Does Keto Hurt Your Liver?

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Written by Edibel Quintero, Medical Doctor and medically reviewed by Abby Courtenay

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Fatty liver disease was thought for many years to be solved by eliminating fats from the diet. 

Now, thanks to investigations we know that the cause of many metabolic diseases actually comes from the excessive consumption of carbohydrates.

For this reason, the relationship between the keto diet and liver disease has become an important focus of attention these days to understand how a high-fat regime can improve this condition.

Our livers are in charge of transforming the excess blood sugar into fat for later storage. You can imagine how much work it is for this organ to transform excess refined sugar into energy reserves when eating out of control. Some of this fat is stored in the liver, resulting in non-alcoholic fatty liver disease (NAFLD), or simply a “fatty liver” (NAFL).

This process is associated with insulin resistance, which results in a state of chronic inflammation that can affect not only the liver, but also the heart, increasing cardiovascular risk in people who are overweight.

 

About the effects of the keto diet on the liver

Since the ketogenic diet requires eating high amounts of fat-rich foods, is keto bad for the liver? Or, to be more specific,

Does keto cause fatty liver? 

No, in fact, the keto diet can improve this condition.

On keto, fatty acids are used as a source of energy and are constantly "burned," thus reducing the levels of the fat in the organ, compared to a conventional low-calorie diet in which fat is not burned as efficiently.1

It is important to note that the keto effects on the liver are positive as long as the diet is applied correctly, maintaining a caloric restriction that leads to weight loss. 

Hypercaloric diets2 (eating too many calories) prevents you from losing fat, including the fat around your stomach (visceral fat). Abdominal obesity can damage your liver.
 

What happens to the liver during ketosis?

Obesity is a metabolic disease associated with insulin resistance that interferes with glucose transport. Insulin resistance can lead to the development of nonalcoholic fatty liver disease (NAFLD). 

Can a low-carb diet slow down liver damage?

Fortunately, emerging research has shown that during low-carbohydrate, high-fat nutrition, as long as calories are restricted, it is possible to improve insulin resistance and decrease fat synthesis by this organ during ketosis.

In addition to insulin resistance, enzymes are another important indicator of the health of this organ.

Liver enzymes4 are proteins that enable different vital chemical reactions in the body. When elevated, they can be a sign of a medical condition including liver damage. 

Can the keto diet raise liver enzymes?

Fatty liver (and subsequently increased liver enzymes) is strongly associated with obesity. Because the keto diet can help you to lose weight, it can have the potential to lower liver enzymes in those suffering from NAFLD.

 

What is a keto liver detox?

This detox is a nutritional plan based on specific foods rich in healthy fats and fiber that help rid the body of toxins and accumulated fat. 

Although they are not well supported by science as there is no research to prove that they are useful, they are widely applied due to the immediate effects that users describe in their experience:

  •  Better digestion
  •  Reduced abdominal bloating
  •  More alertness and mental clarity
  •  More energy
  •  Increased metabolism

When you do a keto liver cleanse, you cut out processed foods and limit alcohol consumption. In general, this is a healthy move and gives this organ a well deserved break. 

 

Is keto good for fatty liver?

Yes, following a low-carb diet for fatty liver is a very wise idea because there is less substrate (glucose) to convert to fat.

This important detoxifying organ supports key functions such as blood sugar regulation, transport and synthesis of cholesterol, and food digestion.5 Therefore, going on a diet that aims to improve hepatic function has many benefits for your health.

Being on a keto diet means your body is burning fat for energy, this includes the fat in this organ.  

Of course, the keto diet for fatty liver (NAFL) should go hand in hand with a medical review by your doctor to identify your risk factors and the conditions that have led you to have this condition, if any, and to address them appropriately.

A keto diet may be a good solution for people with NAFL because it stops the "de novo lipogenesis,"6 a biochemical process that converts blood sugar into fats. By following a low-carbohydrate diet, fewer carbs are converted to fat in the liver and the fat begins to be burned off through ketosis for immediate use as energy.

 

What is the relationship between keto and liver damage?

Liver damage can occur for a number of reasons, including obesity and related disorders like type 2 diabetes, insulin resistance, and dyslipidemia, excessive alcohol consumption, and hepatitis infection.7

Obesity and its related disorders are a common cause of non-alcohol-related fat accumulation that can occur in this organ, a condition better known as nonalcoholic fatty liver disease (NAFLD). 

The keto diet can help address this as it can be an effective method to lose weight. When you make healthy choices on the keto diet, like choosing unsaturated fats over saturated ones and eating plenty of vegetables while limiting ultra-processed foods, then you can also address some of the obesity-related disorders and thus improve the health of your liver. 

 

Good fats promote healthy livers

A meal plan low in carbohydrates, high in fat, and with adequate calories according to your requirement does not provide sugars that can be converted into fat in this organ.

In addition, the introduction of healthy foods and the reduction of ultra-processed products supports detoxification, making it easier for unhealthy substances to leave your body.

If you have any form of liver disease, consult your health practitioner to get the necessary tests before you consider following the ketogenic diet so that you can enjoy its benefits without health risks.
 
 
References
 

  1. Efficacy of a 2-Month Very Low-Calorie Ketogenic Diet (VLCKD) Compared to a Standard Low-Calorie Diet in Reducing Visceral and Liver Fat Accumulation in Patients With Obesity. Randomized Controlled Trial Front Endocrinol (Lausanne). 2020 Sep 14;11:607. doi: 10.3389/fendo.2020.00607. eCollection 2020. https://pubmed.ncbi.nlm.nih.gov/33042004/#:~:text=Conclusion%3A%20Patients%20undergoing%20a%20VLCKD,for%20the%20treatment%20of%20NAFLD.
  2.  Nonalcoholic fatty liver disease is associated with excessive calorie intake rather than a distinctive dietary pattern. Malte H. Wehmeyer, MD, Birgit-Christiane Zyriax, MD, [...], and Johannes Kluwe, MD. Medicine (Baltimore). 2016 July; 95(28): e0916. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907683/#!po=2.77778
  3.  Dietary Fat and Carbohydrates Differentially Alter Insulin Sensitivity During Caloric Restriction. CLINICAL—ALIMENTARY TRACT| VOLUME 136, ISSUE 5, P1552-1560, MAY 01, 2009 
  4.  Cleveland Clinic. Elevated Liver Enzymes. https://my.clevelandclinic.org/health/symptoms/17679-elevated-liver-enzymes
  5.  Physiology, Liver. Kalra A, Yetiskul E, Wehrle CJ, et al. [Updated 2021 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK535438/
  6.  Hepatic de novo lipogenesis in normoinsulinemic and hyperinsulinemic subjects consuming high-fat, low-carbohydrate and low-fat, high-carbohydrate isoenergetic diets. Jean-Marc Schwarz, Peter Linfoot, Doris Dare, Karmen Aghajanian. The American Journal of Clinical Nutrition, Volume 77, Issue 1, January 2003, Pages 43–50, https://doi.org/10.1093/ajcn/77.1.43 https://academic.oup.com/ajcn/article/77/1/43/4689632?login=false
  7. National Health Service. Liver disease. https://www.nhs.uk/conditions/liver-disease/