Diets affect Health

John...I agree on the dark side of keto. Fallout from a keto diet killed my Mother. As my once twiggy mom grew older, she was told that she was pre-diabetic....and that a keto diet could reverse that trend. She went on keto, lost a few ponds, blood sugar levels were good...but to maintain this , she could not go off the keto diet. After a while she developed chronic diarrhea. Nothing would touch it. Her doctor finally told her to take some horrid amount of Pepto Bismol daily. She did, it helped a bit. She could not go off the Pepto. Doctor told her to take even more. Turns out high doses of Pepto B. for extended periods of time can cause dementia like symptoms. Not just the garden variety of , "Have you seen my car keys?" but accelerated dementia. That was the diagnosis! Her husband freaked out, called Hospice, signed her up for "End of Life Care" and Hospice fulfilled the 4 months contract on her life and drugged her to death with off label use of what they called "comfort drugs". There is a very good chance that detoxing could have reversed the "accelerated dementia" from the attempt to shut down the keto diarrhea with Pepto, but I don't know how we could have stopped the keto induced issues?. I tried to save her, but Hospice would not let me.

John Suavecito wrote:
I think they are very effective as a temporary way to lose weight, but over the long run, not so helpful.   No long living society has ever existed on a keto type of diet.
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In my current research on this, "metabolic switching" is coming up a lot. This is training the body to switch easily back and forth betwen keto (fat-burning) mode and carb-burning mode. Necessarily, there would be a regular switch-up of the diet to make this happen. As with many things, moderation is important!

John Suavecito wrote:One thing to remember about keto diets is that they reduce your life span.  They result in higher all cause mortality.

I think they are very effective as a temporary way to lose weight, but over the long run, not so helpful.   No long living society has ever existed on a keto type of diet.

John S
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I think a lot more studies would be necessary, but I personally don't believe this to be true.  I'm not recommending the keto diet for anyone.  I do recommend the paleo diet which is similar in many ways, but still different.

For every study I have seen saying the keto diet is unhealthy, I can find another that disagrees.  There are so many variables that it's hard to form a consensus.  

This is just one of many, many articles.  From Paleo Plan Inuit article

An excerpt:

Vilhfalmur Stefansson’s Findings
Vilhfalmur Stefansson wrote a book about his stay with the “Eskimos” called My Life with the Eskimo, which, for some reason you can read online here.  He was with them before Weston Price, and found similar things in his studies.  Namely, that you can thrive on a very, very low carbohydrate diet.  For up to 6-9 months of the year, they ate nothing but meat and fish. Stefansson noted that his hosts got the necessary nutrients in the winter without much (or any) vegetable matter by eating the organs and oils we talked about above. He reported that there were no ill health effects to them or himself when he lived with them (he stayed with them for 11 years total), and for that he came up against a lot of scrutiny.  He proved his naysayers wrong by going on a year-long meat and entrails-only diet and maintaining excellent health.

The traditional Inuit diet is the lowest in carbohydrates and the highest in combined protein and fat of the many hunter-gatherer diets that have been studied.  I chose to write on the Inuit first in this series of hunter gatherer profiles for a reason: I think it’s the most fitting to fly in the face of the conventional belief that a lot of fat and protein is bad for you.  Just goes to show that it can work if you’re eating the right kind of fats and proteins…

Well,  I've been doing low carb in one form or another for going on 30 years,  and keto for the last 5 or so.  

I just had bloodwork done and everything is in healthy range;  my dr. said my kidney and liver values look like that of someone 2 decades younger, so that was interesting.   I do have pre-diabetes symptoms if I let my carbs stray up too high and I've had to adjust my carb count down every 5-10 years over time.  

Just started intermittent fasting back in December, and I'm down 25lbs.    I was REALLY skeptical about it, I do not like being hungry.    But it was a fast adjustment and I often go a few hours past the "start" time without even realizing it.  It's been really interesting.   I'm having some sleep issues at the moment, but that could be a lot of things.   I may experiment with adjusting my eating window a bit and see if that changes.

For some people in Arctic areas, they have little choice.  Many of them got really good omega 3's,, fresh air, no toxins, good exercise, and community connections,  which is excellent, but not the whole picture. It might be the best diet if you live there, but hardly any of us live in the Arctic Circle.  There are no vegetables or fruits available for most of the year.  This isn't just my opinion.  Several doctors I respect were just citing large studies affecting all cause mortality, as I said.  It was a statistical outcome.  I was skeptical until I kept seeing more and more studies.  There are some people who say they are on keto and they eat a lot of vegetables and berries.  That could be good for you, and is not what they are talking about.

John S
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Was out doing chores, feeding hay etc, and thinking about this "thread". I can understand a very real appeal to fasting...and I think it need be approached from a place of "wisdom" in knowing your body...my point is that there can be issues that a person may not realize. Liver function being foremost in my mind, due to a tsunami of toxins. I know folks like to imagine "anorexia" as being a sort of "out of control" issue..it can get there as far as "consuming"...but truly, anorexia was for me in my 20s, the ONLY thing in my life I actually was in total control of. That "control" was intoxicating...I am just concerned that in the crazy world of today, that profound lurking "helplessness" being a potential issue in our lives, fasting can have that same level of empowerment and intoxication...Just be careful, listen very closely to your body, your life depends on this.

I'm so glad this thread popped up.  It's been around for over 4 years so we get to see its progression.  I came across Dr. Fung's video's many years ago and then ordered his books.  This was a life changer for me.  I had spent a life time trying diets and even had gastric by-pass surgery 30 years ago but nothing proved to work long term.  I finally gave up and figured I would die young, and then I found Dr. Fung.  For the first time, I understood why I was hungry all the time.  It was my insulin resistance driving the hunger and then the high sugar foods I would crave only made matters worse.  When I first started, I would eat one day and completely skip the next day meaning I fasted (water or tea only) for 3 days a week.  The pounds began to drop off and I found it to be so easy.  The problem was, he didn't mention anything about the liver and how it could be damaged by such a quick weight loss so I ended up with liver disease.  Probably more importantly though, it taught me how not to eat but not what to eat so I was still eating horrible foods on my eating days, and lots of it.  After I lost 50 pounds, I switched to fasting one day a week (eat 5 pm on Sunday night and not a bite again until Tuesday morning) and was able to keep the weight off for 5 or 6 years.  Then I had all sorts of health problems, liver enzymes were up, cholesterol was way high, triglycerides way up, blood pressure too high, etc. so I decided I had to learn how to eat, not just how to fast.  That brought me to the book "How not to die" which is full of research on whole food plant based eating.  I became so fascinated with food as medicine, reading research papers became my new hobby.  As of August of last year, I gave up all added sugar, knowing it is my trigger and I am just as addicted to it as someone to tobacco, alcohol, or drugs.  The first 2 weeks was horrible but then the cravings left.  As someone here said, I do think it was the gut biome than changed.  I had to starve out the "sugar" eaters before they would leave me alone so to speak.  I am 7 months into it and now I have lost another 30 pounds and am just 10 pounds from my goal weight.  I now understand the benefits of fasting but just as importantly, I understand the foods that I must get regularly to stay healthy.  The result, my liver enzymes are back to normal (one should never lose more than 1 to 2 pounds a week to protect the liver), my cholesterol is 141 (never, ever, been that low), and all other numbers are in the very healthy range.  I feel so much better and my blood pressure is under control.  So, I will most likely continue fasting one day a week forever but I make sure on the other 6 days, I get lots of fruits, vegetables, beans, nuts, seeds, healthy fats, spices, and at least 30 minutes of exercise that raises my heart rate.  I no longer even think about those foods that used to fill my every thought and I am loving moving around in my new body.  It's a great place to live!          

