I’m writing in hope for some guidance. It’s about liver pain. I try to put a long story short, but trying to add all necessary details. I’m a male, 34 years of age now. I was binge drinking in my 20’s on many weekends, but was also doing sports and eating more or less healthy. I was drinking in my 30’s as well, but in much smaller quantities and health became more important to me. Almost 2 years ago I started a ketogenic diet, back then I was convinced it is healthy and good for sport performance as well. I did the diet for ~8 months. During that 8 months I was slowly developing some strange ache, dull pain in my liver area. I went to see a hepatologist, Fibroscan returned a 6,3 kpa score without fatty liver, ultrasound showed signs of mild liver damage. I immediately stopped the diet, returned back to eating balanced meals without drinking alcohol of course. After 3 months Fibroscan showed normal scores of 4,3 kpa. Hepatologist told I will be fine, just don’t go back to keto. So I did, but the liver pain is present since then after 1,5-2 years of quitting the diet. It’s not constant, but it’s there and recently I found a connection, that it always intensifies when I’m doing cardio exercise in a fasted state first thing in the morning, weight lifting seems only to trigger it when I go heavy on some full body exercise like squats or deadlifts. When I eat a spoonful of honey before exercising, the pain won’t come. And it’s the same, when the pain comes during the day, if I eat something heavy in carbs like honey, pain goes away. I’m afraid that the keto diet was just something which shed light on an already existent liver condition what probably the drinking was causing. Does anyone of you have had something similar? Do you know what this could indicate or if it is possible to heal this condition somehow? Shall I continue to eat honey whenever I feel the pain? Seems obvious but I'm afraid of doing more harm than good, I don't know to be honest anymore...
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werna4
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I feel dull ache when I eat, it is worse in the morning and I noticed that it is worse with cold foods such as grapes and blackberries.
I did read however Chinese medicine say's your organs are actually still "asleep" early morning and to wake them up with hot water and lemon. I'm having couple hot drinks first (tea) before eating and it appears to ease it.....I am currently waiting for my first appointment with the hepatologist so i've no idea if it is linked to any damage of sorts. Maybe keep a diary of foods/times? I have started in hopes it can provide them with better picture for my appointment
Thanks for the answer. Interesting what you are writing. I noticed that it's not food dependent for me, I mean there are no specific foods that trigger the pain, it seems that it's always an issue, when I'm getting into a fasted state and only Carbs seem to help. My other problem is, that as my labs and exams turned out to be good (apart from the mild liver damage shown on the ultrasound), the doctors don't seem to be bothered with the pain which is not normal in my opinion. Good luck with your appointment, I hope it turns out to be nothing serious
Yeah, mine is food and drink. for example As part of the investigation they found I had H.Pylori, treated that. Then i noticed when i was having the little actimel shots there was a "sensation" on my right side, it became more apparent and i started to notice it with some food as well, not all though. It is more apparent with cold food and when i have an empty tummy, like the morning or if i've skipped lunch. The opinion of my GP was as it wasn't after a large/fatty meal so didn't believe it wasn't related to liver. Personally i find the GP's nowadays are experts in medicine. They are very good at that part!
All my results were fine, 2nd time one was raised but it could have been due to liver or bone as it was ALP (the testing was due to inflammation in my thumb joint). I paid for my own ultrasound as I, like you knew there was something going on, the ALP had been raised on previous tests where the inflammation was not present. The ultrasound resulted in my referral as it found 2 masses on my liver (they've since been confirmed as benign) but the follow up was in place already because of this.
It has taken me to push and keep pushing. GP still refused until speaking with the liver team after I passed her my ultrasound results. It was them who ordered the MRI with contrast. Had the referral not been made, I personally for my own peace of mind would have been booking to see a private hepatologist. The Nuffield, when I originally looked in to it offer an initial consultation for £200.
