Millions in west don't know they have aggressive fatty liver disease, study says | Hacker News Reader

Millions in west don't know they have aggressive fatty liver disease, study says

theguardian.com

86 pointsrobaato101 comments

For those who are curious, there's some anecdata online that extended fasting (days or weeks) can reverse this disease.

I can't find much published research on it to be fair, but I think the science in this field is lagging behind people's personal experiences.

If there's evidence to the contrary let me know, I'm not trying to spread misinformation. It's just one of the things I consistently recall reading over the years.

Edit since I'm being downvoted:

https://pmc.ncbi.nlm.nih.gov/articles/PMC6893587/ (prolonged fasting, ~8 days)

> The improvement of FLI correlated with the number of fasting days (r = −0.20, p < 0.0001)

https://eglj.springeropen.com/articles/10.1186/s43066-021-00... (ADF rat model)

> MSRDF rats showed cure of grade-1 NAFLD and significantly decreased LW than other groups and normalized HOMA-IR, HbA1C TC, LDL-C, ALT, and CRP.

https://www.cell.com/cell-metabolism/fulltext/S1550-4131(22)... (exercise + ADF, humans)

https://www.nature.com/articles/s41467-024-45260-9

this is the main thing I could find.

https://prolonlife.com/ sells a prepackaged fasting-mimicking diet. plenty of reviews online about the subjective effects on energy levels and soforth during the fast.

I didn’t like it. day 2.5-3 will put me back into the headspace of food scarcity and even knowing that the next meal was sitting in the box and that this is temporary … it was a mental challenge for me. if you’ve never experienced food scarcity, it can be all-consuming and seriously warp your cognition and emotional baseline.

Even cutting back a couple hundred calories a day can leave you absolutely exhausted, in my experience. Even just increasing exercise by a couple hundred calories a day without eating more is also incredibly exhausting, after a few weeks it becomes thought dominating second-by-second.

Hunger is truly a powerful driver.

and that’s when you’re doing it willingly :)

If you're going to fast, especially extended fasting, it would serve a person well to drop carbs and sugar and get into ketosis, at least for a while, so your body can start burning fat more effectively. If you've never done this before, it can be an uncomfortable process, with a lot of headaches, mood swings, etc. Making sure you take in enough electrolytes (sodium, magnesium, and potassium) will help a lot during all this, and during longer fasts.

I cleaned up my diet about a month ago, and have accidentally done some 24 hour fasts when I was busy and it's been fine. By the time I do eat, I'm really not even hungry, though my stomach may be growling a bit. The first time I ever did this, I had horrible headaches and felt miserable for a while, but subsequent times have been easier.

Good sleep maters too. Bad sleep will throw your hormones out of whack. I'm extremely hungry when this happens, and crave all the wrong things. Knowing what's going on helps a little.... just a little.

I find all this much easier than just trying to cut back by 200 calories with what I normally eat. It's all about hormones.

This sounds like a diet problem. You eat till your stomach is full. That because your food is not actually feeding you.

Long story short: meat and vegs + fruits. It takes a while.

Personally it is a strange thing. Diffcult to do over 24 hours but easy over a few days. Once you get over the head space of "im hungry must eat!" It turns into "im hungry, oh well".

But this is a sample size of 1 and results definetly vary wildly between folks.

I can concur - that shift in mindset to "i'm hungry, oh well" is crucial for your body I feel.

this is easier to do when you aren’t on the programmed diet that has you tantalizing your equanimity constantly.

> "im hungry, oh well"

The real danger is if you dont swap back and just created yourself an eating disorder.

That's not an eating disorder. Just because you're cold doesn't mean you need to put on a sweater. Learning not to let minor discomforts bother you builds discipline and character.

Fasting is great because you live off of your muscles. Keep at it and you will loose so much muscle, you will develop an eating disorder. The stomach and intestines are muscles too.

My understanding is that if you are healthy and you fast, it's great. If you are actually ill and fast it's still great but it only hides your illness and you are on a very bad path (eating disorder)

Anorectic are very dosciplined and proud of their ability to not eat. Hunger not being "well so what" is normal healthy biology. It is not just discomfort. It is biologcal mechanism to prevent very real harm.

