Groundbreaking study: low carb is an effective treatment for fatty liver


The following is a guest post by Ann Fernholm, author, science journalist and PhD in molecular biotechnology. She is the founder of the not-for-profit Dietary Science Foundation.

Approximately 25 percent of adults in the Western world have fatty liver and are thus at an increased risk of developing cirrhosis, liver cancer, type 2 diabetes and cardiovascular disease. Fatty liver is considered a chronic disease, but researchers at the University of Gothenburg have now proven that it is possible to get rid of the liver fat in just two weeks. The medication is called: a strict low carb or keto diet.

Fatty liver – what is that? You might wonder, and perhaps think that this is referring to that fat-rich paté which the French love. But fatty liver is one of the most common HIDDEN diseases in the world. In earlier decades, fatty liver was mostly associated with alcoholism, but in the footprints of the obesity epidemic, the frequency of the disease has sky rocketed. Approximately one out of every ten adolescents in both Europe and the US have the disease today.

A little fat in the liver is not harmful (given that you’re not a goose and thus are at risk of becoming paté), but in the long run the liver risks becoming inflamed and the liver cells can die. A fatty liver also increases the risk of developing cirrhosis, type 2 diabetes and cardiovascular disease. To avoid this, people need to get the fat out of the liver.

The advice given to people with fatty liver has been to exercise, count calories and lose weight, but – as we all know – most people fail and the fat remains in the same place. That’s why it is an important breakthrough that researchers at the University of Gothenburg have showed that the fat can go away without substantial weight loss. The participants in the study simply continued to eat the same amount of calories, but swapped carbs for protein. Within just two weeks, the liver was significantly thinner than before.

Surprising discovery: the microbiome started producing folic acid

The study, which was published in Cell Metabolism, included only ten people and is small, but it’s a very interesting piece to dig into as a biochemist like yours truly. It’s an extremely detailed map showing what happens when a person cuts down on sugar and starch in their diet. The liver metabolism changed almost immediately. Instead of creating fat, it started burning it and already in the first day you could see a significant reduction in liver fat. As a great side effect, the participants also improved their cholesterol profiles.

The microbiome also changed. A surprising discovery was that it started producing more folic acid, a vitamin which is important in the liver’s metabolism. Low levels of folic acid has earlier been associated with an increased risk of fatty liver.

Is sugar a worse than starch?

In my Swedish book, Det sötaste vi har (The Sweetest Thing We’ve Got), I write that some researchers suspect that our high consumption of sugar is an important reason explaining the epidemic of fatty liver. Sugar contains the sugar molecule fructose, which is metabolized in the liver. When we consume too much candy, soda and other sweets, our liver starts producing fat and after a while fat appears to get stuck in the liver.

In order to test this hypothesis, researchers at UCSF in San Francisco have earlier let children with fatty liver replace the sugar in food with starch (which contains the sugar molecule glucose). Just like the current study conducted in Gothenburg, the intention was to let the children continue to eat the same amount of calories and maintain their weight.

Despite the fact that the children ate carbs in the form of starch, the liver’s metabolism changed rapidly. Within nine days, almost half of the fat was gone. Some children also lost weight, but the amount of fat in the liver also decreased among the children who simply maintained their weight.

The Dietary Science Foundation invests in a study on fatty liver

So what conclusions can you draw from all this? First and foremost: it’s time to stop counting calories. Different types of calories have different effects on the body. Carbs do more harm than good for people with fatty liver, and there is reason to suspect that sugar is the worst of all carbs.

BUT. Both the Gothenburg and the USCF study are small and lacking a control group. In order to establish a new treatment, a better form of studies is required, randomized controlled trials. The Dietary Science Foundation just invested in this type of study at the Karolinska Institute in Stockholm, where a strict low-carb diet will be compared to 5:2 intermittent fasting and conventional treatment. If the study confirms the results above, it’s an important step in establishing a new dietary treatment in the medical care. And a chronic disease with over one billion sufferers, might turn out to be treatable in just a couple of weeks. Guess if that would reduce a lot of costs and strain on the medical system?

Ann Fernholm

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New study: Can low carb help reverse a fatty liver?

US experts raise red flag over fatty liver disease

All earlier posts about liver disease

Ann Fernholm

Ann Fernholm is a science journalist, author and PhD in molecular biotechnology. She is also the founder of The Dietary Science Foundation and runs a blog in Swedish.



