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Keto Diet May Cause Fatty Liver & Insulin Resistance

Dr. Linda J. Dobberstein, DC, Board Certified in Clinical Nutrition


Within the last several years, the “keto diet” has been advertised and praised for its ability to help weight loss, improve metabolism, enhance athletic performance, reverse neurological distress, and much more. It continues to be highly popular for the layperson and of great interest as well as controversy for researchers. If you follow a keto diet, here are some recent studies and thoughts for you to be aware of.


Keto Diet


The Western diet is filled with high fat, high refined carbohydrate intake with low nutrient intake. To offset obesity and other degenerative effects of the Western diet, many have turned to the “keto diet” to reverse poor health. As you walk down the grocery store aisle, products advertise “keto-friendly” making it look enticing and easy to follow. Or is it?


Classical Keto Diet


The keto diet or ketogenic diet is focused high fat, low protein, and low carbohydrate foods. Carbohydrate intake is limited to 50 grams or less per day. The goal is to put your body into ketosis by burning fat or ketones for fuel rather than glucose or blood sugar. There are a few different diet variations.


The classical ketogenic diet developed in the 1920’s consists of a 4:1 ratio of fat to protein and carbohydrate. In this diet, 90% of calories come from fat, 6% from protein, and 4% from carbohydrates.


Following a true classical ketogenic diet is very difficult and requires diligence, careful monitoring, and long-term dedication. A detailed plan is outlined and prescribed by medical professionals who specialize in managing the effects and needs of this diet. Ongoing follow-up care is required with significant nutritional management.


Modified Keto Diet


The modified keto diet is less strict. It has macronutrient ratio of 1:1 and 2:1. Medical centers that prescribe this diet also require nutritional supplements to provide micronutrients, electrolyte support, fiber, etc. as well as regularly monitoring of ketosis levels.


In other scenarios, individuals may cycle on and off their version of a keto diet, have higher protein intake, or follow other ratios of nutrients. Other low carb diet variations exist that do not lead to nutritional ketosis.


Clearly, the high fat, high refined carbohydrate, high calorie Western diet with nutrient poor foods is unhealthy and threatens human health. You might quickly lose weight with any of the keto-diet variations, but it comes with risks and concerns. Here are some recent findings to consider.


Keto Diet – Metabolic Effects on the Liver


Concerns exist about the effects of a high fat, low carb, low protein diet with liver health. Research from 1991 showed that the diet in rats led to fat accumulation in the liver and insulin resistance in as little as 3 days. More recent animal studies have demonstrated similar results with the development of insulin resistance in the liver.


In a 2018 study, researchers observed the effects of a ketogenic diet and a high fat (Western) diet in animals. Each group underwent a 3-day diet challenge. It was followed with a short fasting period and then glucose or carbohydrates were reintroduced into the diet.


Upon initial examination, the mice fed a keto diet appeared to be healthy while in a fasting state and had some metabolic improvement. Both groups however experienced glucose intolerance when it was reintroduced to the diet.