Yhe issue with anorexia is that it works as cycle - if ypu have genetic predisposition, starwing affects metabolism, your discomfort about food gets worst and you are in it.

That feels like the incorrect framing, the burden of proof is on the initial claim. That'd be like saying "I've heard online that leprechauns live on the moon. I haven't found published research on it, but I think science in this field is lagging behind personal telescopic experience. If there's evidence to the contrary let me know, but I've read it online a lot." and treating that like it's proof of moon leprechauns.

It's not exactly the same, as there are studies, there just haven't been a lot yet, since a lot of the study around it is new, although fasting has been practiced for thousands of years. There is no money in fasting, so the number of organizations willing to fund the studies goes way down.

To put some numbers to it:

https://pmc.ncbi.nlm.nih.gov/articles/PMC10564080/

> Only five out of the 1304 studies on NAFLD involved IF.

Here is one that mentions there may be some efficacy to the idea and no harm.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8958240/

> In conclusion, current evidence suggests that intermittent fasting in patients with NAFLD is a feasible, safe, and effective means for weight loss, with significant trends towards improvements in dyslipidemia and NAFLD as illustrated through non‐invasive testing (NIT).

If someone has NAFLD, they can either sit around and eat cake for 20 years waiting for the science, or they can try doing some fasting, which is very low risk (assuming they don't have other issues going on), and find out very quickly if it works for them. Sure, it's an n of 1 in that case, but who cares, if they are the test subject it only matters if it works on them.

I'd add to this that the carbs should be kept low and the diet having quality foods outside of the fasts. Eating aforementioned cake during a feeding window every day is going to leave a person miserable, burning muscle, and still leave the hormones all screwed up. Insulin needs to be controlled and lowered. Fasting does that quickly, but don't abuse it during your meals on a regular basis.

From what I've read elsewhere, fasting can help in the early stages to reverse it, but once real damage occurs that sticks around.

There may be some medical benefits to periodic fasting, especially for people with excess adipose tissue. But in terms of "no harm" the Memel et al paper you linked doesn't seem to mention anything about loss of lean muscle tissue. This can cause serious harm for some patients — especially older patients with the "skinny fat" body type — by leading to sarcopenia (higher musculoskeletal injury risk) and endocrine dysfunction (muscle is a glucose sink). Loss of muscle can be limited to an extent by doing resistance training and maintaining high protein intake during non-fasting periods. But overall there are still a lot of unknowns in this field.

Add also refeeding syndrome to the list of risks. It can also serve as trigger for eating disorder.

Long calories deficit can lead to permanent brain damage too. And heart damage.

A lot of that would be covered under the “other issues” I mentioned. Obviously, consult with your doctor first.

In terms of muscle loss, from what I’ve read, muscle loss is more of an issue for low calorie carbohydrate based programs. When fasting there might be some muscle loss when at the very start, but then it tends to preserve muscle, and like you said, adequate protein intake and resistance training can mitigate that.

Those, like Peter Attia, who saw muscle loss from long term keto and fasting over several years, weren’t using fasting as a medical intervention. He was already metabolically healthy, but maintained a pretty extreme fasting protocol in an effort to gain longevity benefits, effectively experimenting on himself based on some results of early studies around the benefits of fasting for longevity.

The general theory now seems to be making the fasts much less frequent once healthy. Maybe only a couple times per year.

I’m sure this area of study will continue to evolve slowly.

From your chosen quote, it doesn't seem to indicate that fasting specifically changed things, but fasting being an "effective means for weight loss" was the bit that really mattered. I don't see anything to divorce the two - general weight loss and improvement to the FLI.

> Available evidence suggests that any form of caloric restriction may be beneficial and specific forms of IF should be tailored to the individual.

Also important to notice that once the liver is damaged it's not recommended to fast:

> Additionally, it is important we investigate the possible risks of fasting in patients with cirrhosis, which is currently not recommended.

so live a life of gluttony and "reverse" it in few days of fasting. seems like a good deal.

