I first became aware of the link between diet and NAFLD from my own experience in completely reversing my NAFLD that I had suffered from for at least 10 years in the space of 13 weeks of a low carb eating approach.
Two recent articles have reviewed the evidence on the relationship between low carb or ketogenic diets and NAFLD. Watanabe concluded that virtually all reviewed studies assessing liver fat content report positive results after very low carbohydrate diets (VLCDs,), very low carb ketogenic diets (VLCKDs), and high fat ketogenic diets (HFKDs). Carbohydrate restriction, with its well-established role in modulating insulin levels, and the newly proposed pathway involving the microbiome shift with increased folate production, surely plays a primary role in the reported effectiveness of KDs towards NAFLD.
Watanabe M, Tozzi R, Risi R, et al. Beneficial effects of the ketogenic diet on nonalcoholic fatty liver disease: A comprehensive review of the literature. Obesity Reviews. 2020 Aug;21(8):e13024. doi: 10.1111/obr.13024. Epub 2020 Mar 24.
The recently published review by Risi et al stated that most of the latest evidence shows that carbohydrate restriction plays a fundamental role in the modulation of lipid metabolism leading to similar efficacy in improving NAFLD compared with LFDs. The hepatoprotective role of carbohydrate restriction appears to be boosted when ketogenesis is induced, when the total calorie intake is extremely reduced, or, possibly, when dietary interventions have reduced content in free sugars, making such interventions valuable tools to deal with NAFLD.
Risi R, Tozzi R, Watanabe M. Beyond weight loss in non-alcoholic fatty liver disease: the role of carbohydrate restriction. Current Opinion in Clinical Nutrition & Metabolic Care. 2021;24(4):349-353. doi:10.1097/MCO.0000000000000762
The most recent published RCT by Holmer and colleagues showed that both a low-carb high-fat and the 5:2 diet are effective in treating fatty liver caused by obesity.
Holmer M, Lindqvist C, Petersson S, et al. Treatment of NAFLD with intermittent calorie restriction or low-carb high-fat diet – a randomized controlled trial. JHEP Reports. Published online February 17, 2021:100256. doi:10.1016/j.jhepr.2021.100256
A number of studies have specifically looked at the role of sugar-sweetened beverages (SSBs) in the development of NAFLD. A systematic review and meta-analysis by Chen et al published in 2019 included twelve studies with a total of 35,705 participant. The results showed that the consumption of SSBs was associated with 1.39-fold increased odds of NAFLD. The risk of NAFLD rose with an increased consumption of SSBs, while the consumptions of low doses (< 1 cup/ week), middle doses (1–6 cups/ week) and high doses (>7 cups/ week) of SSBs increased the relative risk of NAFLD by 14%, 26% and 53%, respectively.
Chen H, Wang J, Li Z, et al. Consumption of sugar-sweetened beverages has a dose-dependent effect on the risk of non-alcoholic fatty liver disease: an updated systematic review and dose-response meta-analysis. Int J Environ Res Public Health. 2019;16(12). doi:10.3390/ijerph16122192
The Role of Sugar Sweetened Beverages (SSBs)
Fasting and Liver Function
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