Ketosis and Fatty Liver

If you've been diagnosed with fatty liver disease, eating more fat might seem like the last thing you want to do. However, putting your body into ketosis means that it will start burning body fat in addition to dietary fat. That's good news for your liver, as eventually, your body will get around to eradicating the very problem that is causing fatty liver.

Roughly 80 to 100 million Americans have nonalcoholic, fatty liver disease (NAFLD), making it the most common form of liver disease in the country. People are at higher risk as they get older, have blood sugar problems or high lipids, or if they collect weight in the abdomen. You might get diagnosed with the disease if you visit your doctor with symptoms such as pain in the upper right abdomen accompanied by fatigue and a distended or painful midsection.

The liver becomes clogged with excess fat. Once the fat level reaches about 10 percent of the liver's weight, the liver no longer is able to function normally. As a result, it's not able to metabolize insulin effectively, and blood sugar levels get out of whack.

A simple fatty liver can progress to an inflammation known as nonalcoholic steatohepatitis (NASH). Eventually, the condition can evolve into cirrhosis of the liver, which is scarring that takes up an increasing amount of the liver, rendering it unable to function. Cirrhosis may lead to total liver failure as well as liver cancer, fluid buildup in the abdomen, swollen veins in the esophagus that could rupture or symptoms that include confusion, slurred speech and drowsiness.

There are several causes of fatty liver, but the exact reason some people tend to accumulate fat around their liver and others don't isn't completely clear. The disorder is associated with high blood fats and sugar disorders. People with fatty liver also commonly have high triglycerides, insulin resistance, high blood sugar and are living with overweight or obesity.

Another suspected source of fatty liver disease is polyunsaturated fats, such as soybean oil, corn oil, and oils made from seeds such as sunflower oil, canola oil and safflower oil.

It's not so much what you eat that brings on fatty liver disease; it's what your body does with what you eat. When it comes to carbs, your body converts them to palmitic acid, a type of fat that is the first step to making long-chain fatty acids. Long-chain fatty acids take longer to metabolize in your system than do short- or medium-chain fatty acids and are often deposited as fat in the body. An abundance of too many carbs leads to deposits in the liver.

By the same token, an excess of sugar also sets up fat deposits in the liver. The liver converts sugars to fat and, if there's too much for the liver to process, deposits it as fat on location.

​Read more​: 15 Reasons to Kick Sugar

Although it sounds counterintuitive, eating a high-fat, low carb diet has shown promise to reverse fatty liver disease. The ketogenic diet transitions the body from burning glycogen — sugar and carb-based energy — to burning fat in the form of ketones. The liver makes these ketones from body fat or dietary fat, giving your body a nonstop source of fuel.

A 2018 study published in Current Nutrition Reports showed that a ketogenic diet can help improve both lipid and blood glucose levels. Metabolism and inflammatory markers also improved in the study. These results were due to insulin levels remaining low from limited carbohydrate intake, increased insulin sensitivity and the breakdown of fat stores.

You should always consult your doctor before making a major lifestyle change such as starting a diet. However, when you have fatty liver disease and are thinking about going keto, it's imperative to consult a medical professional. If your fatty liver is already having trouble functioning, for example, increasing fats in your diet could harm rather than help. Other health issues you might have that aren't appropriate for this diet include a history of pancreatitis, gallbladder issues, trouble digesting fat or taking medication that slows digestion.

If your doctor gives you the green light, get ready for radical change. The mainstay of your keto diet will be 75 percent healthy fats, 20 percent protein and 5 percent carbohydrates. By contrast, the average American eats 50 to 55 percent carbohydrates or more in their daily dietary intake.

​Read more​: Curious About Keto? Start With These 10 Healthy Recipes

Although keto diet gurus might tell you to consume lots of saturated fat, there is plenty of controversy about its influence in the body. A 2018 study published in the Journal of Investigative Medicine noted that most NAFLD patients reported having a diet high either in carbohydrates and sugars or high in saturated fat.

The study found that both diets contributed to fatty liver disease when too many calories were consumed. The study also found that patients in both groups improved their lipid profiles — showing promise to reverse fatty liver — when they reduced their caloric intake.