It could well be as it is related to something else, who can say. It is only due to the location i am assuming it "may" be down to my liver. I'll let yo know what they say. the chinese medicine theory could be old wives tales to the experts
I try to convince myself as well, that if there would be something serious, my hepatologist would have treated this with more seriousness, but still, pain is always a sign of something going on which might become serious going down the road. It's just that I'm lurking the internet for at least one similar case, or cases where the keto diet has damaged someone in a similar way, but I found nothing yet. I feel like this stupid diet has done something of which my liver can't really recover from, as if some of it's functions have been compromised or I don't know.. I will go next month to do a blood test and for a control ultrasound whether the damage has improved in the last 1,5 years or not. I will bring up the honey+exercise thing as well, maybe it will help the doc to make some conclusions.
Chinese medicine might be considered as old wives tales by experts, but I think many of the observations of these ancient civilizations and even our grand parents even if the scientific background was and is still not understood were right and are helping a lot of people even nowadays, especially in cases where today's modern medicine is clueless. Of course there is the placebo effect as well, so it's mind boggling for sure But you never know when you meet an expert who is open for these things. I live in Hungary, the medical professionals here are rather conservative
Hi Werna4. I was very interested to read your post. Although I can't relate to many of the issues you have, I am intrigued by the keto subject. I had perfectly normal liver function test results last august, but by November my ALT and ALP results were very high. I am on quite a lot of medication (for a heart attack in 2019), but had not changed anything. The only difference was that I had lost 2 stone following a very low carb diet. Am due for an ultrasound soon, to see if there is any liver damage. I don't have pain in the liver area as such, just some discomfort. Strange eh? Can't find anything online as to why keto could cause liver problems. Are you still being treated by the hepatologist?
Hi Nettekin, thanks for reading and replying. I was looking in the internet even before I started the diet, to find any evidence that it can be unhealthy, but I haven't really found anything just positive experiences, and even if something wasn't working for someone, there was always a "guru" who told what to eat, how to eat and the issues went away. But my hepatologist told me, that my condition is not uncommon in people who went on the keto diet, just 2 weeks before my visit she had a similar case and there is a fitness celebrity here in Hungary who is promoting the diet whit their own brand and wanted to collaborate with my hepatologist who is a nutritionist as well, and because of her experience she never teamed up with the fitness guy to promote this diet. The hepatologist told me, that all of us are different and some can tolerate this diet for years without ill effects, but this is practically the worst thing someone can do to their liver long term. It's quite effective for losing weight, but it's very easy to slip back once one is going back to eat carbs. Out of my own experience, for me a plant based way of eating is the way to go, not vegan, but mostly plant based. I went down the rabbit hole in so many topics regarding diets for health/longevity etc. but you will always find convincing proponents for every side let it be 100% frutarian or 100% raw carnivore.
Back to Keto and liver issues, it's interesting that I never had elevated liver enzimes, but my cholesterol went through the roof. My ferritin numbers and uric acid numbers were borderline high as well. My D vitamin levels plummeted, and I did everything "right", didn't eat junk, I've eaten the fats considered good in Keto, ate enough protein, ate some greens as well. As I wrote earlier the first fibroscan reading was a bit elevated, but ultrasound showed mild fat infiltration of the liver. My hepatologist was 100% convinced that this was the keto diet, and not my previous drinking habits. She also told, that there might have been a silent liver inflammation going on at the end of my diet, so I did the best to quit it.
Regarding your question, I'm not treated as of now, but I just want to book an appointment for controlling my labs and to have an ultrasound done. I hope I can get rid of this somehow, it's quite frustrating... I wish you all the best, and if I can give you one advise, be very cautious with this diet.
Thank you for all that info werna4. I followed a very low carb diet for about 16 weeks in order to try and reverse my diagnosis of diabetes. It absolutely worked for that - the readings went from just into the full blown type 2 diabetes range down to no diabetes at all. I was delighted by this of course as well as the way it helped me lose weight relatively easily. The only downside has been these worrying liver issues. Going forward I think I will leave low carb alone and focus on a more balanced diet. I have been a vegetarian for 40 years and will steer clear of 'white' carbs but reintroduce some of the wholegrains back into my diet as I would like to lose some more weight. A more rounded, lower calorie diet may be my best option. Best wishes to you.
