- A clinical trial found a ketogenic diet reduced liver fat by 67% after four to five months.
- All diet groups lost about 10% of body weight, but keto produced the largest liver-fat reduction.
- About half of the keto group no longer met criteria for prediabetes, although long-term safety and suitability still matter.
A ketogenic diet has again produced striking metabolic results, this time in people with obesity, prediabetes and fatty liver disease.
The trial compared a ketogenic diet with a Mediterranean diet and a plant-forward lower-fat diet.
All three groups lost around 10% of their body weight after four to five months.
That is already clinically meaningful.
But the liver-fat results separated the groups.
People following the ketogenic diet had an average 67% reduction in liver fat.
The Mediterranean and plant-forward groups each saw an average reduction of around 45%.
That difference matters because fatty liver disease is closely linked with insulin resistance, type 2 diabetes and cardiovascular risk.
The keto group also showed a stronger shift out of prediabetes.
About 50% of participants in the ketogenic group no longer met criteria for prediabetes after the intervention.
That compared with 29% in the Mediterranean group and 7% in the plant-forward group.
Researchers also found that insulin sensitivity improved across all three groups.
The ketogenic group had the largest rise in glucagon and the greatest fall in insulin levels, both of which may help explain the liver-fat reduction.
One surprising finding was that the keto group did not see the expected rise in blood fats or cholesterol despite eating the highest-fat diet.
That will get attention, but it should not be overinterpreted.
Keto diets vary hugely.
A diet built around fish, eggs, olive oil, nuts, seeds and non-starchy vegetables is not the same as one built around processed meats, butter and cheese.
For people with diabetes, medication safety matters too.
Low-carbohydrate diets can increase the risk of hypoglycaemia in people taking insulin or sulfonylureas unless medication is reviewed.
They may also be unsuitable for some people with kidney disease, a history of eating disorders or other medical conditions.
So this is not a casual DIY recommendation.
The real message is more nuanced.
Weight loss helps, but diet composition may change where the benefits show up.
For fatty liver and prediabetes, carbohydrate restriction may offer added metabolic effects beyond weight loss alone.
The next question is whether those benefits can be maintained safely and realistically over the long term.
Study link: Effect of diet macronutrient content on the cardiometabolic response to weight loss
