Category Archives: Liver Disease

Ketogenic Diet Dramatically Reduces Liver Fat in Non-Alcoholic Fatty Liver Disease #NAFLD

stages of liver damage
<p class="has-drop-cap" value="<amp-fit-text layout="fixed-height" min-font-size="6" max-font-size="72" height="80">Excessive fat accumulation in the liver is also referred to as fatty liver or hepatic steatosis. When enough fat accumulates, it starts hurting the liver, then we call it non-alcoholic fatty liver disease (NAFLD). This can lead to cirrhosis in which scar tissue replaces healthy liver cells, and is one of the leading reasons for liver transplantation. Experts debate which is the best diet for reducing liver fat, but nearly all agree that losing overall excess body weight is helpful, assuming a well-designed diet that avoids nutritional deficiencies. Excessive fat accumulation in the liver is also referred to as fatty liver or hepatic steatosis. When enough fat accumulates, it starts hurting the liver, then we call it non-alcoholic fatty liver disease (NAFLD). This can lead to cirrhosis in which scar tissue replaces healthy liver cells, and is one of the leading reasons for liver transplantation. Experts debate which is the best diet for reducing liver fat, but nearly all agree that losing overall excess body weight is helpful, assuming a well-designed diet that avoids nutritional deficiencies.

Fat in the liver and elsewhere in the body is composed almost entirely of molecules called triglycerides. When you lose fat weight, you’re converting the triglycerides into energy your body can use.

<p value="<amp-fit-text layout="fixed-height" min-font-size="6" max-font-size="72" height="80">Here's a study that found dramatic results in just six days:Here’s a study that found dramatic results in just six days:

Ketogenic diet is an effective treatment for nonalcoholic fatty liver disease (NAFLD). Here, we present evidence that hepatic mitochondrial fluxes and redox state are markedly altered during ketogenic diet-induced reversal of NAFLD in humans. Ketogenic diet for 6 d markedly decreased liver fat content and hepatic insulin resistance. These changes were associated with increased net hydrolysis of liver triglycerides and decreased endogenous glucose production and serum insulin concentrations.

Source: Effect of a ketogenic diet on hepatic steatosis and hepatic mitochondrial metabolism in nonalcoholic fatty liver disease

Steve Parker, M.D.

The Ketogenic Mediterranean Diet is incorporated into the Advanced Mediterranean Diet, 2nd edition.

Altering the omega-6/omega-3 fatty acid ratio reduces liver fat in obese adolescents

salmon, salad
Greek salad with canned salmon. Salmon is one of the cold-water fatty fish.

Omega-6 fatty acids predominate in vegetable oils, including soybean oil. Omega-3 fatty acids, on the other hand, are concentrated in cold-water fatty fish. Some experts believe that excessive consumption of omega-6 fatty acids is inflammatory, contributing to chronic diseases of civilization.

The usual U.S. omega-6/omega-3 fatty acid diet ratio is 15:1. The study at hand altered that to 4:1. That is, they reduced omega-6 or increased omega-3 fatty acid consumption over 12 weeks.

I’ve written about fatty liver disease many times (use search box in interested). The worst outcome is chronic inflammation leading to cirrhosis.

liver disease, hepatic steatosis, NASH
Stages of liver damage. Healthy, fatty, liver fibrosis and cirrhosis. Vector illustration

The study at hand suggests that reducing dietary omega-6 fatty acids and increasing omega-3s can help reverse fat build-up in the liver, at least in obese adolescents.

From a poster presentation published by the American Diabetes Association:

Recent literature suggests that the dietary imbalance between high omega-6 (n6) and low omega-3 (n3) polyunsaturated fatty acids (PUFA) intake, characteristic of the Western diet (average ratio 15:1), leads to development of fatty liver disease. We aimed to determine whether 12 weeks of a low n6/n3 PUFA ratio (4:1) normo-caloric diet might impact fatty liver (MRI assessed hepatic fat content ≥5.5%). Twenty obese adolescents with fatty liver were recruited (13.2±2.9y). Abdominal MRI and OGTT were performed at baseline and after 12-weeks intervention, the oxidized derivatives of linoleic acid (OXLAM) were measured every 4 weeks to assess compliance. Food was supplied to participants isocaloric to their pre-study diet. To control for weight change variable, weight was maintained stable throughout the study. Seventeen adolescents completed the study. After 12 weeks HFF%, decreased of about 26% (Figure 1). There was also a significant decrease in plasma concentrations of ALT (Figure 1), triglycerides (p=0.04) cholesterol (p=0.03), LDL (p=0.07) and an improvement of whole-body insulin resistance (p=0.01). There was a significant decrease of the OXLAM, 9- and 13-HODE (p=0.03 and p=0.01, respectively) and 9- and 13-oxo-ODE (p=0.05 and p=0.01, respectively). These data suggest that, independent of weight loss, a low n6/n3 PUFA diet is effective to ameliorate the metabolic phenotype of adolescents with fatty liver disease.

