Intermittent calorie restriction offers only modest advantages over a low-carbohydrate, high-fat diet (LCHF) for treating non-alcoholic fatty liver (NAFLD), researchers say.
The intermittent diet provides more benefits for liver stiffness and low density lipoprotein (LDL) cholesterol and may be easier to maintain, said Magnus Holmer, MD, director of the department of hepatology at the Karolinska Institute in Stockholm, Sweden.
But the intermittent diet has drawbacks, too, and the differences between the two have been minor, he told Medscape Medical News.
“They were more or less equally effective in reducing liver steatosis in NAFLD and also in reducing body weight,” he said. “And from this we can say that the composition of macronutrients like fat or sugar seems to be less important than how many calories you eat.”
Holmer and colleagues presented their results at the International Liver Congress (ILC) 2021 and published them in JHEP Reports.
While previous studies have shown that diet can effectively treat NAFLD, researchers have debated whether a popular low-carb, high-fat diet could do more harm than good.
At the same time, intermittent low-calorie diets are also gaining popularity, especially the 5: 2 diet, where participants eat normally 5 days a week and limit their calories on the other 2 days.
How do the two diets compare?
To see if one was more effective than the other, the researchers recruited 74 people with NAFLD. They diagnosed the patients either by radiological examination or a combination of controlled attenuation parameters (CAP)> 280 dB / m and obesity or a CAP> 280 dB / m, elevated alanine aminotransferase and obesity. 16 of the patients were treated with statins.
The researchers randomly assigned 25 people on the LCHF diet, 25 on a 5: 2 diet, and 24 on standard care. The groups were similar at baseline for diet, age, body mass index (BMI), liver stiffness, and most other criteria, although there were more women in the standard care group.
At the start of the study, participants in the standard care group consulted a hepatologist who advised them to avoid sweets and saturated fats, eat three meals a day, and avoid large portions.
The researchers asked women on the 5: 2 diet to consume up to 500 kcal / day on 2 days per week and up to 2000 kcal / day on the other 5 days. They asked the men in the group to consume up to 600 kcal / day on 2 days a week and up to 2400 kcal / day on the other 5 days.
They provided all 5: 2 participants with recipes that followed the Nordic dietary recommendations, an adaptation of the Mediterranean diet that emphasizes traditional foods in the Nordic countries, particularly grains such as whole rye, oats and barley; Fruits such as apples, pears, berries and plums; Root vegetables, cabbage, onions, peas, beans, fish, boiled potatoes and dairy products; and the use of rapeseed oil (canola). The calories contained in the recipes consisted of 45% -60% carbohydrates, 25% fat and 10% -20% protein.
The researchers asked women on the LCHF diet to consume an average of 1600 kcal / day and men an average of 1900 kcal / day. All participants used recipes based on meat, fish, eggs, low-carb vegetables and milk fat. The participants avoided sugar, bread, pasta, rice, pies, potatoes and fruit. The calories in the recipes are made up of 5 to 10% carbohydrates, 50 to 80% fat and 15 to 40% protein.
All participants reported what they ate in the last 3 days, both at the start of the study and after 12 weeks. Participants in the 5: 2 and LCHF groups also received follow-up calls to report their last 24 hours of eating on week 2, 4, 8, and 12, as well as week 6, when they visited a nutritionist.
In addition, the researchers measured the participants’ linoleic acid and α-linolenic acid intakes to see if the diets of the participants were different in the groups.
After 12 weeks, all three groups lost a significant amount of liver fat, but the LCHF and 5: 2 groups lost more than the standard care group. Liver stiffness decreased significantly in the 5: 2 and standard care groups, but not in the LCHF group.
Table. Change in body composition
|diet||Mean change in liver steatosis,%||Mean change in liver stiffness, kPa||Mean change in body weight, kg|
The differences in steatosis change between the standard care and LCHF groups were statistically significant (P = 0.001), as were between the standard care and 5: 2 groups (P = 0.029). The differences between the LCHF and 5: 2 groups were not statistically significant for weight or steatosis, but were statistically significant for liver stiffness.
In addition, the 5: 2 group significantly reduced total and LDL cholesterol, while the standard care group did not. In the LCHF group, all LDL, HDL and total cholesterol levels increased.
The long-term effects of cholesterol results are unclear, said Holmer. He hopes to be able to follow up on these patients after 18-24 months. But the initial cholesterol findings may be enough to set a red flag for anyone with a history of cardiovascular disease, Holmer said.
Adherence to the diet
Only one person dropped out of the 5: 2 group, compared to 5 in the LCHF group and 4 in the standard care group. More people in the LCHF group reported adverse events such as gastrointestinal upset.
