Q&A 6/7/22 Fatty Liver

Podcast Highlights:

00:44 Acupressure and Essential Oils

05:15 A little bit about water

12:23 Do you use toothpaste with fluoride?

13:31 Hey, Dr. John, my brother was diagnosed with nonalcoholic, fatty liver disease. Is that a real thing? Should I be worried about it? Should I be tested for it? And is there a treatment?

15:51 It is now estimated that 25% of the world’s population has fatty liver disease.

19:18 Screening online tools for NAFLD

23:50 Looking at early stage dementia

25:16 Treating Fatty Liver

Transcript from Webinar:

Hello, this is Dr. John.  Back for another Tuesday afternoon Q&A with you. Today will be a little different. I’ve been doing a lot of PowerPoint so you would have information to go with.  Today, I’m not going to do a PowerPoint. I just have a lot that I want to speak about because of some questions that came in, and I probably won’t do quite as long today, although who knows? You never know once my mouth gets warmed up.

Before I get started, Kathryn Black has a little tidbit for you. We’re going to have her doing some helpful hints often, because she gets asked these questions, as well as I do.


Kathryn: Hi!  I’m Kathryn. I work with Dr. John Nieters. I’m also the patient care coordinator at Alameda Acupuncture. One tip that I give to my patients who are experiencing anxiety, that they could do outside of the acupuncture clinic is some acupressure, and especially some acupressure with essential oils. Essential oils are a great way to be able to stimulate and activate certain acupuncture points without needing needles and has a great benefit for quite a while.

The suggestion I’m going to give you is actually the only way that my mom was able to drive in the car with my dad. He wasn’t the best driver, so it calmed her nerves down enough to where they both are able to handle the drive. The essential oil that I’m going to talk about today is Ylang Ylang; this is kind of like a flowery, very light scent. It really works on the emotions specifically, so it’s a good oil for any kind of emotional issue that you may be wanting some help for calming down.

There are two places that I recommend to put this that is great for anxiety.  One is on the upper ear in the upper crease. There is a great point there that’s called Shen men, which is calming the heart.

If you wanted to, you could just take your finger, get one drop of the essential oils and just stimulate that point. It’s just a great way to just calm the whole body and mind down. The other place (and this is where my mom put it) is take a drop, and you are going to put it in the inside of your wrists, about two finger lengths below; Pericardium six is what we call it.

You are going to stimulate that point. It specifically helps to open up the heart in the chest area so they don’t feel so constrained. So you can put it below the wrist or on the upper ear.  Lavender and Jasmine are other really good essential oils to help with anxiety.


Dr Nieters: I have a couple comments. One, that smells really crazy good, too. It’s very, very effective. I don’t really use essential oils in my practice because I’m not that versed in it, where Kathryn is very well-versed in it, and she’s in my practice, so it just makes sense to have her do it. It’s a very nice adjunct to other anti-anxiety treatments.

Again, the number one thing that we treat in acupuncture in the United States today is anxiety. Anxiety cases have gone up by 400% over the last two years, so this is really a big deal. A lot of people are so anxious, so much of the time, they don’t even realize they’re anxious anymore. So, you know, just pay attention. The thing are these are great treatments no matter what.


I just read a study this morning looking at a hospital study. Quite a few patients are looking at acupressure or pressing on acupoints with warm compresses. This was done at some birthing centers. They did it for anxiety for women, and they pressed on the points that Kathryn mentioned. They also did some breast points which helped bring in the milk. This is some very valuable stuff. Anything that works on those acupoints can be extremely powerful.  We choose acupuncture because I think it’s the most powerful, because you’re penetrating right down to the point itself, which of course is three dimensional. They’re not on the surface; they’re into the body a bit.  Acupuncture can reach those a little better. However, the essential oils penetrate very well and stimulate these points. Now, one of the keys with essential oils is they are actually extremely powerful. Therefore, use the dosage that’s recommended or even a little less the first time you use it. Anybody can have an allergy to anything.  Also, only get top-quality essential oils. You want to make sure they are extremely pure because they are so powerful. Thank you, Kathryn.

Kathryn: You’re welcome.


Dr John: I want to say a little bit about water. Actually, that’s not true. I don’t want to say anything about water, because I could talk for a week. It’s actually a ridiculously complex subject. I have a book around here which I didn’t take the time to find right now, written in the 1600s in Japan and it’s called the Yo Jo Kun.  It’s about healing practices. There is an entire chapter, in fact a couple, just on water. He goes into great detail to talk about the therapeutic effects for many different types of water. The water that you catch during a rainstorm.  The water that you get from a stream.  The water you get from a lake.  The water you get from a well. They all have extremely different qualities. He was looking at which waters you use for particular healing activities.  I just want to make a couple of general statements.

