A low-carb diet best for fatty liver


Study after study shows a more effective weight loss on a low-carb diet. And if you reduce abdominal fat, you’re also reducing the amount of liver fat. The disease fatty liver is strongly associated with obesity and type 2 diabetes.

Not surprisingly, yet another study* shows that a low-carb diet can be a good treatment for fatty liver. In only six days on a low-carb diet, the reduction in the amount of liver fat was about the same as it was for seven months (!) on a calorie-restricted diet. Furthermore, the volume of the liver decreased, probably because of less glycogen and fluids (decreased swelling).

How do you effectively decrease the amount of fat in your liver? In the same way that you melt fat off your abdomen. Less sugar and starch in your diet.


New Study: Does Sugar Cause Heart Disease?

Another Diabetic Healthier and Leaner With LCHF

* Here’s another study showing a greater reduction in liver fat with a high-fat low-carb diet.


  1. charles grashow
    Since this is just the abstract and it contains NO details about the diets used it is - IMHO - worthless

    Also - the study only lasted 6 days - c'mon

    Reply: #2
  2. FrankG
    "In only six days on a low-carb diet, the reduction in the amount of liver fat was about the same as it was for seven months (!) on a calorie-restricted diet."

    Wasn't six days enough? Is your contention that this was only a short-term effect and that in due course on an LCHF diet, the amount of liver fat would return to baseline, or even increase? This has certainly not been my experience but do you have any evidence in support of that position?

  3. Alan
    "In brief, the protocols of these three studies were as follows:
    Short-term low-carbohydrate diet: 17 subjects (subjects from the first study (15)) received a 6-day low-carbohydrate diet (-1000 kcal/day, </=20 g carbo-hydrate/day). The 6-day duration was chosen since the study of Kirk et al. (10) showed that liver fat can be decreased rapidly (-
    30% in 48 hours) by a low-carbohydrate diet. Long-term hypocaloric diet: 26 subjects from the second and third studies were placed on a hypocaloric diet (1000 kcal/week until approximately 5% weight loss was achieved), in which 30% of energy was derived from fat (10% saturated, 10% monounsaturated, and 10% polyunsaturated fat), 50% from carbohydrate, and 20% from protein for 7 months. In the second study(16), subjects received either rimonabant or placebo in addition to a nutritionally balanced hypocaloric diet. Of these subjects, only those receiving placebo (nine subjects with complete MRI data) were included. In the third study (17), 17 subjects were placed on a similar hypocaloric diets as the second study. High-carbohydrate overfeeding diet: 17 subjects (subjects from the third study (17)) were placed on a 3-week high-carbohydrate diet (1000 extra kcal/day, 98% of energy from
  4. Cheryl
    But let us not forget that low carb diets are not good for adrenal fatigue or thyroid issues. Period.
    Replies: #6, #8, #9, #10, #11, #18, #19
  5. Adrian
    I know this is not the right place, but I have a doubt, can I use vinegar on a LCHF diet?

    I'm doing everything right about the diet but I've read somewhere else (a comment from a person on facebook) who say it's not LCHF.

    I'm doing it 100% perfect, but if that is true it'll be imposible for me to stop using it.

    His argument was that vinegar, alcohol and fruit are fermenting foods.

    Reply: #7
  6. Paul the rat
    Really? - any hard data to support this? or it is just. Period.

    Metabolism. 2006 Feb;55(2):243-51.

    The metabolic response to a high-protein, low-carbohydrate diet in men with type 2 diabetes mellitus.

    Nuttall FQ1, Gannon MC.
    Author information

    We recently reported that in subjects with untreated type 2 diabetes mellitus, a 5-week diet of 20:30:50 carbohydrate-protein-fat ratio resulted in a dramatic decrease in 24-hour integrated glucose and total glycohemoglobin compared with a control diet of 55:15:30. Body weight, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and serum ketones were unchanged; insulin and nonesterified fatty acids were decreased. We now present data on other hormones and metabolites considered to be affected by dietary macronutrient changes. The test diet resulted in an elevated fasting plasma total insulin-like growth factor 1, but not growth hormone. Urinary aldosterone was unchanged; free cortisol was increased, although not statistically. Urinary pH and calcium were unchanged. Blood pressure, creatinine clearance, serum vitamin B12, folate, homocysteine, thyroid hormones, and uric acid were unchanged. Serum creatinine was modestly increased. Plasma alpha-amino nitrogen and urea nitrogen were increased. Urea production rate was increased such that a new steady state was present. The calculated urea production rate accounted for 87% of protein ingested on the control diet, but only 67% on the test diet, suggesting net nitrogen retention on the latter. The lack of negative effects, improved glucose control, and a positive nitrogen balance suggest beneficial effects for subjects with type 2 diabetes mellitus at risk for loss of lean body mass.

  7. Richard
    Adrian - studies show that vinegar reduces the insulin response to carbs, so it could be a useful addition to a low carb diet as it might allow you a little more flexibility.

    Eg: pubmed/16015276
    Eur J Clin Nutr. 2005 Sep;59(9):983-8.
    Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects.
    Ostman E1, Granfeldt Y, Persson L, Björck I.

  8. Paul the rat
    OK so it is just. Period.

    "Adrenal fatigue or hypoadrenia are terms used in alternative medicine to describe the unproven belief that the adrenal glands are exhausted and unable to produce adequate quantities of hormones, primarily the glucocorticoid cortisol. Adrenal fatigue should not be confused with recognized forms of adrenal dysfunction such as adrenal insufficiency or Addison's Disease.

    The term "adrenal fatigue" may be applied to a collection of mostly nonspecific symptoms such as "tiredness, trouble falling asleep at night or waking up in the morning, salt and sugar craving, and needing stimulants like caffeine to get through the day". There is no scientific evidence supporting the concept of adrenal fatigue and it is not recognized as an actual diagnosis by the medical community.
    Blood or salivary testing is sometimes offered by alternative medical practitioners to diagnose adrenal fatigue, but these tests lack a scientific basis. The concept of adrenal fatigue has given rise to an industry of dietary supplements marketed to treat this condition. These supplements are largely unregulated in the U.S., are ineffective, and in some cases may be dangerous."

  9. Galina L.
    "Period"? Why such certainty? That nonsense about LCarbing ruining thyroid should stop. Weight loss on any diet puts a person in an altered metabolic state, leptine drops, and thyroid gets less active to steer body away into a weight gain.
    I really feel annoyed when some people keep telling me that I must have some "adrenalin fatigue" from the diet on which I thrive because their quack of choice said so. BTW, I have thyroid issues diagnosed almost 20 years ago, and I feel much better on a LC diet which I started 6+ years ago.
  10. bill

    Paul asked if you have any hard data to support your claim.

    Heck, do you have any evidence at all?

    Why do people do this - post contrary suppositions on discussions
    and offer nary a shred of evidence? Do they want to instill doubt?
    Are they too busy to enlighten us?

    I just don't get it.

    Reply: #12
  11. Zepp
    Sure.. that must be right.. or not!

    "The findings suggest that T3 regulates insulin level in the circulation after glucose ingestion and the increase in serum T3 levels after glucose ingestion is necessary for the glucose removal from the circulation in humans."


    "An increased iodine requirement as a result of significant changes in human nutrition rather than a decreased environmental iodine supply is suggested to represent the main cause of the iodine deficiency disorders (IDD). The pathomechanism proposed is based on the fact that serum concentrations of thyroid hormones, especially of trijodothyronine (T3), are dependent on the amount of dietary carbohydrate. High-carbohydrate diets are associated with significantly higher serum T3 concentrations, compared with very low-carbohydrate diets. While our Paleolithic ancestors subsisted on a very low carbohydrate/high protein diet, the agricultural revolution about 10,000 years ago brought about a significant increase in dietary carbohydrate. These nutritional changes have increased T3 levels significantly. Higher T3 levels are associated with an enhanced T3 production and an increased iodine requirement. The higher iodine requirement exceeds the availability of iodine from environmental sources in many regions of the world, resulting in the development of IDD."