The U.S. Department of Agriculture recommends in its 2015-2020 Dietary Guidelines that Americans limit saturated fats to no more than 10 percent of your caloric intake. For keto dieters who get roughly 75 percent of their diet from fat, this means focusing on polyunsaturated and monounsaturated fats for most of the diet, such as those found in nuts, avocados and olives.

You've undoubtedly heard that a low-fat lifestyle equals a healthy heart. Although reviews of recent studies show no such connection, it's natural to worry about clogging your arteries with fat as you work to reverse fatty liver.

The fact is, the topic is still highly controversial, as total cholesterol and LDL levels tend to vary from person to person when eating a low-carb, high-fat diet. It's essential to monitor your lipid profiles and confer with your health care practitioner regularly when embarking on this lifestyle.

​Read more​: 10 Cool Facts About Your Heart

Constipation can be one of the tell-tale signs of liver damage. However, it's common for those beginning a ketogenic diet to experience constipation for the first few weeks of the diet as your digestive system learns to adapt to your new way of eating.

A ketogenic diet will typically release water weight from your body when you first start it, but that's not what's making you constipated. If you're not consuming enough liquids or sodium, your body will suck it out of your colon, leaving your stool compacted and dry.

Using dry substitutes such as coconut flour or almond flour for nonketo ingredients can also promote constipation, leading to concerns about liver function. Although these flours are fiber-rich, they absorb lots of water, leading to further drying of your stool. Add psyllium husks to water, whip up some chia pudding, nosh on nonstarchy veggies or add in more other keto-friendly fiber sources to move things along.

It's important to take in more fluids than you think you need. Herbal tea, broth and water with mineral salt and lemon are good choices to help you retain needed fluid in your colon. If you're still constipated, milk of magnesia can get you going again. If problems persist, check out the type of stool you're experiencing on the Bristol Stool Chart and share the information with your doctor.

It's easy to binge on drying foods such as coconut flour or other sources of soluble fiber that absorb water from your gut. Focus on eating foods with a high moisture content to avoid getting the "keto flu" when you're starting the diet or having digestive upset such as diarrhea or constipation that could be confused with symptoms of fatty liver.

As most fruits are verboten on the keto diet, it's important to make a grocery list that includes veggies, meats and a few keto-friendly fruits to keep your digestive system hydrated and functioning optimally as you begin to burn body and liver fat.

​Juicy Fruits​. Raspberries and blackberries are low in net carbs — about 2 net carbs and 3.5 carbs per quarter-cup serving, respectively — and are high in fiber. Blueberries have 4 net carbs per quarter-cup serving. Use these keto-friendly fruits in a smoothie or sprinkle on top of chia pudding for dessert.

​High-Water Veggies​. Some keto-friendly veggies are 90 to 99 percent water, according to the USDA National Nutrient Database. The most hydrating choices include cabbage, celery, lettuce, pickles, spinach and cooked squash. Avocados are also a good choice, at 70 to 79 percent moisture content.

​Moist Meats and Other Proteins​. Who knew meat could help you stay hydrated? Chicken breast and salmon deliver 60 to 69 percent water content, making them the best choice for a keto diet that will help you avoid ill effects that could be confused for complications of a fatty liver. Ground beef and steak come in at 50 to 59 percent. Avoid hot dogs and other processed meats with fillers, as their carb content can knock you out of ketosis.

Add a squeeze of fresh lemon juice at least once a day. If fresh lemon isn't available, use fresh-squeezed juice or pressed organic juice such as Italian Volcano.

Include the lemon peel in your beverage, if possible. A 2019 study published in the Biological and Pharmaceutical Bulletin found that citrus peel extract significantly helped fatty acid synthesis in mice with NAFLD after just eight weeks.

If your doctor determines that a ketogenic diet isn't right for you, don't despair. There are other diets and lifestyle modifications you can make to improve your liver disorder.

The Mediterranean Diet is one of the most highly recommended diets for NAFLD. It reduces carbs to 40 percent of daily caloric intake and increases monounsaturated and omega-3 fatty acids to up to 40 percent of the diet. A 2017 study published in the European Association for the Study of the Liver showed that the diet was effective in reducing NAFLD or NASH by at least one stage.

Exercising more and reducing sedentary time such as watching TV, scrolling social media or playing games on the computer are other ways to counteract these liver disorders. The study determined that common factors in study participants with the disorders included poor diet, low exercise and a sedentary lifestyle.