Restoring liver function with LCHF?


I received an e-mail from Eduarda Castro, whose husband was diagnosed with Gilbert’s syndrome when he was a teenager.

This is a relatively common and benign hereditary cause of sporadic jaundice (yellowing of the skin due to elevated bilirubin levels) caused by the liver not being able to get rid of bilirubin at the normal pace.

Here’s her story on how her husband normalized his liver function:

The Email

Dear Andreas,

Me and my husband have done a Low Carb LOW Fat diet for the last couple of years but for the last month we changed it to an LCHF diet.

We had some blood tests done last week and we were astonished with my husbands results. He was diagnosed Gilbert’s syndrome when he was a teenager and now (he is 36 years old) for the first time, his bilirubin hit normal levels.

His doctor always told him to avoid sugar, fat and not to exercise too much. For years he followed his advice.

For the last two years (on LCLF) the only recommendation he followed was to avoid sugar and fat. He exercised 3 times a week. His bilirubin decreased.

Direct bilirubin650

Pink and red lines denote the lab’s reference range for direct bilirubin. Weight stable from 2008 to present.

Over the last month he has changed to a LCHF diet. He started to eat a lot of fat (butter, olive oil, coconut oil, red meat, oily fish, avocado…) and continued to exercise about 3 times a week.

We though this might interest you so I’m including a spreadsheet with the data and a couple of graphs with his results over time.

Please feel free to contact us if you want any more details.

We love the work you are doing and we are planning on creating a blog in Portugal to spread the word. ;)
Kind regards!

Eduarda Castro


Very cool! I don’t know if this is just a fluke or if the LCHF actually helped with the Gilbert’s syndrome. It does help in fatty liver disease so who knows, it might.

Have you heard of anything like this?

Share your story

Do you have a success story you want to share on this blog? Send it (photos appreciated) to, and please let me know if it’s OK to publish your photo and name or if you’d rather remain anonymous. It would also be greatly appreciated if you shared what you eat on a typical day, whether you fast etc. More information:

Share your story!


LCHF for Beginners

A Low-Carb Diet Best for Fatty Liver


  1. Frances
  2. Anne Robertson
    I had a liver and kidney transplant almost 13 years ago. Six years ago, due to a catheter having been left in place for nearly 7 years instead of 6 weeks, my transplanted kidney had to be cut open to remove the accumulation of stones due to the calcification of the catheter. After that, my liver and kidney functions were deteriorating. Just over 5 years ago, we read "Trick and Treat" by Barry Groves and decided to change the way we eat. Within 6 months, my liver and kidney functions had started to improve, but that wasn't all. My body shape improved, I lost some weight and best of all, I was no longer catching infections easily. In fact, I haven't needed antibiotics for 5 years! I've tried to persuade my hepatologist, who is professor of hepatology at a large Parisian teaching hospital, that this is the way to go for transplant recipients, but he remains sceptical. The transplant coordinator, however, is sure it works so I'm hoping she'll be working on him. In the meantime, my liver and kidney functions are those of a healthy person without a transplant and the toxic medication that goes with it. My husband's health also improved on LC/HF and our dogs and cats are also thriving on it.
  3. Humberto
    I can vouch for fatty liver, as since having spent the last four months on LCHF my liver functions tests have improved markedly, with now only a marginal ALT reading out of normal. I have also shed over 22kg and got my blood glucose, high blood pressure, and resting heart rate under control. And as a bonus, I am loving my new diet no end.
  4. Oscar
    I too have Gilbert's Syndrome. I have not checked my bilirubin since going LCHF but this sounds promising! However I've never really understood what's the problem with bilirubin or Gilbert's at all. My doctor told me the same advice of little exercise, no alcohol, good sleep, no fat, but I ignored it all and never really had any problems whatsoever. I've even heard from evolutionary medicine that bilirubin is a potent antioxidant...
    Eduarda: Did the patient also had to go on a starvation diet to get diagnosed? I hated that part.
  5. sten
    The subject is up in another thread here on diet doctor and I have written extensively about it.
    The whole thing is so simple that most doctors and professors dealing with any kind of liver disease should be ashamed if they cannot prevent gall bladder removal or transplantations.

