C.
(14) Non-Alcoholic Fatty Liver Disease by NICK G. (The American Liver
(15) Racial and Ethnic Disparities in Nonalcoholic Fatty Liver Disease
Prevalence, Severity, and Outcomes in the United States: A Systematic Review
and Meta-analysis by Rich NE1, Oji S1, Mufti AR1, Browning JD1, Parikh
ND2, Odewole M1, Mayo H3, Singal AG. (PubMed)
(16) Emerging Trends Conference: EMERGING TRENDS IN NON-
(17) Hepatic Encephalopathy by the Canadian Liver Foundation
(18) LIVER DISEASE AND ASCITES by Sequana Medical
(19) Nonalcoholic fatty liver disease manifesting esophageal variceal bleeding
by Tang CP1, Huang YS, Tsay SH, Chang FY, Lee SD. (PubMed)
(20) Non-alcoholic fatty liver disease by Genetic Home Reference. (NIH)
(21) Systematic review: the diagnosis and staging of non-alcoholic fatty liver
disease and non-alcoholic steatohepatitis by J K Dowman,*† J W Tomlinson,‡
and P N Newsome. (PMC)
(22) Current treatment options for nonalcoholic fatty liver disease and
nonalcoholic steatohepatitis by Melanie D Beaton, MD FRCPC. (PMC)
(23) Herbal medicines and nonalcoholic fatty liver disease by Hong Yao, Yu-Jie
Qiao, Ya-Li Zhao, Xu-Feng Tao, Li-Na Xu, Lian-Hong Yin, Yan Qi, and Jin-
Yong Peng. (PMC)
(24) An Overview of Herbal Products and Secondary Metabolites Used for
Management of Type Two Diabetes by Ajda Ota and Nataša P. Ulrich.
(25) Triterpenoids are compounds with a carbon skeleton based on six isoprene
units which are derived biosynthetically from the acyclic C30 hydrocarbon,
squalene From Pharmacognosy, 2017. (Science Direct)
(26) The triterpenoid-rich fraction from Ilex hainanensis Merr. attenuates non-
alcoholic fatty liver disease induced by high-fat diet in rats by Cui WX, Yang J,
Chen XQ, Mao Q, Wei XL, Wen XD, Wang Q.(PubMed)
(27) Turmeric, the Golden Spice. From Traditional Medicine to Modern
Medicine by Sahdeo Prasad and Bharat B. Aggarwal. (NCBI)
(28) Popular #Herbs - Turmeric (Curcuma longa) by Kyle J. Norton
(29) Effect of curcumin on serum and liver cholesterol levels in the rat by Rao
DS, Sekhara NC, Satyanarayana MN, Srinivasan M. (PubMed)
(30) [Recent advances in curcumin and its derivatives for the treatment of liver
diseases].[Article in Chinese] by Sun Y, Peng ML. (PubMed)
(31) [The effects of curcumin derivative on experimental steatohepatitis].
[Article in Chinese] by Zeng CH, Zeng P, Deng YH, Shen N, Peng ML, Liu Q,
Ren H.(PubMed)
(32) Phytochemical Piperine and antimicrobial activity by Kyle J. Norton
(33) Piperine reverses high fat diet-induced hepatic steatosis and insulin
resistance in mice by Choi S1, Choi Y, Choi Y, Kim S, Jang J, Park T.
(34). Phytochemicals in Foods - 15 Health Benefits of Resveratrol by Kyle J.
