Jamile’ Wakim-Fleming, MD

The prevalence of fatty liver disease is rising globally reaching over 20% to 40% of the general population depending on the geographic location. The rise in fatty liver disease parallels the rise in obesity. Fatty liver disease begins as fat deposits in the liver — also called steatosis — this is a harmless stage that can be reversed. If not addressed or treated at this stage, however, steatosis in the liver can progress to an aggressive form called NASH by inducing inflammation in the liver. This stage is the turning point in the development of advanced liver disease, fibrosis and cirrhosis. Cirrhosis, when established, puts the individual at risk for liver cancer and liver failure.

Fatty liver disease in its early form of steatosis has been targeted to halt the progression to more advanced liver disease. There are several ways to do this. The most cost-effective way is a stepwise approach that begins by losing weight in these individuals who have obesity.

Multiple diets, such as low-calorie diets, and fasting methods have proven effective in decreasing steatosis in the liver. In the end, there is a negative balance of caloric intake and improvement or resolution of steatosis. Most low-calorie diets are based on low carbohydrate intake, excessive fat or protein intake. Low-calorie diets can be very restrictive if an individual wants to lose over 1,000 calories per day. The more restrictive the diet is, the more symptoms the individual may encounter such as fatigue, nausea, diarrhea, hair loss, headaches, constipation and micronutrient deficits. High-fat diets take longer to digest, and they decrease stomach emptying, which gives a feeling of fullness in the stomach for a longer period and a prolonged satiety. In addition, the glycemic index is smaller, and secretion of insulin is less sharp than with a diet high in carbohydrates. Insulin contributes to the buildup of fatty tissue. However, there is a caveat with high-fat diets, and that is they worsen the lipid profile and put the individual at risk for heart disease. The individual needs to look at all these factors as a whole and find a healthy balance with the supervision of a nutrition specialist.

The 5:2 fasting means that the individual eats normally 5 days a week and less calories 2 days a week.

Regardless of what method is used to decrease caloric intake, all diets are almost all equal in value after 6 months in achieving less steatosis. However, I caution when diets are very restrictive. In addition to associated side effects, there are associated nutrient and vitamin deficiencies, and these individuals need to be monitored very closely by a registered dietitian or by their physicians and take supplements when needed.

Further studies have shown that any 5% to 7% weight loss will improve steatosis/fat in the liver, so the message is to go slow (eg, 500-750 caloric restriction a day), be persistent, eat heathy, exercise at least 150 minutes a week, seek the assistance of a health care specialist (especially when severe restriction is to be considered). It is also very important to maintain weight loss by adopting a lifelong healthy maintenance strategy because the disease may recur.