Your liver is one of the largest organs in your body. It sits under your ribcage on the right side of your abdomen, and it is essential to your normal functioning. It’s always working, like your heart and your brain. Though it’s essential for your wellbeing, it doesn’t usually make a fuss. In fact, most people don’t know what their liver does or how it works; that’s how efficient and self-sufficient it tends to be. Unfortunately, many Americans unknowingly harm their livers with excessive alcohol and poor diet and lifestyle choices, which can lead to a variety of medical conditions, including liver cancer, fatty liver disease, and cirrhosis (liver scarring). Consequently, it’s important to know whether your diet is helping or hindering this important organ.
So is the keto diet safe for the liver? Does it affect the liver for better or for worse? Will eating a high-fat, low-carb diet cause fatty liver disease? The answer is good news: a ketogenic diet may keep this hard-working organ healthy and even possibly prevent or reverse certain liver conditions.
What Does Your Liver Do?
Your liver helps to:
- Detoxify your blood. Your liver processes and alters toxins and excess hormones, then it sends them back into the blood, bowel, or urine for elimination.
- Regulate blood sugar. You can store 100 grams of glucose (about 375 calories worth) in your liver as glycogen. If your blood sugar levels spike, your liver keeps that glycogen for later. Blood sugar levels too low? Your liver breaks down glycogen to release more sugar into your blood.
- Digest food for energy. Your liver metabolizes amino acids and produces bile for the breakdown and absorption of fats in your diet. It’s even involved in lipolysis, or the process of using your stored fat for energy.
- Store minerals and vitamins. Your liver stores vitamins A, D, E, K, and B12, and the minerals iron and copper. It releases them into your blood when you’re running low on them and need them.
How Can You Tell if Your Liver Is Unhealthy?
With the liver, no news is good news; it’s when things go awry that your liver may call attention to itself. Signs of poor liver function can be hard to identify but include:
- Jaundice (when your skin and eyes appear yellowish)
- Abdominal pain and swelling
- Swelling in your legs and ankles
- Dark urine
- Pale stool color; bloody or tar-colored stool
- Loss of appetite and nausea
- Itchy skin
- Bruising easily
If you notice these symptoms, consult your primary care physician as soon as possible. Medical tests for elevated liver enzymes and other biomarkers can gauge your liver’s health.
Unhealthy Liver Conditions
Liver conditions include liver cancer, hepatitis A, B, and C, and fatty liver disease. Not all of them are influenced by diet and lifestyle. But they all may lead to cirrhosis of the liver, which is when your liver becomes so scarred from damage that basic liver function becomes impaired. The most pressing liver condition these days is fatty liver disease.
What Causes Fatty Liver Disease?
Fatty liver disease is what it sounds like: When the fat stored in your liver becomes more than five to 10 percent of your liver’s weight, you have one of two types of fatty liver disease:
- Alcoholic fatty liver disease occurs from years of chronic alcohol abuse.
- Non-alcoholic fatty liver disease (NAFLD) happens when your liver builds up excess fat not related to alcohol abuse. NAFLD affects 30 to 40 percent of adult Americans. A NAFLD condition could get worse and become non-alcoholic steatohepatitis (NASH). NASH causes liver inflammation, scarring, and increases risks of cirrhosis and liver cancer.
What causes non-alcoholic fatty liver disease? Scientists know metabolic syndrome and insulin resistance are almost universal findings in NAFLD. Metabolic syndrome is a cluster of conditions related to obesity, heart disease, and type 2 diabetes. People with NAFLD also typically have insulin resistance. When you’re insulin resistant, your body stores fat in your liver when your sugar levels get too high.. This is more dangerous than storing excess fat elsewhere, like your hips or thighs, for example.
Researchers believe the most significant causes of non-alcoholic fatty liver disease are:
- Lack of exercise
- Your gut bacteria
- Overeating sugar, especially high-fructose corn syrup
While you can’t do anything about your genetics, you can do something about your diet and lifestyle. NAFLD is not only preventable, but it’s also reversible, and one of the best solutions to help reverse the condition may be a ketogenic diet.