(35) Nutraceutical Approach to Non-Alcoholic Fatty Liver Disease (NAFLD):
The Available Clinical Evidence by Arrigo F. G. Cicero,1,* Alessandro
Colletti,1 and Stefano Bellentani. (PMC)
(36) Natural products berberine and curcumin exhibited better ameliorative
effects on rats with non-alcohol fatty liver disease than lovastatin by Feng
WW1, Kuang SY2, Tu C3, Ma ZJ3, Pang JY3, Wang YH3, Zang QC3, Liu
TS4, Zhao YL3, Xiao XH3, Wang JB. (PubMed)
(37) Higher serum carotenoids associated with improvement of non-alcoholic
fatty liver disease in adults: a prospective study by Xiao ML1, Chen GD1,
Zeng FF1,2, Qiu R1, Shi WQ3, Lin JS1, Cao Y1, Li HB1, Ling WH1, Chen
YM. (PubMed)
(38) Carotenoids Found in Tomatoes by SF Gate
(39) Greater serum carotenoid levels associated with lower prevalence of
nonalcoholic fatty liver disease in Chinese adults by Cao Y1, Wang C2, Liu J2,
Liu ZM3, Ling WH2, Chen YM. (PubMed)
(41) Quercetin Induces Mitochondrial Biogenesis through Activation of HO-1
in HepG2 Cells by Nabin Rayamajhi, Seul-Ki Kim, 1 Hiroe Go, 3 Yeonsoo Joe,
1 Zak Callaway, 1Jae-Gu Kang, 4 Stefan W. Ryter, 5 and Hun Taeg Chung.
(42) Quercetin ameliorates HFD-induced NAFLD by promoting hepatic VLDL
assembly and lipophagy via the IRE1a/XBP1s pathway by Zhu X1, Xiong T1,
Liu P1, Guo X1, Xiao L1, Zhou F1, Tang Y2, Yao P. (PMC)
(43) Metabolomics Characterizes the Effects and Mechanisms of Quercetin in
Nonalcoholic Fatty Liver Disease Development by Xu Y1, Han J2, Dong J3,
Fan X4, Cai Y5, Li J6, Wang T7,8, Zhou J9, Shang J. (PubMed)
(44) The Health Benefits of Anthocyanin by Cathy Wong. (VeryWell Health)
(45) Anthocyanins inhibit high glucose-induced renal tubular cell apoptosis
caused by oxidative stress in db/db mice by Jinying Wei,#1,2,* Haijiang
Wu,#1,2,* Haiqiang Zhang,3 Fang Li,1,2 Shurui Chen,1,2Baohua Hou,1,2
Yonghong Shi, #1,2,* Lijuan Zhao,4 and Huijun Duan. (the International
Journal od Modular Medicine)
(46) Cyanidin-3-O-β-glucoside regulates the activation and the secretion of
adipokines from brown adipose tissue and alleviates diet-induced fatty liver
by Pei L1, Wan T1, Wang S1, Ye M1, Qiu Y1, Jiang R1, Pang N1, Huang Y1,
Zhou Y1, Jiang X1, Ling W2, Zhang Z3, Yang L. (PubMed)
(47) Phytochemicals in foods - 12 Health Benefits of Epigallocatechin gallate
(EGCG) by Kyle J. Norton
(48) (-)-Epigallocatechin-3-gallate and atorvastatin treatment down-regulates
liver fibrosis-related genes in non-alcoholic fatty liver disease by Ying L1,2,3,
Yan F2,3, Zhao Y1, Gao H2,3, Williams BR2,3, Hu Y4, Li X5, Tian R6, Xu P1,
Wang Y. (PubMed)
(49) Potential Biological Effects of (-)-Epigallocatechin-3-gallate on the
Treatment of Nonalcoholic Fatty Liver Disease by Chen C1, Liu Q1, Liu L1,
Hu YY1,2,3, Feng Q. (PubMed)
(50) Phytochemicals in Foods - 16 Health Benefits of Astaxanthin by Kyle J.
(51) Food components with antifibrotic activity and implications in the
prevention of liver disease.
Bae M1, Park YK1, Lee JY. (PubMed)
(52) Astaxanthin prevents ischemia-reperfusion injury of the steatotic liver in
mice by Li S1,2,3,4, Takahara T5, Fujino M1,6, Fukuhara Y7, Sugiyama T5, Li
XK1, Takahara S. (PubMed)
(53) Astaxanthin by Tetsuo Satoh, in Nutraceuticals, 2016. (Science Direct)
(54) The anti-obesity activity of the marine carotenoid fucoxanthin(PubMed)
(55) The effects of Xanthigen in the weight management of obese
premenopausal women with the non-alcoholic fatty liver disease and normal
liver fat by Abidov M1, Ramazanov Z, Seifulla R, Grachev S.marine
carotenoid fucoxanthin.Gammon MA1, D'Orazio N. (PubMed)
(56) Glucoraphanin by Science Direct
(57) Glucoraphanin: a broccoli sprout extract that ameliorates obesity-induced
inflammation and insulin resistance by Xu L1, Nagata N1, Ota T. (PubMed)
(58) Glucoraphanin Ameliorates Obesity and Insulin Resistance Through
Adipose Tissue Browning and Reduction of Metabolic Endotoxemia in Mice by
Nagata N1, Xu L1, Kohno S2, Ushida Y3, Aoki Y3, Umeda R3, Fuke N3,
Zhuge F1, Ni Y1, Nagashimada M1, Takahashi C2, Suganuma H3, Kaneko S4,
Ota T. (PubMed)
(59) Phytochemicals in Foods - 10 Health Benefits of Sinigrin by Kyle J.
(60) The antioxidant dietary approach in the treatment of fatty liver: New
insights and updates by Alessandra Ferramosca, Mariangela Di Giacomo, and
Vincenzo Zara. (PMC)
(61) Popular #Herbs - Anise Kyle J. Norton
(62) Pimpinella anisum L. fruit: Chemical composition and effect on a rat
model of nonalcoholic fatty liver disease by Asadollahpoor A1, Abdollahi M2,
Rahimi R3,(PubMed)
(63) Popular Herbs - Hawthorn (Crataegus)
(64) Traditional Chinese medicines benefit to nonalcoholic fatty liver disease: a
systematic review and meta-analysis by Shi KQ, Fan YC, Liu WY, Li LF, Chen
YP, Zheng MH. (PubMed)
(65) The relationship between obesity and the severity of non-alcoholic fatty
liver disease: systematic review and meta-analysis by Lu FB1, Hu ED1, Xu
LM1, Chen L1, Wu JL1, Li H1, Chen DZ2, Chen YP. (PubMed)
(66) Sida rhomboidea. Roxb Leaf Extract Down-Regulates Expression of
PPARγ2 and Leptin Genes in High Fat Diet-Fed C57BL/6J Mice and Retards in
Vitro 3T3L1 Pre-Adipocyte Differentiation by Menaka C. Thounaojam,1
Ravirajsinh N. Jadeja,1 Umed V. Ramani,2 Ranjitsinh V. Devkar,1,*and A. V.
Ramachandran. (PMC)
(67) Prevention of High Fat Diet-Induced Insulin Resistance in C57BL/6J Mice
by Sida rhomboidea ROXB. Extract by Menaka Chanu Thounaojam,
Ravirajsinh Navalsinh Jadeja, Ansarullah, Ranjitsinh Vijaysinh Devkar, A. V.
Ramachandran. (Journal of Health Science)
(68) Sida rhomboidea. Roxb Leaf Extract Down-Regulates Expression of
PPARγ2 and Leptin Genes in High Fat Diet-Fed C57BL/6J Mice and Retards
inVitro 3T3L1 Pre-Adipocyte Differentiation
Menaka C. Thounaojam 1, Ravirajsinh N. Jadeja 1, Umed V. Ramani 2,
Ranjitsinh V. Devkar 1,* and. V. Ramachandran. ( International Journal of
Molecular Science)
(69) Phytochemistry and medicinal properties of Teucrium polium L.
(Lamiaceae) by Bahramikia S1, Yazdanparast R. (PubMed)
(70) Teucrium polium in the prevention of steatohepatitis in rats by Rahim
Amini, Narges Nosrati, Razieh Yazdanparast, Mahsa Molaei. ( Liver
(71) Teucrium polium reversed the MCD diet-induced liver injury in rats by
Rahim Amini, Razieh Yazdanparast and Safiyeh Aghazadeh. (Sage Journal)
(72) Popular Herbs - Grapefruit Seed Extract by Kyle J. Norton
(73) Resveratrol improves non-alcoholic fatty liver disease by activating AMP-
activated protein kinase by Shang J1, Chen LL, Xiao FX, Sun H, Ding HC,
Xiao H. (PubMed)
(74) SIRT1 as a potential therapeutic target for the treatment of nonalcoholic
fatty liver disease by Colak Y1, Ozturk O, Senates E, Tuncer I, Yorulmaz E,
Adali G, Doganay L, Enc FY. (PubMed)
(75) Popular #Herbs - Milk Thistle by Kyle J. Norton
(76) The therapeutic effect of silymarin in the treatment of nonalcoholic fatty
disease: A meta-analysis (PRISMA) of randomized control trials by Zhong S1,
Fan Y, Yan Q, Fan X, Wu B, Han Y, Zhang Y, Chen Y, Zhang H, Niu J.
(77) Silybum marianum oil attenuates hepatic steatosis and oxidative stress in
high fat diet-fed mice by Zhu SY1, Jiang N2, Yang J3, Tu J4, Zhou Y3, Xiao
X3, Dong Y. (PubMed)
(78) Popular #Herbs - #Ginseng, Asian (Panax ginseng) and Ginseng, North
America by Kyle J. Norton
(79) Acanthopanax senticosus Extract Prepared from Cultured Cells Decreases
Adiposity and Obesity Indices in C57BL/6J Mice Fed a High Fat Diet by Youn-
Soo Cha, Soon-Jae Rhee, and Young-Ran Heo. (Journal of Medicinal Food)
(80) Acanthopanax senticosus reverses fatty liver disease and hyperglycemia in
ob/ob mice by Sang, Hyun Park, Sang Gil Lee, Sung Keel Kang, and Sung
Hyun Chung. (Springer Link)
(81) Chinese Herbs – Ze Xie by Kyle J. Norton
(82) Protective effects of the Alisma Orientalis extract on the experimental
nonalcoholic fatty liver disease byXuezhi Hong, Huiqing Tang, Limao Wu,
and Lianda Li. (Wiley Online Library)
(83) Cissus quadrangularis by Wikipedia
(84) Cissus quadrangularis stem alleviates insulin resistance, oxidative injury
and fatty liver disease by Chidambaram, Jaya, Carani Venkatraman, and
Anuradha. (Science Direct)
(85) Cissus quadrangularis - Wikipedia
(86) Clerodendron glandulosum Coleb., Verbenaceae, ameliorates high fat diet-
induced alteration in lipid and cholesterol metabolism in rats by Jadeja RN;
Thounaojam MC; Ansarullah; Devkar RV*; Ramachandran AV. (Scielo)
(87) Popular #Herbs - Turmeric (Curcuma longa) by Kyle J. Norton
(88) NAFLD and Atherosclerosis Are Prevented by a Natural Dietary
Supplement Containing Curcumin, Silymarin, Guggul, Chlorogenic Acid and
Inulin in Mice Fed a High-Fat Diet by Amato A1, Caldara GF2, Nuzzo D3,
Baldassano S4, Picone P5, Rizzo M6, Mulè F7, Di Carlo M. (PubMed)
(89) Turmeric Supplementation Improves Serum Glucose Indices and Leptin
Levels in Patients with Nonalcoholic Fatty Liver Diseases by Navekar R1,
Rafraf M1, Ghaffari A1, Asghari-Jafarabadi M2, Khoshbaten M. (PubMed)
(90) Popular Herbs - Ginkgo biloba by Kyle J. Norton
(91) Inhibitory effect of Ginkgo biloba extract on fatty liver: Regulation of
carnitine palmitoyltransferase 1a and fatty acid metabolism by Shi Dong Wang,
Zuoquan Xie, Jia Chen and Ke Wang. (Research Gate)
(92) Superfoods - Flaxseed oil by Kyle J. Norton
(93) Flaxseed lignan lowers blood cholesterol and decreases liver disease risk
factors in moderately hypercholesterolemic men by Fukumitsu S1, Aida K,
Shimizu H, Toyoda K. (PubMed)
(94) Flaxseed dietary fibers lower cholesterol and increase fecal fat excretion,
but the magnitude of the effect depends on food type by Kristensen M1, Jensen
MG, Aarestrup J, Petersen KE, Søndergaard L, Mikkelsen MS, Astrup A.
(95) A comprehensive review on Nymphaea stellata: A traditionally used bitter
by M. K. Mohan Maruga Raja, Neeraj Kumar Sethiya, and S. H. Mishra.
