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Why a Low-Carb, High-Fat Approach Might Help Fatty Liver Disease (NAFLD)

Confused about what you can and can’t eat when you’re living with nonalcoholic fatty liver disease? Trying the keto diet just might be the best move for your health.

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It’s easy to think of your liver as a powerhouse organ that can handle anything. But without even realizing it, you can develop fat in and around your liver, leaving you living with a condition called nonalcoholic fatty liver disease (NAFLD). While NAFLD is surprisingly common – it’s one of the most common liver diseases – it isn’t exactly easy to treat.

Currently, the first line of treatment for NAFLD is losing weight. While weight loss is a common goal, typical weight loss approaches might not work so well for those with NAFLD. You want to make sure you’re eating foods that are good for your liver and your weight. And not every diet or approach is necessarily the best for improved liver health. 

Often, the Mediterranean diet is recommended because it’s great for overall health, helping to combat inflammation and promote weight loss, all of which are key for fighting fatty liver disease. New research links keto diets to speeding up weight loss and, in turn, improving NAFLD. Our dietitian weighs in on how to do keto right for better liver health 

Low-carb, high-fat diets have great potential for fatty liver

A research study published in June 2021 examined the impact of different eating approaches on individuals with nonalcoholic fatty liver disease. Over the course of 12 weeks, researchers examined 74 patients, randomly assigning each a 12-week NAFLD treatment program with one of three approaches: a low-carb, high-fat diet, a 5:2 intermittent fasting diet, or general healthy lifestyle advice and suggestions from a hepatologist. 

By the study’s end, researchers noted a higher reduction in steatosis (abnormal fat retention in the liver) and overall body weight in those who followed the low-carb, high-fat diet. Compared to the typical NAFLD lifestyle recommendations given by a hepatologist, a low-carb, high-fat diet offered more promise and potential.

While those who followed the recommendations of a hepatologist focused primarily on eating a healthy diet and controlling calorie intake, those on the low-carb, high-fat diet saw significant decreases in liver fat. That diet also proved more effective in reducing body weight, helping participants shed more extra pounds. On average, the low-carb, high-fat diet led to a 7.3 kilogram weight loss; those who stuck with the hepatologist-advised approach lost just 2.5 kilograms.

In addition to the liver health benefits of the low-carb, high-fat diet, researchers also saw healthy improvements in participants who tried the 5:2 intermittent fasting approach. Those who gave the 5:2 diet a try saw improvements to their cholesterol levels and less liver stiffness, and they lost an average of 7.4 kilograms each. So, there may even be potential benefits to going low-carb, high-fat and trying intermittent fasting at the same time (though it’s important to note the researchers didn’t study this combination of approaches).

Isn’t low-carb, high-fat the same as the keto diet?

If you’re wondering why the low-carb, high-fat diet tested in this research study sounds familiar, that’s because it’s pretty popular. It’s a version of the keto diet, just with a different name.

Just like the diet approach mentioned in the above study, the ketogenic diet is all about slashing carbs and upping fat intake. And while it might sound completely counterintuitive to eat more fat when you’re dealing with a fatty liver disease, this isn’t the first research to support the idea that a keto-like approach to your diet can have a positive effect on your liver.

A research review published in August 2020 took a look at the benefits of a ketogenic diet in individuals with nonalcoholic fatty liver disease. While there’s been hesitancy about a fat-rich diet, the authors of this review noted that ketone bodies were a potential boon for inflammation – one of the key concerns for those with NAFLD. It’s hypothesized that a keto approach can help NAFLD patients lose weight, reduce inflammation and potentially offer additional benefits through ketosis. And it’s thought that the low-carb component of a keto diet may be what has the biggest impact.

While more in-depth research is needed, a keto diet could help you target two of the most critical factors in developing fatty liver: inflammation and being overweight. But is a high-fat diet really a good idea for people who are dealing with fat buildup in the liver?

Our expert weighs in

We spoke with Jessie Shafer, RD, registered dietitian at The Real Food Dietitians, about keeping fat – and nonalcoholic fatty liver disease – in mind when trying a keto diet. “It is natural to think that you should avoid fat if you’ve been diagnosed with fatty liver disease,” Jessie said. “But all people, including people with fatty liver disease, need to eat fat for many beneficial reasons, including absorption of key vitamins, supplying energy, building immunity, and protection of nerves and cells.”

When you’re picking out high-fat foods, Jessie recommends making sure you eat the right types of fat: “Not all fats are created equal, and someone with compromised liver health needs to especially pay attention to the types of fats they are eating. The best thing to do is to swap out trans fats and highly processed oils in favor of plant-based fats (think avocado, coconut and olives) and animal-based fats that contribute beneficial omega-3 fatty acids (think fatty fish and grass-fed beef).”

And if you’re ready to give a keto diet a try, it’s important to keep in mind that NAFLD can make this eating approach more challenging. As Shafer explains, “What people with fatty liver should know is that, while diets like keto can be done (studies have lasted from 6 days to 6 months) and can show benefits, they are also quite intense and restrictive. If you were to ‘slip’ one day and eat more carbohydrates, then your body is not in ketosis anymore.” 

So, if you are going this route, it’s important to follow the keto approach closely. In order to better your overall health – and your liver health – you’ll find success if you make every meal and snack keto-approved, with liver-friendly plant- and animal-based fats. 

And we’ve got recipes that offer exactly what you need. Try these keto-approved breakfast recipes that’ll help you start the day with the low-carb, high-fat approach that can benefit fatty liver disease.

Cauliflower Hash Browns with Low-Carb Ketchup

Cauliflower hash browns with low-carb ketchup
Photo: Rachel Korinek

We’ve made this classic breakfast dish healthier, and lower in carbs, thanks to a versatile cruciferous vegetable. Get the recipe here.

Keto Sheet Pan Breakfast

keto sheet pan breakfast
Photo: Rachel Korinek

A bag of packaged slaw makes an easy cheat in this low-carb roasted vegetable sheet pan topped with hearty bacon and eggs. Get the recipe here.

Keto Breakfast Pizza

Keto Breakfast Pizza
Photo: Rachel Korinek

We’ve all eaten breakfast for dinner, but this pizza serves up dinner for breakfast – and you’re going to love every bite. Get the recipe here.

Keep reading to learn how to feed your liver with a low-carb, high-fat diet or other approaches that have been shown beneficial for fatty liver disease: