Can low carb diet cause elevated liver enzymes?

The ketogenic diet is a high-fat, moderate-protein, low-carbohydrate diet that can induce weight loss and improved glycemic control, but presents a risk of inducing hyperlipidemia, elevated liver enzymes, and the onset of fatty liver disease. Our meta-analysis of clinical trials revealed that LCDs improved liver fat content, but not serum levels of liver enzymes in subjects with NAFLD. However, there are many sources of heterogeneity that need to be considered, for which we were unable to perform subgroup analysis. A new study has shown that a low-carb diet can improve liver function in people with fatty liver disease.

The study was published in the journal Diabesity in Practice and involved 69 patients who had very high levels of the liver enzyme gamma-glutamyl transpeptidase (GGT), which is a typical marker of fatty liver, insulin resistance, or excessive alcohol consumption. While several observational and experimental studies have examined the effects of low-carb diets (LDCs) on nonalcoholic fatty liver disease (NAFLD), there are considerable inconsistencies between the studies. Conversely, low-fat diets high in sugar, starch, grains, and cereals are the main culprits, as is alcohol. Forest plot showing the overall effect of a low-carb diet on serum gamma-glutamyl transferase levels in subjects with nonalcoholic fatty liver disease and subgroup analysis based on study design (parallel or cross-over and pre-post studies using a randomized effects model).

Forest plot showing the overall effect of a low-carb diet on serum alanine transaminase levels in subjects with nonalcoholic fatty liver disease and subgroup analysis based on study design (parallel or cross-over and pre-post studies using the random-effects model). Forest plot showing the overall effect of a low-carb diet on liver fat content levels in subjects with nonalcoholic fatty liver disease and subgroup analysis based on study design (parallel or crossover and before-after studies using the random-effects model). Forest plot showing the overall effect of a low-carb diet on serum levels of aspartate aminotransferases after eliminating ketogenic diets in subjects with non-alcoholic fatty liver disease and subgroup analysis based on study design (parallel or cross-over and pre-post studies using a model of random effects). This was a British study, and currently the NHS recommends a low-fat diet to treat fatty liver, but The British Liver Trust believes that a low-carb diet is much more effective and could reduce premature deaths from fatty liver.

Forest plot showing the overall effect of a low-carb diet on serum levels of aspartate aminotransferases in subjects with non-alcoholic fatty liver disease and subgroup analysis based on study design (parallel or cross-over and pre-post studies using a randomized effects model). Forest plot showing the overall effect of a low-carb diet on serum alanine transaminase levels after eliminating ketogenic diets in subjects with non-alcoholic fatty liver disease and subgroup analysis based on study design (parallel or cross-over and pre-post studies using a model of random effects).