  12. Paul the rat
    it is an inflated ego thing, that would be my take
  13. Tami
    I just had blood work done for my thyroid and everything else and it all came back perfect. I have done LC most of my adult life (when I don't go completely AWOL being found in the nearest Krispy Crème) but seriously. How can eating the way all animals were intended to eat be the unhealthy way. It is the natural way. People tell me "you don't eat fruit? You must be deficient in vitamin c. Fruit is good for you" I am sure that there are tons of vitamins in fruit. But there might be a ton of vitamins in poison ivy too. But the effects from eating it aren't pleasant. Sure you could lose a ton of weight like I did before I started doing LC by doing zero to low fat, at which I lost at least 1 pound (my gallbladder) from not having the fat intake to keep it working. Along with the 40 pounds I gained back along with an additional 60. There are always going to be opposing arguments to high fat moderate protein, very low carb ways of life. In fact, even my doctor I just saw said "I don't like the high fat part" AND SHE IS AN INTERNIST!!!!! Someone needs to go back to school. My cholesterol was awesome. My blood pressure was awesome. I don't get stomach cramps from the gluteny carb load. I don't feel all bogged down. So people that want to argue with this are those that are scared of fat. Well, enjoy your celiac disease.
    Reply: #17
  14. Chupo
    This study was a bit longer. In people with NAFLD, an ad-libitum low carb diet cleared 55% of hepatic TG in two weeks compared to just 28% in the calorie restricted group.


    By the way, my thyroid tested just fine and I have no symptoms of adrenal fatigue. I should be feeling like walking death but am full of life and energy! The "low carb causes hypothyroid" meme has got to stop. It gets old after a while and is quite annoying.

  15. Jesskat
    I have chronic fatigue, have tried following a LCHF diet, with advice to go very low carb. I can't do it. I have to have at least two half cup servings of some kind of carb like rice or sweet potato a day otherwise I get even more fatigued than normal. I even stopped eating fruit as the advice is it raises blood sugar levels too much. I've been eating this way for six weeks now, the first two weeks I felt like I have the flu and was extremely fatigued (more than normal), week three I started to feel like I had more energy and had reduced my belly by 2cm, week four and five have been awful as I reduced my carb even further as per the advice given on LCHF. I've not lost anymore belly fat and I feel much worse than usual. So I'm going back to medium carb and high fat like I was in week three. Everyone of course is different, but for me my body needs more carb's. Oh and I don't take supplements, I'm using food as my medicine
    Replies: #16, #21, #29, #31
  16. Snusmumrik
    Jesskat, in my opinion it looks like your liver has not yet adapted completly to a very low carb diet. Give it a few months on a moderate carb diet and try again and see if it works for you.
  17. François
    Tami, your experience is unfortunately quite common for a number of reasons:
    1. Physicians receive minimal training in nutrition. When I did medicine 33 years ago, we had one full afternoon. Nowadays, it is not much better.
    2. That teaching, just like that of dietitians, is now heavily subsidized by Big Food and Big Pharma. So physicians are shown how healthy (!) it is for diabetics to eat and drink up to 300 grams of carbs (sight) in a pamplet made up by pepsico. In a way, with Big Food and Big Pharma heavily subsidizing medical studies, physicians and dietitians have now become in a way prostitutes, allowing Big Food and Big Pharma to dictate what they must believe and say to their patients.
    3. Biostats and epidemiology teaching is minimal and the average physician is incapable of reading a medical article: they are happy to read the abstract and the conclusion, nothing more. So they cannot be critical of what Big Food and Big Pharma wants them to believe.
    4. Medical school is quite long and the emphasis is on medication: there is now a pill for everything and sometimes, Big Pharma makes sure new diseases are invented so their pills can be used. Diet is seen as useless: only pills work of course... In many HMO's in the US, a physician has to prescribe a statin by the number: He may give a dietary advice, but needs to prescribe a statin in order to receive a full pay.
    5. Surprizingly, many physicians have over-inflated egos and lack curiosity and when presented results obtained by diet, will reject them as a fluke: if it does not fit your preconceived ideas, reject it! I have rarely seen anyone wonder why intensive insulin treatment for diabetes results in more complications and deaths... Most physicians and nutritionists have also minimal knowledge of biochemistry. (I wonder if Cheryl is one of my pompous colleagues). So when I cured my mother-in-law's severe statin-induced cardiac failure (15% ejection fraction) and brought it back to normal (more than 50%) by stopping her statin and giving her ubiquinol, I only got a pompous sneer from the senior resident in cardiology: it was simply an accident, not her ubiquinol. I wish there were more accidents like that.
    6. But there is hope. Some physicians (Andreas here, Jason Fung in Scarborough Ontario (Canada) are doing a remarquable job of presenting the evidence. I presented in the clinic where I am currently working in Hawaii Jason Fung's diabetes reversal program with LCHF and skipping breakfast to my colleagues. I presented the science and every physician decided this was a good idea. They have all started on LCHF because of the marked advantages this gives. One asked me many questions on this approach (she is an internist also) to treat her father's diabetes. Very open minded. There is hope, I tell you! I guess we'll need to get to a critical mass and then physicians will start noticing. Diabetes is exploding in the world. In Hawaii, I am lucky when the patient I see does not have diabetes or prediabetes. So I spend a tremendous amount of time teaching LCHF to each and every patient. Most react positively. There may be the occasional jerk, but it's his life.
    7. Should you have an interest in diabetes reversal with LCHF and skipping breakfast, search Dr Jason Fung on Youtube. It is a video worth listening to.
    8. So keep on doing what you are doing: it works! And politely refer your internist to Andreas' blog. Maybe her mind will open!
    Good luck.
  18. frewal
    “The fundamental cause of the trouble is that in the modern world the stupid are cocksure while the intelligent are full of doubt.”
    ― Bertrand Russell
  19. Linda
    "But let us not forget that low carb diets are not good for adrenal fatigue or thyroid issues. Period."