    When the liver cleans the blood it binds the toxins in intricate ways so that it can pass out to the bile without being re-absorbed in the intestines and re-circulate.
    But liver excretions - gall or bile - is not taking place just/when the liver is "full" of extracted toxins. Instead it takes place as a response to fat digestion, as this is a "dual functioning organ" allowing emulsification of fat at same time as it cleans itself.... Smart and preserving. But if fat consumption declines, bile flow also goes down....
    The intermediate result is a thickening and slower flowing bile, which should indicate that something is wrong. (Bad temper one day will be seen as a warning to increase fat in diet ?) Adding to this as the occasional high fat intake can result in gallstones, directly formed from the oversaturated slow flowing bile, the standard doctor recommendation is to avoid fat even more, something that naturally accelerates the deterioration, and then just one splash out with a little fat can be enough to trigger gall bladder removal. Anyway, wth a continued low fat diet the gall bladder is hardly needed! Yet the liver keeps losing ts functions as its flow output is still triggered by fat...

    That the solution is to restore a "normal" fat intake so that bile becomes thinner and cannot any more form stones but instead slowly dissolve them looks like a natural solution, at least for me.

    Great to hear a practical good result to these unnecessary and painful sufferings, with and without transplantations!

  6. Francois
    I am not sure what to make of this post. Nor can I explain it... But I do find it beyond interesting. Gilbert syndrome is not a disease it is " a common, harmless genetic condition in which a liver enzyme essential to the disposal of bilirubin (the chemical that results from the normal breakdown of hemoglobin from red blood cells) is abnormal (there is less of it). The condition has also been referred to as constitutional hepatic dysfunction and familial nonhemolytic jaundice. The enzyme abnormality in Gilbert syndrome results in mild elevations of bilirubin in the blood, particularly after starvation or dehydration." []
    As you see in the definition, it is not a disease: my wife has the condition and only has a better tan than I do. What I do not understand - and find fascinating - is that according to the textbook definition, "starvation" may increase the bilirubin to the point of producing some jaundice. Starvation is a ketogenic state and yet, so is a LCHF diet (if relatively severe).

    I do not question the ability of a LCHF diet to cure fatty liver within days (where a starvation high carb diet will take months to achieve the same results) and Anne Robertson's results are extraordinary. (Bravo Anne, remarquable decision d'etre allee a contre-courant!). This is getting really fascinating.

    I am beginning to question the medical dogma. In this "dehydration and starvation", was dehydration the real culprit? Was the ketogenic state actually somehow protective against dehydratation? Would the condition have been worse without fasting (if this was true fasting, that is, please see below). I do not know.

    Has anyone with Gilbert's syndrome other than Eduarda done this measurement with either a ketogenic diet or some science-based fasting (and if so, what type of fasting? The 2/5 fast, the daylong fast with all food consumed in one big evening meal versus the religious many days starvation fast (just water or, worse, fruit juices and fruit "fast")...

    Fasting is something with many definitions and means very different things for different people. Hindis fast regularly for religious reasons. But their fast includes lots of carbs (fruits and fruit juices). This cannot have the same effect as a low carb fast. So I wonder if Eduarda did not put a finger on a flaw in medical knowledge. If anyone with Gilbert syndrome has done something similar to what she has done, please post it. It would be most fascinating.

    And by the way, this "limited exercise" necessity is hogwash. My wife is an athlete who does intense interval training and gruesome cardio every day with no appearance of jaundice. Though she eats a protective LCHF diet, she has not always and even when on a high carb diet, she was never significantly jaundiced despite her exercise. But I'm happy she's now protected by LCHF.

    Reply: #8
  7. Michael
    Hello All,

    I had this 'harmless' genetic condition called Gilberts Syndrome. Harmless is in brackets because on the bad days, nausea, light headedness, dizziness and other symptoms can be very outspoken. Days without mild nausea are are very rare in my case. Please keep in mind that this is an n=1 observation !

    When I started eating Low carb, after watching Andreas talk, I just gave it a try. I did not had to lose weight or anything else but what I noticed after a while is that the nausea went away.