(96) Nelumbo nucifera alkaloid inhibits 3T3-L1 preadipocyte differentiation
and improves high-fat-diet-induced obesity and body fat accumulation in rats
by Xie Bin, Wan Jin, Wang Wenqing, and Shi Chunyang. (Research Gate)
(97) Improvement in High-Fat Diet-Induced Obesity and Body Fat
Accumulation by a Nelumbo nucifera Leaf Flavonoid-Rich Extract in Mice by
Cheng-Hsun Wu, Mon-Yuan Yang, Kuei-Chuan Chan, and Pei-Jun
Chung. (Research Gate)
(98) Healthy #Foods - Nuts & Seeds - Olive (Olea europaea) by Kyle J. Norton
(99)Olive leaf extract prevents the spontaneous occurrence of non-alcoholic
steatohepatitis in SHR/NDmcr-cp rats by Omagari K1, Kato S, Tsuneyama K,
Hatta H, Sato M, Hamasaki M, Sadakane Y, Tashiro T, Fukuhara M, Miyata Y,
Tamaru S, Tanaka K, Mune M. (PubMed)
(100) Hypolipidemic and antioxidant activities of oleuropein and its hydrolysis
derivative-rich extracts from Chemlali olive leaves by bJemai H1, Bouaziz M,
Fki I, El Feki A, Sayadi S.(PubMed)
(101) Super Foods - #Pomegranates(Punica granatum) by Kyle J. Norton
(102) Effect of Punica granatum Linn. (flowers) on blood glucose level in
normal and alloxan-induced diabetic rats by Jafri MA1, Aslam M, Javed K,
Singh S. (PubMed)
(103) Antidiabetic effect of Punica granatum flowers: effect on hyperlipidemia,
pancreatic cells lipid peroxidation, and antioxidant enzymes in experimental
diabetes by Bagri P1, Ali M, Aeri V, Bhowmik M, Sultana S. (PubMed)
(104) Popular #Herbs - #Ginger (Zingiber officinale) by Kyle J. Norton
(105) Anti-diabetic activity of Zingiber officinale in streptozotocin-induced
type I diabetic rats by Akhani SP1, Vishwakarma SL, Goyal RK. (PubMed)
(106) Antiobesity Actions of Zingiber officinale Roscoe by Li-Kun Han, Xiao-
Jie Gong, Shiho Kawano, and Masato Saito. (Research Gate)
(107) Healthy #Foods - Green tea - Leaves of Camellia sinensis by Kyle J.
(108) Green tea polyphenols ameliorate non-alcoholic fatty liver disease
through upregulating AMPK activation in high fat fed Zucker fatty rats by Tan
Y1, Kim J1, Cheng J1, Ong M1, Lao WG1, Jin XL1, Lin YG1, Xiao L1, Zhu
XQ1, Qu XQ. (PubMed)
(109) Combination of citrus polymethoxyflavones, green tea polyphenols, and
Lychee extracts suppresses obesity and hepatic steatosis in high-fat diet induced
obese mice by Pan MH1,2,3,4, Yang G1, Li S1, Li MY5, Tsai ML5, Wu JC6,
Badmaev V7, Ho CT8, Lai CS. (PubMed)
(110) Super Foods - Wolfberry by Kyle J. Norton
(111) Lycium barbarum polysaccharides improve hepatic injury through NF-
kappa-B and NLRP3/6 pathways in a methionine choline deficient diet
steatohepatitis mouse model by Xiao J1, Wang F2, Liong EC3, So KF4, Tipoe
GL. (PubMed)
(112) Lycium ruthenicum extract alleviates high-fat diet-induced nonalcoholic
fatty liver disease via enhancing the AMPK signaling pathway by Lin J1,
Zhang Y1, Wang X1, Wang W. (PubMed)
(113) Popular #Herbs - #Garlic (Allium sativum) by Kyle J. Norton
(114) Traditional Chinese herbal extracts inducing autophagy as a novel
approach in therapy of nonalcoholic fatty liver disease by Liu C1, Liao JZ1, Li
PY. (PubMed)
(116) Effect of garlic powder consumption on body composition in patients
with nonalcoholic fatty liver disease: A randomized, double-blind, placebo-
controlled trial by Soleimani D1, Paknahad Z2, Askari G3, Iraj B4, Feizi A.
