Is the Keto Diet Good for Fatty Liver Disease?

If you have been diagnosed with fatty liver disease (MASLD, formerly NAFLD) you are likely being bombarded with conflicting advice when it comes to what you should eat.

One camp screams that you need to cut all fats immediately, the other claims the Ketogenic diet, high in fats and ultra-low in carbs, is the magic bullet you’ve been waiting for.

The stakes are obviously high because fatty liver is reversible, but it requires the right nutritional approach. I know this because I’ve been there.

Since being diagnosed in 2014, I successfully reversed my condition and have spent over a decade analyzing what works and what doesn’t.

While the Keto diet has a massive following and undeniable weight loss benefits for some, the question remains: is it safe for a liver that is already compromised?

My short answer is no. While it might move the needle on the scale, the risks it poses to liver health are often glossed over. But to understand why, we need to look past the hype (and, let’s be honest, past our desire to eat all the delicious foods it allows us to).

Experts weight in on the Keto Diet and Fatty Liver Disease

The ketogenic diet works by massively limiting carbohydrate consumption. The goal is to force the body into a metabolic state called “ketosis.” In this state, your body stops relying on glucose (sugar) for fuel and starts burning fat to produce ketones.

On paper, this sounds perfect for us. A fatty liver is, literally, a liver full of fat. Burning that fat for fuel seems like the logical solution. And there are some studies showing that the Keto diet can reduce liver fat content rapidly.

However, the “rapid” part is where the problems begin. The liver is a sensitive organ, and it hates sudden shocks – especially now, when it’s already affected.

Not to mention the fact that entering ketosis isn’t as fun as some claim to be. Apart from potential inconveniences like bad breath, insomnia, and fatigue, we have more potential health problems that could result from it.

The UChicago Medicine website mentions additional risks, such as low blood pressure and increased chances of heart disease, nutrient deficiencies,s and kidney stones.

Additionally, the Harvard Medical School warns that following a Ketogenic diet could cause liver problems. The reasoning is that since the liver has so much fat to metabolize, it could make any existing liver conditions worse.

NEW Study: Just in! An article on Science Alert talks about a study from the University of Utah (made on mice): the research found that male mice on the keto diet developed fatty liver disease and showed impaired liver function.

And this is exactly what you don’t want to do. Sure – you might start losing weight early on, but the impact this insanely strict weight loss program has on your liver might not be easily seen.

After all, this diet is constantly ranked as one of the worst (usually THE worst) diets in the world…

The “Dirty Keto” Trap

Why is Keto so popular if there are risks? Because unlike most diets, it promises you can lose weight while eating foods that feel like “cheating.”

Unlike most diets out there, the ketogenic diet also seems easy to follow. Many people either promote it or believe it to be like eating bacon all day. And everybody loves bacon, right?

However, there is a massive difference between “Clean Keto” and what is popularly known as “Dirty Keto” which is usually the hyped one.

• Clean Keto focuses on avocados, olive oil, nuts, and fatty fish (unsaturated fats). This version might be beneficial for the liver in controlled settings.
• Dirty Keto is the version most people actually follow and it relies heavily on bacon, butter, heavy cream, and red meat (saturated fats).

In other words, being on the Keto diet doesn’t mean that you will be gobbling up pounds of bacon like there’s no tomorrow.

There are still strict guidelines that one should follow and even though the amounts of fat and protein are huge compared to a regular diet, there are still plenty of restrictions.

The reality of a proper ketogenic diet is strict, and you will be calculating macros extensively.

The Reality of the Restrictions

You can eat natural fatty foods like butter, oils, red meat, cheese, and eggs, but you are severely limited on vegetables and fruits due to their carb content.

The biggest challenge is consuming less than 50 grams of carbs per day (this was upped from the previous amount which was extremely restrictive – 20 grams).

To put that in perspective, take a single banana. Eating one results in consuming about 23 grams of carbs, which is almost half the amount you are allowed daily. This is still better than the past, when it was already over.

However, even those who don’t have a sweet tooth, even they will find it restrictive. You won’t just cut sugars you should cut anyway (cakes, candy, sodas), but also healthy fruits, vegetables and even cereal like apples, oranges, carrots, and oats to name just a few.

And judging by expert claims on the risks of nutrient deficiencies, it might be too dangerous for a body that needs vitamins to heal.

