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How to Treat Non-Alcoholic Fatty Liver Disease?
Ketogenic/Low-Carb Diets and Non-alcoholic Fatty Liver Disease
To date, very few studies have examined the effects of the ketogenic diet in treating NAFLD. Thus, there is not enough evidence to recommend the ketogenic diet in people with fatty liver. A recent meta-analysis suggests that low carbohydrate diets (less than 40% of total calories) and moderate carbohydrates diets (40 to 50% of total calories) combined with regular physical activity may be beneficial to improve the risk factors of metabolic syndrome, promote weight loss, improve liver function and treat fatty liver. In general, a moderate carbohydrate restriction can be achieved by limiting sugars that have a poor nutritional value such as sugary drinks, sweets, added sugars and refined grains (white bread, white rice, white pasta, etc.).
Vitamin E Supplementation and Non-alcoholic Fatty Liver Disease
Vitamin E supplementation (800 IU of a-tocopherol daily) is recommended for nondiabetic adults with histologically confirmed NASH to improve liver enzymes and histology. The efficacy of vitamin E supplementation as an antioxidant in improving biochemical and/or histological abnormalities in NASH has been studied in several clinical studies. However, there is considerable heterogeneity among studies with respect to study power, entry criteria, vitamin E dosage, vitamin E formulations used, additional use of other antioxidants or medications, and histological data to assess outcomes. Despite these limitations, it has been concluded that vitamin E use is associated with improvement in liver enzymes (decrease in ALT, AST), steatosis and inflammation, as well as resolution of steatohepatitis.
References
1) Bischoff et al (2020) ESPEN practical guideline: Clinical nutrition in liver disease. Clinical Nutrition; 39:3533-62.
2) Cusi et al (2022) American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocrine Practice; 28:528-62.
3) Schugar et Crawford (2012) Low-carbohydrate ketogenic diets, glucose homeostasis, and nonalcoholic fatty liver disease. Curr Opin Clin Nutr Metab Care; 15(4): 374–380.
4) Haghighatdoost et coll. (2016) The effects of low carbohydrate diets on liver function tests in nonalcoholic fatty liver disease: A systematic review and meta-analysis of clinical trials. Journal of research in medical sciences 21(1):53.
5) York, Puthalapattu et Wu (2009) Nonalcoholic Fatty Liver Disease and Low-Carbohydrate Diets. Annu. Rev. Nutr; 29:365–79.
6) Fondation canadienne du foie (2024) Fatty Liver Disease. https://www.liver.ca/patients-caregivers/liver-diseases/fatty-liver-disease
7) Katsagoni et coll. (2017) Effects of lifestyle interventions on clinical characteristics of patients with non-alcoholic fatty liver disease: A meta-analysis. Metabolism Clinical and experimental; 68: 119-132.
8) Paul et Davis (2018) Diagnosis and Management of Nonalcoholic Fatty Liver Disease. JAMA;320(23):2474-2475.
9) Chalasani et coll. (2018) The Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance From the American Association for the Study of Liver Diseases. Hepatology; 67 :1.
Author
Kathryn holds a Bachelor Degree in Nutrition as well as a Bachelor and a Master Degree in Kinesiology, all from Laval University. She is a Registered Dietitian and active member of the Ordre professionnel des Diététistes Nutritionnistes du Québec (ODNQ) and of the American Academy of Nutrition and Dietetics. She holds the Monash University's certification for the FODMAP diet and IBS, and has considerable clinical experience in that area. She is also an accomplished athlete, having ran track and cross-country at a national level. Kathryn specializes in sports nutrition, weight loss, diabetes, as well as heart and gastrointestinal health.
Hello. I am treated for my liver, I ´have a biopsy next week. What can I do to help taking care of my liver,what to eat or what not to..I have a fat liver, I have diabete too. Thank you.
Hello Marie Reine,
As explained in this article, To help your condition you should follow a Mediterranean diet and loose weight.