Let me start by saying I don't want to downplay the experience of anyone that has struggled with eating disorders or any other health issues.  Our health is truly the most important thing we have and I can't think of anything more stressful and terrifying than dealing with a serious health problem, either in oneself or a loved one.  That said, I think it's very important to keep in mind that fasting has been done for literally the entire evolution of the human and animal world.  Our predecessors, as well as millions of people currently living, were forced by circumstance to fast.  Nearly every religion teaches it adherents about fasting for both spiritual and physical reasons.  Healthy people have no problem at all with short term fasting, and there are untold instances of unhealthy people getting healthy by fasting.  Anything taken to an extreme can be damaging, but I think it's very easy to show that the average American diet is far, far more dangerous than fasting.   I would hate to see someone that could benefit greatly from fasting turned off to the idea by thinking the dangers are greater than they are.  

kay fox wrote:As of August of last year, I gave up all added sugar, knowing it is my trigger and I am just as addicted to it as someone to tobacco, alcohol, or drugs.  The first 2 weeks was horrible but then the cravings left.  As someone here said, I do think it was the gut biome than changed.  I had to starve out the "sugar" eaters before they would leave me alone so to speak.  I am 7 months into it and now I have lost another 30 pounds and am just 10 pounds from my goal weight.

Kay, you can be so proud that you overcame your addiction! I can't really relate as I have never had those cravings for sweet things (although I did snack quite a lot as a -slim- teenager).
But I have heard from my sister in law that there are several members of her family that have an addiction that never goes entirely away. She cannot have a single sweet item in the house or she will hunt it down and eat it completely. She now is vegan, doing exercise every morning and never eating sweets, but she says as soon as someone would offer her she would fall for it.

This sounded quite scary to me, quite like drug addiction. My husband has it to a lesser degree. He is aware that he should not eat it and I only buy very few items (for the kids, and I am not too happy about it, but that is a different story).
My mother in law was a doctor, specialized in diabetes and nutrition of all things, and when she visited she would sneak into my pantry to eat candy and chocolates. It must be terribly trying if you have not overcome this "eating disorder" while knowing that it is bad for you.
I am also convinced that zero calorie or "light" products just fuel your hunger for sweets and I would recommend to everyone to drink plain water.

In Germany there is - finally - a discussion to ban all advertisement of sweet products aimed at kids. I hope it passes legislation. I get very angry when I see those TV ads for sugary snacks "to combat that little hunger/give you more energy" and whatnot. Or the snickers ad "You are not yourself when you are hungry" (not sure how the English text would be). People are led to believe that they are helping their body when pushing their bloodsugar to spikes.

I wish everybody lots of strength on their journey!

Thanks Anita.  As with any addiction, it really is horrible.  We know better yet we can't help ourselves.  Addictions can be controlled while never fully cured.  People used to tell me everything in moderation so I thought I could do that with sugar.  I could not.  I know that now so while people mean well when they encourage me to indulge at that party or buy me a birthday cake, etc., I simply cannot give in.  I know if I do, I will be in full addiction mode again and I'm not sure I would be able to pull out of it next time.  Success breeds success though and it keeps me from taking that first bite because I could no longer say I haven't touched it in 7 months.  I hope the day comes when I can say I've been clean 20 years.  I understand that not everyone has that addiction though so I did bake the pies and other goodies for my family during the holidays but I didn't trust myself to even lick the spoon.  Now that it is under control, I do not have the cravings so it isn't as hard to walk away.  The gut biome has recently been the talk of science and discovery and I know mine has changed.  Whatever we feed flourishes and I now eat for beneficial microbes and in turn, I reap the benefits.  I do not want to introduce or feed the bad ones or they will take over again.  That's what sugar and junk food does.  I sleep so much better these days now that I am healthy.  My mind is also in a much better place.  I just see the world through positive eyes whereas dark clouds often overcame me before.  All of that is related, which makes me sad for those of us who suffered for years with addictions, cravings, depression, illness, and just feeling bad when we didn't have to.  Knowledge is power and now that I know, I am in charge of my health and that includes fasting as well as getting lots of nutrition.   Let's keep learning from each other.    

Trace, I don't think anyone should be encouraged not to be healthier...Statistics show that 1 in 4 Americans has or will develop Fatty Liver Disease, (Non Alcoholic variety.) I think you may want to do a bit of research on the "silent killer" aspect of this. Many folks have no outer symptoms that are different from the other 75%..until there has been considerable damage. So, a big YEAH for the other 75%. ( A chain is only as strong as it's weakest link.) I am not espousing that the 25% should not "fast"...or strive to be healthier. I just from personal experience and research, believe, start slow and realize that stubborn belly fat, dogged obesity, diabetic issues, thyroid issues, chemical sensitivities...all leading causes to pursue a healthier life style, may also be of deeper concern for tens of millions of Americans. I looked into "fasting and fatty liver"...I did find a recommendation of every other day fasting combined with the Mediterranean Diet and a good exercise routine. It seems in life it may be very easy for the "un-afflicted" to champion a "full steam ahead, caution to the wind " attitude...but, it is not their life that is perhaps at stake. Liver damage is very real and very serious. A Game Changer. A potential Game Ender! Get healthy, start slow!

Kay, thank you for sharing your story. You are a very courageous woman! Strength and Blessings to you!

jackie woolston wrote:Trace, I don't think anyone should be encouraged not to be healthier...Statistics show that 1 in 4 Americans has or will develop Fatty Liver Disease, (Non Alcoholic variety.) I think you may want to do a bit of research on the "silent killer" aspect of this. Many folks have no outer symptoms that are different from the other 75%..until there has been considerable damage. So, a big YEAH for the other 75%. ( A chain is only as strong as it's weakest link.) I am not espousing that the 25% should not "fast"...or strive to be healthier. I just from personal experience and research, believe, start slow and realize that stubborn belly fat, dogged obesity, diabetic issues, thyroid issues, chemical sensitivities...all leading causes to pursue a healthier life style, may also be of deeper concern for tens of millions of Americans. I looked into "fasting and fatty liver"...I did find a recommendation of every other day fasting combined with the Mediterranean Diet and a good exercise routine.