In my research for beating nafld, I have read a ton about keto and low carb and adopted a hybrid of the 2. I have not seen anything similar to keto causing liver pain. Quite the opposite actually from most of the info I have read and watched. Keto can be great for insulin resistance, diabetes, and nafld.
For my own experience, after having blood work done 2 times in one week, my liver enzymes went up mysterly even though they had been trending down prior to the 1st. I hypothesized that week in between that I had smoked a brisket and ate a ton of redmeat for a week which my liver was not happy about. I asked my doctor who ordered the test but he didnt answer the question
So my question, are you sure you're truly in ketosis? And 2nd question, have you tried working out in a non fasted state? Most everything I've read and seen is just that exercise is important, but you can absolutely still achieve a healthy live style by working out in a non fasted state. And 3rd question, what version of keto are you doing (clean vs dirty)? I chose not to do full keto because i felt that a more balanced diet was right me and I needed some carbs if i was going to maintain. I was also trying to balance the amount of red meat to be more heart (and liver) healthy. Some of the suggestions you see out there for keto just dont seem healthy to me long term.
And last thing, (sorry this turned into a book), dont always assume you're doctor will have all the answers. You should keep digging and asking questions. My primary said no tylenol/no booze and referred me to a hepatoligist. My first hepatoligist just ordered tests and didn't give me any advice. I kept asking until he got annoyed and referred me to another who answered most of my questions. If you think something is not right, you know your body. Keep asking for help or find a doctor who will keep investigating
Thanks for replying That's the point, I haven't found anything negative regarding keto, especially regarding keto and liver neither, but as I wrote according to my hepatologist I'm not the first one visting her with liver issues caused by keto. I would be cautious with saying it's good for insulin resistance and type 2 diabetes. True, you can get low blood sugar readings with keto, and therefore you can manage type 2 diabetes with it, but you are actually just masking the problem in the background, namely that the body is unable to process glucose as it should, and eating some carbs while doing keto you get a much worse response to carbs than before keto. It's highly debated whether this keto caused peripheral insulin resistance is pathologic or not, even amongst "keto experts". Interestingly enough, a lot of people are managing their type 2 diabetes with a whole food plant based diet, with 400+ gr of carbs a day, without medications, but don't get me wrong, I'm not advocating anything here, I burned myself with keto, and I will never follow anything extreme anymore in my life.
Regarding your questions. I quit keto ~1,5 years ago, and still suffering the consequences. When I was doing it, I was in ketosis all the time, blood work showed it and you can feel it in your breath as well. I was doing clean keto most of the time, but with a high amount of red meat and organ meats as well, it was grass fed, highest quality you could get. Normally I was working out fasted, it's only nowadays that I'm having a spoonfull of honey before the workouts, as it seemingly hinders the appearance of the pain. I'm constantly looking for answers and doctors, who are interested in what I'm saying regarding the pain, but once they figure out I have no serious liver damage, fibroscan is ok, and labs are ok they don't seem to be interested that much, and which is quite annoying as well, that this is private care for lots of money, as here in Hungary you don't have a chance to get anything done right within the "state funded medicine" (sorry I'm not a native speaker, I have no idea how this is called in english). So yes, I'm still looking and searching for answers and most importantly for a remedy...
Hi ! Could l just pop in here .... the liver is not keen on being over loaded with fats as it has a hard time processing them and can lead to problems such as fatty liver. The body also stores sugar as fat and in turn also attacks the liver. Since keto is a high fat low carb faddy diet it is not good if you do have liver problems. If you are working out too your body will function better with proteins found in lean white meats and fish. Plenty of fresh fruit and vegetables. Experiment with them as not all fruits suit all people the same. It's also important not to workout especially with weights on an empty stomach.... you body needs to be fuelled first. A small amount of porridge with fruit /berries to sweeten naturally for breakfast will slowly release energy throughout the morning to keep you from feeling hungry for longer and it will keep your strength up. Lay off the alcohol too..... thats poison to the liver. There is more info on the livertrust wesite about the right eating plan to keep your liver healthy and reverse any damage which may have occurred which in turn will gradually cure the pain. Stay fit, stay healthy and stay safe.