Top comments

  1. Richart
    This has been long discovered by Atkins!!!When all thought he was nuts & on the low fat diets...Atkins was ahead of his time.
    Reply: #35
    Read more →
  2. Lynne
    Dr. Atkins wrote many books on the many benefits of low carb diets, from weightloss, low cholesterol,low blood pressure, low triglycerides, etc etc Unfortunately most doctors paid no attention so we have a very sick society ☹️Thankfully the ketogenic diet is back ?
    Reply: #15
    Read more →

All comments

  1. Susan West
    Thanks for sharing this, I personally have had great success with reversing NASH. The following is something I have shared on FB hoping to open the eyes of others that there is hope for what some have called a “silent killer”.
    I have NASH, form of NAFLD that causes cirrhosis, and is rapidly becoming #1 reason for liver transplants. Sugar or carbs basically cause same effect as alcohol. My liver enzymes improved rapidly after starting Keto. I had Fibroscan recently, this is fairly new form of ultrasound that my hepatologist ordered, it only cost $50, and didn’t really need the Dr. order, it showed a lot of improvement. Even as a nurse I hadn’t realized the threat of NASH until my mother suddenly died of a complication of it. Didn’t even know she had liver disease, because it can be fairly asymptotic til it is too late. Studies suggest 5% of US population has NASH, but most wouldn’t know it, often the lab levels aren’t high enough to alert the Dr.. Anyway the good news is Keto has been very effective in reversing mine from so far stage 3/4 to 1/4 fibrosis. My hepatologist is very happy and says I have changed my genetic destiny.
    Replies: #31, #36, #47, #59
  2. L. Cohen
    Thank you for this most helpful comment, which is quite encouraging. I had despaired of ever being able to treat NASH and your remarks have inspired me to try to change this most important health risk by dedicating myself to a keto diet. Anyone can make a two week change for something this impressive. I hope to be able to get the scan to which you refer, and look forward to cutting all carbs, and MOST primarily sugar, from my diet in order to see this improvement.

    As a non-drinker (no alcohol), I had previously despaired of being able to change the composition of my fatty liver. Again, thank you so much for offering hope and a solution.

  3. 1 comment removed
  4. Arika Beals
    Keto is a moderate protein diet. Carbs are not replaced by protein on keto, they are replaced by healthy fats. Also, sugar is not fructose, its sucrose.
    Replies: #9, #11, #24, #28, #38, #45
  5. Richart
    This has been long discovered by Atkins!!!When all thought he was nuts & on the low fat diets...Atkins was ahead of his time.
    Reply: #35
  6. Gentiann
    Agree with you, Richart.
    The difference is that studies are done now. Atkins could get any study done because of the low fat madness.
  7. Lynne
    Dr. Atkins wrote many books on the many benefits of low carb diets, from weightloss, low cholesterol,low blood pressure, low triglycerides, etc etc Unfortunately most doctors paid no attention so we have a very sick society ☹️Thankfully the ketogenic diet is back ?
    Reply: #15
  8. Katrina
    Surely, if you are a biochemist, you would know that the microbiome would start producing folate, not folic acid! Folic acid is the synthetic form of folate, so a human body wouldn’t produce folic acid!
    Replies: #10, #57
  9. Mike
    Arika - Both glucose and fructose are sugars, along with sucrose and more. The important thing is that the liver metabolizes fructose differently than others and as a sugar it's definitely to be avoided, especially as HFCS. As for Keto, it's definitely a low carb diet (<20 grams/day).
  10. Mike
    Katrina - Nutritionally, folate and folic acid are interchangeable terms. See more here:
  11. Dave
    Sugar (Sucrose) is a molecule of glucose joined to a molecule of fructose
  12. Iii
    Thank you for the report on fatty liver I found out from my doctor about a year ago but was told there was nothing I could do as I had already lost about 60 pounds and was feeling better but the Bulge on my right side was getting larger and I was getting worried now I know I will cut carbs from my diet and stick to high protein and continue to drink 6270 oz of liquid a day I pray that will help me thank you for the info
    Replies: #27, #46
  13. Linda Smith
    I had a fatty liver. I started to live like carb to loose weight! I had a health issue and had to have an ultrasound. The woman doing the ultrasound asked if I had lost weight. I replied yes. She then informed me that it was reflected in my liver. That my liver had a lot less fat in it. I'm writing this so to add to the results of your study!!
  14. Arthur Cline
    Interestingly people get the same effect from high carb low fat diets consisting of whole foods. Just look up fasting and it's been known for centuries how effective it is not only for health, but for your waistline. Keto diets are unhealthy using a secondary energy source fat when your body needs it's primary source of energy carbohydrates. Just cut back on your meals per day through intermittent fasting and maintain a healthy whole food diet. You will be giving your body the fuel it needs, but also burning excess fat through ketosis.
  15. Arthur Cline

    Dr. Atkins wrote many books on the many benefits of low carb diets, from weightloss, low cholesterol,low blood pressure, low triglycerides, etc etc Unfortunately most doctors paid no attention so we have a very sick society ☹️Thankfully the ketogenic diet is back ?

