Ketogenic Diet and Fatty Liver - A Solution or a Problem

Nonalcoholic fatty liver disease is a major cause of chronic liver disease, characterized by the accumulation of fat in the liver and the possible development of inflammation, fibrosis, and cancer.

The ketogenic diet, with its drastic reduction in carbohydrates, is an eating method used for weight loss, and has raised safety concerns about a possible association with fatty liver.

However, ketogenic diets have also been reported to be beneficial in certain liver pathologies, where ketone bodies can act as effective modulators of inflammation and fibrosis. (1)

This brings us to the question: Is the ketogenic diet good or bad for fatty liver? Read on for the evidence-backed answer.

RELATED: Fatty Liver Diet

Is the keto diet good for fatty liver?

The keto diet could have a positive impact on fatty liver disease. This is as long as it is high in healthy fats, and low in calories.

Although it may seem logical that eating more fat makes you and your liver fatter, our bodies are much more complex than that.

Evidence shows that too many carbohydrates in our diets are probably the main culprits for fatty liver by causing insulin resistance . (2.3)

Insulin resistance is a metabolic condition in which your cells do not respond to insulin as they should.

This causes a high level of glucose in the blood , which the body manages by sending it to the liver. This excess glucose is transformed into fat and this is where fatty liver appears.

In sum, when most of the carbohydrates in your diet are refined, sugar, glucose, fructose, flour rather than starch and fiber, your chances of developing insulin resistance and fatty liver are greatly increased.

In the ketogenic diet, these carbohydrate foods are replaced by fats, which can reduce and in some cases even reverse insulin resistance and help fatty liver.

Also, while it’s not entirely clear yet whether ketosis plays an additional role. Several mechanisms have been proposed between ketosis and fatty liver enhancement, for example the production of intermediates that promote triglyceride oxidation . (4) Clarifying these aspects is a potential target for researchers.

Can Following A Ketogenic Diet Cause Fatty Liver?

The short answer is no.

There is no evidence that a ketogenic diet inevitably leads to a fatty liver, even though it is notoriously high in fat.

In fact, a recently published comprehensive review on the subject concluded that virtually all studies found that low-carb and ketogenic diets led to improvements in liver fat content. (2)

That is, the common belief that increasing dietary fat intake leads to fatty liver and prevents fat loss has been proven to be wrong.

In contrast, a keto diet high in calories, bad fats, and low in certain nutrients could have negative impacts on the liver.

On the one hand, any excess of macronutrients and calories leads to increased body fat, which increases that and worsens insulin resistance.

On the other hand, when it comes to the type of fat that is worst for liver health, saturated and trans fats are problematic, while unsaturated fats – healthy oils improve metabolic and liver health.

Animal studies also show that deficiencies in two essential nutrients , choline and methionine, may be behind fatty liver (5). Both are found in eggs, fish, nuts, and seeds, and are essential for health.


While it may seem counterintuitive, the keto diet can reverse fatty liver, not cause it.

It is considered that the main cause of fatty liver disease is insulin resistance, this is the result of a poor diet, high in sugars and a sedentary lifestyle.

When it comes to fat intake, eating too much can also be bad. But, in a context of a keto diet low in calories and good fats it would not be a problem,

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