Which Diet is Best For a Fatty Liver?

A recent randomized controlled trial (C Properzi et al. Hepatology 2018; 68: 1741-54) compare the Mediterranean diet (MD) and a low-fat (LF) diet for non-alcoholic fatty liver disease.

A total of 48 patients completed the 12-week study and were analyzed; subjects had a mean BMI of 31.  Both groups consumed a 2400-2600 kcal diet.

Key findings:

  • Despite minimal weight loss, both groups had significant reduction in hepatic steatosis as determined by magnetic resonance spectroscopy (MRS): 25.0% in LF and 32.4% in MD.  Both had wide confidence intervals due to the small number of subjects.
  • Liver enzyme improved in both groups.
  • Weight loss was minimal, 1.6 kg and 2.1 kg in LF and MD respectively
  • Framingham Risk Score (FRS), cholesterol, triglycerides, and hemoglobin A1c were improved with MD but not with LF (all P<0.05)

The associated editorial (pg 1668-71) notes the following:

  • “Considering the current evidence, recommending the MD for patients with NAFLD might be an appropriate therapeutic option, not least because …[of the} increased risk of CVD.”
  • Longer-term RCTs are needed
  • “It has to be stressed that, in most cases, any form of healthy diet (eg. LF or MD), which leads to caloric reduction…should be encourage for patients with NAFLD…The importance of weight loss has been highlighted in patients with biopsy-proven NASH.”

My take: If you have to make a dietary recommendation, this study indicates that MD is probably a better diet than LF in patients with NAFLD.

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Town of Banff



Eating the Right Foods and Weight Loss

In a recent NY Times article, Rethinking Weight Loss and the Reasons We’re ‘Always Hungry’, the idea that too many calories causes obesity is challenged:

“…overeating doesn’t make you fat. The process of getting fat makes you overeat.”

Here’s an excerpt:

Dr. Ludwig, an obesity expert and professor of nutrition at the Harvard T.H. Chan School of Public Health, argues that weight gain begins when people eat the wrong types of food, which throws their hormones out of whack and sets off a cycle of cravings, hunger and bingeing. In his new book, “Always Hungry?,” he argues that the primary driver of obesity today is not an excess of calories per se, but an excess of high glycemic foods like sugar, refined grains and other processed carbohydrates…

Simply cutting back on calories as we’ve been told actually makes the situation worse. When we cut back on calories, our body responds by increasing hunger and slowing metabolism. It responds in an effort to save calories…

It’s the low fat, very high carbohydrate diet that we’ve been eating for the last 40 years, which raises levels of the hormone insulin and programs fat cells to go into calorie storage overdrive.

My take: The idea of changing the types of foods that we consume is not new in the fight against excessive weight gain.  Some of the best data on healthy eating is associated with the Mediterranean diet.

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Another review (from the NY Times) of the book ‘Happy Gut’ describes a diet promoted by a NY internist to help with problems like irritable bowel: Seeking a ‘Happy Gut’ for Better Health. “Cutting out dairy and gluten reversed many of his symptoms. Replacing processed foods with organic meats, fresh vegetables and fermented foods gave him more energy and settled his sensitive stomach.”

Banning Mills

Banning Mills


Reading Past the Headline: Low Fat vs Low Carb

A recent study purportedly showed that a low-carb diet is superior to a low-fat diet.  However, David Katz explains how this study was flawed.  Here’s the link: Huffington Post “Low-fat” versus Low-carb and here’s an excerpt:

It was published in the Annals of Internal Medicine.. Allegedly, the researchers compared a low-fat to a low-carb diet. But in fact, they compared a diet that allowed up to 30 percent of calories from fat to a diet that allowed up to 40 grams of daily carbohydrate…

baseline carbohydrate intake was 240 grams per day, so while fat intake was “trimmed” 5 percent, carbohydrate intake in that assignment was slashed 75 percent. This might have been billed “a study to compare a really big change from baseline diet to a really small change from baseline diet.”…

the low-carb diet, since it was actually low-carb, obviously was much more restrictive than the low-fat diet, which wasn’t actually low-fat. That had the predictable result: those on the low-carb assignment took in many fewer calories…

I am not an advocate of low-fat diets. I think the concept is obsolete. I am an advocate, based on the evidence, of wholesome foods in sensible combinations. That dietary pattern can be low or high in fat, relatively lower or higher in carbohydrate.

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Six years later-Mediterranean diet comes out on top

This month a followup letter provides long-term data on the outcomes of individuals assigned to either a low-carb, low-fat, or Mediterranean diet (NEJM 2012; 1373-74).

An initial study posted two-year results.  Now after an additional four years, the following results were noted:

  • Among the 259 participants (80% of original groups and 95% who completed the initial two years), 67% had continued their original assigned diet.
  • For the entire 6-year period, the total weight loss was 3.1 kg in the Mediterranean group, 1.7 kg in the low-carb group and 0.6 kg in the low-fat group.
  • At 6 years the change in the ratio of LDL to HDL were similar in all three groups though the low-carb group had the most favorable results with a reduction of 0.16.
  • At 6 years, the reduction in triglyceride levels from baseline were significant for the Mediterranean group (21.4 mg/dL) and the low-carb group (11.3 mg/dL).
  • All of the groups had regained some of their weight loss from the initial 2-year period.  The most favorable outcomes were noted in the Mediterranean diet and then the low-carb diet in this workplace intervention trial.

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