Treatment of fatty liver (letter submitted to Canadian Journal of CME, 2008-3-27)

While catching up on my reading, I came across an item in “Consultant’s Corner” which piqued my interest, and I am writing to bring both your readers and your consultant up to date. In the Aug 2007 issue of the Canadian Journal of CME, a question was submitted by a reader (p32): “It seems like many of my patients are found to have a fatty liver on abdominal ultrasound. What is the best way to eliminate this liver fat and its associated risks?” Your consultant included in his response, “…I recommend weight loss to such patients, given the lack of any other effective therapies…”
Here are references to two articles on the treatment of liver steatosis with a low-carbohydrate diet. The Hollingsworth article suggests that the liver fat loss is rapid and exceeds the loss that could be expected from weight reduction alone.
One of my medical school classmates, a liver transplant specialist, assures me that when potential donors are found to have fatty liver on workup (unfortunately, a frequent finding), their program recommends a low-carbohydrate diet. This approach has led to a gratifying reduction in liver fat in some who then go on to donate.
Browning JD, Davis J, Saboorian MH, Burgess SC. A low-carbohydrate diet rapidly and dramatically reduces intrahepatic triglyceride content. Hepatology. 2006;44:487-488.
Hollingsworth KG, Abubacker MZ, Joubert I, Allison ME, Lomas DJ. Low-carbohydrate diet induced reduction of hepatic lipid content observed with a rapid non-invasive MRI technique. Br J Radiol. 2006;79:712-715.
Here is the response from the Consultant: “A low carb diet (with associated weight loss) might be effective, but the studies referenced don’t look at the important, clinical outcomes (which would be reduced liver fibrosis, cirrhosis, etc.)”
Dr. Mark Borgaonkar

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