Source: 772-P: Effect of a Low n6/n3 PUFA Diet on Intrahepatic Fat Content in Obese Adolescents | Diabetes

Steve Parker, M.D.

PS: The Mediterranean diet traditionally is low in omega-6 and rich with omega-3 fatty acids.

Three Ways to Reduce Your Risk of Fatty Liver

Where does bile come from? The liver.

I found this study a while back. TL;DR: Physical activity, the Mediterranean diet, and legume consumption are linked to lower incidence of liver fat. At least in a Spanish population with metabolic syndrome.

Abstract

Objective

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver morbidity. This condition often is accompanied by obesity, diabetes, and metabolic syndrome (MetS). The aim of this study was to evaluate the connection between lifestyle factors and NAFLD in individuals with MetS.

Methods

A cross-sectional study with 328 participants (55–75 y of age) diagnosed with MetS participating in the PREDIMED-Plus trial was conducted. NAFLD status was evaluated using the non-invasive hepatic steatosis index (HSI). Sociodemographic, clinical, and dietary data were collected. Adherence to the Mediterranean diet (mainly assessed by the consumption of olive oil, nuts, legumes, whole grain foods, fish, vegetables, fruits, and red wine) and physical activity were assessed using validated questionnaires.

Results

Linear regression analyses revealed that HSI values tended to be lower with increasing physical activity tertiles (T2, β = –1.47; 95% confidence interval [CI], –2.73 to –0.20; T3, β = –1.93; 95% CI, –3.22 to –0.65 versus T1, Ptrend = 0.001) and adherence to the Mediterranean diet was inversely associated with HSI values: (moderate adherence β = –0.70; 95% CI, –1.92 to 0.53; high adherence β = –1.57; 95% CI, –3.01 to –0.13 versus lower, Ptrend = 0.041). Higher tertiles of legume consumption were inversely associated with the highest tertile of HSI (T2, relative risk ratio [RRR], 0.45; 95% CI, 0.22–0.92; P = 0.028; T3, RRR, 0.48; 95% CI, 0.24–0.97; P = 0.041 versus T1).

Conclusion

Physical activity, adherence to the Mediterranean diet, and consumption of legumes were inversely associated with a non-invasive marker of NAFLD in individuals with MetS. This data can be useful in implementing precision strategies aimed at the prevention, monitoring, and management of NAFLD.

Source: Influence of lifestyle factors and staple foods from the Mediterranean diet on non-alcoholic fatty liver disease among older individuals with metabolic syndrome features – ScienceDirect

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

What’s the Best Diet to Combat Non-Alcoholic Fatty Liver Disease (NAFLD)?

Stages of liver damage. Healthy, fatty, liver fibrosis, and finally cirrhosis

A recent article in Gastroenterology Clinics suggests this one:

•Prioritize intact starches such as brown rice, quinoa, and steel-cut oats, and limit or avoid refined starches such as white bread and white rice

•Replace some of the CHO [carbohydrate], especially refined CHO, in the diet with additional protein from a mixture of animal or vegetable sources, including chicken, fish, cheese, tofu, and pulses

•Include a variety of bioactive compounds in the diet by consuming fruits, vegetables, coffee, tea, nuts, seeds, and extra virgin olive oil

•Get most fat from unsaturated sources, such as olive oil (ideally extra virgin), rapeseed oil, sunflower oil, safflower oil, canola oil, or nuts and seeds

•Limit or avoid added sugars, whether sucrose, fructose, maltose, maltodextrin, or any syrups. If any of these words appear in the first 3–5 ingredients of any food item, it is best to avoid that item and choose a no-sugar version instead. Examples are yogurts and commercial cereals•In particular, avoid liquid sugar such as carbonated sugary drinks/sodas, lemonade, any juices, smoothies, and added sugar to tea and coffee

Source: Nutrition and Nonalcoholic Fatty Liver Disease – Gastroenterology Clinics

See the article for a typical daily menu. Looks like a Mediterranean diet to me.

Excessive fructose and saturated fatty acid consumption appear to be particularly harmful to the liver.

The authors also seem to endorse exercise: 150 t0 300 minutes per week of moderate- to vigorous intensity aerobics exercise, performed at least thrice weekly.

