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Nutrition

Get excited about nutrition, and learn as you go with these information-packed resources on a wide variety of nutrition-centric topics! Our bistroMD experts review the importance of the macronutrients protein, fat, and carbohydrates, as well as how to make them work most efficiently for you.

Can Keto Cause Fatty Liver Disease?

Can keto cause fatty liver? Research suggests so but the link between the keto diet and fatty liver is complex. We simplify the data here!

Can Keto Cause Fatty Liver Disease?


The keto diet continues to gain interest as a weight loss diet. However, going keto raises potential health concerns, including for the liver. 

The liver carries out over 500 processes to keep the body healthy like breaking down fat, digesting nutrients, and filtering blood. Perhaps the most fascinating fact about the liver is that it can regenerate completely, but only as long as 25 percent of the tissue remains.

So, does the high-fat diet known as keto hurt your liver? Find out the emerging link between a keto diet and fatty liver disease here.

What Is the Keto Diet and Fatty Liver?

Before jumping into the link between a keto diet and fatty liver, it's important to understand what each is on its own.

Fatty Liver 101

Fatty liver, clinically known as hepatic steatosis, is an excess of fat in the liver. More specifically, fatty liver occurs when lipids accumulate in over 5 percent of liver weight.

Excess alcohol intake was once the primary cause of fatty liver. However, obesity is now well-known for the climbing rates of this form of chronic liver disorder. Interestingly, too, fatty liver can also occur in those considered to be lean and non-obese

When fatty liver occurs in the absence of alcohol, it is referred to as non-alcoholic fatty liver disease (NAFLD). This is a chronic liver disease that can progress to nonalcoholic steatohepatitis (NASH), which is an aggressive inflammation of the liver. 

Advanced liver conditions include liver cancer and cirrhosis, severe liver cell damage in which healthy liver tissue is replaced by scar tissue. This can block blood flow through the organ, reduce the function of the liver, and lead to liver failure.

When addressing the underlying cause, NAFLD can be reversed. Unlike NAFLD, cirrhosis leads to permanent liver damage and may require liver transplantation. This stresses the need to prevent such a devastating outcome, which may include rethinking the ketogenic diet.

Understanding Keto

A ketogenic diet, or simply keto, is a high-fat and low-carbohydrate diet. The goal of going keto is to put the body in a metabolic state of ketosis, in which the body produces ketones from body fat and uses them as energy. 

A standard keto diet uses a ratio of either three or four grams of fat for every one gram of carbohydrate and protein. This translates to about 75 to 80 percent of daily calories coming from fat and 50 grams or less of carbs per day. With such an increased need for fat, there is heavy use of whipping cream, butter, mayonnaise, oils, and high-fat meats.

Some research suggests the keto diet can lead to weight loss and other benefits. But other data has some major warnings, including fatty liver and kidney stones. 

Can Keto Cause Fatty Liver?

A study shows long-term maintenance on a ketogenic diet stimulates NAFLD development in mice. The link between ketogenic diets and insulin resistance in both humans and rodents continues to be brought to light. 

Besides, one of the critiques of going keto is the inability to sustain it long-term, which may lead to yo-yo dieting. "Strict diets are challenging to stick with, so people break it," states Dr. Caroline Cederquist, founder of bistroMD. 

"Since people think eating mostly fat is okay, they are left with a diet rich in saturated fat then add carbs and sugar. This combination is a potent fuel for fatty liver and weight gain in general."

Keto Diet for Fatty Liver Treatment

Interestingly, a ketogenic diet might be helpful in reversing fatty liver according to a 2020 study. Another 2020 study suggests a ketogenic diet may be beneficial, particularly when weight loss is established. 

A more recent 2021 study compared the effects of intermittent calorie restriction (the 5:2 diet) and a low-carb high-fat diet (LCHF) on the reduction of hepatic steatosis. While the LCHF and 5:2 diets were highly effective in treating NAFLD, the 5:2 diet reduced LDL and liver stiffness and was tolerated to a higher degree. All in all, the data suggests dietary advice can be tailored to meet individual preferences.

Taken together, weight loss accomplished with or without a ketogenic diet is a primary method to eliminate NAFLD. That being said, improving diet, exercise, and other lifestyle factors cannot be emphasized enough for nonalcoholic fatty liver disease treatment and management. These changes can help lower cholesterol, triglycerides, and blood sugars, too.

But it is vital to consult with a doctor before beginning any sort of diet, especially if managing a health condition such as fatty liver disease. The positive outcome Dr. Cederquist provided to a patient highlights the importance of seeking out professional assistance. 

"I have had at least one patient doing some sort of keto on his own with a severe case of fatty liver," states Dr. Cederquist. "It has largely resolved with our recommended controlled carb, lower-fat diet."

Is a Low-Carb Diet Best for Fatty Liver?

Research does suggest a low-carb diet can help manage fatty liver disease, although "low-carb" has many depictions. For instance, a keto diet often ranges between restricting carbohydrates to 20 to 50 grams per day, in which fat content dominates the remainder. A controlled carb diet, on the other hand, offers about 100 grams of carb from complex carb and fiber-rich sources.

"I have seen great results with improvement and resolution of fatty liver with a controlled carb diet while continuing to watch fat and ensuring adequate-protein," states Dr. Cederquist. Ideally, carb sources should be sourced from whole grains, fruits, veggies, beans, and legumes rich in fiber. Milk and dairy products also naturally contain carbohydrates and other beneficial nutrients.

Ultimately, keto or not, fat included in a balanced diet should ideally be from unsaturated fats. For instance, the Mediterranean diet is an eating pattern proven to lower the risks of metabolic syndrome, type 2 diabetes, and many other health risks. It is rich in healthy fat sources, including olive oil and fatty fish, other nutrient-rich plant-based sources, and lean meats.

BistroMD's Keto Flex program is a flexible dietary approach, offering similar weight loss benefits to the ketogenic diet without tight restrictions. The program is also customizable to meet individual needs and preferences, including the ability to order a full-week plan with unlimited dietitian support. 

Keto Diet and Fatty Liver Recap

Sustainable and healthy diet changes are key for maintaining weight loss, but exercise is as well. Health experts likewise recommend starting aerobic exercise and strength training to help improve fitness levels, symptoms of metabolic syndrome, and overall health. 

Overall, making healthy lifestyle changes and choices can lower risk factors tied to fatty liver and other health conditions. And before falling victim to any diet claim or fad diet, consult with a healthcare professional for safe assistance.

Sydney Lappe's Photo
Written By Sydney Lappe, MS, RDN. Published on October 28, 2019. Updated on June 20, 2022.

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