Lifestyle approaches to treating NAFLD:
- Exercise - move more, work up to at least moderate intensity - Low, moderate or slow carbohydrate diet - Fasting: intermittent or time-restricted eating, single or multiple-day fasts, fasting-mimicking diet, alternate day fasts - Sleep improvement because it changes metabolism - Stress reduction because it also changes metabolism
Example scenarios: - A middle-aged woman with minor metabolic syndrome might find that a moderate-carbohydrate diet and moderate exercise is sustainable and gentle on her hormones. - A middle-aged man who just crossed the threshold of obesity might find that low-carbohydrate and eating just two meals a day, combined with lifting weights several times per week, fits well with a busy schedule and improves his physique rapidly, encouraging him to stick with it. - An overweight child with NAFLD might be restricted to whole foods and encouraged to eat more protein and vegetables, but not restricted in terms of quantities or timing of food. - A thin, young, active person with NAFLD should be evaluated for unusually high levels of stress hormones, poor sleep, or unusual circumstances driving poor metabolism.
- Fructose consumption leading to its conversion into fat (called "de novo lipogenesis" or making new fat) is estimated to contribute to 25% of the fat accumulation in fatty liver. This estimate may be revised over time - originally it was thought to be a very small percentage of fat (well under 10%), but the experiments were skewed because the test subjects were fasting before the fructose challenge. Since they were fasting, there were other places for the excess energy to go, rather than getting stuck in the liver and turned into fat.
-Exercise allows sugar to get into muscles without insulin (or, perhaps more importantly, in spite of cellular insulin resistance)
- The fatigue that results from fatty liver and insulin resistance can lessen the appeal of exercise for those who need it. This is where gardening, walking around the neighborhood, parking the car farther away, clearing out the garage, are necessary steps to build tolerance and get the process started. An accountability partner for walks (human or animal) or a specific goal can be really helpful.
- Metabolic syndrome is associated with depression, which can be one more reason why someone would need extra support to get out and get moving.
- For those who don't like swallowing pills, consider powdered or liquid vitamins, or just better-quality food.
Although fat accumulation in the liver might not seem to call for a fat-rich diet to heal it, for a number of reasons we'll discuss tomorrow, it might be the most reasonable approach for a particular person.
Here are a few of those reasons:
- a ketogenic diet can still reduce the overall number of calories ingested, which is one factor (by no means the only factor) regulating insulin resistance, glucose tolerance, and overall weight - the fullness experienced on a ketogenic diet can make adherence easier - ketogenic diets can benefit some autoimmune conditions so this kind of diet might be particularly helpful if those are some of the causes of metabolic syndrome in a particular person - some people enjoy other effects on this kind of diet, like better sleep, increased mental clarity and focus, and gut healing, all of which improve daily quality of life. Elevated stress hormones, poor sleep, and gut dysbiosis contribute to metabolic syndrome and may have been the initial trigger.