Keto And Liver Health: Is It Safe?

The ketogenic diet is a popular eating plan that involves eating a high-fat, moderate-protein, and low-carbohydrate diet. While it has been shown to aid in weight loss, there are concerns about its potential impact on liver health. Non-alcoholic fatty liver disease (NAFLD) is a condition where fat accumulates in the liver, causing inflammation and dysfunction, and it is a growing problem affecting about 25% of the population in Western countries. NAFLD can lead to serious complications such as cirrhosis and liver cancer. Some experts warn that the keto diet may increase the risk of developing NAFLD due to the high-fat content. However, other sources suggest that a ketogenic diet may actually help prevent and treat NAFLD by reducing insulin resistance and improving blood sugar parameters.

Non-alcoholic fatty liver disease (NAFLD)

The keto diet has been linked to a higher risk of NAFLD by some experts. The keto diet involves consuming a large amount of fat and restricting carbohydrates, which can lead to fat buildup in the liver. In addition, the keto diet can increase blood cholesterol levels and induce elevations in liver enzymes, further contributing to the risk of NAFLD. However, it is important to note that not all studies agree on the negative effects of the keto diet on liver health. Some studies suggest that the benefits of improved glycemic control may outweigh the potential risks of elevated LDL cholesterol.

It is worth noting that mild dietary ketosis, when the body burns fat for fuel instead of carbohydrates, is not inherently harmful to individuals with normal, healthy, functioning livers. Ketosis is a natural adjustment to the body's reduced intake of carbohydrates, and it can be beneficial for weight loss and managing seizure disorders. However, a high-fat, severe ketogenic diet may pose risks, especially for those with pre-existing liver conditions.

Alcoholic fatty liver disease

The treatment for alcoholic fatty liver disease primarily involves stopping alcohol consumption. Abstaining from alcohol for an extended period, such as months or years, allows the liver to recover and return to normal. Support, advice, and medical treatment for alcohol addiction may be available through local alcohol addiction support services. In severe cases, a liver transplant may be necessary if the liver has sustained irreversible damage.

The most effective way to prevent alcoholic fatty liver disease is to avoid alcohol consumption or adhere to recommended drinking limits. Men and women are advised not to regularly exceed 14 units of alcohol per week. Spreading alcohol consumption over three or more days can also help reduce the risk.

Ketosis and ketoacidosis

Ketosis is a natural metabolic state in which the body burns fat for energy due to a low intake of carbohydrates. It can be caused by a low-carbohydrate diet, fasting, or the ketogenic diet. Ketosis is generally safe and is a normal, natural body response to low-carbohydrate diets or fasting. The ketogenic diet was originally developed to treat epilepsy in children, and it has been shown to be effective in reducing seizures. It is also used to induce weight loss, and it has been shown to be more effective for weight loss than low-fat diets. However, it is not completely without risk. It can lead to an increase in cholesterol levels and liver enzymes, and in rare cases, it has been associated with non-alcoholic fatty liver disease (NAFLD). NAFLD is a "silent killer" that can lead to cirrhosis and liver cancer, and its prevalence is increasing alongside the increase in obesity.

On the other hand, ketoacidosis is a serious, potentially life-threatening condition mainly affecting people with Type 1 diabetes due to high blood sugar and ketone levels. Ketoacidosis occurs when the body produces dangerously high levels of ketones, which can cause the blood to become too acidic. This is often a result of insufficient insulin, illness, infection, or not following a diabetes management plan. The symptoms of ketoacidosis include fatigue, confusion, abdominal pain, vomiting, extreme thirst, fruity-smelling breath, and frequent urination. It is a medical emergency that requires immediate treatment, usually in a hospital or emergency room. Treatment typically involves insulin therapy, fluid replacement, and electrolyte replacement.

It is important to distinguish between ketosis and ketoacidosis, as they have different effects on the body. Ketosis is a natural and safe metabolic state, while ketoacidosis is a dangerous and potentially life-threatening condition.