Hi Laura009! Thank you for your answer I will never follow a high fat diet again, that's 100% sure. I would be really interested in your oppinion regarding something which is bothering me for a while. Everyone is saying to follow a low fat diet, especially with liver conditions, that's clear. You are also mentioning plenty of fruit, which is actually containing a lot of sugar, of course together with the fiber and vitamins as well. Altough I'm having a desk job, I'm a fairly active person working out almost every day to somehow counterbalance that, so I need ~2500 Kcal to maintain my weight. If I keep the fats at a minimum, and even if I eat protein around 150 gr/day which is more than enough for me as I weigh ~71 kg (~157 lb) the rest of the calories need to be filled with carbs which brings me around 350gr of carbs a day which seems to be a lot and I have to eat starchy carbs in order to be able to eat that much, or isn't that a problem if it gets burned during the day? Or considering that someone is trying to heal a liver condition, proteins should be higher and rather lower the carbs? I'm so hesitant as I really don't want to do any more harm to my liver, and I never find clear directions, because I always hear and read that fats should be low, carbs should be low as well, but don't overdo it with protein either But what should one be eating then? Sorry for going into details this much, and I totally appreciate that you can't give medical advise, but I would be really interested what your oppinion is. Thanks in advance if you are asnwering, have a great day
Oh, and yes, I will quit the booze totally, last time I drank a beer was 2 months ago, but I don't miss it, my first priority is getting back my health.
Laura has actually left the forum but appreciates your response. She wants you to know that the sugars in fruits are natural sugars, unlike the processed variety.
For myself, I spent 19 months on a transplant list and a mainstay of my diet was absolutely loads of fresh fruits. I discussed it with my Consultants and they were more than happy with this. I firmly believe that I benefited enormously by eating copious amounts of fresh fruit and vegetables.
I was eating them whole, grapes, blueberries, strawberries, plums, apples, bananas, kiwi fruits, pineapple etc. Juicing them reduces the amount of fibre and I was suffering with HE. I couldn’t cope with the lactulose, and found that the fruit produced some of the beneficial effects.
Hey Werna, been looking for this report of yours for years, since I've started trying the keto diet. I actually quit many times because of this.
My guess is that it's related to an increased fat intake that overloads the liver. So I'm now approaching the Keto diet is a "higher" fat and not an absolute "high" fat diet, specially because I'm still shedding some pounds, when my liver is mostly breaking down my own fat storages for energy due to the high calorie deficit.
In fact, the keto diet is a very low calorie diet if you do it right. Calorie is limited and maintained by the fat + protein + fiber combination that deliver satiety.
I am now experimenting with having only enough fat to induce ketosis so i dont eat only plants and meat. A good rule of thumb I've created is fattening foods only for seasoning them, so am no longer eating fatty cuts of meat, deep frying or going heavy with oils at all.
I also once found a relation of this symptom with dehydration and the keto flu, and because of this I've also increased my salts intake (sodium, potassium and magnesium) supplementing or increasing the amount of food where they naturally occur.
This post was not intended to be structured or give any medical advice. I'm just someone trying to realize its own body.
Hi Healp, if you have any sort of liver problem then a Keto Diet or any radical diet plan needs to be run past your consultant first. Ideally you should ask to see a liver specialist dietician for individualized diet advice.
Some of the things you've posted might be of some concern if people have liver disease.
When you say your own liver is burning body fat for fuel - that ends up not being the case with conditions like cirrhosis because fat is so difficult for the liver to process it instead burns muscle for fuel. Leading to muscle wastage and other issues.
Increasing salt intake is also not recommended for people with liver disease in that it can damage the liver and also in cirrhosis can lead to retention of fluid and ascites build up.
I know you are new on board here so don't know your back story or condition but we need to be cautious with diet as it is a very individualized thing - what is needed for some isn't recommended for others.
Thanks Katie! I will also consider testing more often, so i can see how it develops. Maybe we can talk more dynamically over my progress and research in the chat if you're interested?