“With LCHF, it’s a drastic change for most people,” said Holmer. “Many patients are a little shocked when they realize how much fat to eat for breakfast, lunch, and dinner. They may eat bacon and eggs for breakfast every day.” Diet could be challenging for people looking to reduce their meat consumption for environmental reasons, he added.
The 5: 2 group has the advantage that people can choose what to eat as long as they stick to the calorie restrictions, he stressed. Still, he warned that the diet wouldn’t work well for people with insulin-dependent diabetes because it was difficult to adjust insulin levels on fasting days. He also advised against this diet for people with cirrhosis because they have to eat frequent meals.
LCHF and 5: 2 Diets Can Work Can
But for most people, the good news is that a variety of diets will work to treat NAFLD, Holmer said.
“I start by telling my patients that this can be completely cured as long as you are able to lose weight,” he said. “Then the next question is how are you going to cope with this task? And if you are already interested in a particular diet, I can promote it based on these results.”
Stephen Harrison, MD, visiting professor of hepatology at the Radcliffe Department of Medicine, University of Oxford, Oxford, UK, said longer term results will be important. For example, it will be interesting to see if the diets had any effect on ballooning or inflammation, he told Medscape Medical News.
Another limitation of the study is that it is relatively small, he said. He suggested that people with NAFLD should increase their physical activity and eat less.
Still, Harrison enthusiastically welcomed the results, saying, “This is an important study.”
It’s useful to compare two popular diets head-to-head, and it’s also encouraging to get confirmation that either can work, he added.
The study was supported by grants from the Stockholm County Council, the Nutrition Science Foundation (Kostfonden), the Skandia Research Foundation and the Åke Wiberg Foundation. Holmer has not disclosed any relevant financial relationships. Harrison is a consultant to Madrigal Pharmaceuticals.
International Liver Congress (ILC) 2021: Abstract OA-1627. Presented on 06/25/2021.
JHEP reports. Published on February 17, 2021. Full text
Laird Harrison writes about science, health and culture. His work has appeared in national magazines, newspapers, on public radio and on websites. He is working on a novel about alternative realities in physics. Harrison teaches writing at the Writers Grotto. Visit him at lairdharrison.com or follow him on Twitter @ LairdH
Is Whole Wheat Actually Better Than White Bread or Pasta?
Multigrain is a brilliant approach to selling both white bread and fairness. The term has quietly crept under the umbrella of health. It wasn’t clear exactly why. (The grain part? Or the multi?) At least it wasn’t white bread, was it?
When many bread eaters understood that white bread is a nutritional equivalent of Pixy Stix – the nutritious, fibrous husk of the wheat has been removed and we are left with only the inner strength that our bodies convert to sugar almost instantly – it took some renaming.
Multigrain is often used today to imply wholesomeness, a virtue to which it is often not entitled. Having the multiple grains in flour doesn’t mean they contain whole grains. If millers leave the grain intact before grinding, it is whole wheat flour. It contains fiber, which soothes the pancreas and the microbes that need it for optimal performance. So the term we are looking for is 100 percent whole grain. (Or whole grains, although the grain is usually wheat.)
It’s a valuable piece of health knowledge, especially given the results of an extensive analysis published today by the Harvard School of Public Health: Eating at least three servings of whole grains a day is associated with a lower risk of dying from cancer. Heart disease and stroke.
This is especially relevant at a time when many people needlessly skip gluten or simply think that carbohydrates are bad.
“There are still some misconceptions about the role of carbohydrates in a healthy diet,” said Frank Hu, Professor of Epidemiology and Nutrition at Harvard and one of the study’s authors. “Some people still believe that all carbohydrates are bad, and some people still promote very low-carb diets without strong scientific support.”
Hu sees this study as further evidence that the type of carbohydrate is “very important”.
Lauren Giordano / The Atlantic
The new Harvard study, published in the American Heart Association’s journal Circulation, is an analysis of 12 previous studies as well as previously unpublished results from the National Health and Nutrition Examination Survey. The combined studies involved 786,076 people and a total of 97,867 deaths.
This is a correlation, an epidemiological study – so predictably, people on Facebook timelines and comment threads will be screaming that correlation is not causation. The allegation, while true, is out of place. Epidemiology is perhaps the most important type of research available to us to understand the role of food in chronic disease.