Lots of the numbers here are confusing in relation to other numbers…

“The researchers found that just under 3% of people in the UK, France and Germany, and 4% of those in the US have MASH, but diagnosis rates were below 18%. That means about 20 million people in the US, UK, Germany and France are living with MASH but only 2.5 million people have a diagnosis, leaving more than three-quarters – about 16.7 million people – unaware they have the condition.”

2.5/20 is 12.5%, which is under 18% but a very weird and specifc way to put it; 16.7 is more than 3/4 of 20 indeed (by a lot), but adding 2.5 to 16.7 is about 19 not about 20. This just all seems randomly off in various ways that make little sense to me. Anyone has any good theory how such sentences escape editorial edits, or can find a simple typo or two that make this paragraph coherent again?

I wonder, given the instances of common diseases that were discovered/strongly suspected recently to have a microbial component (eg. ulcers + heliobacter pylori, Guillain–Barré + cytomegalovirus, Alzheimer + HSV, Several cancers in men and women + HPV), what are the odds we'll eventually discover fatty liver disease is a symptom or is triggered by "hepatitis X" or something like that?

That won't be the case for a disease that is almost 100% correlated to asedentary lifestyle, bad diet and alcoholism

This frankly scares me somewhat. I had a liver ultrasound where the radiologist warned me I had some signs of fat on the liver though not extensive yet.

I weigh 72kg at 178cm height. At peak, when I got tested I weighed around 86kg. I was barely overweight and definitely not obese and yet...

Knowing the weight alone is not enough though: you can be 72kg and fat or 86kg and very lean but also very muscular.

E.g. I'm 178cm as well but when I was 71kg I was visibly "fat", or at least skinny fat to be charitable. I'm currently 67kg but very lean and somewhat muscular.

At 86kg I had a bit of dad bod going on. Not a huge gut but somewhat pudgy here and there. Not hugely so and not overly visible as most of it was visceral fat. I haven't had an ultrasound since losing the weight. I hope the liver looks better now. I've been eating fewer calories, healthier calories and swimming. Hopefully that's enough to at least halt the damage done by my old lifestyle.

I had moderate NFLD and managed to get rid of it completely by just eliminating fried food, most dairy, and sugary snacks for about 6 months, I also almost never eat red meat. It's not so much about being overweight, but what you're eating.

You totally changed your diet and didn't lose weight?

I did lose weight, but it wasn't crazy dramatic.

Yep, the dietary recommendations have been consistent for decades at this point. Dairy, meat, sugars and excessive oils are not great for us. A little in moderation is fine, that is a lot lower than what most people think.

But it isnt pushed hard because it is difficult to steer the ship of humanity. Like how doctors will say "lose some weight" but they arent really expecting miracles on it as they know the battle that is.

Not to mention, there's a good chance that your doctor is fatter than you are.

I eat enormous amounts of dairy and red meat and recently I had abdominal surgery and the doctor afterwards confirmed I was in very good shape and had no signs at all of fatty liver and very little visceral fat generally.

I eat around a pound of beef a day, a gallon of yogurt a week, and almost everything (eg oatmeal) is made with copious amounts of butter.

I think unless you know something specific about your genetics, just eat plain natural foods people have been eating for millennia and you will be perfectly fine. Basically, buy plain meat, vegetables, grains, and dairy and prepare them yourself. Don’t eat preservatives, corn syrups, or novel vegetable oils like canola. Maybe they’re fine but there’s no reason to risk it. Also do your best to make sure what you eat followed the same rule; eg my beef was grass fed and finished and was not fed skittles in a feedlot. Diet affects animal meat as well, just as it does us.

This is good advise to get behind. I do feel like a lot of the optimal dietary advice is far to hard lined and that a better path really is just whole foods in moderation.

Dietary recommendations have fluctuated widely for decades, and still differ substantially between sources. So far there is zero direct evidence that meat consumption causes fatty liver disease; I mean it's possible but we just don't know one way or the other. The only real data we have comes from low-quality observational studies (basically junk science).

If someone wants to try limiting meat consumption as an "n=1" experiment to see how it affects their body composition and other biomarkers then go ahead. Just don't expect a major impact from that one factor.

