Keto And Fatty Liver: What's The Connection?

The ketogenic diet is a popular weight-loss strategy that involves eating a very low-carbohydrate diet, typically between 5-10% of total calories for the day. While the keto diet can be an effective weight-loss strategy, some doctors worry that it might worsen an increasingly common condition known as nonalcoholic fatty liver disease (NAFLD). NAFLD is a silent killer that often goes unnoticed until serious complications arise, such as cirrhosis and liver cancer. Research in mouse models has shown that the high-fat content of the keto diet can lead to NAFLD. However, other studies have found that the keto diet can be beneficial for NAFLD by reducing liver fat and improving insulin sensitivity. The conflicting evidence surrounding the keto diet and NAFLD highlights the need for further research to fully understand the effects of this diet on liver health.

Keto diets can cause non-alcoholic fatty liver disease (NAFLD)

Non-alcoholic fatty liver disease (NAFLD) is a condition where fat accumulates in the liver, causing inflammation and dysfunction. NAFLD is a "silent killer", as patients rarely show early symptoms. Late symptoms include fatigue and pain in the upper right side of the abdomen.

NAFLD is estimated to affect about 25% of the population in most Western countries, and up to 1 billion people worldwide. It is caused by many factors unrelated to alcohol, with obesity being the largest associated risk factor. Other risk factors include being middle-aged or older, and belonging to Hispanic or non-Hispanic white ethnicities.

Keto Diets and NAFLD

Keto diets are low-carbohydrate diets, typically consisting of 5-10% carbohydrates, a high fat intake, and unrestricted total calorie intake. The goal of the keto diet is to achieve ketosis, where the body uses fat instead of carbohydrates for energy.

Research suggests that keto diets may cause NAFLD. A study on mouse models showed that eating lots of fats and restricting carbohydrates can lead to NAFLD. A 2020 meta-analysis of 154 articles also concluded that, in addition to caloric restriction, macronutrient distribution plays a role in NAFLD treatment. High-fat keto diets had a greater and faster impact on liver fat content than only restricting carbohydrates.

How Keto Diets Cause Liver Damage

Carbohydrates are made up of single and chains of sugars. The keto diet severely restricts all carbohydrates, resulting in a drop in blood sugar levels, which in turn causes blood insulin levels to decrease. While low insulin levels cause fat cells to release stored fat, if a person on a keto diet then gains weight, fat may be preferentially stored in the liver. The liver draws out the fatty triglycerides from the bloodstream into its own cells, and if large amounts of triglycerides are stored in the liver, a fatty liver develops.

NAFLD Treatment

Weight loss is the main treatment for NAFLD. Losing even 3-5% of body weight can reduce the amount of fat in the liver, lower inflammation, and reduce scarring. However, there are no FDA-approved medications to specifically treat NAFLD.

Alternative Dietary Approaches

A well-balanced diet that features high-fiber foods, vegetables, fruits, fish, lean meats, nuts, seeds, and unrefined oils is recommended for those looking to lose weight, prevent cardiovascular disease, diabetes, and cancer. The Mediterranean and paleo diets have also been shown to be beneficial for NAFLD.

NAFLD is a silent killer

Nonalcoholic fatty liver disease (NAFLD) is a silent killer that affects about a quarter of the population, yet many are unaware they have the condition. NAFLD is caused by fat accumulation in liver cells, which can lead to severe health complications if left untreated. While heavy drinking is often associated with fatty liver disease, poor lifestyle choices and obesity have made NAFLD increasingly common.

NAFLD is often asymptomatic and can go unnoticed until it's too late. The disease doesn't produce symptoms in its early and middle stages, but once it advances, it can lead to life-threatening complications such as cirrhosis, liver cancer, or even death. People who have cirrhosis might experience symptoms such as breast enlargement in men, swelling in the legs, easy bleeding or bruising, and yellow eyes and skin.

The primary cause of NAFLD is still unclear, but certain factors increase the risk of developing the disease. These include high levels of fat in the blood, especially triglycerides, side effects from medications, certain rare genetic conditions, and infections such as hepatitis C. Obesity, type 2 diabetes, high blood pressure, and high cholesterol are also risk factors for NAFLD.

NAFLD can be treated through lifestyle changes such as weight loss, regular exercise, and a healthy diet. Maintaining a good weight, staying away from liver-harming medications, avoiding or limiting alcohol consumption, and adopting a nutrient-rich, low-trans-fat, and low-refined-carbohydrate diet are crucial steps in managing NAFLD. Additionally, increasing physical activity and incorporating omega-3 fatty acids found in foods like salmon can help reduce the risk of NAFLD.

A ketogenic diet has been found to be an effective treatment for NAFLD. This diet consists of a very low carbohydrate intake, typically between 5-10% of total daily calories, and a high fat intake. Studies have shown that a ketogenic diet can decrease liver fat content, reduce insulin levels and insulin resistance, and suppress appetite. Additionally, the diet can promote abdominal fat loss and improve heart health markers.

