To Keto or not to Keto?

[Jkf1]

Is the Keto diet diet bad for the liver or not? I am seeing trials and opinions that differ. I like the concept of eating only a small amount of berries with lean meats and vegetables and good fats, but the keto typically uses a lot of saturated fat with butter, heavy cream , cheese, etc. With no whole grains or beans. I know that it is sugar, and bad carbohydrates and inflammation that is what causes the most harm. Experts are now saying that saturated fat isn't the bad culprit that used to be. I need to lose significant weight and am starting a delivery meal service but I am torn on which way to eat. I have stage F2 from fatty liver that progressed. What do you guys think?

[Rm2816]

I believe keto contributed to my fatty liver which I didn’t have prior. Granted I did lose weight but, now have a fatty liver.

[Jkf1 in reply to Rm2816]

Oh no! Thanks for sharing that.

[CTink]

My son did the Keto diet before he got married but has put it all back on again. At the time I asked my specialist If it was any good for me as I was struggling toLose weight, and she said definitely not. I have NASH stage 2. She advised me to do a Mediterranean diet.

[Jkf1 in reply to CTink]

Thanks.

[Hidden]

Hi sorry don't know about diet but I am wonderring is the avatar photo a place in United States

[Jkf1 in reply to Hidden]

I don't know, I just randomly picked it.

[kensimmons]

I'll keep following my doctors suggested ELF diet.

Eat. Less. Food.

I tag on common sense stuff like limiting sugar and salt and oommon sense exercise like taking the stairs not the lifts.

Works for me. All the other diets seem to be completely contradictory.

Here are two articles about why some diets work for some and not others. I highly recommend them (if you are not a subscriber its okay you get like five free articles a month).

Best article (a bit long)

nytimes.com/2016/12/12/heal...

nytimes.com/2018/12/10/heal...

nytimes.com/2019/10/24/maga...

[Jkf1]

Thank you

[dave_tsda]

Hi jfk1, i did not do a full keto diet, but more a combo with keto and Mediterranean. So it was fairly low carb, and probably higher in fat than what is recommended on these forums. Full keto didnt seem maintainable to me in the long run as there are good carbs like beans, assorted veggies and a few fruits like berries that would kick you out of ketosis.

My hybrid diet worked very well for me, and i lost about 15% of my body weight. but I previously had a very high carb/western diet.

Its always good to talk to a doctor or dietician if possible. But there is a ton of research and articles that will point you to a low carb diet being great for weight loss and nafld.

Hope that helps. Feel free to PM me if you have any questions

[Jkf1 in reply to dave_tsda]

Thanks so much! I am already doing exactly as you are! It will be interesting to see my next bloodwork and test results in January.

[Kokomodo]

Jkf1,

I have explored diet, exercise, and the psychology of dieting for many years. I've researched and explored (personally) keto, atkins, paleo, low fat, and low carb diets. I've weighed as much as 280 lbs and as little as 158 on various diets. I've also applied data science techniques to my own daily calorie, macronutrient, exercise, weight, and body composition over a period of years. My experience and results track the results of NIH and other dietary and nutrition professionals.

Some key points:

1) Your mileage may vary. The amount of self-reported "I lost weight doing this" information available is overwhelming. (This includes the very post I'm writing now.) Be suspect of anything coming from the lay community.

2) What you hear from the marketing and commercialized food industry, even if they use the same words, is not the same as what NIH and other professionals likely mean. Be extremely cynical and suspicious of any commercially produced food and any information coming from anyone making money from food or from any specific diet. "Saturated fat isn't the culprit." It's not that simple. Everything depends on what kind of diet you have been following (initial conditions) and what the over all balance of macronutrients you have in your diet. It also depends on whether you are talking about cardiac health, physical condition, liver health, general well being, etc. No single macronutrient, food group, or nutrient means anything on its own. Everything is connected. It's the total picture that matters.

3) The psychology of dieting is not well aligned with how we think of ourselves as people. That is, we like to think that "we" are a single mind that makes decisions. The reality is that your mind is produced through a process of pre-conscious decisions that "vote" on a desired outcome, creating your subjective experience. What does this mean? It means that once you are deprived of calories and begin losing weight, "you" may decide that it's okay to eat a cookie, or, have a second helping, or, whatever. This is not the same "you" that made the decision to diet. In order to stick to the plan, you need to disengage from your immediate thoughts and be prepared to stick to a legalistic plan even if "you" think it's a good idea to indulge.

4) Along the same lines as above, all of the signals that normally guide your calorie intake will become unreliable (hunger, fatigue, etc). You cannot rely on what you feel. You must measure what you eat and be detailed about tracking calories and exercise. Use an app (such as LoseIt) that will adjust your calorie budget as your weight decreases. Do not trust typical "portions." An apple today is twice as big as an apple from the 1960s. Weigh everything.

