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Journalism of Courage
If you thought that time-restricted eating or intermittent fasting (IF) can help you lose weight and reverse non-alcoholic fatty liver disease (NAFLD) faster, then a recent Chinese study takes some sheen off that theory. It found that this was just as effective as a traditional calorie-restricted diet and had no extra advantages for the patient.
In a randomised clinical trial of adults with obesity and NAFLD, a time-restricted regimen (eating only between 8 am and 4 pm) did not achieve additional benefits for reducing intrahepatic triglycerides (IHTG) content, weight, body fat and metabolic risk factors compared with daily calorie-restricted (DCR) diet or low calorie diets had at habitual meal timings. Both diets produced a comparable effect on liver stiffness and resolution of NAFLD. The trial was conducted over 12 months at Guangzhou, China, between April 9, 2019, and August 28, 2021. All participants were instructed to maintain a restricted diet, 1500 to 1800 kcal/d for men and 1200 to 1500 kcal/d for women. The findings were published in JAMA Network. Both diets reduced metabolic risk factors equally, including systolic and diastolic blood pressure, pulse rate, total cholesterol, triglycerides and low-density lipoprotein (LDL) cholesterol levels.
WHY ARE THESE FINDINGS SIGNIFICANT?
NAFLD affects approximately 20 per cent to 30 per cent of adults in the general population, and more than 70 per cent of patients with obesity and diabetes.
Although there aren’t any medications to treat NAFLD, a good diet and regular exercise can reverse it. Losing 10 per cent of your current body weight can dramatically decrease the amount of fat in the liver as well as reduce inflammation. This is where the role of diets becomes important in disease management.
WHAT DOES THIS MEAN FOR OUR DIET PROTOCOLS?
“Intermittent fasting is a popular method of losing weight. Simplified, what this means is that after 14 hours of fasting, the metabolism switches on, mobilises and uses stored fat and decreases cellular death. But in every study on weight loss done in clinical settings, or even this one done specifically for NAFLD, there’s not much difference between a time-restricted and calorie-restricted diets. This means that the real deal is in the calories. The traditional restricted diet advocates taking anything between 1,200 to 1,500 calories, spread across three to four meals, while a time-restricted or intermittent fasting diet crams all those calories in an eight-hour eating window. The study shows that both work equally and there is no advantage that one has over another, which means that one has to customise one’s method of calorie reduction. Calorie-restriction on a meal-by-meal basis becomes a bit difficult for working professionals, who find the intermittent fasting format easier to adopt,” says Dr Ambrish Mithal, Chairman of Endocrinology and Diabetes at Max Healthcare.
Adds Dr Anoop Misra, Chairman, Fortis CDOC Hospital for Diabetes and Allied Sciences, “Considering that the superiority of intermittent fasting is yet to be established, I put all my patients on a disciplined diet.”
As for fatty liver management, Dr Mithal says that while diets need to be customised on a case-specific basis, the larger formula should be to reduce calories, refined carbohydrates, overall fat intake, exercise moderately and lose visceral fat. “Though there are no specific medications approved for fatty liver, there are some that work better on those with diabetes than others. These include Pioglitazone, SGLT2 inhibitors and GLP1 receptor agonist drugs like Semaglutide. Vitamin E can help those with regular fatty liver somewhat,” adds Dr Mithal.
WHY DIETS SHOULD BE SUSTAINABLE OVER A LONG TERM
Since the key component of reversing fatty liver is weight reduction, Dr Abhijit Bhograj, Consultant Endocrinologist, Manipal Hospitals, Bengaluru, advocates a practical and sustainable diet. “The problem with fad diets is that they become unsustainable over a long term and followers tend to give them up midway. In such cases, the weight comes back in a year’s time. So start a meal plan that you can sustain and increase physical activity so that the weight loss is permanent. Intermittent fasting is a good starting tool to lose weight and shows discernible benefits in the short-term, where there is a 10 to 15 per cent change in body weight, a reduction in levels of cholesterol, fat and a better control of diabetes. Later, one has to have a balanced meal that is customised according to a person’s physical activity patterns and the time when their energy requirements are the most. When it comes to Indian diets, which are high on fats and carbohydrates, five to ten meals in a week tend to be unbalanced,” he adds.
WHAT DOES THIS MEAN FOR INTERMITTENT FASTING USERS?
“The basic difference between intermittent fasting and simple calorie restriction is that our bodies tend to adapt to low calorie intakes over a period of time. As a result, we stop losing weight after three to six months despite persisting with a low-calorie intake. It is thought that allowing ‘normal’ food intake intermittently is able to keep the body responsive to changes in diet. Ultimately, when we fast for prolonged periods, our body fat stores start melting. Human studies have shown that intermittent fasting typically produces weight loss of three to five kilos over two to three months, although there is wide variability in the results. Unfortunately, for the proponents of intermittent fasting, most studies have not shown a significant benefit of intermittent fasting over other approaches in terms of weight loss, lipid parameters, blood glucose levels and others. The impact of intermittent fasting in these short to medium-term studies could largely be attributed to a reduction in calorie intake. For comparable calorie intakes, conventional calorie restriction was as effective as intermittent fasting in improving metabolic parameters. So I believe that the present use of intermittent fasting is determined by individual choice. Some may find it easy to control their calories by fasting. Others may find it impossible to fast for 16 hours, particularly if they have some chronic health conditions. But this study proves that intermittent fasting can just be an option, not a permanent solution,” adds Dr Mithal.