Two of the biggest problems with our water supply today. Fortunately, it’s pretty well disinfected. There are still bugs that get passed, and there’s still drugs that get passed. You know, all of these hormonal treatments that are getting peed into the toilet, then they get into the run off and are recycled right into our water supply. These are problems.

The two biggest problems, though, are chlorination and the use of fluoride. Now chlorination is great. It protects us from a lot of bugs. The problem is, it is extremely damaging to the body.

So there is a column in the periodic table and those are halides. In that column is iodine. Well, before you get the iodine, which means it is a smaller molecular size, you have bromine, fluorine and chlorine, which all then because they have a smaller molecular size but the same shape, the same outer shell of electrons, can bind into the iodine sites.


In this country, we already face a crisis of not getting enough iodine into our diets and then into our bodies, which is one of the reasons our breast cancer rates and our breast cyst rates, etc., are so dramatically higher than they are say in Japan where they get quite a bit of iodine. So, that’s one problem. Then you have chlorine, fluorine and bromine, which can bind into those receptor sites and block iodine uptake.  That’s a real problem. The way I recommend you deal with that is try to work so that you are in an area that doesn’t have fluoridated water. There are studies going back into the 1950s. There’s a great series of YouTube videos by a gentleman who worked for the NIH. In fact, he was the top chemist for the NIH. I’ve seen his charts showing the dramatic incidence of increase in cancers, particularly bone cancers in young men and boys that he published going way, way back.  You can still find them on YouTube. I recommend you check them out. Looking at fluoride and cancer from the drinking water. I would never let them put fluoride on my teeth at a dentist’s office. In fact, they did once against my wishes and my kidneys were sore for three days.  I finally called them and said, “Could you look at my notes and see if they use fluoride on my teeth?” And they said, “Oh yeah, yeah, she sure did.” I said, “I specifically asked her not to, and every time that happens, I can feel it in my kidneys.” People think I’m crazy. Maybe I am, but I can feel it.


Fluoride was used by the Nazi Germans in the concentration camps. It lowers IQ. There are very well done studies showing that fluoride lowers the IQ in children, not something you want to do. Chlorine is a stimulator of the hormone system and has been linked to a few problems because of that hyperstimulation of the hormonal system.

My recommendations would be to first get a whole house system that removes fluoride and chlorine. Those are a little pricey, and if you’re renting it, it’s just not worth it. You can get pretty good setups that go under your sink that have four different filtration systems in it for only a couple hundred dollars from Costco.  We’ve had ours for years, and our water tastes great. I use it for all of our drinking water purposes for sure, and I highly recommend it, so I would recommend getting that. 

I also recommend a shower trap to trap the chlorine in the shower. That’s the number one most dangerous thing. Chlorine can be in a gaseous form. In fact, it was used as a poison gas in World War One. You don’t want the chlorine gas being breathed in. Also, your head is one of the areas that you are most vulnerable to things penetrating.  I will have my patients that swim a lot in chlorinated pools definitely will wear bathing caps, and you can get a lotion that you can put on your body that reduces chlorine intake through the pores of the body. Those are a couple things. I would definitely stay away from those.

Then we get into the minerals versus non minerals, hard water versus soft water. There were many people that for years touted hard water because of the mineral content. When I look at the actual research and the studies recently, I’m not seeing the benefits that were touted. So I don’t know. I haven’t really researched it thoroughly for a while.

I personally drink spring water from deep, deep, deep springs where water has been being filtered through the aquifers in the mountain ranges, etc. for hundreds to thousands of years. Very purified. Also, it’s pretty alkaline because it’s picking up a lot of minerals. That’s what I drank. So, you know, I’ve gotten a lot of questions about water and that’s about the best I can do right now.

All right. We have a question, huh?

Kathryn: So do you brush your teeth with.

Dr Nieters: No, I don’t brush my teeth.


Kathryn: In other words, do you use toothpaste with fluoride?

