March 13, 2009

How to Reverse Fatty Liver

Two recent studies have come up with some useful information about what it takes to reverse nonalcoholic fatty liver disease.

This is a condition where fat accumulates in the liver. It is often considered "benign"--that is not associated with any adverse health effects. But in rare cases it can lead to liver damage and, very rarely, this damage may lead to liver failure.

Fatty liver disease is caused by--or found in association with--the taking of certain medications, gastric bypass surgery, high cholesterol, high levels of triglycerides in the blood, malnutrition, metabolic syndrome, obesity, rapid weight loss, toxins and chemicals, such as pesticides, Type 2 diabetes, and Wilson's disease.

The drugs reported as causing fatty liver include total parenteral nutrition, methotrexate (Rheumatrex), griseofulvin (Grifulvin V), tamoxifen (Nolvadex), steroids, valproate (Depakote), and amiodarone (Cordarone).

However, most people with Type 2 diabetes who develop fatty liver probably develop it because of exposure to the very high triglycerides that result from uncontrolled high sugars.

If you are diagnosed with fatty liver, you will probably be told that losing weight will reverse fatty liver, and this appears to be true.

The two studies I want to discus here tell us two things: how much weight you have to lose to reverse your fatty liver and what the most effective diet might be for doing that.

How Much Weight Loss Reverses Fatty Liver

The first study Orlistat for overweight subjects with nonalcoholic steatohepatitis: A randomized, prospective trial. was another drug company supported trial that hoped to prove that the drug, Orlistat, which blocks the digestion of fat would reverse steatohepatitis, which is the term for the inflammatory liver condition that develops in some people with fatty liver.

In fact, the study found that Orlistat neither enhanced weight loss or made any positive changes in the laboratory markers relating to the inflamed liver. However, what it did discover was that when patients managed to lose weight--using any technique--their liver disease improved. Beyond that, the study quantified how much weight loss was needed to achieve this.

Their findings were these:
...subjects who lost 5% of body weight over 9 months improved insulin resistance and steatosis [liver inflammation], and those subjects who lost 9% also achieved improved hepatic histologic changes [liver cell changes visible on microscopic exam].
In short, inflammation started to recede when 5% of the starting weight had been lost and when subjects lost 9% or more of their starting weight and maintained that loss over a period of nine months, the damage that had been done to their livers started to improve.

This is good news, because it turns out that 10% to 20% of starting weight is about as much weight as most people can lose without obsessional dieting, so it's good to know that losing only 20 lbs when you weigh 200 lbs though it isn't enough to make you comfortable wearing a bikini, is enough to reverse any liver damage you might have sustained.

Which Diet Burns Liver Fat Best?

The second study is Alterations in hepatic glucose and energy metabolism as a result of calorie and carbohydrate restriction.

To understand this study which is quite technically complex, I'd suggest you read the article about this study that was posted on Diabetes in Control: Low-Carb Diet Burns More Excess Liver Fat Than Low-Calorie Diet.

In brief, this study assigned 7 overweight people to a low calorie diet, 7 overweight people to a low carbohydrate diet, and used a group of 7 lean people eating normally as controls. Though the numbers are very small, that is because of the high expense of the techniques employed. And I already like this study, because of the inclusion of controls. This is a factor so often lacking in diet studies.

After two weeks, they studied their livers using advanced imaging techniques. They found that the liver behaved differently in people on a low carbohydrate diet. To quote Diabetes in Control,
“We saw a dramatic change in where and how the liver was producing glucose, depending on diet,” said Dr. Browning. Researchers found that participants on a low-carbohydrate diet produced more glucose from lactate or amino acids than those on a low-calorie diet. “Understanding how the liver makes glucose under different dietary conditions may help us better regulate metabolic disorders with diet,” Dr. Browning said.
In addition,
people on a low-calorie diet got about 40 percent of their glucose from glycogen, which is comes from ingested carbohydrates and is stored in the liver until the body needs it.

The low-carbohydrate dieters, however, got only 20 percent of their glucose from glycogen. Instead of dipping into their reserve of glycogen, these subjects burned liver fat for energy. [emphasis mine]
This latter finding is the one of most interest to those with fatty liver disease. The doctors who conducted the study believe it may point to the superiority of eating low carb diet when attempting to reverse fatty liver disease and will be doing more research to look into this.

By the same token, if you don't already have fatty liver disease, eating the low carbohydrate diet that has been shown repeatedly to lower triglycerides may prevent you from developing it.


Anonymous said...

I had fatty liver for many years (at least assumed NASH based on elevated liver enzyme values. I never had a liver biopsy to confirm. However, just correcting my BG levels with judicious insulin usage and a lower-carb diet fixed them. Never have had abnormal LFT's since.

