Visceral Fat & Hepatic Fat -- Not one and the same
It seems that any time the discussion of fatty livers developing on ketogenic diets comes around, a spate of confusing discussions tend to ensue. One of the confusing issues is that ketogenic reducing diets are effective at reducing hepatic fat levels. However, these studies usually start with a fatty liver and with weight loss comes hepatic fat loss. If there's a study out there where obese people are simply transitioned from a SAD to an equi-caloric ketogenic diet (85+% fat) demonstrating any change in liver fat accumulation, I'm not aware of it. However I believe the evidence of rodents on such diets is at least enough to be concerned that the change, if any, would be for the worse, not the better.
A lot of lean people also think, I can't have a fatty liver because I don't have a pot-belly so I don't have visceral fat. One of the reasons I thought the Eades' 6 Week Cure for the Middle Aged Middle book was such a disaster is that the first two weeks were supposedly devoted to detoxifying your liver. There were several references discussing just that, and a reduction in hepatic fat. I had high hopes for the book at the time, because I was expecting some science on how to specifically reduce visceral fat. I was disappointed that there was little if any discussion devoted to this topic. Let's look at the human abdomen. For starters, the liver is rather assymetrical. Additionally, although obesity leads to a higher prevalence of fatty liver, lean T1 diabetics have a rather high incidence of the disease. Roughly a quarter of those with fatty liver disease (FLD) have normal sized livers, so accumulation of hepatic fat does not necessarily increase the size of the liver. A normal adult liver has a span of 7-10 cm and an enlarged liver is over 2-3 cm larger. Still, this does not seem to be sufficient to cause a large belly. Also note the location of the liver. Most "bellies" are considerably lower.
Let's look at visceral fat depots. That mauve thing in the diagram on the right there is the liver. The "pot belly", as modeled by the fella on the left, is mostly omental visceral fat, and/or the front retroperitoneal visceral fat.
While the woman at left here is likely packing some visceral fat, that "spare tire" roll around the middle is evidence of considerable subcutaneous fat. While the guy above could probably squeeze some fat between a set of calipers, his tummy is likely relatively hard to the touch. In any case, if either had an enlarged liver, it would be the proverbial "drop in the bucket" of overall fat mass.
I think this is a very important distinction to be made in discussions of insulin resistance as IR is associated with both hepatic triglyceride content and visceral fat accumulation. Note I said associated as I'm not implying nor attempting to discuss causality here.
In my recent post, I discussed two studies implicating a ketogenic diet producing a fatty liver in mice, I also discussed these previously. In the second post, there is a table from the study showing that the triglyceride level of the keto-mice was higher than even the high-fat chow fed mice, despite growth and body mass similar to that of calorie restricted mice. In the second protocol from the same study, the results -- where some high fat fed mice were switched to keto diets and lost body mass to equal normal (low fat, ~12% usually) chow fed mice. However:
Paradoxically, the increase in glucose tolerance and correction of lipid profiles occurred in the context of increased hepatic triglyceride content compared with both HF and C groups
Thus, since many employ ketogenic diets for weight loss, from a metabolic profile similar to the HFD mice, if not worse*, the results of this study seem pertinent at least as cause for concern. Since most folks eating a "ketogenic" diet are eating nowhere near the 90+% fat diet, the cause for concern is somewhat mitigated ... but perhaps if you are one of those humans with the "mighty metabolism" exhibited for these mice (10 &15% higher energy expenditure than standard chow and calorie restricted chow respectively), in other words you truly are eating more and losing or not gaining or whatever, then perhaps you might want to get your liver tested. Elevated hepatic triglycerides occurred during growth of mice on KD and weight loss (then stabilized) after they were made obese on HFD. It may be that during the loss phase, liver triglycerides were reduced, but they weren't after weight stabilized.
But ... but ... my belly got flatter! (My own personal experience to the contrary aside ...) Here is where this blurring of the distinctions becomes important. Chances are if you gain or lose fat in your liver, we are not talking about a noticeable difference even if it is enlarged ... and it may well not be enlarged despite increased triglyceride content. You may have lost a lot of visceral fat around your organs ... or just subQ fat outside of the abdominal wall ... but the two are not one and the same. Therefore visceral or subcutaneous "slimness" is no reliable measure of your liver fat. In addition, you are likely to "feel great" for a very long time! The prevalence of some degree of FLD in Americans is shockingly high and it doesn't interfere with liver function for a good long time, certainly to any discernible degree. You may be looking at several years or even decades before it progresses to a deleterious state. Food for thought ...
