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Keto and Fatty Liver: What Does the Research Say?


Fatty liver disease or too much fat buildup in the liver can worsen over time and lead to serious damage. You may have heard of keto and fatty liver, and how the keto diet can help reduce fat and even reverse the condition (*).


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Let’s take a look at how a very low-carbohydrate eating pattern plays a role in preventing healing fatty liver — whether it’s caused by overconsuming alcohol or other unhealthy lifestyle habits.

What is Fatty Liver Disease?

Whereas the liver normally has a small amount of fat, too much fat is present in those with fatty liver (also known as steatosis). There are two types of fatty liver: One is alcohol-induced fatty liver, which results from habitual alcohol drinking, and the second is nonalcoholic fatty liver disease (NAFLD), which is associated with diabetes, obesity, and elevated triglycerides (*).

What’s interesting is that a person’s eating habits can influence their likelihood of developing NAFLD. This points to the keto diet as a promising approach to decreasing liver fat.

According to the American Liver Foundation, NAFLD is common in the United States, and 25% of adults have it. Those who do usually have simple fatty liver, which means there is only little or no inflammation involved, and scarring is absent (*).

NAFLD has no symptoms — which is why it’s called “silent liver disease” — but as it worsens, it causes severe tiredness, abdominal discomfort, yellowish skin and eyes, weight loss, and itching (*).

Causes and Risk Factors

Except for alcohol-induced fatty liver caused by excessive alcohol use, nonalcoholic fatty liver has no single cause but involves a combination of factors.

Your risk of developing fatty liver increases if you have/are:

  • Overweight (a BMI of over 25) or obese (a BMI of over 30)
  • Type 2 diabetes
  • High triglyceride levels
  • Low HDL cholesterol
  • Metabolic syndrome, also called “insulin resistance syndrome,” in which a person has three or more of these — a large waistline, high blood sugar, high blood pressure, high triglycerides, and low HDL (*)
  • Taking certain medications, such as corticosteroids and antipsychotic medications (*)

To detect fatty liver, you’ll need to undergo liver function tests, which include the alanine transaminase (ALT) test and the aspartate aminotransferase (AST) test.

Research on Keto and Fatty Liver

Many studies have demonstrated the effectiveness of the keto diet for losing weight, reducing blood sugar, lowering blood pressure, and improving cholesterol numbers (by lowering triglycerides and increasing HDL) (*). Addressing these health markers can in turn prevent fatty liver or reverse liver damage if it is still early.

Below, we reveal some research on the effects of the keto diet on fatty liver, including its possible risks for someone who already has the condition:

The Relationship Between Carbohydrate Intake and Fatty Liver

While carbohydrates, in and of themselves, do not cause fatty liver, consuming high amounts — especially refined carbs like white bread, pastries, desserts, breakfast cereals, and sweet drinks — can promote fat storage in the liver.

Research shows that ingested carbs are a major stimulus for storing lipids and are more likely to contribute to nonalcoholic fatty liver than dietary fat. In those who already have scar tissue in their liver or fibrosis, high fructose corn syrup (a type of carb that combines glucose and fructose, and is found in ice cream and baked goods) worsens fibrosis (*).

In a pilot study, it was discovered that eating less than 20 grams of carbohydrates per day for 6 months led to significant weight loss, as well as improvements in liver steatosis, fibrosis, and inflammation as shown in liver biopsies (*).

The Role of Ketosis in Reducing Liver Fat

Ketosis, the metabolic state in which your body utilizes fat for energy as a result of limited carbohydrates, prevents fat from accumulating in the liver. During ketosis, circulating insulin levels are lower. This reduced insulin stops the creation of new liver fat molecules (*).


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Interestingly, a study found that the ketone molecule BHB (beta-hydroxybutyrate) offers a protective effect on liver injury caused by alcohol. According to the study, “BHB reduced hepatic steatosis, total liver triglyceride, and plasma ALT (*).”

Given that beta-hydroxybutyrate has anti-inflammatory effects, taking a BHB ketone supplement may help reduce liver inflammation and injury (*). When it comes to preventing fatty liver, you can enter ketosis and boost ketones naturally by significantly reducing carbs, taking MCT oil, and exercising (*).

Potential Risks of Following the Keto Diet with Fatty Liver Disease

If you have fatty liver disease and decide to start the keto diet, you need to be aware of the keto flu, which is a temporary side effect. This refers to a collection of symptoms that include fatigue, headaches, disrupted sleep, and digestive issues (such as nausea, constipation, and diarrhea). Keto flu can sometimes make it difficult for an individual to continue the diet.

Someone with a diagnosis of diabetes, in addition to having fatty liver, may also need to consult with their doctor regarding medication adjustment. This is to prevent low blood sugar levels. Remember that the keto diet reduces blood sugar, which drops lower due to medications like insulin and metformin (*). The same thing is true for those who are taking antihypertensive medications.

Nutrient deficiencies do not happen on the keto diet unless a person fails to replace high-carb foods with low-carb foods containing lots of vitamins and minerals. Research shows that vitamin E and vitamin C combined reduce the odds of hepatic steatosis (*).

Getting Started with Keto for Fatty Liver

Make sure you see a healthcare professional, such as a doctor or registered dietician, if you plan on doing keto to reduce liver fat. This is especially true if you’re currently taking medications for diabetes and hypertension.

Besides creating a specific keto diet plan that aligns with your goals and needs of the moment — your doctor may decrease your medication doses or discontinue them and monitor you along the way.

Someone who wants to follow a keto diet would have to decrease their carb intake to less than 50 grams per day. At the same time, get enough protein and fats. There’s research showing that a carbohydrate-reduced high-protein diet reduces liver fat in those with type 2 diabetes (*).

Prioritize whole, nutrient-dense foods like eggs, fish, beef, pork, and lamb. See this complete list of keto foods to eat and avoid.

Don’t forget to measure your ketone levels to confirm whether your body has already entered ketosis. You can do this conveniently using keto test strips.

Also, monitor your liver health to determine how well the keto diet is working (alone or in combination with supplements you’re taking and lifestyle practices).

Other Lifestyle Changes That May Help with Fatty Liver

In addition to a low-carb diet, extra steps you can take for a healthy liver include the following:

  • Avoiding alcohol
  • Exercise, such as going for a walk, running, cycling, and lifting weights
  • Regular coffee drinking (*)
  • Getting a good night’s sleep
  • Including foods with fiber, such as spinach, broccoli, and avocados (Tip: Make sure you wash fresh produce properly to remove pesticides, which affect liver function.)
  • Avoiding added sugars
  • Intermittent fasting
  • Staying hydrated

The Bottom Line

With a diet that reduces obesity and improves metabolic health markers, you can prevent or reverse fatty liver disease. Switching to the keto diet has been shown to reduce liver fat and protect your liver from further injury.


Join 90k+ people who are losing weight with Keto Kickstart, our doctor-developed program designed to give you real weight loss results.

Focus on carb reduction, eating enough protein and fat, and other healthy lifestyle recommendations (as we’ve shared in this article). Seek guidance from your healthcare provider who can help make personalized adjustments to your plan and keep you accountable.

17 References

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