While what you said is sort of true, it's also misleading.  1 in 4 may have fatty liver disease, but there are two types of fatty liver disease in non-alcoholic people.  The dangerous kind that causes liver inflammation and damage is much more rare that the other type, and it is found in obese and diabetic people in the overwhelming majority of cases.  In other words, intermittent fasting and weight loss is the best way to prevent it.  

Here is an excerpt that explains it from  NIH.gov:

"What is NAFLD?
Nonalcoholic fatty liver disease (NAFLD) is a condition in which excess fat builds up in your liver. This buildup of fat is not caused by heavy alcohol use. When heavy alcohol use causes fat to build up in the liver, this condition is called alcohol-associated liver disease.

Two types of NAFLD are nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). People typically develop one type of NAFLD or the other, although sometimes people with one form are later diagnosed with the other form of NAFLD.

NAFL
NAFL is a form of NAFLD in which you have fat in your liver but little or no inflammation or liver damage. NAFL typically does not progress to cause liver damage or complications. However, NAFL can cause pain from enlargement of the liver.

NASH
NASH is the form of NAFLD in which you have inflammation of the liver and liver damage, in addition to fat in your liver. The inflammation and liver damage of NASH can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis, in which the liver is scarred and permanently damaged. Cirrhosis can lead to liver cancer NIH external link.

Experts are not sure why some people with NAFLD have NASH while others have NAFL.

How common is NAFLD?
NAFLD is one of the most common causes of liver disease in the United States. The majority of people with NAFLD have NAFL. Only a small number of people with NAFLD have NASH. Experts estimate about 24% of U.S. adults have NAFLD and about 1.5% to 6.5% of U.S. adults have NASH.1

Who is more likely to develop NAFLD?
NAFLD is more common in people who have certain diseases and conditions, including obesity, and conditions that may be related to obesity, such as type 2 diabetes. Studies suggest that one-third to two-thirds of people with type 2 diabetes have NAFLD.1 Research also suggests that NAFLD is present in up to 75% of people who are overweight and in more than 90% of people who have severe obesity.2, 3"

jackie woolston wrote:

It seems in life it may be very easy for the "un-afflicted" to champion a "full steam ahead, caution to the wind " attitude...but, it is not their life that is perhaps at stake.

If that is what you got from my post, I clearly did a terrible job of explaining my point of view.

I looked for studies that showed fasting having a detrimental effect on liver health.  I found literally dozens in a matter of minutes pointing to the benefits of fasting on fatty liver disease and the people that live with it, but I couldn't find any showing any adverse effect.

Trace, I wish very strongly that someone would have told me "Go Slow". My, perhaps limited experience, with the medical profession has been that there is virtually no consideration for toxicity. So, to deal with my metal exposure from iron working, (because I wanted to be healthy and I knew that things were going bad.) I went to a Naturopathic Dr.  This Doctor assured me that the rapid high dose Vitamin C detox that they were recommending was "perfectly safe", across the board safe, some diarrhea to be expected.  I could have lived a long time with that metal toxicity and other "toxins" and not be where I am today with severer liver damage. I wish they had at least mentioned to me the dangers of that rapid detox...I still  would have moved forward but I would have looked into a slower liver friendlier cleanse. And yes, I agree with you the assumption that 25% of the population may be headed down a slippery slope of liver issues, could appear misleading...thing being the "not so bad' liver issue can be nudged into the Nastier deadly one, that is where it starts...I don't think there is a clear picture of how exactly one goes from "not a problem ...to damm!" I can tell you, that as a person who trusted what they were told and it turned out badly...ERRING ON THE SIDE OF CAUTION IS A VERY GOOD THING! I am not saying "don't fast", just be careful, take it slow. Instant gratification may not be the best path. Rapid weight loss and detox can dump a lot of toxins back into circulation and overwhelm a liver, and if that liver is dealing with the not so bad fatty liver stage...where could it end up? So, yes, I would say 25% of the population needs a heads up. I would not wish this on anyone. I am happy for you that you are not in this boat.  It sucks!

NAFLD...

Toxins and Liver damage: (note this is not even a current paper.)
Nicole Cutler, L.Ac., MTCM, Dipl. Ac. (NCCAOM)®
Apr 20th, 2010
https://www.liversupport.com/update-on-toxins-harming-the-liver/
While large quantities of environmental toxins used to be implicated in liver damage, new research claims that even small amounts of chemicals are sufficient to cause liver problems.

Due to increased awareness and activism, today’s growing eco-conscious movement is steadily chipping away at the poisonous chemicals that surround us. Unfortunately, environmental toxins can still be found everywhere. Whether found in our food supply, building materials, health devices or agricultural products, toxins are known to cause damage to the liver.

Many people mistakenly assume that only high levels of toxic chemical exposure is dangerous. However, low toxin levels do not equate with safety. For a liver that is already battling ongoing disease, any amount of toxins strains the body’s detoxification system. In addition, researchers from Kentucky have recently discovered that even low levels of environmental toxins appear to play a role in creating liver disease.

Over the past year, clinicians have estimated that approximately one in every four American adults has fatty liver disease. However, fatty liver disease is just one of many kinds of chronic liver disease. To investigate liver disease’s rapid growth in the American population, Matthew Cave, MD, assistant professor of medicine at the University of Louisville, extracted data from the 2003-2004 National Health and Nutrition Examination survey (a database often used by researchers). By looking at abnormal levels of a liver enzyme associated with liver injury, Cave’s research revealed just how common liver problems are. After excluding people with traditional risk factors for liver disease, such as hepatitis and alcoholism, these Kentucky researchers concluded that more than one in three adults in the U.S. have some form of liver disease.

According to Cave, many instances of liver disease are linked with environmental pollutants, such as pesticides and heavy metals. The survey participants’ blood and urine were evaluated for about 200 common pollutants. Among the chemicals studied, were:

·    Lead – A highly toxic metal found in small amounts in the earth’s crust, lead is abundant. Lead and lead compounds have been used in a wide variety of products including paint, ceramics, pipes, solders, gasoline, batteries and cosmetics. Since 1980, government standards have reduced the amount of lead allowed in consumer products and occupational settings. Today, the most common sources of lead exposure in the United States are lead-based paint in older homes, contaminated soil, household dust, drinking water, lead crystal and lead-glazed pottery.

