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STUDY: Guided Ketogenic Diet Improves Fatty Liver in Type 2 Diabetes

A new study demonstrated working with a knowledgeable practitioner via telemedicine to utilize nutritional ketosis markedly improved fatty liver markers. Gee, that sounds like a service this site offers!

The Ketogenic Diet is very useful for those who have been overloaded with carbs. It isn’t the goal to switch everyone to this way of eating permanently, however, it serves to improve numerous therapeutic outcomes – if done right. That is where the guided part comes in.

If someone decides to jump on the Keto train and starts at Dr. Google, there will be quite a crowd.

With all that information floating around – some good, some bad – the key to success with clinical outcomes is partnering with experienced clinicians.

Objective One year of comprehensive continuous care intervention (CCI) through nutritional ketosis improves glycosylated haemoglobin(HbA1c), body weight and liver enzymes among patients with type 2 diabetes (T2D). Here, we report the effect of the CCI on surrogate scores of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis.

Conclusions One year of a digitally supported CCI significantly improved surrogates of NAFLD and advanced fibrosis in patients with T2D

osthoc analyses of surrogate markers of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis in patients with type 2 diabetes in a digitally supported continuous care intervention: an open-label, non-randomised controlled study1

Treating Fatty Liver with a High Fat Diet?


The most powerful interventions we have to offer often come in the form of removing a factor versus taking more drugs or supplements. In this case sugar, espescially fructose.

What causes fatty liver is mostly excess dietary carbohydrate (like type 2 diabetes). The liver converts that energy into fat for distribution in the body. If it continues to receive carbs from the diet in excess of its ability to export that fat, accumulations take place in the liver tissue. Long term, this is no good.

Utilizing a low carb diet removes this trigger for buildup, again, if done right.

Glocose vs Fructose

Similar sounding names, completely different metabolism in the body.

Glucose is the sugar measured in blood to check for diabetes. Sucrose, table sugar, is half glucose and half fructose. High fructose corn syrup (HFCS) is about 55% fructose, 45% glucose.

Carbohydrates mostly raise blood glucose, including grains such as wheat and corn, and other starches like potatoes. Fructose comes in from the diet, other carbs don’t convert starches to that form.

Fructose is common in higher percentages in fruits. But, those whole fruits have fibers that blunt some of the absorptions into our bloodstream. Still though, on a keto diet, fruits would limited.


Fructose is metabolized directly by the liver. Most cells will not use it for fuel, unlike glucose. When introduced, the liver bears the brunt of processing it into fuel storage (glycogen) or shipping it out as fat. Most people on a high carb diet with low activity have a full glycogen tank in the liver so the latter is more common – hello fatty liver!


Fructose also has another metabolic feature. Its breakdown process depletes ATP (cellular energy currency) AND increase uric acid – the main player in gout.

Ready to slurp down some HFCS in your favorite sweetened beverage?

How Keto Can Help Fatty Liver

Type 2 diabetes and fatty liver are both carbohydrate fuel overload. Keto, if done correctly, switches fuel sources from carbs to fat. Add in a little calorie restriction and/or intermittent fasting on top, and we can create an increase in demand over supply and fat can get used up for energy as opposed to accumulating in all kinds of sneaky places, including the liver.

I put together a whitepaper on type 2 diabetes, please click here to read – FREE!

There are many pitfalls to implementing a keto diet though. Too much protein, sneaky carbs, the wrong kind of fats, dehydration all can lead to less than desirable outcomes.

This is where the guided piece, described in the article, comes into play. They used clinical experience, and home testing to ensure proper results – and it succeded compared to normal protocols.

These findings highlight the beneficial effect of the comprehensive continuous care intervention (CCI) on diabetes management and in ameliorating the liver-related injury. These changes were not reported in the usual care (UC) patients receiving standard diabetes care treatment.

Improve or Manage?

In pharmacy school, the buzz was around “chronic disease state management”. Cool sounding, right? It was especially for pharmacy students looking to perform at a higher level than just dispensing medication. I was game.

Now, the more I know about how chronic disease works, management is not a goal I am looking to set. Managing simply revolves around medicating to, in this case, a singular benchmark – blood sugar control. Currently, our health care system is full of effectively managed patients – they keep getting their monthly medications.

How about improving? Precisely the point behind the whitepaper mentioned earlier, why don’t we change the trajectory of the disease process? That was the dichotomy presented in the study – standard care versus a team approach to change the course of the disease, and the team approaced improved outcomes.

Study recruitment and intervention
Patients participating in the continuous care intervention (CCI) had access to a remote care team consisting of a personal health coach and medical providers (physician or nurse practitioner). The participants in the CCI self-selected between two different educational modes, either via on-site education classes (n=136, CCI on-site) or via web-based educational content (n=126, CCI virtual). The CCI patients were routinely assessed for nutritional ketosis based on blood beta-hydroxybutyrate (BHB) concentrations. We also recruited and followed a cohort of UC patients with T2D (n=87) who received a standard diabetes care treatment from their primary care physician or endocrinologist without modification

Being a pharmacist, and a Certified Human Potential Coach, with experience implementing ketogenic diets for clinical outcomes, makes for a service that is uniquely positioned to partner with those looking to improve – not manage – their medical conditions. Please reach out for a free introductory call today and get started!

One more parting reason to utilize our approach – there are no drugs!

urrently, there are no approved pharmacological interventions for N
non-alcoholic steatohepatitis (NASH; indicating significant hepatocellular injury).

  1. https://bmjopen.bmj.com/content/9/2/e023597

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