A recent study reveals that a ketogenic diet may be more effective than the Mediterranean diet in reducing liver fat among individuals with obesity and prediabetes, highlighting diet composition’s role in managing fatty liver disease.
A new clinical trial has added fresh weight to the debate over whether keto can beat the Mediterranean diet for people with fatty liver disease. Researchers reported in Cell Metabolism that a ketogenic eating plan cut liver fat more sharply than either a Mediterranean diet or a low-fat, plant-forward plan in adults with obesity, prediabetes and liver fat. The study also found that about half the people on keto no longer met the criteria for prediabetes after roughly four to five months.
Fatty liver disease, now more commonly called metabolic dysfunction-associated steatotic liver disease, develops when excess fat builds up in the liver. It is closely linked to insulin resistance, obesity, type 2 diabetes and other metabolic problems, and it often causes no symptoms at first, which means many people do not know they have it until routine testing picks it up. Cleveland Clinic, Mayo Clinic and Johns Hopkins Medicine all note that alcohol, some medicines and genetic factors can also play a role.
Catherine Metzgar, a registered dietitian and director of coaching at Virta Health, said a ketogenic diet sharply reduces carbohydrate intake, keeps protein moderate and uses fat as the body’s main fuel. In the study, the keto group reduced liver fat by 67%, compared with 45% in the Mediterranean group, even though participants in all three groups lost about 10% of their body weight. That suggests the composition of the diet, not just weight loss, may matter for liver health.
Metzgar said keto may be especially useful for people with insulin resistance, prediabetes or type 2 diabetes, because lowering carbohydrate intake reduces the amount of glucose the body needs to handle. But she also said the best diet is the one a person can follow safely and consistently. For some, that may be keto; for others, a Mediterranean or another lower-carbohydrate plan may be easier to sustain.
Experts also caution that keto is not for everyone. People with type 1 diabetes, eating disorders, kidney, liver or pancreatic disease, or those who are pregnant or breastfeeding should seek medical advice first. Metzgar also recommends speaking with a clinician before starting keto if a person takes blood pressure or diabetes medication, because doses may need to change quickly as carbohydrate intake falls and blood sugar improves.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
