Non-alcoholic fatty liver disease (NAFLD) affects a whopping 22% of the US population and as many as 30% of Europeans. If NAFLD is caught early (before the progression to liver inflammation and fibrosis), the risk of progression to cirrhosis is 1-2%. However, 10-15% of patients who have already demonstrated liver inflammation and fibrosis (non-alcoholic steatohepatitis or NASH) will progress to cirrhosis within 8 years, and some even progress to hepatic cancer.
Dr. Adam S. Nally, an obesity medicine specialist and one of the leading voices in the keto community, explains; “when I started seeing this disease in my practice 15 years ago, one out of ten would have mild elevation of liver enzymes (elevated AST and/or ALT levels) in a routine physical exam. An ultrasound of the liver would return results of “fatty liver infiltration” without any other symptoms. These were people who didn’t drink – or rarely drank – alcohol, and they had no other risk factors for hepatitis or liver damage. Though a few patients complain of fatigue and vague right upper abdominal discomfort, those with NAFLD commonly experience no pain and are symptomatic.”
Dr. Nally found that each of these patients had features of metabolic syndrome: impaired fasting glucose or type 2 diabetes mellitus, central obesity, elevated cholesterol and elevated blood pressure. He also found that they were all practicing a low-fat, calorie restricted diet and had a high insulin response to carbohydrates. When fat in the liver accounts for more than 10% of the liver’s weight, insulin can no longer properly control blood sugar – a condition known as insulin resistance. A patient with insulin resistance produces 2 to 20 times the normal amount of insulin in response to carbohydrates or sugars.
Many studies have since been carried out that show the fat in the liver doesn’t come from dietary fat but rather from carbohydrates. The liver turns dietary carbohydrates into a blood fat called triglycerides, and it’s this fat that is stored in the liver. This is why corn (a high-carb grain that many think is a vegetable) is used to fatten up pigs, and fatten the livers of ducks and geese to make foie gras (which literally means “fatty liver”!)
FATTY LIVERS & LOW-CARB DIET STUDY RESULTS…
Digestive Diseases and Sciences published a study in September 2006 that showed 10 healthy volunteers had experienced fat loss in the liver after following a low-carb diet for 10 days.
Another study published in the same journal in February 2007 looked at 5 patients with NAFLD who were all put on a low-carb, high-fat, ketogenic diet for a period of 6 months – these people showed significant weight loss and improvement or even resolved the fatty liver according to their follow-up biopsy. Even the severe scarring (known as fibrosis) that can accompany NAFLD improved on a ketogenic diet.
A May 2011 study published in the American Journal of Clinical Nutrition placed 18 study participants with NAFLD on either a very low-carb diet or a very low-calories diet, and the low-carb diet reduced triglycerides in the liver (called hepatic fat) because of the fat-burning effect brought on by ketosis.
These studies prove very strong support for the positive health effects that happen as a result of being in a ketogenic state. It seems that increasing saturated fat intake and reducing carbohydrate consumption can bring about phenomenal reductions in liver fat.
In the case of non-alcoholic fatty liver disease, you want to lower insulin to allow for increased nutritional ketosis, turn off the excessive insulin production and eliminate fructose as a fuel source. Eliminating fructose and lowering insulin actually allows fat cells to reset their production of adiponectin and leptin. Lowering insulin also allows ketones to rise, which suppresses inflammation.
Lowering insulin levels turns down the stimulus of the liver to produce more triglycerides and lowers the VLDL transport out of the liver.