·    Mercury – Also an element in the earth’s crust, mercury cannot be created or destroyed by humans. Despite its toxicity, mercury is found in many industries, such as battery, thermometer and barometer manufacturing, fungicides, and before 1990 as an anti-mildew agent in paint. In 1999, the public was alerted that thimerosal, a mercury-containing preservative used in some vaccines, could be related to certain diseases. Today, mercury exposure is mostly associated with eating fish contaminated with mercury and dental amalgams, or fillings, by dentists.

·    Organochlorine Pesticides – Organochlorine pesticides have been banned from use in the U.S. since the 1980s, but they can linger in the environment. Exposure to organochlorines can still occur when people eat fatty foods, such as fish, or dairy products contaminated with these long-lasting pesticides.

Alanine aminotransferases (ALT) is a liver enzyme that is released when the liver is injured. Upon evaluating the participant’s ALT levels, Cave found that 34.1 percent had abnormal levels. Additionally, their findings demonstrated that the more lead, mercury and organochlorine pesticides found in a person’s blood or urine, the greater risk of abnormal ALT.

Even after adjusting for obesity, race, sex, poverty and diabetes, the researchers reported, “…the results indicate that there may be a previously unexpected role for environmental pollution in the rising incidence of liver disease in the U.S. population.” According to Gina Solomon, MD, MPH, a senior scientist at the Natural Resources Defense Council in San Francisco, “The thing that is so dramatic about this study is they found associations at the levels that are in the general population. There’s no surprise that these chemicals can cause liver disease, but previous research has always suggested that the doses needed to be much higher.”

In light of this realization, people can protect themselves by reducing or minimizing exposure to substances known to contain toxic chemicals. Unfortunately, there is no way to isolate oneself from all of the possible contaminants in the environment. Thus, another strategy to reduce the impact of environmental toxins is to shield the liver from toxins. Advised by a growing number of health professionals, milk thistle supplementation is ideal for this purpose, because this herb strengthens liver cell walls, thus reducing its vulnerability to toxins.

According to this new research, those who scrape lead paint for a living are not the only ones who need be concerned with their liver’s health. Apparently, just living on this planet is sufficient to cause liver damage in one of every three people. Researchers are actively seeking to understand why so many develop chronic liver disease. Until then, minimizing toxin exposure and fortifying the liver are the best-known ways to deflect the damage (and illnesses) incurred from environmental toxins.


http://emedicine.medscape.com/article/819872-overview, Toxicity, Mercury, Barry M. Diner, MD, Retrieved June 4, 2009, Medscape, 2009.

http://www.drgregemerson.com.au/factfile_show.php?StoryId=102, Environmental Toxins, Retrieved June 2, 2009, Emerson Health and Wellness Centre, 2009.

http://www.niehs.nih.gov/health/topics/agents/lead/, Lead, Retrieved June 4, 2009, National Institute of Environmental Health Sciences, 2009.

http://www.webmd.com/digestive-disorders/news/20090529/environmental-toxins-and-liver-disease, Environmental Toxins & Liver Disease: A Link?, Kathleen Doheny, Retrieved June 1, 2009, WebMD, LLC, May 2009.

http://www.westonaprice.org/envtoxins/index.html, Environmental Toxins, Retrieved June 3, 2009, The Weston A. Price Foundation, 2009.
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Mod Pathol

. 2017 Jun;30(6):834-842.
doi: 10.1038/modpathol.2017.13. Epub 2017 Mar 3.
Aggressive non-alcoholic steatohepatitis following rapid weight loss and/or malnutrition
Jia-Huei Tsai  1   2 , Linda D Ferrell  3 , Vivian Tan  4 , Matthew M Yeh  5 , Monika Sarkar  6 , Ryan M Gill  3
Affiliations

   PMID: 28256569 PMCID: PMC5935795 DOI: 10.1038/modpathol.2017.13

Free PMC article
Abstract

While non-alcoholic steatohepatitis is a slowly progressive disease, patients may rarely present in acute liver failure. We describe six patients who developed severe hepatic dysfunction following rapid weight loss or malnutrition. Rapid weight loss (18 to 91 kg) occurred after Roux-en-Y gastric bypass in four patients and starvation-like dieting or hypoalbuminemia was noted in two patients. Four patients either died or received an urgent liver transplant. Pathologic findings were characterized by advanced alcoholic steatohepatitis-like features, including extensive/circumferential centrizonal pericellular fibrosis, central scar with perivenular sclerosis/veno-occlusion with superimposed hepatocellular dropout, abundant/prominent hepatocellular balloons, and numerous Mallory-Denk bodies, but there was no history of excess alcohol consumption. This study characterizes clinicopathologic features of aggressive non-alcoholic steatohepatitis following rapid weight loss or malnutrition, which should be included in the differential diagnosis with alcohol when a patient is considered for liver transplantation. The mechanism of liver injury in aggressive steatohepatitis is unknown, but rapid fat mobilization in obese patients may potentially cause oxidative stress to the liver and further study is needed to determine if there is a genetic predisposition to this form of injury and if antioxidants may protect the liver during rapid weight loss/malnutrition.
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https://www.vinmec.com/en/news/health-news/general-health-check/why-do-thin-people-also-get-non-alcoholic-fatty-liver-disease/

Post by Master, Doctor Mai Vien Phuong - Department of Examination & Internal Medicine - Vinmec Central Park International General Hospital

Nonalcoholic fatty liver disease (NAFLD) has been recognized as a major cause of chronic liver disease in the industrialized world. The incidence of nonalcoholic fatty liver disease is not only increased in patients with type 2 diabetes, metabolic syndrome, and obesity, but is also associated with more severe forms of the disease, a significant proportion of subjects developing NAFLD despite having a relatively normal body mass index (BMI), a condition known as non-obesity or non-alcoholic fatty liver disease in lean people.
1. Pathogenesis – why do thin people still get nonalcoholic fatty liver disease?

