Digestive Diseases and Sciences

, Volume 52, Issue 2, pp 589–593

The Effect of a Low-Carbohydrate, Ketogenic Diet on Nonalcoholic Fatty Liver Disease: A Pilot Study

  • David Tendler
  • Sauyu Lin
  • William S. YancyJr.
  • John Mavropoulos
  • Pam Sylvestre
  • Don C. Rockey
  • Eric C. Westman
Original Article

Abstract

Nonalcoholic fatty liver disease is an increasingly common condition that may progress to hepatic cirrhosis. This pilot study evaluated the effects of a low-carbohydrate, ketogenic diet on obesity-associated fatty liver disease. Five patients with a mean body mass index of 36.4 kg/m2 and biopsy evidence of fatty liver disease were instructed to follow the diet (<20 g/d of carbohydrate) with nutritional supplementation for 6 months. Patients returned for group meetings biweekly for 3 months, then monthly for the second 3 months. The mean weight change was −12.8 kg (range 0 to −25.9 kg). Four of 5 posttreatment liver biopsies showed histologic improvements in steatosis (P=.02) inflammatory grade (P=.02), and fibrosis (P=.07). Six months of a low-carbohydrate, ketogenic diet led to significant weight loss and histologic improvement of fatty liver disease. Further research is into this approach is warranted.

Keywords

Nonalcoholic fatty liver disease NASH Low-carbohydrate ketogenic diet Cirrhosis Fatty liver 

