How a low-carb, high-fat diet can reverse fatty liver disease

It’s the silent disease that affects up to a third of Australians, but some simple dietary changes mean fatty liver disease doesn’t have to be a life sentence.

Fatty liver disease is an umbrella term to describe a range of conditions caused by the accumulation of fat stored in the liver, according to the Gastroenterological Society of Australia.

We ask the experts how to prevent fatty liver disease, whether a low-carb, high-fat diet can really reverse it – and what to do if you do get a diagnosis.

What is fatty liver disease?

Non-alcoholic fatty liver disease (NAFLD) includes various categories of liver injury, says hepatologist Dr Luis Bertot, who works closely with the Liver Foundation.

This ranges from steatosis (fat in the liver) to steatohepatitis (fat and inflammation) and fibrosis (steatosis, inflammation plus scarring), which can progress to liver cirrhosis and liver cancer, he says.

The condition is also linked to obesity, high cholesterol levels, Type 2 diabetes and alcohol consumption.

What are the symptoms of fatty liver disease?

Typically there are few symptoms, but a routine blood test will pick up any liver problems.

If there are precursors, an ultrasound of the liver will assess the extent of fat deposits.

How is fatty liver disease treated?

“Currently there is no approved pharmacological therapy for non-alcoholic fatty liver disease and weight loss through lifestyle changes remains the cornerstone for treatment,” Dr Bertot says .

“Aim for a weight loss of at least 3 per cent of body weight within six-to-12 months, ideally 10 per cent to reverse severe forms of fatty liver.”

Dr Bertot also recommends at least 150 minutes of exercise a week, ideally 30-60 minutes daily at a moderate intensity or 20-60 minutes, three days per week at a vigorous intensity.

fatty liver disease

Is fatty liver disease really reversible?

While much debate surrounds its reversibility, clinical sports physician Dr Peter Brukner believes a diagnosis can be entirely reversed with a low-carb, high-fat diet.

Dr Brukner recently released a book, A Fat Lot of Good, outlining how he reversed his own non-alcoholic fatty liver disease diagnosis.

“Fatty liver is associated with a number of health issues including insulin resistance, diabetes and cardiovascular disease,” Dr Brukner says.

“Within 13 weeks [of a low-carb, high-fat diet] I had lost 13kg, my blood test results had gone down, my NAFLD had been completely reversed and I was no longer prediabetic.”

What is a low-carb, high-fat diet and how is it different to paleo and Atkins diets?

In his advice to Low Carb Down Under, Dr Brukner says the first week of a low-carb, high-fat diet can be challenging as the body adapts to using fat instead of carbohydrates as its primary source of fuel.

He says within two weeks, your energy levels will likely improve and your hunger cravings will subside as a result of more stable blood glucose levels.

As a general rule, Dr Brukner suggests only eating natural foods and avoiding processed foods.

He says while a paleo diet is similar, it does not include dairy, while the Atkins diet is effectively a low-carb, high-fat diet.

What you can eat on a low-carb, high-fat diet?

The CSIRO offers a series of energy-controlled, nutritionally complete meal plans low in carbohydrates and higher in protein and healthy fats in a series of four books.

Dr Brukner suggests eating a diet rich in eggs, meat, dairy and green vegetables, and cooking with olive oil, coconut oil and butter, while only occasionally treating yourself to red or white wine, spirits, or 70 per cent cocoa dark chocolate.

Look for foods including:

  • Eggs
  • Meat such as beef, lamb, pork, chicken – preferably pasture-fed not grain-fed
  • Bacon
  • Fish, especially cold water fish – such as salmon and sardines
  • Vegetables that grow above ground – cauliflower, broccoli, cabbage, brussels sprouts, asparagus, zucchini, eggplant, olives, spinach, mushrooms, cucumber, lettuce, avocado, onions, peppers and tomatoes
  • Berries, such as strawberries, raspberries, blackberries and blueberries
  • Dairy, including full-fat milk, cream, butter, cheese and Greek yoghurt
  • Drinks, including water, coffee, green tea and beef broth
  • Nuts, such as almonds, walnuts, brazil nuts, hazelnuts and macadamia nuts

What to avoid on a low-carb, high-fat diet?

Dr Brukner recommends not cooking with vegetable or seed oils, such as canola, sunflower, safflower, cottonseed or grapeseed oils and to steer clear of the following:

  • Sugar, including soft drinks, candy, juice, sports drinks, chocolate, cakes, buns, pastries and ice cream
  • Breakfast cereals
  • Bread and related products such as biscuits, crumpets, muffins and cakes
  • Rice
  • Potatoes and other starchy vegetables
  • Pasta
  • Margarine
  • Beans and legumes
  • Most fruit, other than berries
  • Fruit juices
  • Flavoured yogurts
  • Beer
  • Fact v fiction: Is fructose really that bad for you?

Top tips to manage fatty liver disease

  • Lose weight. This is particularly applicable if a liver ultrasound/biopsy determines fat deposits on the liver and your BMI falls within the overweight category. Aim for a waistline of 80cm for women or 95cm for men.
  • Adopt a balanced, nutritious diet. Focus on wholefoods and avoid processed foods high in carbs/sugar, which can spike blood sugar levels.
  • Reduce or even eliminate alcohol consumption. This stands even if your diagnosis is non-alcoholic fatty liver disease.
  • Aim to exercise five times a week. Incorporate resistance and aerobic workouts.

Written by Charlotte Brundrett. Updated by Dan Imhoff February 2022. 

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