Thin people still suffer from non-alcoholic fatty liver disease, several causes of this problem have been implicated, such as high fructose intake, protein malnutrition (Kwashiorkor) as well as use of steatogenic drugs (amiodarone) , tamoxifen, methotrexate, prednisolone, etc.) and genetic predisposition.
Romeo et al highlighted the involvement of the single nucleotide polymorphism rs738409 in the protein containing the patatin-like phospholipase 3 domain (PNPLA 3) gene initiating and progressing NAFLD. However, numerous other gene variants have also been implicated in increased susceptibility to NAFLD/NASH and progression to liver fibrosis and even HCC, such as transmembrane superfamily 2 member 6 (TM6SF2) , the glucokinase regulatory gene (GCKR) and the membrane-associated O-acyltransferase domain containing 7 genes (MBOAT7). In addition, a variant of the interferon-λ3 (IFN-λ3) gene was associated with increased inflammation and liver fibrosis in NAFLD patients, while the rs72613567 polymorphism in the hydroxysteroid 17-beta dehydrogenase 13 gene ( HSD17B13) has recently been shown to reduce the risk of liver fibrosis, NASH, and HCC. Notably, both dietary composition and socioeconomic factors were correlated with NAFLD development. Adherence to the Mediterranean diet has been shown to improve insulin sensitivity in the liver and reduce fat accumulation in the liver while the Western diet, which mainly consists of high amounts of fructose and saturated fat, has involved in the development of NAFLD. Furthermore, prolonged periods of sitting, often associated with high calorie intake and an unhealthy diet, and reduced physical activity are independent risk factors for NAFLD, even in lean individuals.
2. Current data
Current data on the worldwide prevalence of non-obese non-alcoholic fatty liver disease/nonalcoholic fatty liver disease in lean individuals are characterized by wide variability. In a recent systematic review including 84 studies involving 10530308 individuals, Ye et al demonstrated that in the general population, the prevalence of lean and non-obese NAFLD was 5.1% and 12, respectively. first%. In addition, the overall prevalence of NAFLD in the general lean population was 10.6%, while the prevalence of NAFLD in the non-obese population was 18.3%. Interestingly, the prevalence of non-obese NAFLD in the total NAFLD population was highest in Europe (51.3%) and lowest in East Asia (37.8%). Notably, NAFLD patients were classified according to World Health Organization (WHO) and Asia Pacific recommendations as overweight and underweight when their BMI was 25 to 30 kg/m2 and << 25 kg/m 2, in non-Asian subjects, and 23 kg/m 2 to 27.5 kg/m 2 and < 23 kg/m 2, respectively, in the Asian population. However, it is well established that individuals with similar BMIs may have varying degrees of visceral obesity, which is strongly associated with the development of NAFLD. Waist circumference is considered to be a more accurate marker of visceral obesity than BMI, but was not available in the majority of related studies. This editorial will discuss the metabolic profile, prognosis, and associated clinical outcomes, as well as the management of non-obese or lean patients with NAFLD.
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John Suavecito wrote:For some people in Arctic areas, they have little choice. Many of them got really good omega 3's, fresh air, no toxins, good exercise, and community connections, which is excellent, but not the whole picture. It might be the best diet if you live there, but hardly any of us live in the Arctic Circle. There are no vegetables or fruits available for most of the year.

John S
PDX OR

According to this book:

https://www.amazon.com/Plants-That-Eat-Nigi%C3%B1aqtaut-traditional/dp/1602230749

there are many plants available in the Arctic which are used widely by the Inupiat, both in and out of season (they have long employed various primitive preservation techniques). Part of the book's purpose is to dispel the widely reported narrative that native Alaskans living a subsistence lifestyle are almost exclusively carnivorous. They may consume a higher percentage of meat and fish than most, but roots, leaves, and berries are important foods that are eaten regularly.

Trace Oswald wrote:Let me start by saying I don't want to downplay the experience of anyone that has struggled with eating disorders or any other health issues.  Our health is truly the most important thing we have and I can't think of anything more stressful and terrifying than dealing with a serious health problem, either in oneself or a loved one.  That said, I think it's very important to keep in mind that fasting has been done for literally the entire evolution of the human and animal world.  Our predecessors, as well as millions of people currently living, were forced by circumstance to fast.  Nearly every religion teaches it adherents about fasting for both spiritual and physical reasons.  Healthy people have no problem at all with short term fasting, and there are untold instances of unhealthy people getting healthy by fasting.  Anything taken to an extreme can be damaging, but I think it's very easy to show that the average American diet is far, far more dangerous than fasting.   I would hate to see someone that could benefit greatly from fasting turned off to the idea by thinking the dangers are greater than they are.  

I wanted to jump in and point out the religious aspect of fasting is often misunderstood. From the perspective of an Eastern Orthodox Christian, we 'fast' about half the year: Wednesdays and Fridays, Lent, Advent, The Apostles Fast, and the Dormition Fast. But 'fasting' from this perspective is refraining from eating meat, dairy products, eggs, and olive oil. There is encouragement to eat less food and more simple food. Shellfish is allowed, and fish only on certain days. Oil and wine are also allowed on certain days, specifically weekends in Lent. Adherence to the fast is variable depending on situations: kids don't fast, nor do pregnant women. Each person works with their priest to make sure they are doing what is healthy for them - those with health conditions are certainly given leniency.

There are only a few times that a 'total fast' - that is, not eating at all - is prescribed. You are not supposed to eat or drink for the 12 hours before taking the Eucharist (and again, there are relaxations to this depending on health, age, and ability). There are also a few days in the year where it is recommended to total fast.

This, of course, applies to laypeople, that is to people who are not clerics or monastics. There are stricter rules for them, particularly around Lent. To quote the Orthodox Church in America:

   On weekdays (Monday to Friday inclusive) during the seven weeks of Lent, there are restrictions both on the number of meals taken daily and on the types of food permitted; but when a meal is allowed, there is no fixed limitation on the quantity of food to be eaten.
       On weekdays in the first week, fasting is particularly severe. According to strict observance, in the course of the five initial days of Lent, only two meals are eaten, one on Wednesday and the other on Friday, in both cases after the Liturgy of the Presanctified. On the other three days, those who have the strength are encouraged to keep an absolute fast; those for whom this proves impracticable may eat on Tuesday and Thursday (but not, if possible, on Monday), in the evening after Vespers, when they may take bread and water, or perhaps tea or fruit-juice, but not a cooked meal. It should be added at once that in practice today these rules are commonly relaxed. At the meals on Wednesday and Friday xerophagy is prescribed. Literally this means ‘dry eating’. Strictly interpreted, it signifies that we may eat only vegetables cooked with water and salt, and also such things as fruit, nuts, bread and honey. In practice, octopus and shell-fish are also allowed on days of xerophagy; likewise vegetable margarine and corn or other vegetable oil, not made from olives. But the following categories of food are definitely excluded:
           meat;
           animal products (cheese, milk, butter, eggs, lard, drippings);
           fish (i.e., fish with backbones);
           oil (i.e., olive oil) and wine (i.e., all alcoholic drinks).
       On weekdays (Monday to Friday inclusive) in the second, third, fourth, fifth and sixth weeks, one meal a day is permitted, to be taken in the afternoon following Vespers, and at this one meal xerophagy is to be observed.
       Holy Week. On the first three days there is one meal each day, with xerophagy; but some try to keep a complete fast on these days, or else they eat only uncooked food, as on the opening days of the first week. On Holy Thursday one meal is eaten, with wine and oil (i.e., olive oil). On Great Friday those who have the strength follow the practice of the early Church and keep a total fast. Those unable to do this may eat bread, with a little water, tea or fruit-juice, but not until sunset, or at any rate not until after the veneration of the [Plashchanitsa] at Vespers. On Holy Saturday there is in principle no meal, since according to the ancient practice after the end of the Liturgy of St. Basil the faithful remained in church for the reading of the Acts of the Apostles, and for their sustenance were given a little bread and dried fruit, with a cup of wine. If, as usually happens now, they return home for a meal, they may use wine but not oil; for on this one Saturday, alone among Saturdays of the year, olive oil is not permitted.