    This topic might be an interesting one to discuss with Prof. Richard D. Feinman

  8. Paul the rat
    It is all due to, simplifying it to minimum:
    1) superior energy source i.e. more ATP produced per unit of O2 used
    2) less, let us call it, toxic waste associated with production of this energy from ketones
    3) switch to expression of whole plethora of, let us call it (again) health-friendly genes associated with fat (ketones) burning for fuel.
  9. Robin Willcourt
    François- I have just started a patient on Martin Berkhan's Leangains (LG-IF) dietary pattern with LCHF and protein. In 2 weeks her bilirubin has fallen from 38umol/L to 16umol/L after NEVER having been below 30 all her life- she is now 42 yo! The reason for repeating the blood work so soon was not knowing what IF-HF would do in this case. Would the bilirubin improve or get worse?

    I have over 100 patients on LG-IF and much prefer it over the 5/2 pattern because it establishes a CONSISTENT pattern of eating that is easy to stick to once the person is committed to the program.

    Triglycerides normalise very quickly and fat loss occurs in a steady maaner over a few weeks. Greatest result so far- a male of 34 weighing 117 Kg, now 91 and muscular/lean after 5 months on this program and early metabolic syndrome- GONE!

    Medicine is being challenged and changed. Thank Heavens.

    Reply: #15
  10. Joey B
    What is the lchf stance on avocados?
    Replies: #13, #14
  11. Nan
    @sten- good info, thanks. Seems like the 21st Century will be spent undoing the bad medicine--especially in diet/nutrition--of the 20th, not to dismiss all the great advances of that century, but we had a lot of bad, too.

  12. Nan
    @Joey B-avocados are wonderful hflc food. I eat a lot of them.

  13. Zepp
    Eat as many you want.. but it shouldnt replace proper meals.. make it be a part of proper meals!

    And if you special fond of Avocados.. make it a veggie to your meals!

  14. Murray
    I have avocado most days but I find a large avocado will reduce my ketones significantly. Also, avocados have a lot of omega-6, so I don't go wild on them and balance them with salmon roe and other omega 3 sources.

    One way we have come to enjoy avocado is as a sauce for fish and (with different seasoning, such as minced garlic) for meat. I make an emulsion using raw egg yolk (pastured hen) a citrus juice, the avocado, all hand blended to a sauce and then I blend in plenty of extra virgin olive oil. This makes an incredible emulsion and the yolk and olive oil boosts the fat and improves the fatty acid profile. Grass fed flat iron steak with garlic avocado sauce is divine.

  15. sten
    So would high bilirubin level also be a reasonable measure of bile thickness, or inversely of bile flow?

    Correctly interpreted also gall stones could then become a rare condition with an obvious solution and gall bladder removals could soon rightly go into the annals of medicine, where good organs were either removed or cut down. The procedure make good neighbor to lobotomi, electric shock treatments, bleeding,... and whatever other strange medical methods could be implemented and backed by the contemporary medical authority at the time.

  16. Meridith Parkman
    Helpful ideas , I was fascinated by the analysis , Does anyone know where I could get a sample OPM SF 85P copy to complete ?
  17. Rick Bauer
    I just did a fasting blood lab. My bilirubin came back elevated -- a tick outside the normal range. I've been following LCHF for a number of years (probably higher in protein). Why would I have this? I had hepatitis-A but that was back in 1999. That wouldn't affect it all this time later, would it?
  18. Chris Baker
    Curiously I had the same experience, diagnosed with Gilbert syndrome in my youth. Went on a near exclusive carnivorous diet, with high fat moderate proteins and little to no plant food. And had routine blood test that was carried out a month after and I was incredibly surprised to be told my bilirubin count had dropped back to the normal range. Im 34 years old and was diagnosed sometime in my teens.
    I thought there might be a link, but wasn't sure until I found this article.
  19. Pat Turner
    This is such a great site! I just want to add that according to Mark Hyman a diet for fatty liver is a low carb high fiber omega 3 fatty acid diet.
  20. Lee
    I'm curious why this article has made it look like having lower direct/ conjugated bilirubin is a good thing?
    The liver conjugates bilirubin to make it water soluble to excrete. Since this article doesn't show us before and after of unconjugated bilirubun we can't actually see if the lchf diet had improved it. In facr having lower direct/conjugated bilirubin indicates the liver is even more congested, probably due to extra strain of the excessive fat its dealing with.

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