    Actually the Atkins diet has been the standard and basis for every diet since Atkins first published. Everything has been about counting calories and low carbs since the 80's, yet people are still fat. The problem is not enough whole foods and too much meat and fat in the diet. People 100+ years ago lived mainly on high carb based diets and hardly anyone was fat. Today we have the resources to eat a 6oz steak everyday and it has no nutritional value and is high in excess fat and protein.

    Replies: #19, #29
  16. Milko Georgiev
    Groundbreaking ... 10-20-30-40-50... years after many people.
  17. Alex
    @ Ann: Apart from the scientific content, we love the way you write with humor :)
    The phrase "given that you’re not a goose and thus are at risk of becoming paté" made us shake our liver.
    Looking forward to more posts :)
  18. MARK
    Arthur.. if it has no nutritional value how can it be "high in excess fat and protein" the only two nutrients the body needs?

    "Today we have the resources to eat a 6oz steak everyday and it has no nutritional value and is high in excess fat and protein."

  19. Mike S
    Arthur, that's a lot of misconceptions to pack into one post.

    "... the Atkins diet has been the standard and basis for every diet since Atkins first published" - a lot of authors of diet books and programs would be highly amused (or maybe even offended) at this assertion. The hallmarks of Atkins are highly restricting carbs, and not worrying about fat. A few of the highly popular diets which do not fit that bill are Volumetrics, The Zone, South Beach, Mediterranean, and DASH. Volumetrics and DASH especially appear to run almost totally counter to Atkins.

    "Everything has been about counting calories and low carbs since the 80's" - few, if any, diets both count calories and restrict carbs, and a number of popular diets do neither.

    "People 100+ years ago lived mainly on high carb based diets and hardly anyone was fat." Actually, significant levels of obesity have been chronicled at least as far back as ancient Egypt, and places where you find it tend to be highly agricultural (i.e., "high carb based diets") societies. In hunter-gatherer societies, on the other hand, it's true that "hardly anyone was fat", at least until those societies gained access to refined and simple carbs (sugars, flour, etc.), at which point obesity skyrockets.

    "Today we have the resources to eat a 6oz steak everyday and it has no nutritional value..." I'm sorry, but this is, frankly, laughable. Steaks are loaded not only with protein, but also with many important vitamins and minerals.


    "The problem is not enough whole foods..."

    Change "The problem" to "One major problem" and you have a very important truth.

    Reply: #22
  20. Carly
    Arthur Cline there is soooo much nutrition in a grass fed steak. Just not the potatoes or bread that often accompany it. The problem with society is that we eat too much sugar, it's in everything. Please do some research, luckily Diet Doctor is a great resource and you seem to have found no trouble finding us.
  21. Stephanie Grey RN
    We also need to exercise and manage stress. We need to be holistic: mental, physical and spiritual approach in fighting all diseases and addictions .

    Community and family support also. More research needed, diets alone won't work, a n integrative approach is best!

  22. Debra
    Mike S......very well put!! Couldn't agree more!
  23. Barbara
    Until you experience this delicious way of eating and the amazing health benefits of eating LCHF, you really can't understand the attraction. I thought it would be too hard to sustain for any length of time: guess what it isn't! When you lose all desire for sugar and starch it is monumental... YOU are now in control of food, instead of food controlling you! Let this way of eating be your drug of choice; you won't be sorry. Good bye fatty liver, good bye type II diabetes, good bye high blood pressure, good bye acid reflex, good bye obesity!
  24. Steve Kenwright
    Sugar is 50% sucrose and 50% fructose. Fructose ultimately has the same effect as alcohol on the liver, only without the brain "buzz".
  25. michele from new zealand
    so can some one tell me how i can do this two week liver cleanse totally new to all of this , will it help stuborn weight , and belly fat , will it help gout
    Reply: #30
  26. Ann
    How do you find recipes that is low carbs that you don't get burn out on eggs veggies. That my husband and I would like more recipes to use that we can make. Cause we have cut out all the poison foods of carbs. But we don't like squash or avaordos veggies. To make veggie noodles to make casseroles etc. To have different foods to eat. So isn't the same old foods. Plus I have lost weight from cutting carbs out. But after losing weight for a while. Haven't lost anymore weight? I exercise all the time? Thank you.
  27. C
    Let us know how this works for you. Wishing you great improvements
  28. Richard Kite
    Common Table Sugar = Sucrose = 50% Glucose + 50% Fructose.
  29. Richard Kite
    Hi Arthur,