Is the Keto Diet Safe for the Liver?
A ketogenic diet switches your body from running on glucose for energy to running on fat. Getting in ketosis takes a strict daily diet that includes high levels of healthy fats and a carb intake limit of no more than 20 grams of carbohydrates per day. When you’re in the state of ketosis, your liver then produces ketone bodies for fuel from your stored fat and from fat in your diet.
But does eating more fat cause fat to accumulate in your liver? Science says no. The majority of fat in fatty liver disease results from de novo lipogenesis (DNL), which is when your body creates excess fat from having too many carbs in your system. In other words, the less carbs you eat, the less likely you are to get fatty liver disease from your diet.
High-carb diets promote weight gain, decrease insulin sensitivity, and lead to metabolic syndrome and NAFLD. A low-carb diet has the opposite effect. While research is still emerging, studies show few downsides to the liver from a keto diet and many positives:
- Participants with NAFLD following a keto diet for six months lost an average of 28 pounds. They also improved markers related to fatty liver disease.
- Healthy participants following a low-carb diet for 10 days saw significant decreases in liver fat and weight, some in just three days.
- When obese participants with NAFLD followed a keto diet for two weeks, they lost over four percent of their body weight and reduced liver triglycerides by 42 percent.
How to Support Your Liver on Keto
If you want to try keto, follow these simple diet and lifestyle changes to keep your liver running like a champ:
1. Eat to Your Macros
Eating to stay in ketosis ensures you get enough fat and don’t eat too many carbohydrates; a high-fat diet that is also high in carbohydrates strains your liver. Once you know and eat to your optimal macros (macronutrients), you can find your sweet spot for fat consumption by measuring your ketones frequently to see how your blood sugar and ketone levels react and adjust your diet to stay in ketosis while minimizing your fat intake. Aim for ketones between 1.0 mmol/L and 3.0 mmol/L.
Consider supplementing your diet with medium-chain triglycerides (MCTs) and MCT oil extracted from coconut oil. Since MCT oil is absorbed quickly, it’s easily digested and used by your brain and body for fuel. Your liver can kick back for a minute.
2. Exercise More
Skipping your workouts can lead to NAFLD; exercise may prevent and reverse it. Your daily sweat session attacks liver fat to prevent or clear a buildup. A mere 15 percent reduction in BMI (Body Mass Index) from exercise helped type 2 diabetics with NAFLD improve their liver condition and insulin resistance.
3. Eat Liver-Supporting Keto Foods
The essential nutrient choline helps remove fat from your liver so you can either use it for energy or store it somewhere less dangerous. Animal products, such as eggs, meat, and cheese, are especially high in choline.
Fill your diet with other low-carb foods that may reduce liver fat, inflammation, and your risk of NAFLD. Reach for omega-3-rich foods (such as fatty fish and nuts), green tea, and coffee.
4. Try Supplements to Support Your Liver
Supplements that specifically help with fat digestion may also help your liver, such as:
- Digestive enzymes: You can find keto-specific digestive enzymes, which contain pancreatin, an enzyme that helps break down fats and better absorb fat-soluble vitamins A, D, E, and K. Check with your primary care provider to find out which type is right for you.
- Bile salts: Bile salts help your body better absorb fat-soluble vitamins. They also thin bile produced by the liver so it works more efficiently. Bile salts with enzymes lipase and amylase help break down and emulsify fat for easy digestion.
- Whey protein: One study showed obese women decreased their liver fat after supplementing with whey protein daily for four weeks.
The Final Word
A keto diet does not cause non-alcoholic fatty liver disease. You may be able to prevent non-alcoholic fatty liver disease (NAFLD) on a ketogenic diet, and people with NAFLD may see significant improvements. Speak with your doctor before making the switch. Regardless, a diet low in carbs and high in exercise at least three times a week can help to keep your liver healthy.