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Which Diet Is Best to Lower Liver Fat and Improve Insulin Sensitivity?

22 points llm_nerd 2 days ago 18 comments

N_Lens 2 days ago | parent

Sharing my experience with Keto incase it helps someone:

Ketogenic diet is definitely a powerful intervention, as this study shows. It's also been particularly powerful for various neurological conditions such as epilepsy, schizophrenia, and even Autism and ADHD. I have mild AuDHD and being in ketosis significantly improves the feelings of inner resistance and aversion that come with neurodivergence - the mind feels well lubricated and concordant instead of chaotic, it perhaps even feels like the neurodivergence is 'cured'.

However, I tried keto several times in the past and it didn't suit me particularly, I could not sustain it. This is because initially, the diet drops blood plasma volume significantly, and I already have hypovolemia (low blood volume) and sickle cell anemia (minor trait Thalassemia). This meant my blood volume would drop too low and it would stress my body exceptionally hard. I was drinking so much salt water (As the guidelines recommend) and was definitely in Ketosis, but the 'keto-flu' persisted past 7-10 days and I gave up. During that period I had my bloods done and had elevated ALT/AST levels, and had constant shortness of breath and low energy.

It was actually this experience with the keto diet that made me realise the connection with hypovolemia and sickle cell anemia. This led me to supplement with creatine to increase plasma volume and that has an amazing effect on how I feel and my cognitive function =). Thanks for reading.

Rooster61 2 days ago | parent

> sickle cell anemia (minor trait Thalassemia)

Thalassemia and sickle cell anemia are two separate conditions (though admittedly similar in symptoms, affected part of the blood, and likely evolutionary origins). Are you saying you have both, or trying to provide some type of clarification with the parentheses? I ask because hypovolemia IS low blood volume, and you used the parentheses the same way for the latter condition.

N_Lens 1 day ago | parent

Ah I did not know they're not the same thing. I checked and for clarification I have minor trait Thalassemia and smaller red blood cells as a result.

cowanon77 2 days ago | parent

This may be true, but the study size is 42 people. This is woefully insufficient for making any conclusions about something with so many confounding factors. At best this is a safety scan before running a much larger trial.

llm_nerd 2 days ago | parent

Given the controls of the study, and the continuous observation, I think an enormous amount can be drawn from this study, even with the relatively small n.

The truth is that this sort of tightly controlled study -- participants were given 100% of their food as packed meals, were constantly monitored, met with a dietician constantly and so on -- is extraordinarily rare, and you'll never find them with large numbers of participants for obvious financial and logistical reasons.

And just to be clear, I have long been a strong skeptic of keto (there is a religiosity of that movement, and the science often doesn't keep up with the claims), so I didn't post this as a cherry picked adherent spreading a gospel, and instead it was truly interesting to me: I happened to get the correlating video while doing a morning elliptical routine and found it fascinating. What amazed me the most about this study is that the caloric restriction meant that even though the "keto" diet was high in fats and saturated fats, LDL and ApoB dropped among members of that group, well into the ideal range. I mean, it dropped across all the groups as a benefit of losing weight, but I think intuitively we would assume that group would see bad results.

cowanon77 2 days ago | parent

You just can't extrapolate much from a study of this size, for this effect size, with this many confounding factors. The difference in effect sizes were percentages, not orders of magnitude.

The best you can say is: "no evidence found of non-efficacy for these 3 diets. Effect sizes comparable to within 10% of each other."

There's no way to interpret this as "x diet is the best"

majkinetor 2 days ago | parent

The entirety of scientific evidence is so overwhealming at this point, that unless you are genetic freak, it certainly works. We know biological mechanisms and environmental circumestances regarding this. At this point, if you don't beleive in low carb (not keto), you are anti-science.

reducesuffering 2 days ago | parent

Astonishingly simplified. There is far more evidence for the health improvements from ample amount of strength training and aerobic cardio exercise. Good luck lifting 3x and running 3x a week on "low carb".