    1. We all know that there are Essential fatty acids and Essential amino acids that we absolutely must consume in order to live. Can you name one, just one Essential Carbohydrate ?

    2. Also, the often published medical finding "the amount of carbohydrate synonymous with life is zero", would you like to comment on that ?

  30. Richard Kite

    Its easy, Just don't eat sugar in any form - that is it.

    If you want to turbo charge the cleansing effect then I suggest you go on a series of 24hr fasts (eat just once per day and no sugar).

    Dr. Jason Fung says in one of his presentations that if you do not have a fatty liver, he can give you one in just 2 weeks and cure it again in just 4. More acute cases may take longer but there is definitely hope.

  31. Christy Toth
    Hi! Susan,
    I to had the fibroscan and it showed that I was stage 2 almost stage 3. I currently started Keto. Are you saying I can get back some of the dead liver? Is it possible for me to call you? Or email? My email is
    I am very interested in what you ate??
    Thank you in advance!
  32. Robert
    How does replacing carbs with protein make a low-carb diet? Please explain, or is it a simple mistake
    Reply: #37
  33. Andy
    Too many people eat sandwiches because its quick and easy and pasta dishes. I going to stop eating bread and pasta and anything made with flour including cookies and cake. Most people with diabetes already know that blood sugar level rise quickly with even just a small amount of carbs.
  34. Bob
    i have liver cirrhosis from drinking a lot. because of that i went through 6 months straight of retaining 20lbs of fluid a week plus draining sessions (pain/hell), which led to me unable to eat. i went from 175lb to 132lbs and now i am skin and bones. i seem to be "recovering" as in no fluid retention, but i'm still very very skinny (rib cage etc). i eat everything but no weight gain.

    i want to try the all meat diet because it seems to be healing people of a variety of issues, and i love meat.


    1. with liver cirrhosis will my liver be okay just processing meat? (it kinda reads like yes)

    2. if i switch to a 90%+ meat diet, will my body be able to gain weight? (very important)

  35. Lyn
    It was an obese undertaker in the 1800’s that the Low Carb High Fat diet was first tried out on and then named after him - Roger Banting.
  36. Judi
    Was doing Keto the only thing you did to reverse fatty liver and how long did it take?
  37. Steve
    All food is made of some mixture of protein, fat, and carbohydrates.... plus some indigestible filler. So, by definition, replacing carbs with protein would technically be a low-carb diet. However, when you eat a high percentage of protein in your diet, your body will treat a portion as it would with carbohydrates, thus confounding the typical intent of a low carb diet.

    Your best success is likely to be some diet with moderate protein, very low carb, and high fat content. Consuming fat does not make a person fat. Eating excess carbohydrates WILL make one fat, not to mention the other problems such as fatty liver disease.