It totally depends on your underlying health condition and liver state. My hubby has cirrhosis so is on a diet recommended personally for him based on his individual needs and because he was previously deemed malnourished and had muscle degeneration. At 8 stone at one point and now happily maintaining at 10 - 10 1/2 stone with regained muscle and additional stores should he ever return to a transplant needy stage. He is on a high carb, high protein plan as provided by liver specialist dietician - eating frequently with no long fasts and snacking often.
I don't need to go to chat function with you thanks. Just pointing out that what is good for one isn't necessarily good nor even safe for others.
Hi Healp, thanks for replying to the thread. I thought this was long forgotten,as you can see the last correspondence on this was 11 months ago.
I know keto and low(ish) carb works/worked for many, but I'm done with this. My liver pain only began to subside and almost fully dissappear, once I sticked to a mostly plant based diet with smaller amounts of lean meat, many veggies and fruits, grains and legumes. I'm saying "almost fully dissappear" as even now, when I'm eating scrambled eggs from 3-4 whole eggs in the morning and doing this for a couple of days, the liver pain develops again. I just tried this 3 weeks ago, and before that I haven't had the pain since months. For me it's definitely cholesterol/saturated fats that trigger it, and never right after the meal. 1,5 months ago I was having a control ultrasound test and did bloodwork with a 3 point blood glucose tolerance test. Everything was perfect and I was painfree while eating high carb/low fat for months. Actually that's why I tried to eat a couple of eggs in a row of a couple of days, and there you have it, pain came back. Maybe my liver needs more time to fully heal, maybe it never will, but I know now from experience that what works is, what most of the health professionals and doctors are saying and actually what I got here as an advise as well if you read back the whole thread: fruits, veggies, legumes, grains and lean meats in moderation keeping the fat low and the calories in check. This seems obvious, but it wasn't for me neither. I tried to overcomplicate it, and I was stupid for believing the mantras of different diet gurus regarding keto back then when I started it and sticked to it for almost 8 months. But please, don't get me wrong, I'm not judging you at all, and as I wrote earlier, low carb can be a remedy for some, but definitely not for all, and I'm not one of them.
If you are having pain/discomfort, please consider, to consult with a doctor/hepatologist/nutrionist.
Hello there. Your story about the keto inducing some form of "liver pain" is very interesting !
It's the exact same thing for me. I have psoriasis, so I tried to do the keto diet 3 years ago and the pain appeared maybe a couple weeks in. I kept doing it for 8 months or so, then I stopped because of this weird sensation. Its exactly like you describe, some form of tenderness that is not trigger by eating. Its there 24/7. Seems to irradiate in the back sometime too. Worst when fasting or lacking carbs sometimes yes I think.
Its been 3 years that Ive been back at a "normal" whole food diet but its still there. Nothing was ever found on test, except fecal elastase that is low but the pancreas is fine apparently. And I did a MRI and we found a very mild steatosis (6%)
I'm super fit, muscular, eat healthy.. That's crazy ! I'm not sure if you will ever read this, but I wanted to chat with you about this pain. Maybe you could offer some advices ?
Thanks Attila! I will deeply consider dropping it if i end up crashing again, as it has happened more than once in all my tryings.
The thing about keto is that you won't get it as a medical advice unless you have seizures and can't take medications and even then, all you'll get will be recommendations, like restrictions, and nothing else. Most people you'll talk will dismiss it as a fad diet and won't take you seriously.
From this point onwards i should say I'm experimenting with the diet and my body as safely as i can and that i reached to share experience over this "pain" in the liver i have everytime I'm on keto wich is the one and only undesirable result of running it everytime.
I did the keto diet for 8- 9 months and I wonder if it's responsible for my last fibroscan showing that I now have NAFLD (on top of PBC and cirrhosis). I now believe in moderation. I would also watch out for any kind of herbal stuff...I believe my PBC was kicked off by a Chinese herbal called Jin Bu Juan which was eventually banned in Canada because it apparently caused liver, brain and nerve damage. Just because something is an herbal doesn't mean it's safe...there are many herbals that cause liver damage.
I had some minor liver pain (under the rib) when I was first diagnosed and it probably lasted for a year or two but I never have pain there now.
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