    I would need to see data to back this claim up.

    I went low carb when I tested for high blood sugar (over 230 mg/dL and A1C of 8)
    I asked to do this before taking anything like Metformin.

    Within a few months, my fasting level was under 90, and my A1C was 4.8.

    I have no thyroid gland. It was removed with part of the parathyroid 30 years ago.
    This is the first time in years I feel like I have energy again. And I do not know if it is the 80 lbs I have lost since Oct 2012, or my normal blood sugar levels, but my prescription of Levothyroxin went from 225mcg to 150 mcg.

    What are the bad things I as a person with thyroid issues should be worried about?
    Knowing what I have learned since this all began, I am never going back to the recommended amount of carbs we are told is healthy.

    Many people can handle lots of carbs. I am not one of them.

  20. Welldun
    Don't feed the troll guys
  21. Zepp
    Dont go hard core LCHF if you got adrenal fatigue!

    Becuse, some of the transitation problems is probably caused by that extra stress that origin frome adrenal causes in the transitation!

    Make it a long transitation period that your body can adapt.. without any extra cortisol and adrenaline for making glucose!

    And adrenal fatigue can be of different causes, some is becuse of modern living/stress.. whit our stone age reaction patterns of that!

    My mother got this condition of hypothyreosis.. and not suficient medication.. take a test on thyroid hormones to be sure.

  22. Kris
    Tami, I love your comments. I also agree and add, instead of reading scientific papers, I urge anyone to try LCHF for two weeks for themselves. You'll be hooked before the first week is done. You will feel great and most importantly (for me) will feel less hunger and cravings. You will stop thinking about food all the time. LCHF is the first way of eating ever to do this for me. A real blessing. I ate more animal fat in the first month than I think I did my whole 45 years. I was so satisfied. As a bonus I was able to decrease my insulin (I'm diabetic) by a third. A huge saving in $ for me. I only wish I would have known about this 30 years ago.
    Reply: #23
  23. Paul the rat
    "...instead of reading scientific papers, I urge anyone to try LCHF for two weeks for themselves…"

    Point taken, but personally it makes me feel good to know, what/how is it that makes me feel so good on LCHF (for many years now).
    (and for some of us here reading scientific papers is a part of our job)

    Klin Med (Mosk). 2013;91(3):15-24.

    [Glucose, glycotoxins, and protein glycation products: the role in pathogensis].

