Non-alcoholic fatty liver disease (NAFLD) is an increasing epidemic in the U.S. and the rest of the world. It is the leading cause of abnormal liver enzymes and is associated with diabetes and obesity.

Currently 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 recent study published last month in Nutrients, researchers investigated the effectiveness of time-restricted fasting (TRF) for 16 hours without calorie restrictions compared to standard care in nonalcoholic fatty liver disease.

This was a prospective single-blind randomized controlled crossover study that consisted of 32 participants with NAFLD. These patients were between the ages of 18 to 75 years of age with an ultrasound diagnosis of fatty liver disease. Everyone was randomly assigned to time-restricted fasting or standard care for 12 weeks. They were instructed to refrain from eating all food and energy-containing drinks for 16 hours from 8 pm until 12 pm the following day. During this time water, black tea, and black coffee were permitted. During the 8-hour feeding period, everyone was allowed to consume food as desired without any caloric restriction. Twenty-eight participants completed the first arm of the study and 23 completed the crossover arm. The Intermittent fasting intervention caused a significant decrease in hepatic steatosis, weight, waist circumference, and body mass index (BMI) compared to the standard care. In addition, intermittent fasting resulted in additional within-group changes that were not seen in the standard care intervention. The secondary endpoints included changes in liver stiffness, anthropometry, blood pressure, and other specific metabolic factors.

As a result, time restricted fasting offers superior improvements in patients with NAFLD, improving steatosis, weight, and waist circumference despite a modification in caloric intake. Time-restricted fasting should be considered as a primary weight loss intervention in the context of NAFLD.

These individuals have established disease and increased demands then what could be obtained from the diet alone and therefore, dietary supplements should be considered to mitigate to help reduce the progression and improve liver function in patients with NAFLD.

Other nutrients to consider include, delta and gamma tocotrienols, probiotics, carnitine, coenzyme Q10, berberine, and milk thistle.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Feehan J, Mack A, et al. Time-Restricted Fasting Improves Liver Steatosis in Non-Alcoholic Fatty Liver Disease-A Single Blinded Crossover Trial. Nutrients. 2023 Nov 22;15(223):4870.

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