My husband was told he had fatty liver when he had an ultrasound done for another reason in March 2018. Looking back over his blood results, in retrospect it was no surprise. His ALT in December 2017 was 67 iu/l and in May 2016 it was 83 iu/l. Of course, back then I had no idea what that meant. In January, when he had a TIA, he had full blown metabolic syndrome, abdominal obesity, high blood pressure, so when the sonographer said about the fatty liver, we just shrugged – it was kind of expected.
He carried on the low carb and fasting that he started in February and 6 months and 10kg of weight loss later, in September, we got another ultrasound done. Just to see if there was an improvement.
Unfortunately the report still said ‘Mild fatty liver’. Bit disappointed. 10kg of weight loss and nothing had come out of the liver? Maybe it just takes longer than 6 months.
But something didn’t seem right with that idea. Several studies show that fatty liver can be resolved in a few weeks, or less. Here’s one that looked at the effect of a low carb diet on liver fat over 2 weeks (they didn’t even restrict calories). Check out the results:
An Integrated Understanding of the Rapid Metabolic
Benefits of a Carbohydrate-Restricted Diet on
Hepatic Steatosis in Humans
Cell Metab. 2018 Mar 6;27(3):559-571.e5
So there’s a dramatic effect in 14 days, and that’s with a non calorie restricted diet.
Here’s my other clue (start watching at 49 mins in):
This guy, Dr Robert Cywes is saying that he can reverse fatty liver with 48 hours of fasting, and he’s confirmed this with liver biopsy, which is the absolute gold standard.
Unfortunately he doesn’t appear to have published these findings, and I haven’t managed to find any other studies specifically looking at water fasting and the effect on liver fat. (If you find any let me know)
Well, my husband has done many periods of fasting over the period since February, ranging from a 16:8 intermittent fast to 12 days extended fast. BUT he had not done any fasts longer than about 20 hours in the few weeks approaching his second ultrasound.
So I thought, well let’s get him to do a slightly longer fast and see what the ultrasound scan looks like afterwards. Unfortunately its £99 a pop for an abdominal ultrasound, so I can’t afford to be getting them done left, right and centre. However, I do some ultrasound examinations (on other body parts) as part of my job and figured I could learn to scan a liver well enough to see how fatty it is. So one week later I scanned him again after 42 hours of water fasting.
Before I show you the results, here’s a crash course in liver ultrasound to assess fatty liver so you know what you are looking at:
Notice also the diaphragm. It is the bright white line in the bottom left hand corner of the first image above. It appears bright because the ultrasound beam can ‘see through’ the liver very well because there is no fat in the way. Contrast that to the second image – the line that is the diaphragm is faint and fuzzy, because the ultrasound beam cannot ‘see’ well through the fat above.
His first scan – 7th September
On 7th September, with no fasts longer than 20 hours for several weeks, these were my husband’s ultrasound images:
Its really unfortunate but the sonographer did not give us an image including the kidney to make that comparison between the kidney and liver. Shame.
His Second Scan
One week later, 15th September after a 42 hour fast, here’s the pictures:
So with the caveat that I’m not trained in liver sonography, I am prepared to say that there is a definite improvement after just 42 hours of fasting. I should mention that he did not change his diet in that week, he has been eating a low carb high fat diet since February with either one or two meals a day.
Was there complete resolution of the fatty liver? I may not be able to read the nuances of the ultrasound pictures well enough to say for sure. But the fact that the kidney and liver were the same brightness would point in that direction, I think. (Any comments welcome).
So maybe the good Doctor Cywes was right. Maybe you can reverse fatty liver with a 48 hour fast. But then what happens afterwards? Lets go back to the study of the 14 day low carb diet. Remember how the liver fat dropped dramatically after just 14 days? But what happened next? Here’s a quote from the study:
"To test whether the marked reductions in liver fat were linked to the diet intervention, we performed a follow-up MRS in seven of the ten participants 1–3 months after completing the intervention study and returning to their normal diet. We observed that their liver fat content returned to a level similar to that measured before the diet intervention (11.3% ± 1.6% at follow-up versus 13.8% ± 2.5% at baseline, p = 0.08)."
So fatty liver is quick to go, but quick to come back. What does this tell us?
The amount of fat in the liver is the result of this equation:
Fat going in – fat going out or being burnt = fat in liver
So a diagnosis of fatty liver just tells you what is happening to this equation at a particular moment in time. It can change rapidly. It makes sense that during fasting the fat in the liver will be burnt for energy or exported to other body tissues in VLDLs, and this might outweigh the fat coming in as FFAs from peripheral lipolysis. But you can’t fast forever. The equation needs to be balanced on a day to day basis.
The real question becomes: If a healthy person has a normal state of equilibrium where the fat going in balances the fat going out on a day to day basis, what is the imbalance in NAFLD patients that results in the disequilibrium and liver fat build up?
Reversing fatty liver may not be the issue. Keeping it reversed is where it’s at.