Keto Diet - Increased Risk for Fatty Liver, Diabetes and More

Ketogenic diets are attractive to many people because they encourage you to eat a lot of tasty stuff - butter, red meat, cheese. But you’re basically consuming 80% of your caloric intake from fat. Studies are now showing increased health risks from this fad diet.

Eating “keto” is a popular fad diet, and recently I have even noticed some doctors recommending it. But this appears ill advised. Increasing evidence such as from a study by Keck School of Medicine of USC researchers indicates that ketogenic diets that severely restrict carbohydrates and replace them mostly with fats appear to be associated with increased risk for non-alcoholic fatty liver disease or NAFLD.

Fad diet-linked liver disease - a Silent killer

Most people with fatty liver don’t know they have it, leading to its reputation as a “silent killer.” It typically causes no pain or other symptoms. It is not until the disease has progressed to a more serious stage, like nonalcoholic steatohepatitis (NASH) or cirrhosis (scarring of the liver), that patients and doctors become alerted to the problem.

NAFLD appears to lead to diabetes, heart attacks and strokes - Curr Opin Clin Nutr Metab Care, Jul 1, 2012;15(4):374-380. Researchers also suggest the condition is linked to increased risk of liver cancer as well as increased risk of other forms of cancer. Ketogenic diets have been associated with kidney stones, constipation, diarrhea, fatigue, headaches, bad breath, bone fractures, and an increase in LDL (the bad) cholesterol that increases risk for heart disease. Researchers studying ketogenic diets have demonstrated that it increases cholesterol and inflammatory markers - Obesity, June 2019;27(6):971-981.

One of the main issues with the keto diet is that it restricts vegetables, fruits, whole grains and beans. This is generally unhealthy because these plant foods are rich sources of soluble fiber which is converted to short chain fatty acids (SCFAs) in your intestines, which help to lower high cholesterol, high blood pressure, and high blood sugar. A diet low in soluble fiber markedly increases the risk for an overactive immune system, resulting in inflammation that can damage cells throughout your body.

How Keto Diets Cause liver damage

Carbohydrates are made up of single and chains of sugars. The keto diet severely restricts all carbohydrates, so it does results in a drop in blood sugar levels. This, in turn, also causes blood insulin levels to decrease. This initially appears to be good because low insulin levels cause fat cells to release stored fat as triglycerides into the bloodstream. However, if a person on a keto diet then gains weight by any means, fat may be preferentially stored in the liver rather in fat cells elsewhere. The liver then draws out the fatty triglycerides from the bloodstream into its own cells, and if large amounts of triglycerides are stored in the liver, a fatty liver develops. A fatty liver can interfere with the overall function of the liver and appears to be a major contributor to developing diabetes. When blood sugar levels rise in response to eating a meal, your pancreas releases insulin that works to lower the blood sugar by driving sugar from the bloodstream into the liver cells. When the liver is full of fat, the liver cannot accept sugar and blood sugar levels rise even higher, which causes damage to cells and results in diabetes.

More than 40 percent of North American adults have NAFLD, which has no symptoms or signs early on, so most people will not find out that they have this condition until they have already developed diabetes or suffered a heart attack. There are no FDA approved medications to specifically treat NAFLD. It is treated primarily with lifestyle changes.

Do you Have a Fatty Liver?

If you have a large belly and small hips, you probably have a fatty liver and are already diabetic or pre-diabetic - even if your fasting blood sugar is normal (below 100). If your blood sugar rises over 145 mg/dl one hour after meals, you may have a fatty liver. Making the diagnosis is done with an ultrasound or CT scan of your liver which can show whether you have excess fat in your liver. Abnormal liver function tests and high fasting insulin levels may also suggest a fatty liver.

Keto Diets do not result in Permanent Weight Loss

Keto diets may result in short term weight loss. This diet (as do nearly all diets) does restrict sugary drinks and sugar-added foods, processed foods, and other refined carbohydrates in bakery products, pastas and most dry breakfast cereals - foods that have been associated with weight gain, diabetes, heart attacks and premature death. However, there do not appear to be any long-term controlled studies showing that keto diets are associated with permanent weight loss. In fact, one supervised, controlled study showed that the keto diet did not cause increased fat loss over other diets. In that study, weight that was lost was attributed solely to eating less calories, not to the high fat, low carb composition of the diet. Furthermore, the researchers were unable to show that it significantly increased the amount of energy the body burns, which is a claim often made by supporters of the keto diet - The American Journal of Clinical Nutrition, Aug 2016;104(2):324-333.

Keto diets are complicated to follow and difficult for most people to stay on because of the very limited choice of foods. Keto diets:
• restrict many healthful foods (fruits, beans, whole grains, and vegetables) that have been consistently associated with reduction of disease
• usually include high amounts of red and processed meats that have been associated with increased risk for heart attacks and some cancers
• increase intake of saturated fats that raise blood levels of LDL cholesterol, which has been associated with increased risk for heart attacks
• restrict vegetarians to extremely limited choices of foods such as avocados and coconut oils - the latter of which is a high source of unhealthy saturated fat.

Our Recommendations

Go easy on the fats, especially saturated fats from processed foods. Keto is just another fad diet, and the evidence is mounting that this diet may harm you in the long run. Fructose and other sugars are also a major concern, especially in sodas, candy, sugary cereals, sweetened juices and fast food - which can increase cholesterol and results in inflammation in the liver.

Instead, if you want to lose weight, prevent cardiovascular disease, diabetes and cancer, we suggest eating a well-balanced diet that features high-fiber foods, vegetables, fruits, fish, lean meats, nuts, seeds and unrefined oils. It’s a tasty, easy to adopt menu, familiar to those following the Anti-inflammatory diet.

Fabio AlmeidaeZine56