Generally speaking, I actually don't think I recall much of a link between meat and fatty liver, it always seemed to be closer linked to highly refined sugars and possibly high levels of dairy but less of a link there.

The two big ones are high fructose corn syrup and alcohol.

I feel the hfcs is the bigger issue here because it is put in everything in the US, but moderating both of these will help.

Look at labels and put back anything with hfcs.

https://www.nih.gov/news-events/nih-research-matters/how-hig...

https://pmc.ncbi.nlm.nih.gov/articles/PMC6549781/

HFCS isn't any meaningfully different from sugar. It's basically chemically the same as honey. And no, they don't put it in everything. It's in soda and certain sweets (obviously) and sweet sauces, but it's not like it's creeping into unexpected places in some huge way. Yes, there may be foods with a hint of sweetness that have a hint of HFCS, but then it's a negligible amount anyways. HFCS isn't some kind of bogeyman. It's essentially just sugar. Treat it accordingly.

Fructose is processed by the body quite differently than sucrose, in a way quite relevant here.

And actually one of humanity's major evolutionary advances.

HFCS is typically 42:58 or 55:45 fructose:glucose. Table sugar is 50:50. HFCS is only "high fructose" relative to unprocessed corn syrup, not relative to table sugar and other common sweeteners.

A small difference at small levels but one which obviously matters when it's shoved into countless foods without most people event realizing. It's not just in soda and candy; it's in bread, pasta, almost any processed food (crackers, ketchups and other sauces, canned fruit, applesauce, lunch meat, peanut butter, the list goes on) and many foods one might not considered processed.

It makes sense to try to eliminate it even though it's "only" a small difference. Might as well remove the difference at all and look out for things with no HFCS shoved in it for no reason.

Plain pasta almost never contains any HFCS. Maybe you can find some that does but that's not what most people are buying in their local grocery store. (The sauce is often a different story.)

Fair - I went back and re-edited enough times my original message got jumbled, and I had been thinking of pasta dishes you could buy, which almost invariably have HFCS, but absolutely correct plain pasta pretty much never does.

The point is, it doesn't matter if your ketchup is made with sugar or HFCS. If it weren't HFCS, it would be sugar, because ketchup is supposed to be sweet, and they have the same nutritional effect.

Similarly, it's not suprising when pasta sauce has some sweetness added -- grandma also likely added a bit of sugar if she found tomatoes too acidic, which many do.

The only thing that matters is that it's sugar. HFCS isn't somehow worse. If you're trying to eliminate sugar overall then sure, of course avoid HFCS. But if you're fine with a certain moderate amount of sugar per day, then the relatively small amounts of HFCS in things like pasta sauce and peanut butter are fine. The same way the sugar or honey in teriyaki sauces is. They count towards your daily allotment of sugar. For people trying to eat relatively healthily, avoid the soda but there's no reason to worry about the HFCS in ketchup or normal amounts of tomato sauce, for goodness' sake. The only reason to avoid HFCS entirely is if you're truly cutting sugar out of your diet entirely. Otherwise they're just substitutes for practical nutritional purposes.

That's another fair point that specifically tomato-based products often have sugar, but also kind of missing the forest for the trees. For various reasons, we have a slew of foods that one might not expect to have added sugar (like lunch meat, ham notwithstanding, or applesauce which is already sweet without extra sugar, to pick from my short list above), that do because of reasons. In any case it does pay to still look, because if you're not careful you could pick one random tomato sauce that has double the amount of sugar compared to the jar right next to it on the shelf (Bertolli Tomato & Basil, 11g per serving; Newton's Own Marinara, 6g per serving).

These choices add up, which is the point I was trying to make originally (though I agree I did not do a good job of it); I understand I was being pedantic so I understand the nature of the responses to me. The point is that small differences, isolated, don't matter, but in aggregate they absolutely do. We make arguments like this all the time in software when trying to write correct, performative code -- the milliseconds add up, and so do the grams of sugar.

The anti-HFCS movement, despite having its targets aimed for wrong reasons, is still aiming at the right thing: being more mindful of what's in the things we put in our bodies.

I would actually argue the anti-HFCS movement is not aiming at the right thing.

