Low Carb is an Effective Treatment for Fatty Liver

  • A low-carbohydrate diet (LCD) improves liver fat metabolism in NAFLD patients
  • The LCD promotes rapid shifts in the gut microbiota composition of NAFLD patients
  • The LCD-induced microbial changes are associated with increased circulating folate
  • The LCD increases folate-dependent one-carbon metabolism gene expression in liver

A carbohydrate-restricted diet is a widely recommended intervention for non-alcoholic fatty liver disease (NAFLD), but a systematic perspective on the multiple benefits of this diet is lacking.

Here, we performed a short-term intervention with an isocaloric low-carbohydrate diet with increased protein content in obese subjects with NAFLD and characterized the resulting alterations in metabolism and the gut microbiota using a multi-omics approach.

We observed rapid and dramatic reductions of liver fat and other cardiometabolic risk factors paralleled by (1) marked decreases in hepatic de novo lipogenesis; (2) large increases in serum β-hydroxybutyrate concentrations, reflecting increased mitochondrial β-oxidation; and (3) rapid increases in folate-producing Streptococcus and serum folate concentrations.

Liver transcriptomic analysis on biopsy samples from a second cohort revealed downregulation of the fatty acid synthesis pathway and upregulation of folate-mediated one-carbon metabolism and fatty acid oxidation pathways.

Our results highlight the potential of exploring diet-microbiota interactions for treating NAFLD.

Cell Metabolism: An Integrated Understanding of the Rapid Metabolic Benefits of a Carbohydrate-Restricted Diet on Hepatic Steatosis in Humans