And all experts recommend loss of excess fat weight.

If you really want to get into the weeds, click the link above to read about how fat deposits in liver and muscle lead to metabolic inflexibility, resulting in insulin resistance and mitochondrial dysfunction, which alters lipid metabolism, releasing free fatty acids (some of which are lipotoxic), leading to lipotoxic molecules (like ceramides), causing inflammation and fibrosis.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

What’s the Best Approach to Fatty Liver (Hepatic Steatosis)?

Excessive accumulation of fat in the liver can lead to liver inflammation and ultimately liver failure. Trust me, you don’t want liver failure.

For years, the mainstays of treatment for fatty liver has been loss of excess weight and alcohol abstention.

From Dr Bret Scher at DietDoctor:

Fortunately, we have emerging evidence that low-carb and ketogenic diets improve fatty liver while also helping with glycemic control and weight loss, an impressive combination rarely seen with medications. As we reported earlier, studies have shown that carbohydrate restriction changes liver metabolism, stimulating the breakdown of liver fat. Another study mentioned in the same post showed that when children substitute complex forms of starch to replace sugar, they experience reduced amounts of liver fat.

Yet another impressive study found that despite equal weight loss, a low-carb Mediterranean diet was better than a low-fat diet for reversing liver fat and signs of NAFLD. And finally, Virta Health published a subset of its data showing that one year on a ketogenic diet improved non-invasive tests for NAFLD and liver scarring.

Source: Limiting Carbs Likely Better Than Drugs for Fatty Liver — Diet Doctor

Steve Parker, M.D.

PS: The Advanced Mediterranean Diet book includes the very low-carb Ketogenic Mediterranean Diet.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

Probably under $12 at Amazon.com in the U.S.

Mediterranean Diet Plus Extra-Virgin Olive Oil Linked to Lower Risk of Fatty Liver

Not pictured: olive oil vinaigrette I dressed it with

Excessive accumulation of fat in the liver can lead to liver inflammation and ultimately liver failure. Trust me, you don’t want liver failure.

Circle insets are microscopic views

More results from the PREDIMED study:

ABSTRACT

Background

Adherence to a Mediterranean diet (MedDiet) is thought to reduce liver steatosis.ObjectivesTo explore the associations with liver steatosis of 3 different diets: a MedDiet + extra-virgin olive oil (EVOO), MedDiet + nuts, or a control diet.

Methods

This was a subgroup analysis nested within a multicenter, randomized, parallel-group clinical trial, PREvención con DIeta MEDiterránea (PREDIMED trial: ISRCTN35739639), aimed at assessing the effect of a MedDiet on the primary prevention of cardiovascular disease. One hundred men and women (mean age: 64 ± 6 y), at high cardiovascular risk (62% with type 2 diabetes) from the Bellvitge-PREDIMED center were randomly assigned to a MedDiet supplemented with EVOO, a MedDiet supplemented with mixed nuts, or a control diet (advice to reduce all dietary fat). No recommendations to lose weight or increase physical activity were given. Main measurements were the percentage of liver fat and the diagnosis of steatosis, which were determined by NMR imaging. The association of diet with liver fat content was analyzed by bivariate analysis after a median follow-up of 3 y.

Results

Baseline adiposity and cardiometabolic risk factors were similar among the 3 treatment arms. At 3 y after the intervention hepatic steatosis was present in 3 (8.8%), 12 (33.3%), and 10 (33.3%) of the participants in the MedDiet + EVOO, MedDiet + nuts, and control diet groups, respectively (P = 0.027). Respective mean values of liver fat content were 1.2%, 2.7%, and 4.1% (P = 0.07). A tendency toward significance was observed for the MedDiet + EVOO group compared with the control group. Median values of urinary 12(S)-hydroxyeicosatetraenoic acid/creatinine concentrations were significantly (P = 0.001) lower in the MedDiet + EVOO (2.3 ng/mg) than in the MedDiet + nuts (5.0 ng/mg) and control (3.9 ng/mg) groups. No differences in adiposity or glycemic control changes were seen between groups.

Conclusions

An energy-unrestricted MedDiet supplemented with EVOO, a food with potent antioxidant and anti-inflammatory properties, is associated with a reduced prevalence of hepatic steatosis in older individuals at high cardiovascular risk.

Source: Mediterranean Diet Rich in Extra-Virgin Olive Oil Is Associated with a Reduced Prevalence of Nonalcoholic Fatty Liver Disease in Older Individuals at High Cardiovascular Risk | The Journal of Nutrition | Oxford Academic

You only have one liver. Be nice to it.

 Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

Mediterranean Diet Rich in Extra-Virgin Olive Oil Is Associated with a Reduced Prevalence of Nonalcoholic Fatty Liver Disease in Older Individuals

From the Journal of Nutrition:

An energy-unrestricted MedDiet supplemented with EVOO [extra virgin olive oil], a food with potent antioxidant and anti-inflammatory properties, is associated with a reduced prevalence of hepatic steatosis [liver fat] in older individuals at high cardiovascular risk.

Source: Mediterranean Diet Rich in Extra-Virgin Olive Oil Is Associated with a Reduced Prevalence of Nonalcoholic Fatty Liver Disease in Older Individuals at High Cardiovascular Risk | The Journal of Nutrition | Oxford Academic

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com

Problematic Liver Fat? Low-Carb Mediterranean Diet Works Better Than Low-Fat Diet

From an article at International Business Times:

Reducing hepatic [liver] fat or fat around the liver by 30%, along with moderate weight loss is an important part in reducing obesity-related health risks from a long-term perspective, the researchers of the study said. In addition to moderate weight loss, visceral fat or fat stored within the abdominal cavity was reduced by 25% and fat around the heart decreased by 11%. Fat in and around the muscle and pancreas was also reduced by 1 to 2%.

“Reduction in liver fat is a better predictor of long-term health than reduction of visceral fat, which was previously believed to be the main predictor,” Professor Shai explained in a press release. “The findings are a significant contributor to the emerging understanding that for many obese individuals, excess liver fat is not merely a sign of health risks associated with obesity, including cardiovascular disease and diabetes, but is likely also a cause.”

Source: Scientists Reveal Most Effective Diet For Weight Loss, And It’s Not Keto

Click for details of the study.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com

 

Low-Carb Mediterranean Diet Beats Low-Fat Diet for Reducing Liver Fat

From the study abstract:

Methods

In an 18-month weight-loss trial, 278 participants with abdominal obesity/dyslipidemia were randomized to low-fat (LF) or Mediterranean/low-carbohydrate (MED/LC+28g walnuts/day) diets with/without moderate physical activity (PA). HFC and abdominal fat-depots were measured using magnetic-resonance-imaging at baseline, after 6 (sub-study, n=158) and 18-months.

Results

Of 278 participants [age=48yr;88% men; body-mass-index=30.8kg/m2; mean HFC =10.2%,(range:0.01%-50.4%)], retention rate was 86.3%. %HFC substantially decreased after 6 [-6.6% absolute-units (-41% relatively)] and 18-months [-4.0% absolute-units (-29% relatively);p<0.001 vs. baseline]. Reduction of HFC associated with decreases in VAT beyond weight loss. After controlling for VAT loss, decreased %HFC remained independently associated with reductions in serum gamma-glutamyl-transferase and alanine-aminotransferase, circulating chemerin, and HbA1c (p<0.05). While reduction of HFC was similar between PA groups, compared to LF diet, MED/LC induced a greater %HFC decrease (p=0.036) and greater improvements in cardiometabolic risk parameters (p<0.05), even after controlling for VAT changes. Yet, the greater decreases induced by MED/LC compared to LF diets in triglycerides, TG/HDL ratio and cardiovascular risk score were all markedly attenuated when controlling for HFC changes.

Source: The Beneficial effects of Mediterranean diet over low-fat diet may be mediated by decreasing hepatic fat content – Journal of Hepatology

h/t DietDoctor

Here’s a low-carb Mediterranean diet:

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

Yet Another Epidemic: Fatty Liver In Teens

MedPage Today on May 25, 2012 has an article documenting the rise of fatty liver disease in U.S. teenagers.  Prevalence is now up to one in 10 teens.

An expert quoted in the article says it’s tied in with the rise of childhood obesity.

Youth obesity in the U.S. tripled from the early 1980s to 2000, ending with a 17% obesity rate. Overweight and obesity together describe 32% of U.S. children. Some experts believe this generation of kids will be the first in U.S. history to suffer a decline in life expectancy, related to obesity.

I wrote about a small research study that found a very-low-carb diet more effective against fatty liver, compared to a low-calorie diet.  But that involved adults.

University of Colorado researchers indicate that for weight loss, a low-carb, high-protein diet is safe and effective in adolescents.

Diet researchers found in 2008 that a modified low-carbohydrate Mediterranean diet had significant potential to reduce fatty liver.  My Low-Carb Mediterranean Diet (minus the wine option) would probably help overweight teens with fatty liver disease, but it’s never been tested in such a clinical trial.

Steve Parker, M.D.