The rule of xerophagy is relaxed on the following days:

   On Saturdays and Sundays in Lent, with the exception of Holy Saturday, two main meals may be taken in the usual way, around mid-day and in the evening, with wine and olive oil; but meat, animal products and fish are not allowed.
   On the Feast of the Annunciation (March 25) and Palm Sunday fish is permitted as well as wine and oil, but meat and animal products are not allowed….
   Wine and oil are permitted on the following days, if they fall on a weekday in the second, third, fourth, fifth or sixth week: [First and Second Finding of the Head of St. John the Baptist (Feb. 24), Repose of St. Raphael (Feb. 27), Holy Forty Martyrs of Sebaste (Mar. 9), Forefeast of the Annunciation (Mar. 24), Synaxis of the Archangel Gabriel (Mar. 26), Repose of St. Innocent (Mar. 31), Repose of St. Tikhon, Patriarch of Moscow (Apr. 7), Holy Greatmartyr and Victorybearer George (Apr. 23), Holy Apostle and Evangelist Mark (Apr. 25), as well as the Patronal Feast of the church or monastery].
   Wine and oil are also allowed on Wednesday and Thursday of the fifth week, because of the vigil for the Great Canon. Wine is allowed-and, according to some authorities, oil as well-on Friday in the same week, because of the vigil for the Akathist Hymn.

I think it's important to note that records that we have of religious fasting are almost always the most strict, meant for very few and under strict guidance. Laypeople almost never follow the exact guidelines of the fast. Even in monasteries, a monk would not be allowed to choose how strictly to fast - he would follow the instruction of his abbot. Just as for laypeople, you follow the guidance of your priest (who, of course, you inform about any health restrictions). This, in fact, is a great guard against disordered eating as you are not in control. In today's secular world, I would say this guidance comes from your doctor or clinical nutritionist.

This is a lot of information to basically say: I would not recommend fasting or following a diet on your own initiative. My family has had its experience with eating disorders, and as others have mentioned the point of eating disorders is control. By fasting only at the advice and under the guidance of an educated and concerned guide, you lessen the risk of falling into disordered eating. Of course, you could always run into bad doctors/nutritionists, but if you do your due diligence in research it again lessens risks there as well.

I'm still of the mindset that the standard American diet can easily be shown to be more dangerous than fasting.  According to the CDC, 74% of American adults are overweight, with approximately 40% being obese.  It's very easy to see the effects of being obese on our health.  For a tiny percentage of people, fasting may be dangerous.  Of those, I think it would be hard to show that intermittent fasting of 24 hours or less is dangerous for even a very tiny percentage of people.  If people have severe health issues, by all means, practice caution, but I would also urge people to be realistic with regards to the dangers of fasting.  I believe those dangers to be nearly, or wholly,  non-existent for people if they fast for 24 hours or less.  That said, I'm not a doctor, so I would urge everyone to do their own research and make their own choices.

I think "detoxing" whether using Vitamin C or some other combination of things is an entirely different subject than fasting.  It also seems to be more long term than the 16-24 hours fasts that are promoted for intermittent fasting.  I don't think the two are related in any way, and I'm not at all sure of the safety of various forms of "detoxing".  

There are small amounts of fruits and vegetables that can be preserved. When they are covered by feet of snow, it's tougher. But most people in more temperate areas wouldn't consider partially digested caribou food removed from their stomachs to be vegetables.   The point is, it's way tougher to eat an optimal mix of fruits and vegetables in the Arctic.

John S
PDX OR

Note on religious fast periods : they tend to go hand in hand with the feast and famine times of the agricultural year. And that makes sense when freezing, refridgeration, canning i.e. modern preservation methods and long distance transport is not possible.

John Suavecito wrote:There are small amounts of fruits and vegetables that can be preserved. When they are covered by feet of snow, it's tougher. But most people in more temperate areas wouldn't consider partially digested caribou food removed from their stomachs to be vegetables.   The point is, it's way tougher to eat an optimal mix of fruits and vegetables in the Arctic.

John S
PDX OR

The book to which I referred is silent regarding recycled stomach greens. Its subject matter is confined to actual plants widely consumed for most of the year by Arctic peoples, contrary to what is commonly believed. Whether their diet is optimal hasn't been established, but Weston A. Price noted that the Inupiat displayed the most robust health and constitution among all the indigenous peoples he studied worldwide.

Many people on keto diets lose weight and feel great.  They just don't live as long. One of the reasons is because they don't get enough plants in their diets.  You may say they got "a lot of plants", but it is significantly less than people in more temperate climes.  Some people may prefer that lifestyle and not living as long. It's up to them.  I just want them to know about it before it's a surprise.

John S
PDX OR

Many of the Arctic peoples had to eat partially digested Caribou food, extracted from their stomachs, or they couldn't get enough vitamin C, which is required by humans.
That wouldn't be an abundance of plant materials.

It irritates me that people do this diet or that diet and stick to it because of this and that, ignoring the message their body is telling them.

Trust your body people. If you go vegan and your body tells you that you are going to die if you keep doing that, then stop. Same deal with paleo or any other "back to basics" diet.

Human cells are outnumbered 10 to 1 inside what you consider to be your body.  Be mindful of that, and listen to what the 90% have to say.

John Suavecito wrote:Many of the Arctic peoples had to eat partially digested Caribou food, extracted from their stomachs, or they couldn't get enough vitamin C, which is required by humans.
That wouldn't be an abundance of plant materials.

I don't know that they had to--I've read that partially digested Caribou fodder was considered a delicacy, as many fermented foods are. So they weren't necessarily eating it out of desperation. Berries in particular, high in vitamin C, are and have long been easily kept frozen all winter up here, where they occur in ridiculous abundance. I have a bunch outside right now. "Plants That We Eat" documents all that, among other ancient strategies employed by Arctic Alaskans for preserving plant foods through the winter. It's still in print and interesting reading; well worth checking out.

