Mitochondrial dysfunction in our aging veterans; obesity, fatty liver, and NASH with obstructive sleep apnea treated with CPAP, medication, nutrition and MOVE program

Abstract

Until recently, the medical literature has ignored the contribution of sleep apnea to the etiology of obesity and fatty liver (NAFLD) and its potential to cause Non Alcoholic Steato Hepatitis (NASH), cirrhosis and then possibly, liver cancer. This paper discusses the Medical Hypothesis of a weight loss solutions to the mitochondrial dysfunction associated with aging and co-morbid diseases caused by obstructive sleep apnea leading to diabetes 2, obesity, fatty liver and (NASH). NASH is now the second leading liver disease among those waiting for liver transplantation. The most rapidly growing cause of cirrhosis and liver cancer is fatty liver disease. The observation that obstructive sleep apnea decreases the mitochondrial efficacy with diminished ATP and disordered sleep leading to weight gain, increased abdominal girth, diabetes, fatty liver, NASH, eventual liver fibrosis progressing to cirrhosis and even HCC may be monumental. The free radical theory of aging with reactive oxygen species, the unwanted toxic byproducts of aerobic metabolism, damage the respiratory chain (RC) located in the inner mitochondrial membrane is discussed. Together, these reactive oxygen species (ROS) contribute widely to aging, obesity, fatty liver, NASH and liver fibrosis and cirrhosis. The observation that sleep medicine with CPAP combined with Topramax, Orlistat causing fat malabsorption, the MOVE program with diet and exercise enabled patients at a Veterans Hospital to lose weight, and improve AST and ALT. This solution to this mitochondrial decline and oxidative distress in patients was antioxidant supplementation of Vitamin E and occasionally Silymarin to protect hepatocytes cells from oxidative damage and ultimately up-regulate the RC. Finally, another dramatically different approach is to the up-regulation of mitochondrial function by NIR light and DC EMF with polygenic regulation of antioxidant genes in the future.

CPAP in fatty liver with obesity without topiramate and MOVE program does not cause sustained weight loss but may results in weight gain-an opinion!

“…Additionally the mitochondrial defect in obesity and sleep medicine as directed energy is discussed. 5 Topiramate which has been used in epilepsy is thought by experts in neuroscience that it enhances networks in the brain that have a calming effect and inhibits networks that are over stimulating. "That seems to reduce food cravings," says Joel Yager, MD, a professor of psychiatry at the University of Colorado in Denver, who notes that the drug is also used to combat cravings for alcohol and cigarettes.…”