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.