In many areas of science, the gold standard approach is a randomized controlled trial. This works very well, for example, when drugs are tested for short-term effectiveness and side effects. However, the effects of our food are usually too far-reaching to be used in the same studies. Chronic diseases (as the name suggests) do not manifest themselves over weeks or months, but over decades – longer than most research institutes can keep thousands of subjects on a particular diet. And longer than most people would be willing to participate.
(Would you please help us by just using white bread for the rest of your life and see what diseases you get or not? In fact, wait, you can’t know it’s white bread or it is ruining the experiment. Wear this one always dark sunglasses? and let’s cauterize your tongue?)
Therefore, knowing that long-lived, healthy people tend to eat lots of whole grains is reliable and worthwhile.
However, the study made no distinction between ground grains and whole grains, which tend to be eaten whole – quinoa, farro, amaranth, and the like. I asked Hu what was going on.
“That’s a really good question,” he said. “We don’t have enough data to solve the problem.” But like any good scientist, he was ready to speculate: “When whole grains are ground and turned into whole grain flour, the digestive and absorption process is still fast. And that can lead to higher insulin responses. In theory, this type of product is less beneficial than whole grain products, which are only minimally processed or not processed at all. “
These insulin responses correspond to a measure known as the glycemic index, essentially the rate at which glucose enters our bloodstream when we eat. Pixy Stix are high and broccoli is low. It is known that eating many foods with high glycemic indexes has been linked to diabetes, obesity, heart disease, and even liver damage. (A recent randomized clinical trial in JAMA in 2014 suggested otherwise, but that study only lasted five weeks.) It’s not a perfect metric, but an interesting one.
In this case, it is relevant because white wonder bread and whole wheat bread have the same glycemic index. According to the Harvard website, they are identical. Both are high (even higher than Coca Cola). Ever since I first saw this a few years ago, I’ve been wondering why – and what, whole wheat pasta would make healthier than white pasta, if not a muted sugar spike. (Because I love them both and I want to feel good eating both of them.)
Hu clarified that the glycemic index “mainly depends on the particle size of the food. So when whole grain is ground, the particles are similar in size to those of white flour. “
It can even depend on the structure of the final product. Furio Brighenti, professor of nutrition at the University of Parma in Italy, has – perhaps predictably – studied pasta in great detail. He explained to me how the structure of food affects the absorption of starch in sugar, which he has observed through studies on different types of pasta. Although they are made of the same material, we record them differently.
Based on Wolevar et al., “Glycemic Response to Pasta” Diabetes Care (Lauren Giordano / The Atlantic)
The total surface area of the meal (after chewing) can partly explain the differences in how the body reacts to different pasta, explains Brighenti. Only the thickness of the pasta is variable. According to his results, thicker penne has a lower glycemic index than thinner ones.
Lauren Giordano / The Atlantic
Pastas that are left al dente (really the only way to cook pasta) also have lower indices than those that are left to a pulp like so much canteen nonsense.
He highlights the complexity by graphing for me that different shapes of pasta tend to be eaten with different amounts of oils and sauces, and this changes the way the body ingests food – not just the glycemic index but also the speed at which the stomach empties. However, he cannot explain why whole wheat pasta has a glycemic index similar to that of white pasta.
“The glycemic index is just one of the factors that go into the quality of a high-carbohydrate food,” says Hu. “The amount of fiber, minerals, antioxidants and phytochemicals is also very important. In fact, the whole is more than the sum of its parts. “
This is a basic tenet of dietary wisdom. The grain is a microcosm. Take exactly the same flour and make it into pasta or bread, and it works differently in us:
According to Giacco et al., British Journal of Nutrition (Lauren Giordano / The Atlantic)
The variables are many, but the realization is not complex: eat whole grains instead of their starchy white endosperm whenever possible, and a person’s chances of health will increase. Hu and all the other scientists I have spoken to on this subject are convinced of this. This has been true for a long time. A very similar, large, meta-analysis will appear in another major medical journal later this week, and its results are similar. However, it is usually the studies that reverse convention that make the headlines, so these studies cannot do that.
What makes diet confusing isn’t the science, it’s the news cycle, the diet books warning about gluten and carbohydrates, and the marketing of meaningless things like multigrain bread. If someone asks if you want white bread or multigrain bread, suggest that they harm the health of the public by maintaining a false dichotomy. Or simply “multigrain here”.
Popular Frozen Foods That Help You Lose Weight, Say Dietitians
Filling your freezer with healthy foods is one of the smartest strategies you can use when trying to shed a few pounds. Think of it this way: when you have frozen products and lean protein with you, you have a convenient, nutritious meal option – meaning you are less likely to resort to those processed snacks or high-calorie take-away items.