    Titov VN, Khokhlova NV, Shiriaeva IuK.
    Arteriosclerosis and atheromatosis are etiologically and pathogenetically different non-physiological processes in atherosclerosis localized in the proximal segments of the arterial bed and elastic-type arteries; both affect the structure and function of the arterial wall. They cause an inflammatory reaction with subsequent compaction (sclerosing) of the walls of large and mid-size arteries, the loss of their elasticity due to structural changes in the loose connective tissue of intima-media, impaired elasticity and enhanced rigidity of the wall, inflammation, fibrosis, and increased pulse wave conduction velocity. Arteriosclerosis is initiated by long-term hyperglycemia, chemical collagen and elastin glycation by glucose and its metabolites (glycotoxins glyoxal and methylglyoxal) forming cross-links between collagen and elastin fibers. In contrast, atheromatosis as the main manifestation of atherosclerosis affects elastic-type arteries via accumulation of intimal lipids (cholesterol-esterified essential unsaturated and polyenic fatty acids, plaque formation at the sites of macrophage deposition in intima, necrotic and calcinotic foci. Atheromatosis does not affect collageous and elastic structures in the arterial wall. Arteriosclerosis and atheromatosis are two independent pathological processes in the walls of elastic-type arteries. Arteriosclerosis results from glycation of collagen and elastin chains in muscular-type arterioles, postarterioles, endothelium, and pericytes of exchangeable capillaries. Microangiopathy initiates only glycation and glycotoxin action because muscular-type arterioles have no intima, an interstitial tissue for the collection and utilization of biological "rubbish" from blood and intravascular pool of intercellular medium.

    Reply: #24
  24. murray
    Keep the studies flowing, Paul. I was corresponding to a dietician whom I respect. She reminds me from time to time that she is professionally constrained as to what she can say, even though she knows the metabolic science and clinical experience is going this way. She recently wrote a piece on a study where Paleo outperformed low-fat. I remarked this was ten years behind and she noted that it takes a decade for nutritional studies to catch up to the metabolic results, given the cycle to use new metabolic and clinical evidence to design studies, to apply for grants, conduct the study, to analyze the data and then go through peer review publication. So by keeping abreast of developments in metabolics and other related fields, and being observant of clinical and anecdotal experience, one can be a good decade ahead of the nutrition studies. Yes, all fine and good to wait a decade or two (or four if you followed the then-current science that expressed doubts about the recommendations in the mid-1970s), but many of us feel our current health and eventual health-span longevity need attention sooner. There is a difference between most plausible hypothesis and proof beyond doubt. One can be Prospero without being Othello (food pyramid, acting with indifference to doubt) or Hamlet (the tragedy of inaction due to doubt). There is an excellent theory of applied science embedded in Shakespeare's last 13 plays.
  25. murray
    I envisage Ancel Keyes (Iago) insinuating into the ear of George McGovern (Othello) conjuring false doubt regarding the saturated fat in artherosclerosis (the scarf) to accuse dietary fat (Desdemona) of health infidelity. Tragedy ensues.

    40 years later, something is rotten in the state of nutrition, as chronic disease rates soar. William Banting (the father ghost) bellows from the netherworld. Wade Henderson (Hamlet) hears the call and sees evidence that high-carb is the culprit. Yet, paralyzed by the need for absolute certainty, he cannot act decisively. He spurns the siren call of LCHF (Ophelia)--get thee to a bakery. Tragedy ensues.

    Dr. Eenfeldt (Prospero) studies books less known to his profession and is banished to the Isle of LCHF, where he advances his arts and powers. Though years of clinical experience in exile, he braves suspension of dogma-guidelines (puts doctrine and the need for logical certainty to sleep, perchance to dream) to allow patterns to be perceived in large numbers of anecdotal case studies through bottom-up complex adaptive emergence (the dance, presided over by Iris (communication/efficient cause), Ceres (fertility, final cause) and Juno (marriage contract, formal cause), to forge a new marriage of experience and doctrine--Miranda and Ferdinand). Oh Brave New World. Romance ensues. Charles Grashow (Caliban) skulks in the shadows.

