Keto And Liver Damage: Is It Safe?

Nonalcoholic fatty liver disease (NAFLD) is a common condition that affects about 25% of the population in most Western countries. It is marked by excessive fat buildup in the liver and can lead to serious damage if left untreated. Weight loss is the primary treatment for NAFLD, but a low-carbohydrate diet like the keto diet may also be beneficial. The keto diet has been shown to reduce liver fat and protect the liver from further injury. However, there are potential risks associated with the keto diet, including elevated cholesterol and liver enzymes, as well as side effects like keto flu, which can include fatigue, headaches, and digestive issues. It is important for individuals with fatty liver disease to consult a healthcare professional before starting the keto diet, especially if they are taking medications for conditions such as diabetes and hypertension.

Weight loss and keto

The ketogenic, or keto, diet is a low-carb, high-fat, and moderate-protein eating plan that has been used for centuries to treat specific medical conditions. In recent times, it has gained popularity as a potential weight-loss strategy.

Keto is a low-carbohydrate, fat-rich eating plan. By depriving the body of glucose, the main source of energy, an alternative fuel called ketones is produced from stored fat. This state is called ketosis.

Weight Loss with Keto

The keto diet has been shown to be effective for weight loss. Here are some ways in which keto helps with weight loss:

• Reduced Calorie Intake: Keeping your carb count low also reduces your overall calorie consumption. Carb-focused foods can contribute a large number of calories to your diet.
• Appetite Suppression: Ketogenic diets have been shown to reduce appetite and food cravings due to the high-fat content of the diet.
• Increased Calorie Expenditure: The metabolic effects of converting fat and protein to glucose on a keto diet can lead to increased calorie expenditure.
• Fat Loss: Keto promotes fat loss over lean body mass, partly due to decreased insulin levels.

Challenges with Keto

While keto can be an effective weight-loss strategy, there are some challenges and potential negative side effects:

• Restricted Food Choices: The keto diet bans carb-rich foods like grains, potatoes, corn, most fruits, beans, and legumes. This can make it challenging to stick to the diet and may result in nutrient deficiencies if not properly managed.
• Keto Flu: As your body adjusts to using ketones for fuel, you may experience symptoms like fatigue, mental fogginess, irritability, and constipation.
• High-Fat Content: The high-fat content of the keto diet may be challenging for some people to adjust to and can increase the risk of elevated cholesterol and liver enzymes.

The keto diet can be an effective tool for weight loss, but it is not without its challenges and potential risks. It is important to consult with a healthcare professional before starting the keto diet to ensure it is safe and appropriate for your individual needs and health status. Additionally, working with a registered dietitian can help create a keto meal plan that is tailored to your specific needs and helps prevent nutrient deficiencies.

Reversing liver damage

The liver is the only organ in the body that can repair itself by creating new tissue. However, sometimes the liver gets overwhelmed and can't repair itself, especially if it's still under attack from a virus, drug, or alcohol. Therefore, the first step to reversing liver damage is to remove the cause.

If you have fatty liver disease caused by alcohol, it's important to stop drinking. If it's caused by your diet or being overweight, it's important to eat healthily and lose weight.

• Healthy weight: Being a healthy weight is crucial for liver health. Excess body weight increases the risk of liver damage getting worse. Losing weight can reduce the amount of fat in the liver, lower inflammation, and reduce scarring. Even losing 3-5% of body weight can reduce and even reverse the signs and symptoms of non-alcoholic fatty liver disease (NAFLD).
• Diet: A low-carb or keto diet can be beneficial for people with NAFLD because they can decrease insulin levels, suppress appetite, promote weight loss, and improve heart health markers. Specifically, a Mediterranean diet that emphasizes eating primarily plant-based foods, healthy fats, and olive oil can be beneficial.
• Exercise: Being more physically active can help reduce insulin resistance and liver fat. Aim for aerobic exercise or resistance training for 40-45 minutes, three times a week.
• Specific foods: Include fatty fish like salmon, sardines, mackerel, or anchovies in your diet at least twice a week. These fish are high in omega-3 fats, which reduce liver fat. Additionally, consider adding turmeric or curcumin to your diet, as they may help lower liver enzymes in those with NAFLD.
• Medication: While diet and exercise are the first interventions for NAFLD, there are some pharmacological options as well. Vitamin E, pioglitazone, and GLP-1 receptor agonists have been studied and shown some benefits for liver health.
• Regular monitoring: It is important to see your doctor regularly to check your health and ensure your liver damage isn't worsening. They can also manage other conditions that may increase the chance of progressing to cirrhosis.

Reducing insulin levels

Insulin is a protein-based hormone produced by beta cells located in the pancreas. Its primary purpose is to regulate the metabolism of fats and carbohydrates. Insulin resistance is a condition in which cells throughout the body no longer respond to the normal actions of the hormone. Insulin resistance is very common, affecting an estimated 24% of US adults aged 20 or older.

The Role of Ketogenic Diets in Reducing Insulin Levels

Ketogenic diets are low-carbohydrate, high-fat diets that have been shown to be effective in reducing weight. They change metabolism so that energy comes from fat instead of sugar. By reducing carbohydrate intake, ketogenic diets can help lower insulin levels and improve insulin sensitivity. This is because when the body is deprived of dietary sugar and starch, it reacts by reducing insulin secretion and switching to burning fat for fuel.