5) Plan on a long term process. Any diet will cause a 5-6 lb loss in the first week. That 5-6 lb loss will be regained when you come out of calorie deficit at the end of the diet. (Entry bonus and exit tax.) Plan on a maximum real loss of 1-2 lbs per week (average calorie deficit of 500 to 1000 cal per day.) If you need to lose 20 lbs. That's 10 to 20 weeks, plus the entry and exit week. Also, you have to target 5 lbs past your goal weight in order to account for the exit tax. If you have significant weight to lose, plan on six months minimum. If your calorie budget goes below 1,500 cal/day for men, or 1,200 cal/day for women, fix it to that minimum amount and be strict about meeting it. (For example, if you are a woman and only net 1,000 one day, go over your budget by 200 the next day or over the next few days.)

I know you are thinking, "but what about my question? Do I need keto?"

6) By far the most important factor in losing weight is calorie deficit. Eat fewer calories than you burn, and you will lose weight. Each "special" diet (keto, paleo, etc) affects how you feel when you diet (cravings, etc), and, to some degree, what metabolic process the body uses to replace deficient calories. But, in the end, it's all about energy in and energy out. The type of diet you follow will affect how your body responds when you stop "dieting." The closer your diet is to what you will eat when you are done losing weight the better.

7) You do not need keto. If you are trying to follow a liver healthy diet, target 30% fat (including 7% saturated fat), 50% carbs, and 20% protein. Your carbs should come from nutrient dense, high fiber sources such as lentils, kidney beans, garbanzo beans (humous), oats, quinoa, whole fruit, and whole vegetables. The high fiber content of a such a diet will provide long term satiation similar to what the carbohydrate "famine" does on a keto diet.

8) Follow a natural, whole food diet. Everything commercially produced is "photoshopped" in some way to make it more appealing, and to have a higher reward value. This is to be avoided because it induces hunger and also provides a psychological motivation to eat. You can see this in things as blatant as additives, and as subtle as fruits genetically engineered for higher sugar or "sweetness." Learn to cook. Buy basic, raw ingredients, and prepare your food yourself. Anything in a package or from a restaurant is loaded with "hidden" ingredients, often with innocent sounding names or labels. Avoid "diet" anything (e.g., diet coke) like the plague. To some degree, also be careful with how you spice your own food. If something you eat immediately makes you want to eat more of it, make a note of it and be careful and mindful about when and how often you make it.

9) Practice some form of "crock pot" exercise. Slow and low. Walk for an hour. Hike. Bike. Kayak, yoga. These exercises will take time, suppress your appetite, and burn calories. They also relax you and help alleviate stress.

10) Yoga is helpful because it teaches you to pay attention to your body. Often stress and hunger are linked. Learning to breath and relax can help you relax your body, which can reduce hunger. Mindfulness can also be important, say, in an office environment where there are bowls of candy or boxes of donuts. Visualize the desired outcome (walking past the bowl without taking anything out of it) before it happens. This helps interrupt the pre-conscious neural voting process I mentioned above and helps you maintain cognitive coherence so that the same "you" that wants to diet is the "you" that is making a decision when you encounter the bowl or the box of donuts.

11) Guard your sleep. Be strict about going to bed and sleeping. Protect your sleep from television, spouses, significant others, social media, etc that want to keep you up. Sleep is absolutely critical. If you are starving and want to indulge in something it's better to just go to sleep than to eat. I know that doesn't sound healthy. Trust me. Sleep is valuable. "Rest is a weapon." Think of sleep as an active part of achieving your goals.

12) After you are done losing weight, your metabolism will be lower, and the hormones that govern satiation and hunger will be off kilter. Your body is trying to recover the weight. Losing weight is not like swimming from one spot in a lake to another spot in a lake. It is more like swimming up river. As soon as you stop, the current will take you back to where you started and beyond. Thus, when you enter weight maintenance (rather than weight loss), adjust your maintenance calorie budget down by about 200 calories. Continue to monitor your weight and calorie intake and expenditure. Unfortunately, you may be hungry, even if you have enough calories to maintain your weight. You may be hungry for the rest of your life, unless you choose to gain the weight back in order to reset the hormone levels. Crock pot exercises that, again, take time, suppress your appetite, improve your mood, and burn calories help mitigate that unfortunate reality.

So...no, you don't need keto. When I was diagnosed with cirrhosis, I switched from a whole food omnivore paleo diet (e.g., Mark's Daily Apple) to a whole food (mostly) vegetarian diet in line with what I described above. I've lost about 60 lbs, and will have no trouble maintaining this diet indefinitely. In fact, I rather enjoy what I eat, although I do miss ice cream and alcohol.

It's not easy. But, you are taking the right steps and asking the right questions.

-Kokomodo

[Jkf1 in reply to Kokomodo]

Wow, thank you. You have been more than helpful. I needed to read this. Makes alot of sense in what you have said.. THANKS so much.

[Kokomodo]

You're welcome. By the way, most of my fats come from nuts, seeds, avocado, and olive oil. I also eat salmon occasionally and take a fish oil supplement for a broader spectrum of omega-3 fatty acids. Proteins in my diet are generally from the lentils/beans and yogurt. I agree with the comments on the Mediterranean diet, with the caveat that there is no silver bullet. Balance is important.