Sunday, January 25, 2009

Fatty Liver--Not Just for Geese Anymore

Foie gras, French for "fat liver," is a delicacy produced by force-feeding ducks or geese with corn meal. However, ducks and geese aren't the only species that can get a fatty liver.

Nonalcoholic fatty liver disease (NAFLD) is a condition that can occur in humans. NAFLD, defined as a liver fat content greater than 5.5%, is found in about one third of the U.S. adult urban population. As shown in the figure below, NAFLD (also called hepatic steatosis) progresses from fat deposits that cause liver enlargement, to fibrosis and the formation of scar tissue, to cirrhosis and the actual destruction of liver cells. It occurs in 45% of adult Hispanics, 33% of adult whites, and 24% of adult blacks.

According to the Mayo Clinic website, as diabetes and obesity increase, the incidence of NAFLD is increasing in both adults and children. Unfortunately there is no standard medical treatment for nonalcoholic fatty liver disease. Although several possible treatments are under investigation, none of them has yet proven effective.

With all of that in mind, there is encouraging news from a pilot study performed at Duke University by Eric Westman's group. Westman and his colleagues studied five obese patients who had been diagnosed with fatty liver disease by liver biopsy. They were instructed to follow a low-carbohydrate diet (less than 20 grams of carbohydrate per day) for six months. At the end of that time the patients were biopsied again and they showed significant reductions in liver fat and liver inflammation.

A recent study in Hepatology by Browning et al. explains why a ketogenic diet might reverse fatty liver disease. The investigators divided a group of 14 weight-loss patients into two groups. For two weeks 7 of the patients followed a calorie-restricted diet and the other 7 patients followed a carbohydrate-restricted diet. The scientists used radioactive tracers and NMR spectroscopy to determine how each group was performing gluconeogenesis in their livers.

They learned that the carbohydrate-restricted group produced more of their glucose from lactic acid and amino acids than did the calorie-restricted group. Not only that, the carbohydrate-restricted group burned their liver fat to provide the energy required to perform gluconeogenesis, while the calorie-restricted group tended to use liver glycogen to fuel gluconeogenesis. The researchers also found that the low-carbohydrate group increased fat burning throughout their entire body.

While these studies do not offer conclusive proof that a low-carbohydrate diet should be used to counteract and possibly reverse nonalcoholic fatty liver disease, the findings are encouraging and will be followed up by Dr. Browning and his associates in their next study.


Chris said...

hi there

just popped over to say that this is a great blog and to encourage you a bit.

Stargazey said...

Thanks, Chris! I needed some positive reinforcement!

Chris said...


By the way, I think commenting on Jimmy's blog is pointless. It is hard not to and he is frustrating but I don't think he is really interested in advice.

I've been reading back over your posts and there is some great analysis there. Keep it up.

all the best.

JD said...

All I can think of with that goose staring me in the face is AFLAC.

Stargazey said...

No, THANK YOU, Chris. ;)

You're right, and you have been, all day. I'm doing it more for the sake of Jimmy's readers, though having a type-2 diabetic husband makes me concerned about what the future holds for Jimmy. All the good lipid results in the world won't make reactive hypoglycemia go away.

To JD: Well-spotted! I see it now, too!

JD said...

The fact he doesn't seem to get is hypoglycemia means high insulin. High insulin means potentially heart disease. And given his carb intake his supposedly good lipids may not be all that good. See Dr. Davis' post today about someone had good lipids and overindulged:

Asclepius said...

Just found you through Chris's site (Conditioning Research).

Excellent blog.

Stargazey said...

(For those who might be mystified that some of these comments have nothing to do with fatty liver, the discussion is in reference to another discussion taking place at Jimmy Moore's Menus Blog: January 18, 2009 Low-Carb Menu.)

I saw that, too, JD. Your head can tell you that you're doing low-carb, but your body isn't fooled. Jimmy is only 37 years old and already has reactive hypoglycemia on his version of a low-carb diet. His brother died at 42 of obesity-related illness. But he seems to think that having a set of good lipid results at one point in time will protect him.

Stargazey said...

Hi, Asclepius, and welcome! To be honest, I have avoided Conditioning Research because I assumed it was only about exercise, which I do, but have little interest in it beyond that. But I went over to the site a few times yesterday and realized that Chris has lots to say about many topics, so I will be back. Probably just as a lurker, but there is lots of good information there.

Chris said...

No it is definitely not just about exercise. More an index of what ever I find interesting in terms of diet, exercise, etc.

I'm sure you'll find things you like.

Chris said...

I know it is about exercise.....but you might be interested in this one given the bits about diabetes...
Intervals don't take long...and can prevent diabetes?

Stargazey said...

Hi, Chris! Thanks for the link! I particularly liked this part:

He recommends 4 x 30 second sprints on an exercise bike three times a week.

That's an exercise routine I might actually do! I'll read the whole blogpost more thoroughly tonight.

Anonymous said...
This comment has been removed by a blog administrator.