  38. Elena
    Sucrose is a disaccharide made up of 50% glucose and 50% fructose...
  39. Stacey
    I keep reading conflicting articles on the internet about the Keto Diet & Fatty Liver.. I really don't know what to believe. Are there any studies out there that is accurate? or is it basically different for everyone? I also saw a post that said "Keto Diet is not one-size fits all" and we have to base it on our macros? How would I calculate that? I have so many questions and concerns.. I don't want my health issues to worsen because i'm trying something new. Should I just do low-carb, low-fat? however, I know low-fat means more sugar... and the high fat in Keto are supposed to be the healthy fats. Is cheese okay? dairy? I see a lot of yes and no's about dairy. Who should I speak to about any of this? I went to a nutritionist once for my fatty liver and she said whole grains, 6 small meals a day. If anyone could help, it would be very helpful and appreciated.
    Reply: #40
  40. Kristin Parker Team Diet Doctor
    You can keep it simple! Start with our free two week challenge. It is automatically set up to give you the right keto macro ratios with no tracking or calculations needed!
  41. LaNell Rogers
    I did the Adkins diet and lost 40 lbs in 8 or 9 mths. I did not cheat and it was so easy for me because I loved meat. I guess I should have,at least, used my 20 grams of carbs per day, but I didn't. My hair became damaged looking, but that was all I noticed. I know this diet works, but now I know I have NALC (Non Alcohol Liver Cirrhosis), and had it since birth as my mother and oldest son. I developed type 2 diabetes so now I am a little apprehensive about doing "it" again because I don't like meat anymore (wonder why?) and I have to monitor more and be consistent. My older son that has cirrhosis has much improved his liver condition and many other important blood levels. His doc just says to keep up the good work. It all sounds so contradictory to all we were taught, but the result is in the pudding or rather blood tests. Good luck to all and prayers work wonders!
    Reply: #44
  42. Salinwa
    Stacey, You can’t do low carb low fat, one is going to give way to the other. Find a good naturopath. A good one will KNOW nutrition and how it heals the body, a good one will know that sugar is bad, grains are carbs are sugar... if you aren’t sure about one go see another. I am doing a mix of keto and paleo, my dr says it’s more whole 30. (She diagnosed me diabetic and wanted me to “learn paleo” but I have a keto friend and knew some of that.) Whatever, I don’t like labels. I’m doing low carb high fat and protein - my focus is meat veggies nuts and seeds. In about 3 weeks I reversed my diabetes. I assume my liver is getting better? Many other great things, losing weight, clearer mind, more energy... it works. “Paleo” and “keto” are my guides, not my rules.
  43. Demitha Madushan
    Taking oils and fats on a keto diet won't harm me? I have stage 3 fatty liver.
  44. Ruth
    Did any one respond?
  45. Francine
    Table sugar is a disaccharide composed of two monosaccharides: glucose and sucrose
  46. Azin
    The extra protein will become glucose in your body. Stick to moderate protein. Use Carb Manager app. It’s free.
  47. Kathy
    Hi Susan,

    I’m glad things turned around for you. I have just had a Fibroscan, stage 3 advanced fibrosis. I’m petrified.
    Has keto reversed the fibrosis of the liver? I was under the impression that it cannot be reversed.

    I have an appointment with my hepatologist tomorrow.

    Any advise would be appreciated


  48. Kim
    Hi Kathy
    I just learned I have S3 as well and I am so scared. What have you learned to help reduce the fat in your liver.


  49. Mickie
    I have stage 3/4 early Cirrhosis.My Heptologist told me no more than 100 carbs a day.Lose 15 pounds which I have.Daily exercise. I feel so much better, Complete lifestyle change but some thing I need to do to live
  50. 1 comment removed
  51. Kellie
    Has anyone with late stage liver disease/cirrhosis reverse the disease? My uncle was diagnosed and I suggested trying keto, but my aunt told me doctors say it’s too late, he’s been turned down for transplant. I know the power of this diet as I’ve been on it for years and my health has drastically improved, but have no idea if it really is too late for him. Please, I’m looking for advanced disease results, not just fatty liver. Thank you!!
  52. Kelly P
    What is the title of the study please?
  53. Mal Dowling
    My liver problems have improved dramatically since cutting right back (not entirely eliminating ) on butter, eggs, Olive oil and coffee.
    I'm mostly gluten free too.
    I can't tolerate any fatty meat.
    I only use Coconut Oil for cooking.
    I have almost zero sugar.
    Feeling great.
  54. Sergei
    I'm not convinced. I have a low carb high protein diet, have avoided sugar for decades, as well as carb food like bread and I have severe
    fatty liver disease. I do drink a little wine, and eat potatoes, and that's about the worst of it.
    Reply: #56
  55. Rob C S
    I have hope last 3 years good tests for liver, kidneys, Doc told me I showing signs of Fatty Liver, fate have it now I need to lose 50 lbs so not have to deal with cpap my claustrophobia not letting me adjust to, betting on myself to lose the weight, now week 2 less than 20g carbs a day on Keto diet, Have green chef meals for evening meals so I get my veggies, time will tell
  56. Joe F.
    I wonder if this might have something to do with it:
  57. Elo
    Yes! I was thinking the same thing! Folate, not folic acid. I have a copy of the mthfr gene and I must avoid folic acid, this should be corrected.
  58. E
    The part about folic acid is wrong, it’s folate. Our bodies produce folate. That should be corrected.
  59. Claudio Biazzo
    Hi Susan

    Can I have more information please?
    Thank you

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