Keto diet and fatty liver: my opinion

As I mentioned, I’ve been researching fatty liver since 2014 (after going through it myself and reversing it), and my stance remains firm: a standard Keto diet is not the best path for reversing MASLD.

The main reason why I claim this is that you have to eat a LOT of fat when following this diet, ignoring fruits and many vegetables almost completely and, with them, the benefits and nutrients they provide our body.

If you follow the ketogenic diet, about 75% of your caloric intake should be from fat, which means that if you’re eating the average of 2,000 calories per day which is considered the norm nowadays for adults, you should be feeding your body with around 166 grams of fat each day.

That number is HUGE, keeping in mind that the recommended fat intake for a 2,000-calorie-per-day diet with a balanced meal plan is between 44 to 78 grams per day (source).

So when on Keto, you would be eating up to 3 times more fat than it’s recommended. And we’re not even taking the saturated fat into account (which is the unhealthy type of fat in most fatty foods).

A fatty liver is exactly what the name suggests: excess fat stored in liver cells. Feeding it massive amounts of dietary fat – especially if it’s the saturated kind found in butter and bacon – puts unnecessary pressure on the organ. You are asking the liver to work overtime to produce ketones while it is already inflamed and suffering.

Not to mention the fact that our bodies are not made to eat such small amounts of carbs. Yes, excess carbs and sugars are bad for your health and especially for the liver – but getting to the other extreme might be just as dangerous.

It is even more so if you are not used to dieting since you will basically not be allowed to eat anything sweet – not even in your coffee or tea and you’ll have almost zero options when it comes to satisfying your sweet tooth.

So for somebody who used to eat a lot of sweets – or even moderate amounts – following the ketogenic diet is extremely difficult and it has a greater chances of turning into dieting fatigue fast and resulting in you crashing and giving up, losing all progress, and doing more harm than good.

But even if you would follow the ideal recommendations and eat exactly what you should following the ketogenic diet… I still have my doubts that it would be good for a liver that is already under pressure.

This is an extreme diet that puts a lot of pressure on one’s body. Change is good and it is what you need to reverse fatty liver… but you need the right type of change.

I get plenty of negative feedback from Keto supporters for this stance, and they use to point their weight loss as a proof that it works. But our goal shouldn’t be just weight loss – it should be healing our liver AND learning to eat healthy on the long term. Reversing a fatty liver requires a permanent lifestyle change, not a temporary crash diet.

What alternatives do you have, then?

A balanced diet is what the majority of hepatologists (liver specialists) recommend. I personally reversed my fatty liver by following this slightly modified Mediterranean Diet.

The Mediterranean Diet consistently ranks as the #1 diet in the world by U.S. News & World Report, and for good reason.

It is high in healthy fats (olive oil, nuts, fish) which fight inflammation, but it also allows for complex carbohydrates like whole grains, fruits, and vegetables. These foods provide fiber, which is essential for binding to bile and removing toxins from the liver, as well as plenty of vitamins and mineral..

Other alternatives include the DASH diet or even the Paleo diet – both much better options than keto.

I know many people from our Fatty Liver Support group on Facebook who managed to reverse their fatty liver following the Mediterranean diet or versions of it, where balance is key – as well as nutrients coming from all sources, including meat, fat, fruits, and vegetables.

If You MUST Do Keto, Do It Safely

I would never personally follow a Keto diet because I consider it too extreme. However, if you are convinced this is the path for you, please do not jump in with both feet on day one.

But prepare your body for it first. If you have just been diagnosed with a fatty liver, you will have to greatly reduce your carb intake (and fat intake in my opinion), so just do that first and get used to reducing carbs to a minimum for a few months.

During this time, if you combine a balanced diet with exercise, you will lose a lot of weight and you’ll already start getting your liver healthy.

A healthier liver will handle the switch to the difficult keto diet better – and since you’re already used to eating fewer carbs than you would, it won’t be as difficult for you.

To further underline how difficult a keto diet is to follow, you can check this article in Reader’s Digest to see why most people FAIL to follow it.

Final words

I will always support the idea that balance and moderation are the keys to success so eating healthy, exercising, and balancing nutritious foods has a much better effect on our overall health.

Don’t take my word and all the evidence that I have linked to, though – do further research, but make sure that you do so from trustworthy websites or places that are backed up by medical data, not just forums or “people you know” where anecdotal evidence reigns supreme.

(Yes, I am exaggerating here, but you get the idea! Stay healthy and make sure you always make educated choices, after you research all the Pros and Cons).