* Coming from the SAD, being equivalent to the CAF diet, which was far worse than the standard rodent HFD, matters could well be worse for us humans.
I do not know whether NAFLD is a reported problem there with those complying.
I would also think that couple glasses of Rioja would be nice.
PS those Ketoed mice have very odd enzyme levels.
"A unique metabolic state" - but do not count on upregulating human UCPs.
There are suppose to be some indications that there is too much fat in somebody's liver.
@Mario: Interesting as always ... Update on me: thyroid normal.
That reminds of when I'd stopped visiting the lo-carb and Paleo sites, and then one day was reading about how the common way to induce NAFLD or HS in lab animals was by overfeeding FAT! I was surprised at something that in retrospect seems obvious because the LC and Paleo advocates had only ever mentioned fructose. The main lesson to be learned overall is not to trust advocates to be doing anything except arguing that they are always right and the supposed enemy is always wrong. (I'd assume the same applies to vegans.)
P.S. Nevertheless, one good thing about Eades was that I never saw him do the [crickets] routine of ignoring counterpoints. He would answer just about any counterpoint, even if his answer seemed unfounded.
Speaking of exercise, here's an interesting article on exercise and autophagy: "Exercise as Housecleaning for the Body"
E.g., the "baseline level of cellular housecleaning wasn’t enough to protect [the rodents] from developing diabetes in the face of a poor diet. Only when the control animals ran and pumped up their intracellular trash collection did they regain their health".
and ' “I never worked out consistently before,” Dr. Levine says. But now, having witnessed how exercise helped scour the cells of the running mice, she owns a treadmill.'
The article also states that the researchers induced diabetes via a high fat diet. I noticed some of the comments saying "how can that be? We know that too many carbs causes diabetes". I used to believe that, too -- when I had been wandering around in LC re-education camps :)
I've wondered about this too not only in regard to exercise but also dipping in and out of calorie deficit.
"The article also states that the researchers induced diabetes via a high fat diet. I noticed some of the comments saying "how can that be? We know that too many carbs causes diabetes". I used to believe that, too -- when I had been wandering around in LC re-education camps :)"
Oy vey. Don't get me started.
In the first minute, she talks about diabetes in rural Romania being caused by too much "pig fat".
(Later, she uses the term "malnutrition diabetes", which I haven't seen mentioned here. But that seemed a little sketchy to me, since that effect would also likely have occurred in previous 3rd world generations.)
Also from Einsten Med., here is autophagy researcher Ana Maria Cuervo, M.D., Ph.D. saying (at ~2:40 remaining) that most of what goes wrong with lack of autophagy garbage-collection is related to intracellular lipid:
For health purposes, I skip breakfast most days (except when I've lifted weights the night before and so crave meat, especially beef). Consequently, I've had hunger most every morning since June or so, but I just disregard the feeling. You're hot, you're cold, you feel the wind on your face, you feel hungry... all just feelings. Hunger isn't a command.
The ultimate healthwise might be working out while hungry.
Here's Todd Becker's interesting post about Wim: http://gettingstronger.org/2012/01/the-iceman/#more-3678
The same goes for hunger or even for when I quit cigarettes a decade ago. My motto: Don't dwell on the physical feelings -- you can't fight yourself and win.
FTD, that was a fun article by Becker, thanks :) Once a year or so when hiking at a frozen lake with a thawed shore, I'll stand in the water barefoot. Those people there seem at Becker's somewhat like me :)
Btw, it does soon hurt like a thousand needles. I don't stay too long in it because once upon a time on a cold, windy day outdoors my finger went completely numb and that was very scary for 10-15 minutes.
Last year I made a video for someone in a southern state, to show what it's like walking around at zero degrees... which is different from Iceman in that moving makes your internal furnace come on and all was fine enough to even take my coat off... unless there is a strong wind.
(though I know most people are afraid of clicking on links anyway)
I think I might like that Becker blog, though I hope it's not Paleo :)
You can also become diabetic from starving or crash dieting. It's not common, but it apparently happens enough that "starvation diabetes" is discussed in the literature.