How to support your liver on keto

The keto diet is a high-fat, low-carb, moderate-protein diet that produces metabolic changes similar to those seen in a state of starvation. While the keto diet has many benefits, it may also increase the risk of certain health issues, such as elevated cholesterol and liver enzymes, and non-alcoholic fatty liver disease (NAFLD). Here are some tips to support your liver if you are on a keto diet:

Eat to Your Macros

Staying in ketosis is crucial to ensure you are consuming enough fat and not overeating carbohydrates. A high-fat diet that is also high in carbohydrates can strain your liver. It is important to find your optimal macronutrient intake and adjust your diet to stay in ketosis while minimising fat consumption. Aim for ketone levels between 1.0 mmol/L and 3.0 mmol/L. Consider supplementing with medium-chain triglycerides (MCTs) and MCT oil derived from coconut oil, as they are easily digested and used by the body for fuel.

Exercise Regularly

Exercising regularly is crucial to preventing and reversing NAFLD. Aim for at least three workouts per week. Exercise helps attack liver fat and prevent or clear up build-up. Even a 15% reduction in BMI from exercise has been shown to help improve liver condition and insulin resistance in type 2 diabetics with NAFLD.

Consume Liver-Supporting Keto Foods

Include choline-rich foods in your diet, as choline helps remove fat from the liver. Animal products such as eggs, meat, and cheese are high in choline. Also, incorporate other low-carb foods that may reduce liver fat, inflammation, and your risk of NAFLD, such as omega-3-rich foods (fatty fish and nuts), green tea, and coffee.

Try Liver-Supporting Supplements

Supplements that aid in fat digestion may also benefit your liver. These include digestive enzymes, bile salts, and whey protein. Always check with your healthcare provider before starting any new supplements to ensure they are right for you.

Weight loss and fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease characterised by excess fat deposition in the liver. It is closely associated with obesity and insulin resistance, and is the most prevalent cause of chronic liver disease worldwide.

NAFLD can lead to nonalcoholic steatohepatitis (NASH), which is marked by inflammatory cell infiltrate with hepatocyte ballooning with or without fibrosis, and can progress to cirrhosis and hepatocellular carcinoma. NAFLD is a reversible condition, and the cornerstone of therapy is weight loss.

Weight Loss Methods

Diet

A hypocaloric diet (750 kcal/day deficit) has been shown to improve NAFLD. A 52-week lifestyle intervention involving a hypocaloric diet in 261 individuals with NASH showed that subjects with ≥ 5% weight loss had a greater reduction in NAS compared to those with < 5% weight loss. A target weight reduction of 7-10% can improve liver fat content, NASH, and fibrosis.

Specific diets such as the Mediterranean diet, which is rich in monounsaturated fatty acids and polyunsaturated fatty acids, may be efficient methods of reducing caloric intake and have shown promising results in observational studies and small randomised trials.

Exercise

Physical activity and exercise are important in the treatment of NAFLD. Even modest amounts of moderate exercise, of different types, whether aerobic or resistance training, can improve liver fat and should be part of the therapy for NAFLD.

Pharmacological Therapy

Vitamin E has been shown to improve histologic features of NASH compared with placebo in a randomised study of individuals with NAFLD and without diabetes. Pioglitazone, a diabetes medication, has also been shown to improve liver histology, including fibrosis, and can be considered in patients with or without diabetes.

Surgical Intervention

Bariatric surgery, with resultant weight loss, can lead to an improvement in liver fat and inflammation. A large 2014 study showed that Roux-en-Y gastric bypass resulted in greater improvement in NAFLD compared to adjustable gastric banding, despite a higher baseline BMI and more severe NAFLD.

Ketogenic Diet

The ketogenic diet is a high-fat, low-carb, moderate-protein diet that produces metabolic changes similar to those seen in a state of starvation. It has been shown to be effective for weight loss and can lead to a reduction in cravings and appetite. However, it may increase blood cholesterol levels and induce elevations in liver enzymes, potentially leading to NAFLD.

Weight loss of at least 5% can improve NAFLD, with a weight loss of 7-10% having a positive impact on NASH and fibrosis. Diet, exercise, pharmacological therapy, and surgical intervention are all methods that can be used to achieve weight loss and improve NAFLD. The ketogenic diet may be effective for weight loss, but caution should be exercised as it may increase the risk of NAFLD.

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