Dr Nieters: I would never use toothpaste with. Well, that’s not true. I have one when I was traveling and couldn’t get anything else. I personally and again, I hate to push or talk about our products, but I use Dr. Bronner’s because I have trusted them for 40-50 years with a lot of their products. I use their toothpaste, which is fluoride free and I like it. My whole family uses that. I also use a electric toothbrush, which once I started using an electric toothbrush, you know, when the dentist when they’re doing a cleaning and they’re calling out the pocket deps, well, I had some horrible pocket depths ten years ago. Fives, fours, sixes. And now when they do it, I’m twos and threes and I can only blame my electric toothbrush. My wife also uses a water pick, and I think they’re both fabulous. Okay, cool. So I’m going to talk a little bit about an email I got and I’m going to paraphrase, but basically it was,


Hey, Dr. John, my brother was diagnosed with nonalcoholic, fatty liver disease. Is that a real thing? Should I be worried about it? Should I be tested for it? And is there a treatment? And so the answer to all of those, I believe, is, yes, it is a thing. In fact, it’s so common that most people would be stunned. So historically, fatty liver disease was almost only found in alcoholics.

And the reason for that is that the culprit is fructose. So the body burns and utilizes glucose primarily for fuel. Fructose it can deal with in small amounts. It has to be broken down completely differently in the liver. And if there’s not a complete breakdown, then the liver will store that excess fructose in the form of fats in the liver.

And eventually, over time, you’ll get the fatty liver disease. Now that, you know, historically was really only a problem with alcoholics, because that’s about the only way you can get enough fructose in your system to make a difference. Having a little fruit here and there is fine. It’s not going to do that. I mean, you’d have the massive amounts of fruit before the fructose was a problem. But in the sixties, with the advent of high fructose corn syrup, they put high fructose corn syrup in everything.


You go to the store and try to find something without high fructose corn syrup. And if it says sugar, it’s probably high fructose corn syrup. The only thing that I would get with sugar at this point is if it specifically says some form of cane sugar. Now, cane sugar is still not good for you, for diabetes risk, etc., but it is so dramatically better for you than having high fructose corn syrup. We’re not even in the same ballpark.

So with the advent of high fructose corn syrup being in so many products, the fatty acid I’m sorry, the fatty liver problems really skyrocketed.


It is now estimated that 25% of the world’s population has fatty liver disease. One out of every four people and very few of them have actually been diagnosed with fatty liver disease because the symptoms are all over the map and not particularly severe until the fatty liver disease gets extremely bad and the liver starts to become fibrotic or dying actually. So nonalcoholic fatty liver disease in it is now being called in many countries.

Instead of NAFLD, it’s being called M as in Mary MAFLD. For metabolic fatty liver disease. Because so much of it is related to metabolic issues, including bad diet, but also some other things. So this is a big, big, big problem. It’s actually something that I’m screening for more and more because there are now easier, really ridiculously easy screening tests for it. So I’m now starting to do more work in that area when I see patients.

Now, traditionally fatty liver was diagnosed, if you had certain liver enzyme irregularities. high, high liver enzymes generally. Then if you had a good doctor, they might check you for fatty liver disease and they would do either an ultrasound or if that looked like there might be a problem, they might do a liver biopsy. The problem is, in early to middle stage fatty liver disease often you can miss that on an ultrasound.

It just unless you’re just a brilliant ultrasound specialist it just gets flat out. Missed a great deal of the time and a biopsy is even worse. You’ve got this tiny needle going into this big organ. You’re getting one cell for every 50,000 cells. And fatty liver is not a homogenous thing. There are patches of fat throughout the liver, so it’s not a very good test. Well, now a few brilliant doctors have put together some combinations of different blood tests that by looking them, running them through a screening tool, you can often catch nonalcoholic fatty liver disease very early on. And these are all tests that I run routinely.

So it’s now something I can go back and take a look at. The only thing is I don’t generally ask people about their height and their weight because they’re usually not relevant to what I’m doing. But those are necessary in order to compute BMI or body mass index.


So I will ask those questions more often and that will allow me to screen very simply, very inexpensively for fatty liver disease. And the great news is early stage to middle stage fatty liver disease is very, very treatable, particularly with Chinese medicine. There are some Western ideas about how to treat it, but it’s really something we do very well even when it gets to a fibrotic stage. I’ve had patients who have reversed their liver disease, so the key is to get it diagnosed. Get it diagnosed.


Now if you go online and I think it’s MDCalc.com, but if you go online, you can find the calculator to look to see your likelihood of fatty liver disease. And so you need a few things. You need Albumin, you need AST, ALT, etc., your body mass index, and you just plug those in and it calculates it for you. It says, hey, you know, you likely have it, you likely don’t have it, or it’s equivocal.