Several studies have demonstrated the positive impact of ketogenic diets on insulin levels:

• A 2005 study found that a ketogenic diet improved insulin sensitivity by approximately 75% in obese subjects with type 2 diabetes.
• A 2006 study showed that a very low-carbohydrate diet lowered fasting insulin by 33% in subjects with an average BMI of 33.
• A 2009 study comparing the effects of ketogenic and low-fat diets on insulin resistance in overweight, healthy subjects found that a low-carbohydrate ketogenic diet decreased fasting insulin levels by 49.5%, while a low-fat diet decreased fasting insulin levels by 18.6%.
• A 2010 study of obese and overweight individuals found that a low-calorie ketogenic diet had a greater impact on fasting insulin levels compared to a standard low-fat/drug weight-loss intervention.
• A 2012 study of obese children found that a ketogenic diet led to more pronounced improvements in metabolic parameters, including insulin resistance, compared to a hypocaloric diet.
• A 2014 study of young, healthy, and fit subjects found that a ketogenic diet lowered insulin levels both at rest and during exercise.

Additional Strategies to Reduce Insulin Levels

In addition to ketogenic diets, there are other strategies that can help reduce insulin levels:

• Calorie restriction: Maintaining a calorie deficit can help reduce insulin resistance by reducing the energy load on cells.
• Body fat reduction: Losing visceral fat, which accumulates in the abdominal region, can decrease the secretion of signalling molecules that contribute to insulin resistance.
• Carbohydrate restriction: Limiting carbohydrates can reduce the glycemic load of the diet, helping to regulate blood sugar levels and decrease insulin needs.
• Supplementation: Adding omega-3 fatty acid supplements, such as fish oil capsules, to a ketogenic diet may further reduce insulin levels and improve metrics related to diabetes.

Ketogenic diets have been shown to be an effective approach to reducing insulin levels and improving insulin sensitivity, particularly in obese individuals with type 2 diabetes. However, it is important to note that some studies have also found an increased risk of insulin resistance and type 2 diabetes associated with ketogenic diets. Therefore, it is crucial to monitor insulin levels and overall health when following a ketogenic diet.

Lowering cholesterol

Nonalcoholic fatty liver disease (NAFLD) is a common condition that affects about 25% of the population in Western countries. It is characterised by excess fat in the liver, which can lead to inflammation and dysfunction. While NAFLD can have serious consequences, it can be improved and sometimes even reversed with lifestyle changes, such as adopting a low-carb or keto diet.

The keto diet is a high-fat, moderate-protein, low-carbohydrate diet. It has been shown to be effective for weight loss and improving glycemic control. However, it can also lead to an increase in cholesterol levels, with some cases of elevated LDL-C and total cholesterol reported. Therefore, it is important for individuals on a keto diet to monitor their cholesterol levels regularly.

• Soluble fibre: Soluble fibre binds to cholesterol and prevents its absorption. Good sources include oats, barley, beans, eggplant, okra, and fibre supplements like psyllium.
• Polyunsaturated fats: These directly lower LDL cholesterol. Vegetable oils such as canola, sunflower, and safflower are rich sources.
• Plant sterols and stanols: These block the absorption of cholesterol in the body. Found in fortified foods like margarine, granola bars, orange juice, and chocolate, as well as supplements.
• Soy: Consuming soybeans, tofu, and soy milk can lower LDL by 5-6%.
• Fatty fish: Eating fish two to three times a week can lower LDL by replacing meat and providing omega-3 fats, which also protect the heart.
• Nuts: Consuming 2 ounces of nuts per day can lower LDL by about 5%. Almonds, walnuts, and peanuts are heart-healthy choices.
• Fruits and vegetables: Apples, grapes, strawberries, and citrus fruits are rich in pectin, a type of soluble fibre.
• Whole grains: Barley and whole-grain bread or pasta can help lower cholesterol and the risk of heart disease.

The keto flu

The keto diet is a high-fat, moderate-protein, low-carbohydrate diet that can induce weight loss and improve insulin sensitivity and glycemic control. However, one of its most well-known complications is the "keto flu".

• Stomach aches or pains
• Nausea
• Dizziness
• Sugar cravings
• Cramping
• Muscle soreness and aches
• Irritability
• Diarrhoea or constipation
• Trouble falling asleep or staying asleep
• Poor focus and concentration
• Brain fog
• Fatigue
• Headaches
• Foggy brain
• Irritability
• Difficulty sleeping
• Ease into the keto diet gradually: Instead of abruptly eliminating carbs, start with a typical low-carb diet and give your body time to adjust.
• Stay hydrated: Drink plenty of water to prevent dehydration, which can be a common issue when starting the keto diet.
• Increase electrolyte intake: Add more salts, potassium, and magnesium to your diet, as an extremely low-carb keto diet can deplete these essential minerals.
• Consume enough healthy fats: Ensure your diet includes sufficient healthy fats, as low-calorie intake can trigger keto flu symptoms.
• Get plenty of rest: Prioritise sleep and lighter forms of exercise, such as yoga or stretching, during the initial adjustment period.
• Try light exercise: Light exercise, such as restorative yoga, can help relieve muscle pain and tension associated with the keto flu.

Frequently asked questions