In summary, NAFLD is a silent killer that can have severe health consequences if left untreated. Early detection and lifestyle modifications, including a ketogenic diet, are key to managing and preventing the progression of the disease.

NAFLD can lead to cirrhosis and liver cancer

Non-alcoholic fatty liver disease (NAFLD) is a range of conditions caused by a build-up of fat in the liver. It is usually seen in people who are overweight or obese. While NAFLD does not usually cause harm in its early stages, it can lead to serious liver damage, including cirrhosis, if left untreated.

Cirrhosis is the most severe stage of NAFLD, occurring after years of inflammation, where the liver shrinks and becomes scarred and lumpy. This damage is permanent and can lead to liver failure and liver cancer.

NAFLD can progress to a more serious condition known as non-alcoholic steatohepatitis (NASH), in which the liver becomes inflamed. When the liver attempts to repair these damaged cells, scar tissue forms, resulting in a condition called fibrosis. Eventually, about 20% of NASH cases may progress to cirrhosis.

While only a portion of all NAFLD cases progress to NASH and then cirrhosis, non-progressing NAFLD can still be a health problem. NAFLD has been linked to an increased risk of heart disease and type 2 diabetes.

The good news is that NAFLD can be prevented and treated through healthy lifestyle choices, including maintaining a healthy weight, eating a healthy diet, and staying physically active. In addition, a low-carbohydrate or ketogenic diet has been shown to be effective in reducing liver fat and improving NAFLD.

NAFLD is linked to an increased risk of other forms of cancer

Nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of several cancers, including liver, stomach, pancreatic, and colon cancer. NAFLD is a buildup of fat in the liver of someone who drinks little to no alcohol, and it is often linked to obesity and metabolic syndrome. Obesity is the largest associated risk factor for NAFLD, and it is estimated to affect about 25% of the population in most Western countries and up to 1 billion people worldwide.

NAFLD may be the driver of increased cancer risk associated with obesity. A study comparing cancer rates among adults with NAFLD and a control group found that the risk of all cancers combined was 91% higher in the NAFLD group. Liver cancer showed the greatest increase, with about three times more cases in the NAFLD group. Uterine, stomach, pancreatic, and colon cancer were all around twice as common among people with NAFLD.

The link between NAFLD and cancer may be due to the role of the liver in metabolizing food and eliminating waste. When the liver becomes overwhelmed with fat cells, it can lead to simple fatty liver or the more serious nonalcoholic steatohepatitis (NASH). NASH reflects underlying cell damage, liver fibrosis, or cirrhosis, and can increase the risk of liver cancer.

In addition to cancer, NAFLD is also associated with an increased risk of cardiovascular disease and type 2 diabetes. Therefore, it is important to take steps to reduce the risk of NAFLD, such as maintaining a healthy weight, eating a healthy diet, and staying physically active.

Keto diets can increase cholesterol and inflammatory markers

Keto Diets and Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is a condition where fat accumulates in the liver, causing inflammation and dysfunction. NAFLD is a "silent killer", as patients rarely show early symptoms. The two types of fatty liver disease are alcoholic fatty liver disease (caused by excess alcohol use) and nonalcoholic fatty liver disease (NAFLD). NAFLD is caused by many factors unrelated to alcohol, and obesity is the largest associated risk factor.

Keto diets and NAFLD

The keto diet is a very low-carbohydrate diet, typically between 5-10% of total calories for the day. It consists of a high-fat intake and low-carbohydrate intake with an unrestricted total calorie intake. The goal of the keto diet is to achieve ketosis, where the body uses fat instead of carbohydrates for energy. During ketosis, ketone bodies are formed – water-soluble molecules produced by the liver from fatty acids.

Research has shown that the keto diet can not only assist in weight loss but also help prevent and reverse fatty liver damage. However, it may seem counterintuitive to eat a high-fat diet to manage fatty liver. A 2019 study by researchers at the Keck School of Medicine of USC found that ketogenic diets that severely restrict carbohydrates and replace them with fats appear to be associated with an increased risk for NAFLD. The study also found that the keto diet increases cholesterol and inflammatory markers.

A 2020 study published in the Proceedings of the National Academy of Sciences of the United States of America found that a ketogenic diet can decrease liver fat and hepatic insulin resistance, despite increasing circulating nonesterified fatty acids (NEFA), the main substrate for the synthesis of intrahepatic triglycerides (IHTG). The study also found that keto diets can increase the rate at which fatty acids are broken down, reducing oxidative stress and inflammation in the liver.

While keto diets have been shown to be effective for weight loss and managing fatty liver disease, more research is needed to understand the potential long-term effects of these diets, especially regarding increased cholesterol and inflammatory markers.

Frequently asked questions