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Can the keto diet cause fatty liver

Can the keto diet cause fatty liver

Table of Contents

To understand the question, Can the keto diet cause fatty liver? First, we have to go through the problem of fatty liver. We need to understand how fatty liver develops. In this article, I am going to explain the mechanism behind developing Non-Alcoholic Fatty Liver Disease (NAFLD).

What is Fatty Liver

A fatty liver is caused by excess fat accumulating in the liver. In medical terms, it is known as hepatic steatosis. In most cases, there are no symptoms, and it doesn’t pose a serious threat to the individuals involved. However, sometimes it can cause liver damage.

The extra calories we eat each day are stored as fat by the body. That is a very normal process. But if you store fat in the liver, the problem starts from there. The liver in our body is not supposed to store fat.

In the primary stages of NAFLD, the cells of the liver are being swollen up with stored fat. As it progresses to Non-Alcoholic Steato Hepatitis (NASH, which I will explain letter in the article) inflammation starts in the liver. This inflammation can completely destroy the liver. This liver damage is called cirrhosis.

Cirrhosis is a condition that occurs when the liver is damaged, scarred, or otherwise unable to function. It can result in an increased risk of cancer and other health problems. This can lead to a liver transplant as the only option.

The present situation

When the first case was recorded in 1980, little was known about this disease. Since 1980, it has evolved into an epidemic from an unknown disease.

Almost 30% of the United States population has fatty liver in different stages.

Look at the data from the United Kingdom. It shows hospitalization for fatty liver disease increased almost 10x from 1998 to 2010.

According to this chart, the number of liver transplants has doubled between 2007 and 2013.

  Now let’s talk about the importance of our liver 

Here are some reasons why the liver is important.

1) The most important function of the liver is to digest food. Bile produced by the liver assists digestion.

2) Produces proteins that are needed for the body

3) liver stores macronutrients like iron which is very important for the body.

4) we all know that the energy that we need comes from our food. The liver plays a very important role in converting nutrients into energy.

5) Liver makes immune factors that help the body fight infections. In addition, it helps to remove toxins and harmful bacteria from our blood.


Why fatty liver is a problem?

All the benefits of the liver can be affected by liver damage. Although fatty liver rarely results in liver damage, there is always the possibility of liver failure if left untreated.

Fatty livers come in two forms. 

Alcoholic liver disease

Heavy drinking causes alcoholic liver disease. People between the ages of 40 and 50 are more likely to have this disease. This form of the liver disease affects about 5% of Americans. 

Nonalcoholic fatty liver disease

People without a drinking problem can develop nonalcoholic fatty liver disease. US statistics show one in three adults and one in ten children suffer from this health problem. Despite ongoing research, the nonalcoholic fatty liver disease remains a mystery. However, research has proved that several factors can increase your risks, such as obesity and diabetes.

In this article, my main focus is on Nonalcoholic fatty liver disease


What is the main cause of Nonalcoholic fatty liver disease?

The main cause of fatty liver disease is the presence of too much fat in the liver. But how does the extra fat accumulate in the liver? Let’s find out

Normally, the liver can produce some amount of fat but the main sources of liver fat are

*Plasma Fatty Acids
*Food (Dietary)
*De Novolipogenesis (creation of new fat)

The difference between normal liver and NFDL

The difference between normal liver and Nonalcoholic fatty liver disease is that there is an increased level of fat that is produced by the process of De Novolipogenesis

What is De Novolipogenesis?

De Novolipogenesis is a process where the body transforms carbohydrates/sugar into fat.

Two kinds of simple sugar

There are two main molecules of simple sugar.

Glucose – The main sugar molecule that can be found in starches like bread rice potato flour

Fructose – fructose can be found in fruits, high fructose corn syrup

Fructose plays a very significant role in De Novolipogenesis. All the cells in the body can use glucose but fructose can only be metabolized by the liver.

All of the fructose in our diets is absorbed by the liver. Fructose turns into triglycerides in the liver. Then the liver exports the triglycerides in the bloodstream. When the liver gets more fructose than it can process, it accumulates the extra fat.

