Intermittent fasting as a treatment for fatty liver

Fatty liver is seen in nearly one third of world’s population. Obesity is the major predisposing factor for fatty liver. Lifestyle modification forms a major therapeutic option for fatty liver. Calorie restriction and exercise forms the crux of lifestyle modification. Different diets have been tried for fatty liver. Mediterranean diet has the major validation. Rest all diets have failed to show significant benefits.

Intermittent fasting

Intermittent fasting (IF) is a dietary intervention that involves periodic intervals ofcomplete or almost complete abstinence from food and energy-containing fluids. Thepractice of IF has been performed since thetime of the earliest civilizations, mainly forreligious or cultural reasons. Our society performs these by different fasts for different festivals. IF has shown rapid acceptance and growth amongst all strata of people. Previous studies have reported weight loss, improvement in insulin resistance, reduced oxidative stress, improvements in serum cholesterol and triglycerides, and decreased levels of systemic inflammatory markers, including tumour necrosis factors (TNF) and brain-derived neurotrophic factors.        A recent review looked at the benefits of this modality on actual effectiveness in treatment of fatty liver.

Protocols for IF

The different protocols used for intermittent fasting are as described below

Type of Intermittent Fasting Protocol Description of Intermittent Fasting Protocol
Time-restricted feeding Commonly entails a daily fast for 12 to 20 h
Intermittent energy restriction Involves an energy-restricted fast duringintermittent periods, during which someenergy-laden foods or liquids are consumed
Alternate day fasting Involves fasting for 24 h, followed by a regulareating pattern for the following 24 h
5:2 fasting Consists of fasting on two non-consecutive daysfor every five days of regular intake
Fasting-mimicking diet Includes some energy-laden liquids


Mechanism of benefit of Intermittent Fasting

Time-restricted feeding (TRF) appeared to confer health benefits independent of energy intake. TRF in which food was consumed either between 8 a.m. and 2 p.m. (early fasting) or8 a.m. and 8 p.m. (control) demonstrated improved mean 24-h glucose levels and inducedchanges in circadian clock gene expression, as well as expression of hormones andgenes related to longevity implying anti-aging effects. A decrease in weight as low as 2.5% reduced fat massafter 3 weeks of IF in subjects without obesity. Preclinical studies have demonstrated the ability of IF to beneficially modulate the gutmicrobiome.

Potential Risks of Intermittent Fasting

IF during pregnancy and post-partum period should be advised against until more substantial evidence isavailable. Second, although IF appears safe for people with type 2 diabetes, cautionis warranted for anyone taking glucose-lowering medication. Everyone should be made awareof potential physical or psychosocial effects of IF. Side effects that have been reported instudies of IF include reduced energy levels, headache, presyncope, decreased concentration,mood swings or bad temper, feeling cold, constipation, bad breath, and preoccupation withfood.

Evidence of Intermittent Fasting

In last two years a lot of studies have been published where, IF has shown to reduce liver enzymes (SGPT/ALT and SGOT/AST). There have been also some studies to show that it reduces liver scarring and fat. It is believed that IF benefits by reducing abdominal (visceral) fat independent of weight loss.

Should you do Intermittent Fasting for fatty liver?

IF entails strict monitoring for nutritional deficiencies and so although data is encouraging, IF should be attempted only after guidance from your hepatologist and dietitian for fatty liver.


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