A fatty liver is becoming more common worldwide, affecting about 1 in 3 people. Scientists reviewed studies about whether ketogenic diets (very low-carb, high-fat eating plans) could help treat this condition. The research suggests that keto diets may help reduce fat buildup in the liver and improve related health problems, especially in the short term. However, scientists say we need more long-term studies to understand if keto is truly safe and effective for everyone with fatty liver disease.

The Quick Take

  • What they studied: Whether eating a ketogenic diet (very few carbs, lots of fat) can help people with fatty liver disease get better
  • Who participated: This was a review of many different studies, so it looked at research involving thousands of patients with metabolic dysfunction-associated steatotic liver disease (a type of fatty liver disease)
  • Key finding: Short-term ketogenic diets appear to reduce fat in the liver and lower triglycerides (a type of blood fat) better than regular low-fat diets with the same calories
  • What it means for you: If you have fatty liver disease, a keto diet might help improve your condition in the short term, but you should talk to your doctor first. We still need more research to know if it’s safe and works well long-term for everyone

The Research Details

Scientists reviewed and analyzed all the published research they could find about ketogenic diets and fatty liver disease. They looked at studies that measured different health markers like liver fat, blood fats, inflammation, and gut bacteria. A ketogenic diet is defined as eating very few carbohydrates (less than 20-50 grams per day), moderate amounts of protein, and high amounts of fat. This type of eating causes the body to enter a state called ketosis, where it burns fat for energy instead of carbohydrates.

The researchers examined how these diets affected people’s livers, blood cholesterol levels, body-wide inflammation, and the helpful bacteria in their digestive systems. They looked at both short-term studies (weeks to a few months) and medium-term studies (several months) to see what benefits appeared and how quickly.

A review like this is important because it brings together all the available evidence in one place, helping doctors and patients understand what we actually know about keto diets for fatty liver disease. Instead of looking at just one study, which might have been done with a small group or in a specific way, a review shows the bigger picture of what multiple studies have found. This helps us see patterns and understand how reliable the findings are.

This is a literature review, which means the authors looked at existing studies rather than doing their own experiment. The strength of this type of research depends on the quality of the studies they reviewed. The authors noted that many studies were short-term and that some important areas (like long-term effects and gut bacteria changes) don’t have enough research yet. This means the findings are helpful but not definitive, and more research is needed.

What the Results Show

Studies showed that people following ketogenic diets for short to medium periods (weeks to several months) experienced improvements in their fatty liver disease. Specifically, the amount of fat stored in liver cells decreased, and blood triglyceride levels (a type of fat that can be harmful in high amounts) went down. Some studies also found improvements in steatohepatitis (inflammation of the fatty liver) and early scarring of the liver.

When researchers compared keto diets to regular low-fat diets with the same number of calories, the keto diet appeared to work better at reducing liver fat in the short term. This suggests that the type of diet matters, not just how many calories someone eats. The weight loss that often happens on keto diets likely helps explain some of these improvements, since losing weight is known to help fatty liver disease.

The research on cholesterol levels showed mixed results. Some studies found that keto diets improved HDL cholesterol (the ‘good’ kind), while results for LDL cholesterol (the ‘bad’ kind) were less clear. Some people’s LDL went up on keto, while others’ went down. The review also noted that very few studies looked at how keto diets affect inflammation throughout the body or how they change the bacteria in the gut, which are both important for overall health.

This review fits with what scientists already knew about keto diets and weight loss—they tend to work well in the short term. However, this is one of the first comprehensive reviews specifically looking at keto and fatty liver disease. Previous research on other weight-loss diets showed that losing weight helps fatty liver disease, and this review suggests keto might be particularly effective because it seems to reduce liver fat even beyond what regular calorie restriction does.

The biggest limitation is that most studies were short-term (a few weeks to a few months), so we don’t know if benefits last long-term or if people can stick with keto diets for years. There weren’t enough studies looking at how keto affects inflammation markers or gut bacteria, so those conclusions are weak. The review also noted that studies didn’t always look at whether different types of fats (healthy versus unhealthy) made a difference. Finally, because this is a review of other studies rather than a new experiment, the quality depends on how well those original studies were done.

The Bottom Line

If you have fatty liver disease, a ketogenic diet may help improve your condition in the short term (3-6 months), particularly for reducing liver fat and blood triglycerides. However, this recommendation comes with moderate confidence because long-term studies are lacking. You should only try a keto diet under medical supervision, especially if you take medications or have other health conditions. A doctor or registered dietitian can help you do it safely and monitor your progress.

People with diagnosed fatty liver disease should pay attention to this research and discuss it with their healthcare provider. This is especially important if you’re overweight or have diabetes, since these conditions often go with fatty liver disease. However, this research is NOT a recommendation for healthy people to start keto diets. People with certain medical conditions, pregnant women, and those taking specific medications should talk to their doctor before trying any major diet change.

Based on the studies reviewed, you might see improvements in liver fat and blood triglycerides within 2-3 months of starting a ketogenic diet. However, some benefits may take 3-6 months to fully appear. It’s important to remember that these timelines are based on short-term studies, and we don’t yet know what happens if you stay on keto for years.

Want to Apply This Research?

  • Track daily carbohydrate intake (aiming for under 50 grams per day) and weekly weight changes. Also monitor energy levels and any digestive changes to ensure the diet is sustainable for you.
  • Use the app to log meals and identify high-carb foods to eliminate or reduce. Set reminders to drink water and track your adherence to the keto macronutrient targets (high fat, moderate protein, very low carbs).
  • Create monthly check-ins to review weight trends, energy levels, and how you’re feeling overall. If using the app with medical supervision, share monthly summaries with your healthcare provider to track liver health improvements through scheduled blood tests.

This review summarizes research about ketogenic diets and fatty liver disease but is not medical advice. Fatty liver disease is a serious condition that requires professional medical evaluation and monitoring. Before starting a ketogenic diet or any major dietary change, especially if you have fatty liver disease, diabetes, heart disease, or take medications, consult with your doctor or a registered dietitian. They can assess whether this diet is appropriate for your individual situation and monitor your health with blood tests. This information is based on current research, which is still evolving, and long-term safety data for keto diets in fatty liver disease patients is limited.