Glucose also works in a similar way. If you eat a high carbohydrate diet the extra glucose that you have will be turned into triglycerides, and some of them will be stored in the liver.


In a study conducted in 2012 individuals are overfed with carbohydrates. From the baseline, it increases the bodyweight-only by 2% when they are fed a lot of glucose and fructose.

fatty liver study

The interesting fact is although their bodyweight only increased by 2%, their liver increased by 27%. When it is measured how much De Novolipogenesis happened it is also increased by 27%. In the end, they lost all that liver fat when they stopped eating the high-starch diet.

When you eat a lot of glucose it will stimulate the production of a hormone called insulin. The hormone helps to store the extra energy to store as a form of fat,

The same effect can be seen in the case of overfeeding of fructose. Scientists found in a study that fructose overfeeding increased Triglycerides by 79 %.

fatty liver study

Clearly, the liver is responding to this huge amount of fructose by initiating De Novolipogenesis and converting the fructose into fat.


What are the stages of fatty liver disease

A variety of diseases fall into the category of nonalcoholic fatty liver disease based on severity.

stages of fatty liver

stage 1 steatosis.

This is the primary stage of fatty liver. In this stage the access fat starts to store in the liver cells.

stage 2 steatohepatitis.

The inflammation (swelling) in your liver damages its cells.

Stage 3 fibrosis

 Scar tissue forms in the inflamed part of the liver. 

Stage 4 Cirrhosis of the liver.

The extent of scar tissue affects the healthiness of the tissue.

 By replacing healthy liver tissue with hard scar tissue, the liver’s performance is slowed down. It can eventually prevent the liver from functioning at all. 


Mechanisms of Nonalcoholic fatty liver disease

The exact mechanism of Nonalcoholic Fatty Liver Disease is still unclear. What is clear is that insulin-resistant plays a significant role in developing Nonalcoholic Fatty Liver Disease (NFLD). 

Over time, insulin receptors on various tissues, including liver tissues become less responsive to insulin. Due to this, the liver gets into a mode in which it increases fat storage and reduces fatty acid oxidation. 

What is Steatosis?

The decreased fatty acid oxidation means decreased secretion of fatty acids into the bloodstream in the form of lipoprotein. It results in increased synthesis and uptake of free fatty acids from the blood. This process is called Steatosis.

The formation and growth of fat droplets in the liver are caused by steatosis. These fat droplets push the nucleus to the age of the cell.

A liver with widespread steatosis appears large, yellow, and greasy

Over time, the fat in hepatocytes becomes vulnerable to degradation.

This process damages the lipid membrane leading to mitochondrial dysfunction and eventually cell death. Cell death generates inflammation.

What is Non-alcoholic Steatohepatitis or NASH?

When inflammation and steatosis occur simultaneously, they are called steatohepatitis. In the absence of alcohol, this is called non-alcoholic Steatohepatitis or NASH.

It can be reversible up to steatohepatitis. But it is not the case when fibrosis and cirrhosis occur.

Symptoms of fatty liver

 The individual might not show any symptoms of fatty liver disease even when it is at an advanced stage 

For some individuals, there are some vague symptoms like fatigue or malaise

Once there is significant liver damage though there could be some clear symptoms like hepatomegaly (enlargement of the liver), pain, jaundice, etc.


How to reverse fatty liver

We have seen how this fat is created and stored in the liver. So it should be very clear how to reverse Fatty liver diseases.

As I have discussed in this article, fatty liver is caused by the consumption of too much glucose and fructose.

The simple solution is to restrict glucose and fructose intake. Recent research has also shown us evidence that the restriction of carbohydrates can reverse the fatty liver.

Studies on Fatty liver

Let’s talk about the study that was published in 2019. It was conducted on teenagers with fatty livers. Researchers divided them into two groups. One group was fed a normal diet. Other groups were given a very low sugar diet (less than 3% of calories).

The result was amazing. Look at the chart below the dotted line is the amount of fat in the liver prior to the diet and the circle is how much liver fat there was after following this low sugar diet.