The best, Most foods do not lose any of their nutritional value when frozen, So you can be sure that your body is taking advantage of these vitamins, minerals, and other important nutrients.
Nonetheless, not all frozen foods are created equal – at least from a health perspective. While some products can help you lose weight, others can do just the opposite thanks to high levels of fat and sodium. So if you’re looking to lose weight, we recommend adding a handful of popular frozen food dieters to your shopping list.
When in need of a simple weekday dinner after a long day at work, it’s hard to beat a veggie burger. Many of them are crammed with high-fiber vegetables and whole grains, and some even have a protein content comparable to that of meat. That means you’ll feel full for hours, says Melissa Mitri, RD for Wellness Verge.
“They usually only have 150 calories or less, which makes them a solid choice for a weight loss plan,” says Mitri. “Also, research shows that consuming more plant-based foods can aid weight loss and overall health.”
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Frozen edamame serves as a phenomenal afternoon snack or as a high-fiber addition to stir-fries, grain bowls, and salads. And at around 17 grams of protein per cup, it’s one of the most filling plant-based snacks around. This is what Gabbie Ricky, MS, RDN strongly recommends keeping some edamame in your freezer. Did we mention that research shows that eating a high protein diet helps control your appetite and aid in sustained weight loss?
With little to no fat and high in fiber, it’s no wonder why spinach is a popular weight loss food. Fresh spinach can wilt in the refrigerator after just a few days, which is why it is worth buying it frozen – so you always have something to hand for side dishes, casseroles and more.
“Frozen spinach can be easily added to a variety of dishes including pastas, smoothies, and soups,” says Holly Klamer, MS, a registered nutritionist with MyCrohn’sandColitisTeam.
A 2015 study in the Journal of the American College of Nutrition found that obese adults adding 5 grams of spinach extract to their meal reduced their appetite and craving for food for several hours. Another 2014 study in Appetite found that consuming 5 grams of spinach extract daily resulted in 43% greater weight loss than a placebo. This effect can likely be attributed to the thylakoids – plant membranes associated with a greater feeling of satiety because they delay fat digestion.
In other words, spinach can help you eat less by suppressing your appetite, which can lead to weight loss in the long run. Here’s an important effect of eating spinach, science says.
When your sweet tooth strikes, you definitely want to have a box of these creamy goodies in your freezer, says Sarah Williams, MS, RD, Founder of Sweet Balance Nutrition.
“Greek frozen yogurt bars are a great low-calorie dessert option for weight loss,” she explains. “When people try to lose weight, they often avoid sweets altogether – which usually leads to burnout. Instead, add small treats regularly to keep them from feeling deprived during weight loss. “
As an added bonus, since they’re made from yogurt, these frozen treats often come with a healthy dose of protein and bowel-boosting probiotics.
Storing berries in the freezer is a good idea, according to Ricky, as you can add them to smoothies and baked goods without even having to defrost them.
Berries contain less sugar than many other fruits and are remarkably high in fiber. That might help explain why a 2015 study in Appetite found that people who were given a 65-calorie berry snack ate less food on a subsequent meal than those who were given candies of the same calorie content.
“Frozen shrimp are a low-calorie, high-protein food that can help keep you feeling full long after you’ve eaten,” says Klamer.
In fact, just a 3-ounce serving of shrimp has a whopping 12 grams of protein and only 60 calories.
Try baking, sautéing, or air-frying frozen shrimp and adding them to tacos, salad, and pasta for a more persistent meal.
When it comes to seafood, Mitri says salmon is a nutritional powerhouse that is not only high in protein, but also rich in heart-healthy omega-3 fats. Omega-3 fats can have anti-inflammatory effects in the body and were shown to have potential anti-obesity effects in a 2010 nutritional study.
Whether you’re baking, roasting, or grilling, frozen salmon fillets can make for a super-filling salad topper or an appetizer for dinner. Pro tip: sub-salmon for beef for a healthier homemade burger.
Cauliflower “rice” has just 29 calories and 4.7 grams of carbohydrates per 100-gram serving, making it an excellent rice swap for weight loss.
“You can easily add cauliflower rice to stews, casseroles, and even as a substitute for traditional rice in any dish you would normally serve,” says Trista Best, RD at Balance One Supplements. “Frozen cauliflower rice is probably the most versatile and convenient of them all. It cooks in minutes and provides almost as many nutrients as its fresh counterpart.”
If you’re struggling to get used to the idea of cauliflower rice, Ricky suggests replacing half of your traditional rice with this low-carb alternative.