    Reply: #26
  26. murray
    *Through years ...
  27. Nan
    Too bad they emphasize "short term" for the low carb diet, since we know that permanent is the way to go.


    Reply: #28
  28. charles grashow

    "Too bad they emphasize "short term" for the low carb diet, since we know that permanent is the way to go."

    We do not know that at all!!

  29. Marijke
    Jesskat, I don't know how old you are, but some people have accumulated lots of bad stuff in their bodies during many years of a bad diet. I certainly did. When you start eating better, your body can use the opportunity to get rid of the bad stuff. This makes you feel like you have the flu. You get worse before you get better. For me the solution to this problem was to change my diet only slowly. That may help you too.
  30. Sam
    Organic and grass-fed foods are best, but only if you can easily afford them. Even if you don’t buy organic, your diet will still be a thousand times better than the standard western diet.


  31. Margaret L
    Even Dr. Atkins -- inventor of the original high-protein, low-carb diet way back in the 1960s -- allowed some carbs in his diet. If you "have to have" two half cup servings of some type of carb per day like rice or sweet potato, do it! My best example is the energy benefits of a high-protein breakfast of two slices of bacon and two eggs (ick... as I don't eat bacon anymore...) are extended by also consuming a slice of toast... The carbs provide sugar that extend the energy from proteins (as best I can explain it). Dr. Atkins just recommended that you "count" your carbs and reduce them as best you can, and then gives examples and recipes, most of which contain "some" carbs. While he has passed and there was some concern that he may have died of a heart condition, everybody dies of something... The high-protein, low-carb diet simply makes me feel best energy- and diet-wise!
  32. Kelly
    Atkins died from falling on the ice and hitting his head
  33. Barbs
    Yes he did. And I hate it when people throw out cheap shots like Atkins died because of his LC diet even other so called diet people say this. He died because of a head injury caused by slipping on ice.
  34. Kelly
    I've been eating too many carbs for years, hence my development of fatty liver, high triglycerides, pre-diabetes, etc..

    But that came about as whenever I'd try to eat 'normal' amounts of fat, I'd be up all night with RLS (restless leg syndrome), sometimes even bothered by it during the day after a higher-fat meal.

    Now recently I've been able to increase my fats, but this means about a tablespoon of a blended oil (Udo's), at the most. Have taken omega 3 fatty acids for years, without problem, but still developed fatty liver, etc.

    So how in the world do I increase my fats to get enough calories on this diet so I can reduce the rice, rice noodles and other carbs and reverse this condition?

    Reply: #35
  35. Peter Biörck Team Diet Doctor
    Hi Kelly!

    My best tip is try to eat different kind of food that naturally contains a lot of fat (one at a time)...hopefully some of them work for you... (egg, bacon, avocado, cheese, etc)

    I've been eating too many carbs for years, hence my development of fatty liver, high triglycerides, pre-diabetes, etc..
    But that came about as whenever I'd try to eat 'normal' amounts of fat, I'd be up all night with RLS (restless leg syndrome), sometimes even bothered by it during the day after a higher-fat meal.
    Now recently I've been able to increase my fats, but this means about a tablespoon of a blended oil (Udo's), at the most. Have taken omega 3 fatty acids for years, without problem, but still developed fatty liver, etc.
    So how in the world do I increase my fats to get enough calories on this diet so I can reduce the rice, rice noodles and other carbs and reverse this condition?

  36. Kelly
    Thanks Peter, I'll give that a try. (Sorry for the late reply.)
  37. Steph
    Dr. Atkins DID have a heart condition, but it was unrelated to diet. My Dad's heart attack was also unrelated to diet now that we know about an inherited blood clotting disorder.

    I've been on 100 gr. Carbs per day for over a year and gradually cutting back carbs and adding protein and fat. Currently between 30-40 gr carbs per day and that may be my limit. My endocrinologist is fine with it provided I include one high vitamin C fruit each day. I've really cut back on Novolog, but no change in am BG so Levemir stays the same.

  38. Leo
    "Low-Carb-Diet". Which one? High Fat Low Carb or Low Fat (High Protein) Low Carb? Without this distinction the article is usless!

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