Amongst acquaintances I see low carb adherents. I wonder why they are always the ones woefully less fit than the serious athlete acquaintances. Amongst serious athletes there is no low carb proselytizing lol.

For sure it can help people who don't exercise and thus don't use much carbs in the first place. But that is far from ideal health, and thus the ideal diet.

majkinetor 2 days ago | parent

I do exactly that for a decade. This is not for discussion, we know this. Stop eating carbs 2 weeks and your cells will adapt. There is no such thing as carbohydrate deficiency or we would not be able to surive to this age.

Most of the carby foods are typically nutrient shit. Fiber like psylium exluded and somewhat resistant starch. You better try to avoid all else as your life depends on it.

If you are really serious athlete, do whatever you want honestly. 99.9999999 people are not. Your muscles are sugar pumps in that case (not the teeth though).

> I wonder why they are always the ones woefully less fit than the serious athlete acquaintances.

Thats because you look at the wrong thing. Seriously fit people in my experience are seriously not that fit when they give me their blood tests.

dyauspitr 2 days ago | parent

GLP-1

Xiol 2 days ago | parent

Added benefit here is that we know this works.

faangguyindia 1 day ago | parent

If it universally worked, people would never learn to diet and exercise; this post proves this (by GLP users):

https://www.reddit.com/r/tirzepatidecompound/comments/1omfgx...

DivingForGold 2 days ago | parent

Flawed study.

Recap the very-low-fat plant-forward diet: 70% of calories came from carbs, 15% from protein, and 15% from fat, and it was heavily based on legumes, whole grains, vegetables, fruit, and berries.

They did not include in the study the VETO plant based diet. Very low carbs, low fats, only monosaturated fats, no table sugar (sucrose), no white flour, no cow's milk, etc. and high plant based protein, with lactobacillus cultured non dairy "yogurts".

The standard Keto diet suffers from saturated fats, and while the adherents seem to have better results at first, decades later they will suffer arteriosclerosis and cardiovascular problems.

majkinetor 2 days ago | parent

It doesn't look so, also, it was not keto diet, but lowcarb.

deterministic 1 day ago | parent

> decades later they will suffer arteriosclerosis and cardiovascular problems.

That’s quite a claim, and the opposite of my experience. What’s your evidence?

I’ve seen long-term vegans develop health problems and improve after switching to a low-carb, meat-based diet. I’ve also seen the opposite.

I was vegetarian for over a year and ended up gaining weight and feeling like crap. I switched to keto, and now I am healthy and have lots of energy. It seems to work for me, but that doesn’t mean it’s right for you.

Maybe the answer is to figure out what works for you and ignore the vegan/keto propaganda and influencers.

vishalontheline 2 days ago | parent

How I increased my insulin sensitivity:

- Not eating at least 4 hours prior to sleep.

- No bread, dates, sugar, sugar-substitute, honey, potatoes, sweet potatoes, etc.. with the exception for 1 banana during breakfast.

- Eating the most carb-rich foods (the banana during breakfast, beans during lunch) first, then eating fewer carbs during subsequent meals.

dominotw 2 days ago | parent

how did you measure it and how often.

adrian_b 1 day ago | parent

The analysis from TFA and also the study that it comments on are much better than what is typical for nutrition studies.

TLDR:

1. If fatty liver or diabetes/prediabetes is the problem, a low-carb diet, e.g. a keto diet, was the most efficient.

2. For problems like fat in other organs, e.g. muscles, causing reduced insulin sensitivity, only weight loss mattered, regardless of the diet that caused it.

3. For cardiovascular problems, e.g. atherosclerosis or high blood pressure, a balanced diet, e.g. Mediterranean, was superior to both low-carb and low-fat diets.

Something not discussed in the article is that unlike the alternatives, a low-carb diet/keto diet is much more expensive. In any diet that provides a desired amount of protein and fat, carbs are basically free. When the majority of the calories are no longer provided by carbs, the diet may be unaffordable for many people all over the world, so for them a keto diet may be acceptable only for a short term, as a treatment against prediabetes or fatty liver, but not as a permanent diet.