For even more weight loss tips, read these next:
Adults who consume the most dairy fat are less likely to develop heart disease, study finds
One study suggests that adults who eat a dairy-rich diet are up to 25 percent less likely to develop heart disease.
Previous research has generally gone the other way, linking dairy products to heart problems because things like milk and cheese are high in cholesterol and fat.
But the latest Australian study suggests that the other nutrients in dairy products have protective effects on the heart and help it function normally.
They said people should stick to dairy products, which have fewer additives and are not sweetened or salted.
Heart and circulatory diseases are responsible for around 160,000 deaths a year in the UK while they are responsible for 655,000 deaths in the US.
However, the study’s experts claimed that the type of dairy product consumed, rather than the fat content, could be responsible for the heart problems
Co-lead author Dr. Matti Marklund of the George Institute for Global Health in Australia said it was important to eat dairy products.
“While some dietary guidelines continue to suggest consumers choose low-fat dairy products, others have moved away from that recommendation.
“Instead, it can be suggested that dairy products can be part of a healthy diet, with an emphasis on choosing certain dairy products – for example yogurt instead of butter – or avoiding sweetened dairy products with added sugar.”
What should a balanced diet look like?
Meals should be based on potatoes, bread, rice, pasta or other starchy carbohydrates, ideally whole grains, according to the NHS
• Eat at least 5 servings of different types of fruit and vegetables every day. Count all fresh, frozen, dried, and canned fruits and vegetables
• Basic meals based on potatoes, bread, rice, pasta or other starchy carbohydrates, ideally whole grains
• 30 grams of fiber per day: This corresponds to the consumption of everything: 5 servings of fruit and vegetables, 2 wholemeal cereal biscuits, 2 thick slices of wholemeal bread and a large baked potato with the skin on
• Have some dairy products or milk alternatives (such as soy drinks) and choose low-fat and low-sugar options
• Eat beans, legumes, fish, eggs, meat, and other proteins (including 2 servings of fish per week, one of which should be oily)
• Choose unsaturated oils and spreads and consume them in small amounts
• Drink 6-8 cups / glasses of water daily
• Adults should consume less than 6 g salt and 20 g saturated fat for women or 30 g for men per day
Source: NHS Eatwell Guide
He added, “Although the results can be influenced in part by factors other than milk fat, our study does not suggest harm from milk fat per se.”
In the study – published today in the journal Plos Medicine – researchers tested the blood of 4,000 people in their 60s from Sweden.
They followed participants for 16 years and recorded the number of cardiovascular events and deaths that occurred.
The results were compared with another 17 similar studies involving 43,000 people from the US, Denmark and the UK to confirm their results.
The data showed that people who ate more milk fat in their diet had 25 percent fewer heart problems than those who ate less dairy products.
The study did not record what type of dairy product each participant consumed.
The lead study author Dr. Kathy Trieu of the George Institute of Global Health Australia said it was important to only eat healthy dairy products.
She said, “Growing evidence suggests that the health effects of dairy products are type – like cheese, yogurt, milk and butter – rather than fat, raising doubts as to whether milk fat avoidance is beneficial for those overall cardiovascular health. ‘
Professor Ian Givens, a food chain nutrition expert at Reading University who was not involved in the study, said the results were largely in line with previous publications.
He told Science Media Center, “This study used fatty acid biomarkers to specifically target milk fat because it is high in saturated fat, which is widely believed to increase the risk of coronary artery disease.
“As the authors say, there is growing evidence that the health effects of dairy products depend on the type of food.
“There is perhaps the most evidence for hard cheese, where a number of studies show that the physical and chemical dietary matrix reduces the amount of fat the body absorbs, resulting in moderate or no increases in blood lipids, risk factors for cardiovascular disease are.”
Several studies have shown that consuming more dairy products may be linked to improved heart health.
Researchers have pointed to the high nutritional content in dairy products to explain this boost to the cardiovascular system.
They are an important source of vitamin B12, which is used to build red blood cells and keep the nervous system healthy.
They also contain potassium, which plays a vital role in maintaining nerve and muscle health.
But many dairy products have already earned a bad rap for their high saturated fat content, which has been linked to heart disease.
A British Heart Foundation spokesman previously said: “Dairy products do not need to be excluded from the diet to prevent cardiovascular disease and are already part of the eatwell guide, which forms the basis of our recommendations for healthy eating in the UK.”
They added, “It is currently recommended to choose low-fat dairy products as our total saturated fat intake is above recommendations.”
Other studies have also suggested a link between increased consumption of dairy products and better heart health.
The UK produces more than 16 billion liters of milk each year, nearly 7 billion of which are consumed by consumers.
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