So it’s really easy to do. If you don’t want to do it yourself, have your practitioner do it. It’s part of their job, or at least in my opinion, it should be so.

Kathryn sent out an article today was dementia and nonalcoholic fatty liver disease. Now I’m not going to talk at great length about the dementia part because I’m planning to do that fairly soon. Looking at the horrific rise in dementia, the causes that are largely unknown, everybody looks at the genetics and it’s a tiny, tiny piece of it and then things to do to reverse it.


So we’re going to do a whole show about that. So today I’m going to talk a little bit more about the nonalcoholic fatty liver disease, by the way, 11 years ago already. The estimate was that 10% of all teenagers in the United States already had non-alcoholic fatty liver disease. Now, if that’s accurate and I believe it was, you’ve got to believe that it’s much worse now. And you say, well, why would that be?

Well, every morning. I drive to work and there’s one road I can take where I go by Peet’s on one corner and Starbucks on the other. And before the pandemic, (and it’s starting to return again), I would see groups of kids, young women, often walking together, drinking these gigantic mocha Frappuccino’s right now. So I did a little research. The average mocha Frappuccino has 51 grams of sugar, according to Starbucks.


That’s their side. They’re not going to overestimate that 51 grams of sugar. And that is high fructose corn syrup. By contrast or comparison, a Krispy Kreme glazed doughnut has ten grams of sugar. So drinking one mocha Frappuccino is the equivalent of drinking five plus Krispy Kreme glazed doughnuts. Now, most of the patients, the parents that I know would not let their kid eat those five donuts, but they are letting their kid have the mocha Frappuccino.

So you really need to take another hard look at this. Drinking coffee actually increases longevity. Drinking mocha Frappuccino’s with 51 grams of sugar. I’m going to be doubtful about that. So this is a huge problem that we’re dealing with.

So in Kathryn’s article that I hope you all are opening them. She does some great, great stuff with these


There was a journal article in neurology that was done on 4472 adults aged 20 to 59, and they underwent assessment of liver enzyme activity. That’s a blood test. And a Fatty liver is called hepatic steatosis. Hepatic for the liver. Steatosis. It’s a fatty liver. And they did that by ultrasound. And they also did cognitive evaluation using several computer administrative tests.

They did a simple reaction time. They did a simple digit substitution test and a serial digit learning test. Just reading those five, I already failed, but you get the idea. So they did those. And what they found is the increased activity of the liver enzymes. The two enzymes correlated with lower performance on the SDLT while increased ALT was called correlated with lower performance on the SDST bottom line a strong correlation between fatty liver disease and early stage and probably late stage.


But here they were looking at early stage dementia and that makes perfect sense. So far, being foggy headed, the medical term for that is hepatic encephalopathy, hepatic for the liver and encephalopathy for inflammation in the brain. Okay, so that’s what that’s the technical term for Fatty, I mean, for brain fog. Now it’s generally applied only when the liver is really in bad shape and people are really having a lot of brain fog.

But even low grade foggy headedness is a form of hepatic encephalopathy. So it makes sense that these liver enzyme counts would correspond to increased rates of dementia.

And eventually, if untreated, that fatty liver can go on to, as I mentioned, become fibrotic and then cirrhosis and liver failure, and then you have either death or a liver transplant. So how do you effectively treat fatty liver disease at the early part? It’s pretty easy. You lose weight. 7 to 10% of body weight can improve symptoms. Now, if you find that you have the problem, go talk to your doctor or go talk to your health care provider that you trust.


Mediterranean diet has been shown to work for that. Exercise is good for everything. And here they’re looking 150 minutes of moderate intensity exercise a week. I find that even with 40 to 50 minutes of high intensity exercise, I see huge difference. Stay away from added sugar. Just don’t eat things with added sugar. Unless you’re drinking a really good cup of coffee and you use a little bit of cane sugar. I’m okay with that.

Taking Omega 3 supplement. Avoid liver irritants. Alcohol. A lot of over-the-counter medications. The number one cause of acute liver acute inflammations for liver failure is from taking acetaminophen. So and that’s it at prescribed doses. So it’s a very dangerous medication. And then you’ve got herbs.

Now there are the common herbs that people will know about for liver. If you go to your naturopath, etc.. But the Chinese have blown way past that. We have formulas that are mind blowing in terms of treating liver disease. But you have the regular guys, the milk thistle and turmeric, resveratrol, green tea. I would use vitamin E also. So all of those have their benefits. Now, if you go to the newsletter that Kathryn sent out today, there are a bunch of references.