The passage I read sounded like the person couldn't get himself to eat the undigested caribou stomach contents.  Of course, he had more choices than people in the past.

I liked how Weston Price explained that after getting to know some indigenous people, they showed him one of their secrets.  They removed a small organ from the back of one of the animals and it was crucial for their nutrition.  How many people today know about that? What have we lost by mistreating and disrespecting the people who knew how to live well in these places?

John S
PDX OR

John Suavecito wrote:The passage I read sounded like the person couldn't get himself to eat the undigested caribou stomach contents.  Of course, he had more choices than people in the past.

I liked how Weston Price explained that after getting to know some indigenous people, they showed him one of their secrets.  They removed a small organ from the back of one of the animals and it was crucial for their nutrition.  How many people today know about that? What have we lost by mistreating and disrespecting the people who knew how to live well in these places?

John S
PDX OR

I read that the plains natives liked the ruminated greens, and would hold contests where two people would eat the small intestine and its contents from each end; whoever reached the middle first won. They weren't forced by arctic conditions to resort to eating that. Human tastes are pretty malleable (hence the term "acquired taste"). I heard an account of George Attla, a musher from Huslia, who recalled having to travel to Anchorage as a boy for medical care. His mom fixed him his favorite dish upon his return--beaver tail. He was looking forward to it, but after eating city food for weeks, gagged on the first bite and spat it out. "Stinkhead" is also eaten up here, which is salmon heads wrapped in grass and buried in the sand until they naturally ferment. I doubt most people would find that palatable. I asked a native from Bristol Bay if he ever ate that and if he liked it; he told me he grew up eating it and liked it as a kid. Not sure he still would, though. Scandinavians still eat surströmming, which is fermented herring. I'm half Swedish and it's on my bucket list. Here's a hilarious clip of William Shatner introducing it to some western palates (some of which don't react well):



Often superficial observations are coupled with unwarranted assumptions, leading to inaccurate reports. Wide cultural differences render confusion likely. The lady who wrote "Plants That We Eat" got sick of hearing the trope that arctic people are almost exclusively carnivorous, and wanted to correct the popular opinion.

Yes, I'm half Norwegian and they're always trying to get us to pay $40 for a dinner of lutefisk.  Cod fish soaked in lye.  "It's a delicacy".  No thanks.  I like fresh herring and salmon, but fermented? I'll pass. The fermenting and soaking in lye was necessary at one time to have enough food to avoid starvation.   And the fresh stuff doesn't cost $40.
John S
PDX OR

John Suavecito wrote:Yes, I'm half Norwegian and they're always trying to get us to pay $40 for a dinner of lutefisk.  Cod fish soaked in lye.  "It's a delicacy".  No thanks.  I like fresh herring and salmon, but fermented? I'll pass. The fermenting and soaking in lye was necessary at one time to have enough food to avoid starvation.   And the fresh stuff doesn't cost $40.
John S
PDX OR

We grew up eating Swedish food, but never had lutefisk until I went to a Sons of Norway smorgasbord as an adult and tried some. It was pretty blah. I went with a guy whose wife was from Sweden, and she said it wasn't representative of quality lutefisk, but I doubt it gets too much better. I don't think lutefisk is fermented though, just soaked in the lye. It had a really bland taste and the texture was gelatinous. Nothing to gag on, but palatability is definitely sacrificed for preservation.

I trust the healthiness of the Forks Over Knives way, it has the studies behind it.

I have plans for when I have any to join or any joining me to have land for growing all the food possible for what is needed and desirable growing, along with plants for medication and those for materials to use, to do this together fully and with that grow independent from others outside of that. I have moved toward eating very close to the way that can be included in that.

Fred Frank V Bur wrote:I trust the healthiness of the Forks Over Knives way, it has the studies behind it.

I have plans for when I have any to join or any joining me to have land for growing all the food possible for what is needed and desirable growing, along with plants for medication and those for materials to use, to do this together fully and with that grow independent from others outside of that. I have moved toward eating very close to the way that can be included in that.

Vegan diets come up often.  I believe that the evidence is clear that humans are omnivores and are designed to eat that way.  If a diet needs supplements to be complete and ward of deficiencies, seems enough evidence to me that it isn't what people were meant to eat.  If people want to follow a vegan diet for moral reasons, and because of that are willing to supplement the diet with things like B12, I can fully understand that.  Once people start arguing that the vegan diet is the perfect diet for humans for health reasons, I think they overstepped.

Trace Oswald wrote:

Fred Frank V Bur wrote:I trust the healthiness of the Forks Over Knives way, it has the studies behind it.

I have plans for when I have any to join or any joining me to have land for growing all the food possible for what is needed and desirable growing, along with plants for medication and those for materials to use, to do this together fully and with that grow independent from others outside of that. I have moved toward eating very close to the way that can be included in that.

Vegan diets come up often.  I believe that the evidence is clear that humans are omnivores and are designed to eat that way.  If a diet needs supplements to be complete and ward of deficiencies, seems enough evidence to me that it isn't what people were meant to eat.  If people want to follow a vegan diet for moral reasons, and because of that are willing to supplement the diet with things like B12, I can fully understand that.  Once people start arguing that the vegan diet is the perfect diet for humans for health reasons, I think they overstepped.

Hi! Thanks for communicating with me.

It was why I mentioned Forks Over Knives and studies behind it. I read the book for it, and a little later managed to see the documentary of that; that it would not just be coming across as my claims, that doctors with studies show it, and have people reverse serious issues, and cancers, heart attacks and strokes, high blood pressure, rheumatoid arthritis, diabetes type 2 and other serious issues to well-being are dealt with to not suffer. Sure I would use supplements, if would not just be me and most people will benefit with supplements. B12 is not produced from animals anyway. It is only produced from certain soil bacteria. It used to be more available on vegetation used for food, animals were picking up the soil bacteria that provided that vitamin too. I have no argument to make with what the doctors and studies found, but while I accept that and know sustainable ways can be had with still having that healthy way, a number of others won't, and it is not my agenda to change minds, but share about this with whoever is willing to hear it or see what I communicate of this.

It's exciting for me to see posts about the Orthodox Church here in permies.

As a catechumen I am interested in connecting with other Orthodox permies as well.

I am grateful to have found the Orthodox way of life and to be learning how much of it applies to the permie way of life as well.

May God bless all who read this message.