But uh oh... Becker's blog is moderated. I hate that, and usually never go back to a moderated forum or blog.
(I don't know much of Ferris.)
Okay, my fingers have experienced enough typing-induced hormesis for now.
Did anyone else just have the random urge to do a halo jump? [Hums guitar riff from pearl jam "Alive"]
shhhhhh .... Freddy baby might hear you.
Y'know cwaiand, I've always wondered over this obsessive hunger everyone's always talking about on diets. I'm not talking the 500 cal/day ones, I'm talking the regular ones. In my young ED days, it was OBSESSION over food that drove the bus to binging, blowing my self-imposed starvation, etc. It has nothing to do with hunger. And I do not understand all these overweight low carbers who claim they didn't eat too much on their SAD and couldn't lose weight on 1000 cal/day because of the hunger who remain overweight eating too much on low carb. Ahh well.
In addition to the frequent small meal camp (which actually worked well for me with VLC but I rarely ate a "meal" per se), I think the "breakfast is the most important meal of the day" and "never skip breakfast", "never skip a meal" because you're going to be hungry later and lose control and go apeshit. If I'm not hungry I don't eat!
Probably the most relevant example of self delusion re "healthy" food choices. Bravo. What's the difference between overeating and overeating on LC? Oh, well it might make a difference to your liver come to think of it...but aside from that...[drifts off muttering about not being hungry since Eisenhower was president and it's a good thing...completely healthy and normal...large fluffy LDL by the bucketful]
My guess, LCarbers are mostly people for whom LC diets work. I wouldn't be able to eat two times a day on another diet because now hunger is at tolerable level. I used to carry emergency food with me, had migraines because I didn't eat in time due to some emergency, in short, I had to keep food in mind in order to function, planed my day around meals. Definitely not paleo. Why to be ironic about such issues? Sometimes it is difficult to realized the magnitude of problem other people may have but you don't. I myself can't imagine how feel others who, for example, are scared of spiders or germs, or pay to their church 10% of their income because they are scared of hell or trust into another unproven hypothesis like going to heaven.
do they have different organelles?
"If there's a study out there where obese people are simply transitioned from a SAD to an equi-caloric ketogenic diet (85+% fat) demonstrating any change in liver fat accumulation, I'm not aware of it."
Here links to reports on US study showing that subjects on low carb diet lost significantly more liver fat than those on low calorie diet.
The low carb group also lost nearly twice the weight in the two weeks.
Here is to abstract of one more smaller study:
This is a very interesting study for reasons other than the hepatic fat. I was surprised to see that gluconeogenesis doesn't use any more glycerol as substrate in VLC vs. -800 cal deficit diets.
I'm still looking for a study where weight loss was not involved. Hepatic fat is lost quite rapidly when one loses weight and both of your studies involved weight loss. What happens when weight loss stops or if one never loses weight?
The results supports the growing views that the international fat scare that emanated from the US in the late 1970's was scientifically poorly supported and are still today making people sicker instead of healthier. The basis for the low fat recommendations were associations without proper multivariate regression analysis that used cherry picked data, and no RCTs were conducted or reported.
Low Carb High Fat(LCHF) eating usually gives weight loss and a number of health advantages in the first few months, in part probably due to a more effective daily cleansing of the liver due to bile flow increasing in direct proportion to higher fat intake.
"Bile flow and liver status and other indicators during prolonged low/high fat diets" is a study I have been looking for without luck. Even 2 weeks could show results according to Brownings studies! But without weight change the longer time studies would be required to see differences as they naturally become smaller during weight stable conditions. Your question is good, but no complete answers yet:
"Is a standard high carb low fat weight stable diet affecting liver fats any different to a high fat low carb weight stable diet?"
In between the opposite- more carbs more NAFLD - has been reported. Nothing about weight change in the abstract:
Although here the correlation is with soft drinks that contain lots of fructose resulting in triglycerides when intake is an excess. If subject weights were collected and individually correlated with results your question could be answered, in part. If you find free link to this whole study, please post it!
from it about blogging. thanks.
my web site quantrim online
Post a Comment
Comment Moderation is ON ... I will NOT be routinely reviewing or publishing comments at this time..