Which dietetic intervention is most effective against fatty liver disease or fatty liver disease (NAFLD, NASH)? A recent clinical trial provides some answers.

Why it matters
Currently, no drug treatment is yet available against fatty liver disease (or NAFLD), only healthy and dietary recommendations are effective. And the weight loss that results from a change in diet and regular exercise can, in some cases, reverse this disease.

Fasting and the low-carb, high-fat diet (keto or LCHF) are two dietary interventions that are still viewed with great suspicion by healthcare professionals in France. Yet science is interested in its solutions and there are more and more quality studies. A recent study published in the Journal of Hepatology compared these 2 alternative dietary approaches to classic recommendations in people with fatty liver disease.

The study
In this clinical trial, 74 people whose NAFLD was formally diagnosed (by medical imaging or the presence of two metabolic markers of the disease) underwent 12 weeks a dietary intervention, chosen at random. One group of patients followed a 5: 2 fast (calorie restriction for two non-consecutive days of the week), another followed a ketogenic diet (low in carbohydrates, high in fat) and a third group received standard dietary advice (control group). They were all followed by telephone during the intervention to ensure proper adherence to the program.

Results: The ketogenic diet and 5: 2 fasting were more effective than conventional recommendations in reducing steatosis and weight in patients with NAFLD.

Classic rebalancing Ketogenic diet 5: 2 fasting
Less Steatosis -3.6% -7.2% -6.1%
Weight loss -2.5 kg -7.3 kg -7.4 kg

In practice
Dr Bourdua-Roy, in his Reversa clinic in Quebec, combines these two practices to help his patients get rid of metabolic diseases such as fatty liver disease: “We suggest that our patients significantly reduce carbohydrate intake, ” eliminate as much as possible processed and ultra-processed foods, as well as oils produced industrially from seeds and rich in omega-6 (such as grape seed, sunflower, rapeseed oil, etc.), and increase their lipid intake. So it’s about teaching them to eat a low-carb (100g net carbs and less per day) or ketogenic (20g net carbs and less per day) diet. We also teach them to practice intermittent fasting, as well as prolonged fasting if they are interested ”. And this protocol obtains very good results.

The low glycemic index Mediterranean diet also appears to be a winning dietary intervention against fatty liver disease. In her book The NASH diet against fatty liver disease, dietician nutritionist Angélique Houlbert gives all the keys to adopting such a diet or a low carb diet, in addition to practical lifestyle advice, especially for physical activity.