Non-alcoholic fatty liver disease (NAFLD) has become an increasing epidemic. It is the leading cause of abnormal liver enzymes and is associated with diabetes and obesity with advanced liver disease being one of the leading causes of liver transplantation.

At this time there are few guidelines for diagnostic and follow up methods and limited proven treatment options. Previous research of pharmacological agents to treat nonalcoholic fatty liver disease were performed with poor results.

Insulin resistance is one of the key factors in the development of NAFLD, however, the gut-liver axis plays a significant contribution as well. Gut dysbiosis and intestinal hyperpermeability lead to liver damage by proinflammatory responses.

According to a review published last week in Nutrients, researchers evaluated dietary approaches for the treatment in nonalcoholic fatty liver disease.

This review included six randomized controlled trials including 317 patients with NALFD. Each study ranged from 12 to 98 patients with 50 patients being the average. These studies ranged over a period from 6 weeks to 6 months. The primary outcome of interest was a reduction in hepatic steatosis based on imaging or biopsy. In addition, other outcomes investigated were changes in hepatic fibrosis, reduction in liver enzymes, and weight reduction. Five out of the 6 studies evaluated the effects of a Mediterranean diet, and the other study investigated modified alternate-day calorie restriction, which is a type of intermittent fasting. These were compared to other dietary interventions including a low fat diet, low carbohydrate diet, and usual care. Hepatic steatosis was assessed by magnetic resonance spectroscopy or ultrasound in 5 of the 6 studies. Liver stiffness was measured using shear wave elastography in 4 of the 6 studies.

A significant reduction in hepatic steatosis was seen in 3 of the 5 studies following a Mediterranean Diet and the one study evaluating a low-carbohydrate diet. Two study arms included a low-fat diet, however, only one of these reached a significant reduction in hepatic steatosis. The study with an intermittent-fasting arm also demonstrated a significant improvement in hepatic steatosis. Four studies evaluated liver stiffness with 2 of the 3 Mediterranean diets showing a significant improvement. All six studies evaluated the impact on liver enzymes but only half of these studies showed a significant improvement. It is important to note that patients achieved weight loss in all of these studies with significant weight loss in 5 of the 6 studies.

These individuals have established disease and increased demands then what could be obtained from the diet alone and therefore, dietary supplements should be also considered to help reduce the progression and improve liver function in patients with NAFLD. Nutrients to consider include, probiotics, delta and gamma tocotrienols, fiber, resistant startch, fish oil, coenzyme Q10, berberine, and milk thistle.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Saeed N, Nadeau B, et al. Evaluation of Dietary Approaches for the Treatment of Non-Alcoholic Fatty Liver Disease: A Systemic Review. Nutrients. 16 December 2019, 11(12), 3064.

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