Because they make people think Mexican Coke is fine because it's made with real sugar, or that putting honey all over your toast doesn't count. Like, I know people who think these things, but avoid HFCS like it's the plague.

Unless you're trying to avoid sugar to an extreme degree, the sweetness in tomato sauce is not worth concerning yourself about. The small differences, when added up, don't matter that much. The sugar in your bread and peanut butter is nothing compared to a Coke. Again -- if you're concerned about sugar, then don't drink soda and don't eat dessert. No candies, no sweet drinks, no sweet juices. That gets you 95% of the way. Worrying about HFCS in bread is missing the forest for the trees.

> The government recommends that free sugars – sugars added to food or drinks, and sugars found naturally in honey, syrups, and unsweetened fruit and vegetable juices, smoothies and purées – should not make up more than 5% of the energy (calories) you get from food and drink each day.

> This means:

> Adults should have no more than 30g of free sugars a day, (roughly equivalent to 7 sugar cubes).

https://www.nhs.uk/live-well/eat-well/food-types/how-does-su...

Like I said, it adds up. And as I pointed out above, the added sugar varies wildly in the "same" things you buy off the shelf, so it does pay to pay attention.

I don't see the same argument for adding more beneficial things to your diet like protein or fiber so it's curious to say the negative things don't also have some cumulative effect.

You can easily find peanut butter without added sugar, and applesauce without added sugar, and many more of the garden variety things without added sugar. Sure, there is naturally occurring sugar, but that's the point -- why add more, and why add that to your diet?

Wikipedia:

>HFCS 42 is mainly used for processed foods and breakfast cereals, whereas HFCS 55 is used mostly for production of soft drinks.

In other words, the type of HFCS that's "shoved into countless foods" has less fructose than table sugar, not more. If fructose is the villain here, that actually constitutes an improvement over table sugar.

This is wrong. As another commentator pointed out,the body processes fructose differently from sucrose.

As for honey (and fruit, for that matter) - they are full of beneficial compounds that help your body regulate blood sugar.

To illustrate this, someone I know of with type I diabetes who ate natural honey didn't need to inject as much insulin as when eating commercially processed/heated honey - those beneficial compounds are destroyed during the process. Same for fruit vs fruit juice...

Sucrose is glucose-fructose, and is easily split. My understanding is that it is all split by digestion.

The glucose and fructose than act the same as glucose and fructose from HFCS.

I cannot find the study at the moment (Google you used to be great at this!) but there was one seeing how diabetics blood sugar was impacted from just fruit consumption. Got to the point where even at 20 serves per day (4 times the recommended) in most people it didnt cause an issue. Bundling that sugar with fiber was a big part of regulating sugars.

Corn syrup might or not be different, Im no expert in that field, but simply having highly refined sugars without the filler is monocropping your diet in weird ways. In the same way soil is being killed by mono cropped agricuture, we are doing the same with our gut biome. The flow on impacts are still being discovered.

Bmi is one metric but you need to combine it with a measurement of your belly circumference. I had similar numbers but the weight was al in the belly and got diagnoses as type 2 diabetic with high cholesterol etc.

I wonder who funded the study....

You don't need to wonder. It's in the Acknowledgements section of the paper.

> JVL, HEM, and CJK acknowledge institutional support to ISGlobal from grant CEX2023-0001290-S, funded by MCIN/AEI/10.13039/501100011033, and the Generalitat de Catalunya, through the CERCA Programme. CDB is supported in part by the Southampton National Institute for Health and Care Research Biomedical Research Centre (NIHR 203319). Funding statement: This work was supported by Novo Nordisk and Echosens via a grant to ISGlobal. The funding sources had no role in the study design, writing of this manuscript, or decision to submit the paper for publication, but did carry out the data modelling.

https://www.thelancet.com/journals/lanepe/article/PIIS2666-7...

According to the paper (https://www.thelancet.com/journals/lanepe/article/PIIS2666-7...):

> Funding statement: This work was supported by Novo Nordisk and Echosens via a grant to ISGlobal. The funding sources had no role in the study design, writing of this manuscript, or decision to submit the paper for publication, but did carry out the data modelling.

Fun to see my local government funding something that appeared on HN :)

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