2019 study on fatty liver

On average the liver fat decreased from 25% to 17%. You can see above that most of the circles drop below the original line. We don’t see much change in the usual diet. On a normal diet, it came down to only 20% from 21%.


Another recent study from 2021 randomized people to three types of diet.
-Standard diet
-Low carb high-fat diet

2019 studies on fatty liver

Both the fasting and low carb diet show great results in weight loss compared to the usual diet. More interestingly the fasting and low carb group reduced the amount of fat in the liver by over 50%.

Please feel free to read the two studies that I have mentioned here.

It is very simple if the fat in the liver is caused by too much sugar (glucose and fructose) It would be very logical to say if we cut down our sugar intake it will naturally reverse the fatty liver.

So by following Low carb high-fat diet like the keto diet or doing intermittent fasting we can easily reverse fatty liver disease.


What is keto diet?

In keto diet the intake of  carbohydrate is restricted .

We get our energy from food in the form of carbohydrates. The metabolic process of ketosis allows the body’s cells to use an alternative fuel source when low in carbohydrates. If the body does not get carbohydrates for energy, it will get them from another source.

That is ketones and This process is called ketosis. This process is our body’s automatic survival mechanism when it goes under stress.

In the keto diet, we deliberately deprive our bodies of glucose, which we get from carbohydrates. In this situation, our body gets its energy from ketones that come from our body’s fat cells. So, the keto diet is a great way to lose extra pounds in our bodies.


Relation between fatty liver and keto diet

As we understand, keto is not just a diet. It is a very effective fat-burning way of life.


Can the keto diet cause fatty liver

Many studies have been conducted worldwide, but no research has proved that the keto diet caused fatty liver. On the contrary, most of the studies suggested that the keto diet helps to reduce fatty liver. So if you are concerned about fatty liver,

People make a lot of mistakes while doing the keto diet. Keto diets, if not done correctly, can lead to many health problems.

Most people misunderstand the concept of the keto diet. Often they link fatty liver with the keto diet. 

Because of its high-fat content, people are generally afraid of the ketogenic diet because they believe it will harm their liver. However, they don’t know what causes fatty liver.


The Fatty Liver and the keto diet

The fatty liver is also called steatosis. Triglycerides and extra fat develop fatty tissue, which results in liver inflammation.

When you have more fat than your liver can metabolize, it stores in the liver, and it causes a fatty liver. When we consume way too many carbohydrates, it goes through a process known as de novo lipogenesis. In this process, the carbohydrate turns into fat.

If we eat high fructose corn syrup or fructose in access, the liver can’t handle the pressure. And it stores all the things in the liver as fat. Over time, it develops into the non-alcoholic fatty liver.

The keto diet helps to improve non-alcoholic fatty liver disease.

When we reduce sugar consumption, the liver can control the fat it stores in the liver. With weight loss, fatty livers usually shrink in size.

There are two different components to a fatty liver: five components and an inflammatory component.

When we have excess fat around the liver, those fat cells become inflamed. As a result, these fat cells can contribute to a more significant, larger, fatty liver.

Low carb diets are proven to help you lose weight while decreasing the size of your fatty liver.

In general, a ketogenic diet or low-carb diet decreases intrahepatic triglycerides.

Triglycerides are the main components of free fatty acids. Our bodies use free fatty acids as fuel. Fatty acids circulate through the bloodstream and use it for energy.

But if we have too many triglycerides in our body, it will store extra fat in the liver. In a keto or low carb diet, Triglycerides are not available In excess. So the liver is much healthier.

In recent times A study published in the Journal of Digestive Disease and Science. It looked at five people who had a fatty liver. These five people took the keto diet for six months.

They found that four out of five participants had histologic improvements in their fatty liver. That means the fatty liver decreased by 60% or more.

You have a lower insulin level and are more insulin sensitive when on a low carbohydrate or ketogenic diet.

 It means less glucose contributes to fatty livers and fewer chances of getting fatty livers before they occur.

De novo lipogenesis, a process caused by excess fructose consumption and channeled through the liver, generally causes non-alcoholic fatty liver disease.






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