Caitlin Robbins wrote:

Trace Oswald wrote:Let me start by saying I don't want to downplay the experience of anyone that has struggled with eating disorders or any other health issues.  Our health is truly the most important thing we have and I can't think of anything more stressful and terrifying than dealing with a serious health problem, either in oneself or a loved one.  That said, I think it's very important to keep in mind that fasting has been done for literally the entire evolution of the human and animal world.  Our predecessors, as well as millions of people currently living, were forced by circumstance to fast.  Nearly every religion teaches it adherents about fasting for both spiritual and physical reasons.  Healthy people have no problem at all with short term fasting, and there are untold instances of unhealthy people getting healthy by fasting.  Anything taken to an extreme can be damaging, but I think it's very easy to show that the average American diet is far, far more dangerous than fasting.   I would hate to see someone that could benefit greatly from fasting turned off to the idea by thinking the dangers are greater than they are.  

I wanted to jump in and point out the religious aspect of fasting is often misunderstood. From the perspective of an Eastern Orthodox Christian, we 'fast' about half the year: Wednesdays and Fridays, Lent, Advent, The Apostles Fast, and the Dormition Fast. But 'fasting' from this perspective is refraining from eating meat, dairy products, eggs, and olive oil. There is encouragement to eat less food and more simple food. Shellfish is allowed, and fish only on certain days. Oil and wine are also allowed on certain days, specifically weekends in Lent. Adherence to the fast is variable depending on situations: kids don't fast, nor do pregnant women. Each person works with their priest to make sure they are doing what is healthy for them - those with health conditions are certainly given leniency.

There are only a few times that a 'total fast' - that is, not eating at all - is prescribed. You are not supposed to eat or drink for the 12 hours before taking the Eucharist (and again, there are relaxations to this depending on health, age, and ability). There are also a few days in the year where it is recommended to total fast.

This, of course, applies to laypeople, that is to people who are not clerics or monastics. There are stricter rules for them, particularly around Lent. To quote the Orthodox Church in America:

   On weekdays (Monday to Friday inclusive) during the seven weeks of Lent, there are restrictions both on the number of meals taken daily and on the types of food permitted; but when a meal is allowed, there is no fixed limitation on the quantity of food to be eaten.
       On weekdays in the first week, fasting is particularly severe. According to strict observance, in the course of the five initial days of Lent, only two meals are eaten, one on Wednesday and the other on Friday, in both cases after the Liturgy of the Presanctified. On the other three days, those who have the strength are encouraged to keep an absolute fast; those for whom this proves impracticable may eat on Tuesday and Thursday (but not, if possible, on Monday), in the evening after Vespers, when they may take bread and water, or perhaps tea or fruit-juice, but not a cooked meal. It should be added at once that in practice today these rules are commonly relaxed. At the meals on Wednesday and Friday xerophagy is prescribed. Literally this means ‘dry eating’. Strictly interpreted, it signifies that we may eat only vegetables cooked with water and salt, and also such things as fruit, nuts, bread and honey. In practice, octopus and shell-fish are also allowed on days of xerophagy; likewise vegetable margarine and corn or other vegetable oil, not made from olives. But the following categories of food are definitely excluded:
           meat;
           animal products (cheese, milk, butter, eggs, lard, drippings);
           fish (i.e., fish with backbones);
           oil (i.e., olive oil) and wine (i.e., all alcoholic drinks).
       On weekdays (Monday to Friday inclusive) in the second, third, fourth, fifth and sixth weeks, one meal a day is permitted, to be taken in the afternoon following Vespers, and at this one meal xerophagy is to be observed.
       Holy Week. On the first three days there is one meal each day, with xerophagy; but some try to keep a complete fast on these days, or else they eat only uncooked food, as on the opening days of the first week. On Holy Thursday one meal is eaten, with wine and oil (i.e., olive oil). On Great Friday those who have the strength follow the practice of the early Church and keep a total fast. Those unable to do this may eat bread, with a little water, tea or fruit-juice, but not until sunset, or at any rate not until after the veneration of the [Plashchanitsa] at Vespers. On Holy Saturday there is in principle no meal, since according to the ancient practice after the end of the Liturgy of St. Basil the faithful remained in church for the reading of the Acts of the Apostles, and for their sustenance were given a little bread and dried fruit, with a cup of wine. If, as usually happens now, they return home for a meal, they may use wine but not oil; for on this one Saturday, alone among Saturdays of the year, olive oil is not permitted.

The rule of xerophagy is relaxed on the following days:

   On Saturdays and Sundays in Lent, with the exception of Holy Saturday, two main meals may be taken in the usual way, around mid-day and in the evening, with wine and olive oil; but meat, animal products and fish are not allowed.
   On the Feast of the Annunciation (March 25) and Palm Sunday fish is permitted as well as wine and oil, but meat and animal products are not allowed….
   Wine and oil are permitted on the following days, if they fall on a weekday in the second, third, fourth, fifth or sixth week: [First and Second Finding of the Head of St. John the Baptist (Feb. 24), Repose of St. Raphael (Feb. 27), Holy Forty Martyrs of Sebaste (Mar. 9), Forefeast of the Annunciation (Mar. 24), Synaxis of the Archangel Gabriel (Mar. 26), Repose of St. Innocent (Mar. 31), Repose of St. Tikhon, Patriarch of Moscow (Apr. 7), Holy Greatmartyr and Victorybearer George (Apr. 23), Holy Apostle and Evangelist Mark (Apr. 25), as well as the Patronal Feast of the church or monastery].
   Wine and oil are also allowed on Wednesday and Thursday of the fifth week, because of the vigil for the Great Canon. Wine is allowed-and, according to some authorities, oil as well-on Friday in the same week, because of the vigil for the Akathist Hymn.

I think it's important to note that records that we have of religious fasting are almost always the most strict, meant for very few and under strict guidance. Laypeople almost never follow the exact guidelines of the fast. Even in monasteries, a monk would not be allowed to choose how strictly to fast - he would follow the instruction of his abbot. Just as for laypeople, you follow the guidance of your priest (who, of course, you inform about any health restrictions). This, in fact, is a great guard against disordered eating as you are not in control. In today's secular world, I would say this guidance comes from your doctor or clinical nutritionist.

This is a lot of information to basically say: I would not recommend fasting or following a diet on your own initiative. My family has had its experience with eating disorders, and as others have mentioned the point of eating disorders is control. By fasting only at the advice and under the guidance of an educated and concerned guide, you lessen the risk of falling into disordered eating. Of course, you could always run into bad doctors/nutritionists, but if you do your due diligence in research it again lessens risks there as well.

As someone who does keto and grows all my own produce I want to note that  I eat vegetables with every meal everyday and snack on raw veggies and berries as well.  Keto isn't no veg/carnivore.  It's fat-based low carbohydrates. I don't eat potatoes, grain, sugar. Almost all green veg, avocado, are encouraged and do not move me out of ketosis.  Small amts of tomato, eggplant, pumpkin, onion also fine. Regular fresh herbs and berries and melon as well.  

Attaching a random keto food pyramid example, you can find others.