…according to Iranian and Brazilian researchers who studied an Iranian population. The risk reduction was an impressive 50%.
Thanks to Frontiers In Nutrition for publishing the study for free.
A Clinics In Gastroenterology article in 2019 suggested a different diet for treatment of NAFLD (non-alcoholic fatty liver disease.
Steve Parker, M.D.
Click to purchase at Amazon.com. E-book also available at Smashwords. com.
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Posted in Liver Disease, Paleo Diet
About one quarter of the world’s adults have excess fat accumulation in the the liver called non-alcoholic fatty liver disease (NAFLD). This can lead to liver inflammation, scarring (cirrhosis), and liver cancer. The adverse effects of liver fat can be prevented by loss of that fat. The most common medical recommendation to accomplish that is to loss excess body weight via any reasonable method.
A study published in Gut last year found greater reduction in liver fat in those eating a “green-Mediterranean” diet compared to a regular Mediterranean diet over 18 months. Both diets were supplemented with walnuts 28 grams/day. Details of the green-Med diet:
In addition to [physical activity] and the provision of 28 g/day walnuts, the green-MED diet was restricted in processed and red meat and was richer in plants and polyphenols. The participants were guided to further consume the following provided items: 3–4 cups/day of green tea and 100 g/day of frozen Wolffia globosa (Mankai strain) plant frozen cubes, as a green shake replacing dinner. Both green tea and Mankai together provided additional daily intake of 800 mg polyphenols ((GAE), according to Phenol-Explorer and Eurofins lab analysis, including catechins (flavanols)) beyond the polyphenol content in the prescribed MED diet. Both the MED and green-MED diets were equally calorie-restricted (1500–1800 kcal/day for men and 1200–1400 kcal/day for women).
The researchers don’t tell us where to get frozen Wolffia globosa (Mankai strain) plant frozen cubes.
Study participants were almost all men, so results may not apply to women.
Click for some of the details in Endocrinology Advisor.
Steve Parker, M.D.
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Posted in Liver Disease
What kind of liver disease? NAFLD: non-alcoholic fatty liver disease.
See the Journal of Nutrition for details:
Conclusions
“Daily consumption for nuts and seeds was associated with a lower prevalence of NAFLD in non-Mediterranean, US adults, although the benefits seem to be greater in females across all categories of nut and seed consumption groups compared with nonconsumers. Both males and females presented with lower prevalence of NAFLD with intakes of 15–30 g/d.”
Steve Parker, M.D.
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Posted in Liver Disease, Nuts
Experts are predicting an epidemic of NASH: non-alcoholic steatohepatitis. In other words, fat build-up in the liver with associated inflammation and scarring (fibrosis). Which is related to it’s precursor, NAFLD: non-alcoholic fatty liver disease. These are significant issues particularly for folks with type 2 diabetes. From Diabetes Care:
“The clinical burden of both NAFLD overall and NASH specifically has increased steadily since the 1980s. NAFLD currently affects 25% of the global population and >60% of patients with T2D [type 2 diabetes]. Studies evaluating the prevalence of NASH suggest that it may involve an estimated 1.5%–6.5% of the general population and as many as 37% of people with T2D. Prevalence of NASH is expected to increase by 63% between 2015 and 2030. Although these numbers seem substantially lower than those for NAFLD overall, they still translate to 4.9 million to 21 million Americans and more than 100 million individuals worldwide. Modeling data estimate that the number of patients with NASH-related advanced fibrosis will likely double by 2030, resulting in 800,000 liver-related deaths.”
NASH is already the number 1 indication for liver transplantation in women, patients older than 54 years, and Medicare recipients. Beyond the significant impairment of quality of life experienced by individuals with NASH and advanced fibrosis, Younossi et al. estimated in 2017 that the overall lifetime direct costs of NASH in the United States would be $222.6 billion, and approximately $95.4 billion over the next 2 decades, suggesting a substantial economic burden.”
Loss of excess weight is one way to combat or avoid non-alcoholic fatty liver disease. Let me help you.
Steve Parker, M.D.
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Posted in Liver Disease
Non-alcoholic fatty liver disease is an important contributor to cirrhosis, i.e., scarring in the liver that impairs liver function. In the study at hand, a ketogenic diet reduced liver fat by 31% over just six days. I don’t have many details of the diet used, but it reduced carbohydrates to 20 grams/day.
Significance
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 [days] 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. Partitioning of fatty acids toward ketogenesis increased, which was associated with increased hepatic mitochondrial redox state and decreased hepatic citrate synthase flux. These data demonstrate heretofore undescribed adaptations underlying the reversal of NAFLD by ketogenic diet and highlight hepatic mitochondrial fluxes and redox state as potential treatment targets in NAFLD.
Abstract
Weight loss by ketogenic diet (KD) has gained popularity in management of nonalcoholic fatty liver disease (NAFLD). KD rapidly reverses NAFLD and insulin resistance despite increasing circulating nonesterified fatty acids (NEFA), the main substrate for synthesis of intrahepatic triglycerides (IHTG). To explore the underlying mechanism, we quantified hepatic mitochondrial fluxes and their regulators in humans by using positional isotopomer NMR tracer analysis. Ten overweight/obese subjects received stable isotope infusions of: [D7]glucose, [13C4]β-hydroxybutyrate and [3-13C]lactate before and after a 6-d KD. IHTG was determined by proton magnetic resonance spectroscopy (1H-MRS). The KD diet decreased IHTG by 31% in the face of a 3% decrease in body weight and decreased hepatic insulin resistance (−58%) despite an increase in NEFA concentrations (+35%). These changes were attributed to increased net hydrolysis of IHTG and partitioning of the resulting fatty acids toward ketogenesis (+232%) due to reductions in serum insulin concentrations (−53%) and hepatic citrate synthase flux (−38%), respectively. The former was attributed to decreased hepatic insulin resistance and the latter to increased hepatic mitochondrial redox state (+167%) and decreased plasma leptin (−45%) and triiodothyronine (−21%) concentrations. These data demonstrate heretofore undescribed adaptations underlying the reversal of NAFLD by KD: That is, markedly altered hepatic mitochondrial fluxes and redox state to promote ketogenesis rather than synthesis of IHTG.
Steve Parker, M.D.
PS: If you have the Advanced Mediterranean Diet, 2nd edition, you already have the Ketogenic Mediterranean Diet as one of two options.
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Posted in Liver Disease
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.
Steve Parker, M.D.
The Ketogenic Mediterranean Diet is incorporated into the Advanced Mediterranean Diet, 2nd edition.
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Posted in Liver Disease
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.
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.
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Posted in Liver Disease
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.
Steve Parker, M.D.
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Posted in Liver Disease
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.
Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.
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Posted in Liver Disease
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.
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.
Posted in Ketogenic Mediterranean Diet, Liver Disease
Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.
Advanced Mediterranean Diet 