(117) Superfoods - Uncontaminated Fish Oil by Kyle J. Norton
(118) Fish oil alleviated high-fat diet-induced non-alcoholic fatty liver disease
via regulating hepatic lipids metabolism and metaflammation: a transcriptomic
study by Yuan F1,2, Wang H3, Tian Y4, Li Q5, He L6, Li N7, Liu Z. (PubMed)
(119) Fish Oil Feeding Modulates the Expression of Hepatic microRNAs in a
Western-Style Diet-Induced Nonalcoholic Fatty Liver Disease Rat Model by
Wang H1, Shao Y1, Yuan F1,2, Feng H1, Li N1, Zhang H1, Wu C3, Liu Z.
(120) Superfoods - Flaxseed oil by Kyle J. Norton
(121) Therapeutic effect of flax-based diets on fatty liver in aged laying hens by
Davis JE1, Cain J2, Small C3, Hales DB. (PubMed)
(122) Flaxseed supplementation in non-alcoholic fatty liver disease: a pilot
randomized, open-labeled, controlled study by Yari Z1, Rahimlou M2,
Eslamparast T1, Ebrahimi-Daryani N3, Poustchi H4, Hekmatdoost A.
(123) 71 Health Benefits and 28 Adverse Effects of Coffee by Kyle J. Norton
(124) Green Coffee Extract Improves Cardiometabolic Parameters and
Modulates Gut Microbiota in High-Fat-Diet-Fed ApoE-/- Mice by Caro-Gómez
E1, Sierra JA2, Escobar JS3, Álvarez-Quintero R4, Naranjo M5, Medina S6,
Velásquez-Mejía EP7, Tabares-Guevara JH8, Jaramillo JC9, León-Varela
YM10, Muñoz-Durango K11, Ramírez-Pineda JR. (PubMed)
(125) Effects of green coffee extract supplementation on anthropometric
indices, glycaemic control, blood pressure, lipid profile, insulin resistance and
appetite in patients with the metabolic syndrome: a randomized clinical trial by
Roshan H1, Nikpayam O1, Sedaghat M2, Sohrab G. (PubMed)
(126) Healthy #Foods - Vegetables - Cabbage (Brassica oleracea) by Kyle J.
(127) Dietary Broccoli Lessens Development of Fatty Liver and Liver Cancer
in Mice Given Diethylnitrosamine and Fed a Western or Control Diet by Chen
YJ1, Wallig MA2, Jeffery EH. (PubMed)
(128) Dietary broccoli protects against fatty liver development but not against
the progression of liver cancer in mice pretreated with diethylnitrosamine by
Chen YJ1, Myracle AD1, Wallig MA2, Jeffery EH. (PubMed)
(129) Healthy #Foods - Nuts & Seeds - Walnuts (Juglans) by Kyle J. Norton
(130) Preventive effects of dietary walnuts on high-fat-induced hepatic fat
accumulation, oxidative stress, and apoptosis in mice by Choi Y1,
Abdelmegeed MA1, Song BJ. (PubMed)
(131) Dietary walnut reduces hepatic triglyceride content in high-fat-fed mice
via modulation of hepatic fatty acid metabolism and adipose tissue
inflammation by Choi Y1, Abdelmegeed MA1, Akbar M1, Song BJ. (PubMed)
(132) Healthy #Foods - Fruits - Avocado by Kyle J. Norton
(133) Effect of virgin avocado oil on diet-induced hypercholesterolemia in rats
via 1 H NMR-based metabolomics approach by Tan CX1, Chong GH2,
Hamzah H3, Ghazali HM. (PubMed)
(134) Protective effects of dietary avocado oil on impaired electron transport
chain function and exacerbated oxidative stress in liver mitochondria from
diabetic rats by Ortiz-Avila O1, Gallegos-Corona MA, Sánchez-Briones LA,
Calderón-Cortés E, Montoya-Pérez R, Rodriguez-Orozco AR, Campos-García
J, Saavedra-Molina A, Mejía-Zepeda R, Cortés-Rojo C. (PubMed)