- Fatty Liver Disease develops when fat accumulates in the liver, causing inflammation and dysfunction.
- The two types of Fatty Liver Disease are alcoholic Fatty Liver Disease (caused by excess alcohol use) and nonalcoholic Fatty Liver Disease (caused by many factors unrelated to alcohol).
- Weight loss is the main treatment for nonalcoholic Fatty Liver Disease, but restoring insulin sensitivity by following a low carbohydrate diet like the keto diet may also offer treatment.
What is Fatty Liver Disease?
Fatty Liver Disease is often described as a “silent killer,” meaning patients rarely show early symptoms. Late symptoms of Fatty Liver Disease include fatigue and pain in the upper right side of your abdomen.
When fat builds up in your liver, Fatty Liver Disease can develop. Fatty Liver Disease is broken down into two types: alcoholic Fatty Liver Disease and nonalcoholic Fatty Liver Disease (NAFLD).
Alcoholic Fatty Liver Disease is caused by excessive alcohol use, which causes cellular damage. Over time, alcohol irritates the liver lining, causing inflammation. This inflammation and irritation can lead to liver dysfunction and elevated liver enzymes.
NAFLD is more complex because many factors can contribute to its development. While researchers are still trying to understand it, obesity is the largest associated risk factor. Others include:
- Type 2 diabetes
- Being middle-aged (in your 40s or 50s) or older
- High cholesterol
- High blood pressure
- Metabolic syndrome
- Hepatitis C
- Hispanic or non-Hispanic white ethnicities
These risk factors can promote fat collection and storage in the liver. Sometimes, excess fat in the liver causes inflammation, leading to a more aggressive form of NAFLD called nonalcoholic steatohepatitis (NASH).
Variceal bleeding, which causes bleeding into the GI system, is another complication. Abdominal swelling (ascites) and brain swelling (encephalopathy) can also occur when fatty liver is not identified or treated.
How to detect Fatty Liver Disease.
Since Fatty Liver Disease doesn’t usually show early symptoms, detecting it early is key. With early detection, treatment can begin sooner, and more severe symptoms may be avoided.
For those at risk of alcoholic or non-alcoholic Fatty Liver Disease, a routine full-body scan can be beneficial. At Ezra, a full-body scan looks at up to 13 organs, including the liver.
Fatty Liver Disease treatment.
Once someone reduces or stops their alcohol use, alcoholic Fatty Liver Disease can often be reversed. However, for the most common treatment recommendation for NAFLD is weight loss.
Weight loss can reduce the amount of fat in the liver, lower inflammation, and reduce scarring (or fibrosis) in the liver. By losing even as little as 3-5% of body weight, the signs and symptoms of NAFLD can be reduced and even reversed.
Weight loss techniques can look different depending on a person’s genetics, abilities, and preferences. Sometimes, simply reducing calorie intake isn’t enough or isn’t sustainable long term. This has led to exploring different dietary avenues to reduce fat in the liver.
The keto diet.
More research shows that the keto diet can not only assist in weight loss, but that it can also help prevent Fatty Liver Disease and reverse fatty liver damage. But before we discuss why a keto diet can help with Fatty Liver Disease, let’s review what it is.
The ketogenic diet consists of a very low carbohydrate diet, typically between 5-10% of total calories for the day. The most common type of keto diet consists of a high fat intake and low carbohydrate intake diet with an unrestricted total calorie intake. Tracking macronutrient levels are key to the keto diet.
The goal of the keto diet is to achieve ketosis, or ketogenesis. Ketogenesis happens when your body uses fat instead of carbohydrates for energy. During ketogenesis, ketone bodies are formed — these are water-soluble molecules produced by the liver from fatty acids.
Ketone bodies assist with weight loss thanks to their ability to induce satiety – or the sensation of fullness. This can lead to eating smaller portions without feeling hungry. Additional benefits of the keto diet include a reduction in triglycerides, abdominal fat, and risk for Metabolic Syndrome.
As you work towards ketosis by reducing your carb intake, you will eat more foods that have a low-glycemic index like vegetables and certain fruits. These foods have less of an impact on your blood glucose levels than high-glycemic foods. A diet rich in low-glycemic index foods helps reduce insulin resistance and keep a steady blood sugar level.
Keto and fatty liver.
Keto doesn’t only offer weight loss and insulin level improvement to combat fatty liver. The diet also reduces lipogenesis. Lipogenesis is the process of converting carbohydrates into fatty acids, thus turning them into fat. This fat tends to end up in tissue around the midsection and the liver. So by reducing the fat conversion process, less fat may be stored in the liver.
Not only does a low-carb diet reduce insulin levels and lipogenesis — it can increase the rate fatty acids are broken down, or their oxidation rate. Reducing oxidative stress helps reduce inflammation and irritation in the liver.
What does the research say about keto and fatty liver?
It may seem counterintuitive to eat a high-fat diet to manage fatty liver. But more research highlights the beneficial effects of a high-fat, low-carbohydrate diet on Fatty Liver Disease.
A 2018 study evaluated the effects of carbohydrate-restricted induced ketosis in 262 obese or overweight patients. After one year, participants had improved their blood sugar parameters, reduced their cardiovascular risk factors, and reduced the need for medications to manage high blood pressure and diabetes. Liver enzymes (ALT) used to measure liver health also improved in this trial.
Participants also had sustained weight loss during this trial. Another noteworthy result was a reduction in the diabetes lab test HbA1c, which related to improved liver enzyme levels regardless of weight loss. This highlights the role insulin sensitivity and blood glucose management can play in reducing the risk and worsening of fatty liver.
A 2020 meta-analysis of 154 articles reviewed the benefits of the keto diet on Fatty Liver Disease. The authors concluded, in addition to caloric restriction, macronutrient distribution also plays a role in NAFLD treatment.
That means high-fat keto diets had a greater and faster impact on liver fat content than only restricting carbohydrates. The meta-analysis also notes the role ketosis plays in liver fat reduction due to fatty acid oxidation.
Detect Fatty Liver Disease early with Ezra full-body scan.
Since fatty liver is a silent disease in its early stages, it can easily be missed without proper surveillance. Lab tests evaluating liver enzymes, including ALT and AST, can help identify fatty liver, but only after damage to liver health and function has begun. A liver biopsy is another way to determine if someone has Fatty Liver Disease, but it is invasive and carries risks such as bleeding and infection.
The keto and fatty liver connection continues to be explored by researchers, but it’s encouraging to know there are ways to evaluate liver function on an ongoing basis. The Ezra full-body scans up to 13 organs, including the liver. A medical professional’s interpretation of the scan results can help evaluate liver function and spot abnormalities.