So you can look this all up and see where you want to go with it.


So I have a list of 13 supplements that I use for nonalcoholic or any kind of fatty liver disease. I don’t use them all on any one person, but there’s a very, very large choice.

But again, I would recommend a two weeks of a keto diet or paleo. Just get all of that carbohydrate out of your system and then go to either paleo or Mediterranean long term. I would d-tocopherol which is a form of vitamin E. I would do 200 milligrams twice a day and this is very safe. I would do some cilantro. I’m not going to give you the dosage on that because it would vary and ACV. So those are some places to start.


And then I would use Chinese herbs for sure. And again, go ahead and look up those charts and those calculations for checking out your own likelihood of routing out fatty liver disease. Now, testosterone in males and estrogen in females help prevent hepatic steatosis. So the lower the testosterone levels and the lower the estrogen levels, and that can be age related or it can be for some other problem.

The higher the level of fatty liver disease, low thyroid increases the likelihood intestinal permeability and leaky gut dramatically increased the likelihood of fatty liver dysbiosis. CIBO Intestinal bacteria dramatically increase it. So there are a lot of problems out there that we need to look at and fix to make sure you keep having a good, healthy liver. Now, 79%, 79 of nonalcoholic fatty liver disease is undiagnosed.

That’s a lot. That’s a lot. That means you might be in that category. So go ahead and check out your liver. Now, in Chinese medicine, of course, you’ve heard me talk many times about how the liver is involved in emotional issues and some of the associated conditions. From the Western standpoint, anxiety. 47% of nonalcoholic fatty liver disease patients have anxiety, 53% are depressed, most have cognitive decline and most have significant fatigue.

So again, these are things that are very common but don’t often get recognized for what they are.

Anything else, Kathryn? Anything I want to say?


Kathryn: I think you covered it. Exercise lymphatic.


Dr Nieters:  Castor oil packs over the liver, lymphatic, draining muscle drainage, massage and dry brushing, etc. Anything that’s going to keep things moving in your system and grounding.

Walking outside. Yeah.


There was a study done on an ayurvedic herb combination, actually, a few years ago. Pretty well done study. And they took. A fairly large group of people, and in the herb group only one person developed cancer after having severe liver issues, while nine of the women in the placebo arm ended up with cancer. So it’s a huge difference. Vitamin K2 was also used in that study. Okay. Well, if there are no questions, we got a half hour in. I think that’s good. I’ve had a good time. Hopefully you got something valuable out of this. And I’m going to say be happy, be healthy, and I’ll be back next Tuesday to take more of your questions.

Thank you.





Recommended Supplements to Support Liver (Dr John does not recommend taking all of these at once:

  • Silymarin (from milk thistle)
  • Vitamin E (mixed trocotrinols) 400mg/day
  • Moderate dose CoQ10 (600mg), Ubiquinol 200mg
  • Whole Turmeric (vs Curcumin)
  • NAC
  • Vitamin A
  • Vitamin D3
  • Probiotics (broad range to high dose) Bacillus coagulans specifically
  • L-Carnitine 1000mg
  • Selenium 75-100mcg
  • Berberine
  • Melatonin 6mg or 200mg as suppository
  • Omega 3 fatty acids
  • Green Tea or EGCG
  • Alpha Lipoic Acid 400mg
  • Tudca (at recommended dose on bottle)
  • Carotinoids

Dr. John Nieters L.Ac, DAOM, is an acupuncturist, Chinese herbalist, functional medicine, writer, teacher, and leader in the community. In this episode, John talks about his experience with the importance of finding your vision and purpose in life, in order to create the right goals for you.

Disclaimer: Dr. John Nieters received his Doctor of Oriental Medicine and Acupuncture degree from Five Branches. His use of “doctor” or “Dr.” in relation to himself solely refers to that degree. Dr. Nieters is a licensed acupuncturist in California. This video is for general informational purposes only. It should not be used to self-diagnose and it is not a substitute for a medical exam, cure, treatment, diagnosis, and prescription or recommendation. It does not create a doctor-patient relationship between Dr. Nieters and you. You should not make any change in your health regimen or diet before first consulting a physician and obtaining a medical exam, diagnosis, and recommendation. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. TheBalancingPoint.net, Alameda Acupuncture, and Dr. John Nieters L.Ac, DAOM are not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this video or site.

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