In the news: Fighting Fatty Liver Disease with a Twist on The Med Diet

What is Non-Alcoholic Fatty Liver Disease?

Nonalcoholic fatty liver disease (NAFLD) is now one of the most common chronic liver conditions in the US, estimated to affect 1 out of 4 American adults.

Simply put, NAFLD is caused by a build-up of fat in the liver that’s not related to over consumption of alcohol. A healthy liver contains little fat, so the excess fat stored inside liver cells makes it harder for this organ to function. NAFLD is most often found in people who are overweight or obese – especially those with a large waist circumference, the “apple-shaped” body.

So, is a fatty liver dangerous for your health? Not in the early stages, but it can pose health problems if it’s ignored and progresses. NAFLD is also associated diabetes, cardiovascular disease, and obstructive sleep apnea. The 4 general stages of NAFLD-related liver disease include: • simple fatty liver (steatosis) – a largely harmless build-up of fat in the liver cells • non-alcoholic steatohepatitis (NASH) – a more serious form of NAFLD, where the liver has become inflamed • fibrosis – persistent inflammation causes scar tissue around the liver and nearby vessels, but the liver function is still relatively normal • cirrhosis– the most severe stage where the liver shrinks and becomes scarred after years of inflammation and the damage is permanent

Strategies to Fight NAFLD

As of now, there is no drug treatment for NAFLD and the tried-and-true way to combat NAFLD is weight loss. That means increasing physical activity and eating better and eating less.

A recent Medscape article(1) summarized the new 2020 American Gastroenterological Association (AGA) guidelines for how much total body weight loss is needed to turn around various stages of NAFLD-related disease: losing more than 5% can decrease liver steatosis, greater than 7% potentially leads to resolution of nonalcoholic steatohepatitis, and losing more than 10% possibly allows for reducing fibrosis, or at least stabilizing the condition.

Inflammation and oxidative stress are the major risk factors involved in NAFLD progression. So, in terms of specific diets for taming NAFLD, the Mediterranean (Med) diet with its anti-inflammatory and antioxidant effects, has been put forward by the AGA who also advises limiting red meat and sugary beverages.

Now, a new study(2) suggests that the Med diet with a new twist – extra polyphenols – can improve NAFLD. The study enrolled more than 290 people with abdominal obesity and elevated blood fats who were assigned to one of three groups: one based on healthy dietary guidelines, a standard Med diet and the standard Med diet plus extra polyphenols (“greens”).

Calories were restricted in all three groups, and both Med diet groups got extra walnuts daily, providing 440 mg of polyphenols. However, the Med + diet group received even more polyphenols – 800 mg more in the form of three glasses of green tea daily, plus Mankai (Wolffia globosa a water plant) in the form of frozen cubes made into a green shake dinner replacement.

After 1½ years, NAFLD declined to about 55% in the non-Med diet group, 48% in the standard Med group, and 32% in the Med+ group.

Both Med groups achieved similar weight loss, more than the non-Med group. But the Med + group was found to have lost more liver fat (-39%) compared to the standard Med diet group (-20%) and the healthy diet group (-12%).

The researchers found that he degree of liver fat loss was associated with polyphenols, lower red and processed meat, better blood folate levels, improved lipid biomarkers and changes in gut microflora.

Almost 90% of the participants stuck with their diets. If the extra dinner shake seems daunting, however, following the Med diet, watching calories, including walnuts, and cutting out red and processed meats should go a long way to halting NAFLD.

References

1. Balistreri WF. The Mediterranean Diet, Already Beneficial in NAFLD, Gets a Green Boost. Medscape May 18, 2021.
2. Meir AY et al. Effect of green-Mediterranean diet on intrahepatic fat: the DIRECT PLUS randomized controlled trial. Gut. 0:1–11, 2021.