References

  1. 1.
    Brunt EM (2001) Nonalcoholic steatohepatitis: definition and pathology. Semin Liver Dis 21:3–16PubMedCrossRefGoogle Scholar
  2. 2.
    Matteoni CA, Younossi ZM, Gramlich T, Bopariai N, Liu YC, McCullough AJ (1999) Nonalcoholic fatty liver disease: A spectrum of clinical pathological severity. Gastroenterology 116:1413PubMedCrossRefGoogle Scholar
  3. 3.
    Hilden M, Christoffersen P, Juhl E, Dalgaard JB (1977) Liver histology in a ‘normal’ population—examination of 503 consecutive fatal traffic casualties. Scand J Gastroenterol 12:593–597PubMedCrossRefGoogle Scholar
  4. 4.
    Wanless IR, Lentz JS (1990) Fatty liver hepatitis (steatohepatitis) and obesity. An autopsy study with analysis of risk factors. Hepatology 12:1006–1010Google Scholar
  5. 5.
    Crespo J, Fernandez-Gil P, Hernandez-Guerra M, Cayon A, Mayorga M, Dominguez-Diez A, Fernandez-Escalante JC, Pons-Romero F (2001) Are there predictive factors of severe liver fibrosis in morbidly obese patients with non-alcoholic steatohepatitis? Obes Surg 11:254–257PubMedCrossRefGoogle Scholar
  6. 6.
    Flegal KM, Carroll MD, Ogden CL, Johnson CL (2002) Prevalence and trends in obesity among US adults, 1999–2000. JAMA 288:1723–1727PubMedCrossRefGoogle Scholar
  7. 7.
    Diehl AM (1999) Nonalcoholic steatohepatitis. Semin Liver Dis 19:221–229PubMedCrossRefGoogle Scholar
  8. 8.
    Sheth SG, Gordon FD, Chopra S (1997) Nonalcoholic steatohepatitis. Ann Intern Med 126:137–145PubMedGoogle Scholar
  9. 9.
    Buchman AL, Dubin MD, Moukarzel AA, Jenden DJ, Roch M, Rice KM, Gornbein J, Ament ME (1995) Choline deficiency: a cause of hepatic steatosis during parenteral nutrition that can be reversed with intravenous choline supplementation. Hepatology 22:1399–1403PubMedCrossRefGoogle Scholar
  10. 10.
    Harrison SA, Diehl AM (2002) Fat and the liver—a molecular overview. Semin Gastrointest Dis 13:3–16PubMedGoogle Scholar
  11. 11.
    Chitturi S, Abeygunasekera S, Farrell GC, Holmes-Walker J, Hui JM, Fung C, Karim R, Lin R, Samarasinghe D, Liddle C, Weltman M, George J (2002) NASH and insulin resistance: Insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology 35:373–379PubMedCrossRefGoogle Scholar
  12. 12.
    Pagano G, Pacini G, Musso G, Gambino G, Mecca F, Depetris N, Cassader M, David E, Cavallo-Perin P, Rizzetto M (2002) Nonalcoholic steatohepatitis, insulin resistance, and metabolic syndrome: Further evidence for an etiologic association. Hepatology 35:367PubMedCrossRefGoogle Scholar
  13. 13.
    Marchesini G, Brizi M, Bianchi G, Tomassetti S, Zoli M, Melchionda N (2001) Metformin in nonalcoholic steatohepatitis. Lancet 358:893–894PubMedCrossRefGoogle Scholar
  14. 14.
    Caldwell SH, Hespenheide EE, Redick JA, Iezzoni JC, Battle EH, Sheppard BL (2001) A pilot study of a thiazolidinedione, troglitazone, in nonalcoholic steatohepatitis. Am J Gastroenterol 96:519–525PubMedCrossRefGoogle Scholar
  15. 15.
    Acosta RC, Molina EG, O’Brien CB, et al (2001) The use of pioglitazone in nonalcoholic steatohepatitis. Gastroenterology 120A:546CrossRefGoogle Scholar
  16. 16.
    Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS, Szapary PO, Rader DJ, Edman JS, Klein S (2003) A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 348:2082–2090PubMedCrossRefGoogle Scholar
  17. 17.
    Boden G, Sargrad K, Homko C, Mozzoli M, Stein TP (2005) Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med 142:403–411PubMedGoogle Scholar
  18. 18.
    Yancy WS, Jr, Olsen MK, Guyton JR, Bakst RP, Westman EC (2004) A randomized, controlled trial of a low-carbohydrate, ketogenic diet versus a low-fat diet for obesity and hyperlipidemia. Ann Intern Med 140:769–777PubMedGoogle Scholar
  19. 19.
    Phinney SD, Bistrian BR, Wolfe RR, Blackburn GL (1983) The human response to chronic ketosis without caloric restriction: physical and biochemical adaptation. Metabolism 32:757–768PubMedCrossRefGoogle Scholar
  20. 20.
    Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR (1999) Nonalcoholic steatohepatitis. A proposal for grading and staging the histological lesions. Am J Gastroenterol 94:2467–2474PubMedCrossRefGoogle Scholar
  21. 21.
    Uygun A, Kadayifci A, Isik AT, Ozgurtas T, Deveci S, Tuzun A, Yesilova Z, Gulsen M, Dagalp K (2004) Metformin in the treatment of patients with non-alcoholic steatohepatitis. Aliment Pharmacol Ther 19:537–544PubMedCrossRefGoogle Scholar
  22. 22.
    Huang MA, Greenson JK, Chao C, Anderson L, Peterman D, Jacobson J, Emick D, Lok AS, Conjeevaram HS (2005) One-year intense nutritional counseling results in histological improvement in patients with nonalcoholic steatohepatitis: A pilot study. Am J Gastroenterol 100:1072–1081PubMedCrossRefGoogle Scholar
  23. 23.
    Solga S, Alkhuraishe AR, Clark JM, Torbenson M, Greenwald A, Diehl AM, Magnuson T (2004) Dietary composition and nonalcoholic fatty liver disease. Dig Dis Sci 49:1578–1583PubMedCrossRefGoogle Scholar
  24. 24.
    McDevitt RM, Bott SJ, Harding M, Coward WA, Bluck LJ, Prentice AM (2001) De novo lipogenesis during controlled overfeeding with sucrose or glucose in lean and obese women. Am J Clin Nutr 74:737–746PubMedGoogle Scholar
  25. 25.
    Faeh D, Minehira K, Schwarz JM, Periasamy R, Park S, Tappy L (2005) Effect of fructose overfeeding and fish oil administration on hepatic de novo lipogenesis and insulin sensitivity in healthy men. Diabetes 54:1907–1913PubMedGoogle Scholar
  26. 26.
    Nielsen SJ, Popkin BM (2004) Changes in beverage intake between 1977 and 2001. Am J Prev Med 27:205–210PubMedCrossRefGoogle Scholar
  27. 27.
    Ludwig DS, Peterson KE, Gortmaker SL (2001) Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 357:505–508PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2007

Authors and Affiliations

  • David Tendler
    • 1
  • Sauyu Lin
    • 1
  • William S. YancyJr.
    • 2
    • 3
  • John Mavropoulos
    • 2
  • Pam Sylvestre
    • 1
  • Don C. Rockey
    • 1
  • Eric C. Westman
    • 2
    • 4
  1. 1.Division of GastroenterologyDepartment of Medicine, Duke University Health SystemDurhamUSA
  2. 2.Division of General Internal MedicineDepartment of Medicine, Duke University Health SystemDurhamUSA
  3. 3.Center for Health Services Research in Primary CareDepartment of Veterans’ Affairs Medical CenterDurhamUSA
  4. 4.Duke University Medical CenterDurhamUSA

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