Anonymous said...

I was never fat until my thyroid quit playing nice, then I got non pitted edema in the legs and a big belly. I have found some sites hinting it is linked like and
The first article is frome ADA site, so to me; it looks like the researchers have known for awhile about hypothyroid and insulin resistance

Anonymous said...

I ought to be astonished that they tried to reduce fatty liver by blocking dietary fat, but sadly I'm not.

Hint 1: ask a farmer how they fatten animals rapidly

Hint 2: find out how pate de foi gras is produced

Stuffing people with far too many carbs even if they are Healthy Whole Grains has exactly the same effect. It's one of an increasing number of conditions that can be reversed through a sensible (low) carb diet.

I shall need more coffee to concentrate on the paper but it looks like a most useful explanation of the pathways involved, thanks!

Stephan Guyenet said...

The two easiest ways to give a rat fatty liver is by feeding it either polyunsaturated vegetable oil or fructose. Both together is even worse. Saturated fats don't cause NAFLD or NASH in rats.

Considering the fatty liver epidemic in the U.S. has coincided with a large increase in vegetable oil and sugar intake, I'd say that's probably the culprit. NAFLD can be treated with fish oil as well, again suggesting that a poor omega-6:omega-3 balance is central.

Trinkwasser said...

Stephan's most excellent blog is now added to my What To Read Instead Of Working (Or Walking) list.

Major AHA! moment: so far I've concentrated on starch in general and wheat in particular (wheat gives me major BG spikes which is familial and not uncommon).

The dietician concentrated on removing fats from my diet and replacing them with carbs. About the only fats she permitted were Omega 6s. Add to this a recommendation for fruit and fruit juices and she has given me a triple whammy! No wonder I got rapidly worse rather than just slowly disintegrating as I was before she got a hold of me.

I got as far as working out that probably a low fat diet is even more deficient in Omega 3s than usual but hadn't made the connect with the increase in Omega 6s both in absolute as well as relative terms, or the effects specific to fructose. Gosh, no wonder that healthy bowl of muesli washed down with orange juice and followed by toast with low fat margarine was doing for me!

Anonymous said...

What kind of foods would assist in weight loss?

GyanAnand Baba said...

hi Trinkwasser, your writing is clever, but not clear.
its difficult to work out what worked for you.
lay it out clear please.
you visualise the answer, we cant figure out its nuances.
At least, summarize, what works what doesn't.. thanks
will appreciate a clarification. Even if it means stating that your dietician was wrong, as are many others.
- szar

Unknown said...

Article is good. Could you elaborate what all food items you included in the low - carb diet - RP

Jenny said...

Renjini, I never tell other people specifically what foods to eat, only to measure their blood sugar after meals and cut back on carbs until the healthy blood sugar target is reached. The amount of carb this takes varies dramatically between people.

Cutting out all high fructose corn syrup is a good place to start, since fructose increases fatty liver. Fruit, contrary to common belief does not contain very high amounts of fructose, but many fruits contain enough glucose to raise blood sugar. Berries are kind to blood sugar, apples, peaches, etc. are not. Bananas are the worst.

EarthGirl said...

Thank- you for this post.
I have recent read 2 books the Sugar Fix by Richard Johnson and Sweet Poison by David Gillespie. The first is by a professor of kidney research and the second lost a massive 40 kg / 2yrs.

Both draw on current research linking fructose excess to excess storage of fatty acids in the body and demonstrate this as the primary cause of metabolic syndrome diseases. That is good news as it seems that the starches which are metabolized by glucose pathways have been wrongly maligned AND may not need to be restricted as in current recommendations: eg. the low GI diet or low carb diet.

The great thing about this recent knowledge is that the fructose metabolism that has become overactive in the presence of the excess typical of 'normal' western diet, can be re-set to normal levels in a matter of weeks with all the the metabolic syndrome parameters following at a rate depending on the degree of damage, by controlling the amount of dietary fructose especially from processed sources.

i have personally started to limit fructose and found to my amazement that cravings for sugar just vanished once i was not having ANY sweetened snacks - sugar is half fructose.

Thank-you to Trinkwasser:) How pertinent an observation about fois grois ! That image alone is enough to limit the fructose going into my mouth!

EarthGirl said...

Maybe fruit contains less fructose than typical sugar sweetened snacks or HFCS sodas etc but the amount in several pieces / day with vegetables and grains and legumes IS close to exceedingly the daily limits of fructose metabolism.

In other words current research is showing there is no leeway for frequent excessive fructose intake without health complications. Fructose causes IR and D2 not glucose. High Blood Glucose levels are a sign that the pancreas is giving up the struggle, not the cause and cannot be corrected until fructose metabolism is addressed.