A recent clinical trial suggests that a ketogenic diet may offer metabolic benefits beyond weight loss, including significant reductions in liver fat and improved blood sugar markers in obese individuals with prediabetes and fatty liver disease.
A tightly controlled clinical trial published in Cell Metabolism suggests that a ketogenic diet may deliver metabolic gains beyond weight loss alone for some people with obesity, prediabetes and fatty liver disease. Researchers at Washington University School of Medicine in St. Louis compared the ketogenic plan with a Mediterranean diet and a low-fat, plant-forward diet, and found that the very low-carbohydrate approach produced the biggest improvements in liver fat and some markers of blood sugar control.
The study involved 42 adults, all of whom had obesity, prediabetes and fatty liver disease. Rather than asking participants to self-report their meals, the research team supplied all of the food and had them meet a dietitian each week. That design helped the scientists keep weight loss broadly similar across the three groups, allowing them to examine whether diet composition itself made a difference. The ketogenic diet was extremely low in carbohydrate, with just 4% of calories coming from carbs and 73% from fat, while the Mediterranean and plant-forward diets contained far more carbohydrate and less fat.
All three eating plans improved health. Participants lost body fat and became more sensitive to insulin, which helps regulate blood sugar. But the ketogenic group recorded the strongest changes: liver fat fell by an average of 67%, compared with about 45% in the other two groups. The researchers also saw the largest rise in glucagon, a hormone that helps the body mobilise stored energy, alongside the greatest drop in insulin levels. Notably, the high-fat ketogenic diet did not lead to higher blood fat or cholesterol during the trial.
The most striking result concerned prediabetes. After about four to five months, around half of those on the ketogenic diet no longer met the study’s criteria for prediabetes. That compared with roughly 29% in the Mediterranean group and 7% in the low-fat, plant-forward group. The authors said the findings suggest that, for some patients, reducing carbohydrate intake may add metabolic benefits beyond the effects of weight loss alone. Still, the trial was small and short, so it cannot show whether the same advantages would last over years or prove practical for most people in everyday life.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
