Ketosis and Fatty Liver
Ketosis and Fatty Liver
Fatty liver is usually associated with alcohol
abuse, but even people who don’t drink can
develop nonalcoholic fatty liver disease,
NAFLD includes asymptomatic steatosis, meaning
simple fatty liver, which can progress to
steatohepatitis, meaning inflamed fatty liver.
Later, the disease can cause fibrosis, or
scarring, and ultimately cirrhosis, which
Alcoholic fatty liver can only be treated
by abstaining from alcohol in the early stages
of the disease.
But, because NAFLD is likely diet-related,
it might be reversible by substantially reducing
carbohydrate intake by means of a ketogenic
NAFLD is associated with obesity — especially
abdominal, insulin resistance, elevated blood
sugar, inflammation and high serum triglycerides.
These are all signs of metabolic syndrome,
considered the precurser to Type 2 diabetes.
When the body cannot use sugar properly, some
of it is converted to fat — triglycerides
— by the liver, where it can accumulate.
The Ketogenic Diet
The ketogenic diet is a high-protein, high-fat,
carbohydrate-restricted diet usually used
for weight loss.
Reducing or eliminating dietary carbohydrate
forces the body to rely on stored fat for
However, the body metabolizes fat differently
in the absence of carbohydrates, resulting
in a condition called ketosis.
Incompletely metabolized fat forms molecules
called ketones, which accumulate in the blood
Ketones have limited value as an energy source
in the absence of carbohydrate, mainly for
the brain, but most are excreted in the urine
Effects of Ketosis on Fatty Liver
Ketosis by itself does not reverse NAFLD.
It is most likely the dietary carbohydrate
restriction that has the potential to reduce
the synthesis of fat by the liver.
One of the first studies of the ketogenic
diet’s effect on NAFLD, conducted at Duke
University in 2007, reported that the carbohydrate
depletion seems to reverse or slow the progression
There might be other mechanisms at work as
For example, some research has looked at the
vitaminlike nutrient choline for its role
in preventing fatty liver.
Choline is abundant in meat and other animal
proteins, which is the mainstay of the ketogenic
The ketogenic diet is generally not suitable
for a very long duration.
It can promote uric acid accumulation in the
tissues, osteoporosis, mineral imbalances,
nutrient deficiencies and muscle protein loss
Another side effect is a fruity odor of acetone
on the breath, as this is one route the body
uses to excrete ketones.
However, fatty liver disease is potentially
very serious if it is allowed to progress
and should be addressed.
A trial ketogenic diet under medical supervision,
combined with lifestyle changes that can be
maintained in the long run, might be an effective
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