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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?

Despite its popularity, the keto diet raises potential health risks such as of the liver. Find out the emerging link between a keto diet and fatty liver disease here.

Can Keto Cause Fatty Liver Disease?

The keto diet continues to gain the interest of dieters primarily in hopes to lose weight. Alas, despite its popularity, going keto raises some potential health concerns.

One of the most recent risks involves the liver, which carries out over 500 processes to keep the body healthy. Of the hundreds, the liver helps break down fat, digest nutrients, and filter blood.

Perhaps the most fascinating fact about the liver is that it can regenerate completely. However, this is only as long as 25 percent of the tissue remains.

But does keto hurt your liver? Find out the emerging link between a keto diet and fatty liver disease here.

Does a Keto Diet Cause Fatty Liver Disease?

Fatty liver, clinically known as hepatic steatosis, is an excess of fat buildup 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 nonalcoholic 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.

Nonalcoholic fatty liver disease symptoms are commonly absent, though one may face fatigue or pain and discomfort in the right upper abdomen. NASH and cirrhosis, on the other hand, may cause the following:

• Abdominal swelling (ascites)

• Yellowing of the skin and eyes (jaundice)

• Enlarged spleen and blood vessels beneath the skin's surface

Because NAFLD often displays no symptoms, a diagnosis can be delayed and missed unless another liver problem is suspected. Detection of NAFLD may include:

• Complete blood count

• Liver enzyme and function tests

• Tests for chronic hepatitis

• Metabolic tests, including blood sugar and lipid tests

• Liver biopsy and imaging tests

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

What Is a Ketogenic Diet?

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 namely metabolic state of ketosis, in which the body produces ketones from body fat and uses them as energy.

Altering into the state of ketosis mostly limits access to glucose. With glucose absent in the bloodstream, insulin release is dramatically reduced and body fat releases and transfers fatty acids to the liver. This is where are they converted into ketones and used for primary fuel. The conversion of fatty acids to ketones is critical, as ketones are able to cross the blood-brain barrier and provide energy to the brain, unlike fatty acids.

A standard keto diet uses a ratio of either three of 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.

Keto & Non-Alcoholic Fatty Liver Disease

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.

One of the critiques of going keto is also 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.

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

Then, what is the best diet for fatty liver?

Fatty Liver Diet

Weight loss is likewise a primary method to eliminate NAFLD. But remember, those not considered overweight or obese are still at risk of fatty liver.

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 their own with a severe case of fatty liver," states Dr. Cederquist. "It has largely resolved with our recommended controlled carb, lower fat diet."

So, is a low-carb diet best for fatty liver?

There are various depictions of what a "low-carb" entails. For instance, a keto diet often ranges between 20 to 50 grams of carb, in which fat dominates the remainder. A controlled carb diet, on the other hand, offers about 100 grams of carb from complex carb and fiber-rich sources.

"All-in-all, I have seen great results with improvement and resolution of fatty liver with a controlled carb 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.

Comprehensively, the American Liver Foundation recommends the following diet tips:

• Limit high-calorie foods, including those rich in fat, sugar, and salt.

• Discuss alcohol intake with a doctor. If allowed alcohol, men should limit to no more than two drinks a day. Women should limit intake to one drink.

• Eat a balanced diet from a variety of nutritious food sources, including grains, fruits, veggies, lean proteins, and healthy fat sources.

• Increase fiber in the diet. Women and men should aim for 25 and 38 grams of fiber daily, respectively.

Drink more water to prevent dehydration. Black coffee, green tea, and other unsweetened beverages can count towards fluid needs as well.

Additional highlighted grocery tips to ensure healthy foods for fatty liver include:

1. Pick vegetables and fruits without high-calorie sauces or added salt and sugars.

2. Choose fiber-rich whole grains, including barley, oats, rice, and wheat.

3. Select poultry and fish without skin prepared in a healthy way, such as grilled or baked.

4. Opt for leaner cuts of meat, such as sirloin, instead of those high in fat like beef.

5. Eat fish at least twice a week, especially fish containing omega-3 fatty acids such as salmon, trout, and herring.

6. Choose low-fat milk, yogurt, cheese, and other dairy products.

7. Avoid foods with partially hydrogenated vegetable oils to reduce trans fat intake.

8. Limit saturated fat and trans fat by swapping with monounsaturated and polyunsaturated fats.

9. Cut back on beverages and foods with added sugars.

10. Choose foods with less sodium and prepare foods with little or no salt.

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, and other nutrient-rich plant-based sources and lean meats.

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.

General guidelines for physical activity include:

• Aim for 150 minutes of moderate-intensity aerobic exercise per week. Or, average at least 30 minutes of cardio most days of the week. Brisk walking, jogging, biking, rowing, and movement that increases heart rate is considered aerobic exercise.

• Include strength training at least two to three times weekly to support and increase muscle mass. Target all major muscle groups, including the chest, back, shoulders, arms, and legs.

• Add more activity throughout the day. This may include biking to work if possible and taking the stairs over the elevator. As a general rule of thumb, stand or be active for 10 minutes for every hour of sitting. Really, the utmost importance is not how one chooses to get active, just that they are.

Overall, making healthy lifestyle changes and choices can lower risks 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 October 28, 2019.


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