Eating Fat with a Fatty Liver? How Keto Can Help Reverse NAFLD and Improve Cholesterol

This topic sits at the heart of one of the biggest paradoxes in modern nutrition. For decades, the public has been taught that fat is the enemy of both liver and heart health. So when people with Non-Alcoholic Fatty Liver Disease (NAFLD) or high cholesterol hear about a diet that's 75% fat, their first reaction is fear. This creates a significant mental block, even as they see powerful personal stories of people reversing fatty liver and improving their health markers in a matter of months. The audience is caught between deeply ingrained nutritional dogma and the promise of a radical solution, desperate for a clear explanation of how eating fat could possibly fix a problem that seems to be caused by fat.

The primary concern is that a high-fat ketogenic diet will worsen their existing conditions, leading to a more severe fatty liver, dangerously high LDL ("bad") cholesterol, and an increased risk of heart attack or stroke. Viewers are explicitly worried that in trying to solve one problem like insulin resistance, they might inadvertently create a worse one, like cholesterol-related heart disease. The idea of consuming more fat when you already have a "fatty liver" feels deeply counterintuitive and risky.

The most crucial insight from the sources is that Non-Alcoholic Fatty Liver Disease is not primarily a disease of dietary fat, but a disease of excess carbohydrate and insulin resistance. The liver becomes fatty because high and persistent insulin levels—driven by a diet high in sugar and starch—signal the body to constantly be in "storage mode," turning excess carbohydrates into fat directly inside the liver. A ketogenic diet works by dramatically reducing carbs, which lowers insulin, switches the body out of storage mode, and allows the liver to finally start burning its own stored fat for fuel.

• Dr. Andrew Kutnick: He provides a powerful, data-driven counterargument to the fear of high LDL cholesterol. He discusses a 10-year case study of a patient on a ketogenic diet whose LDL cholesterol nearly doubled, yet their cardiovascular health was better than that of healthy individuals without diabetes. His key insight is that stable glucose control appears to be a much stronger predictor of cardiovascular health than LDL levels alone, suggesting that the benefits of eliminating glucose spikes can outweigh the concerns about rising LDL.
• Dr. Sten Ekberg: He excels at explaining the "why." He places fatty liver disease at the far end of the insulin resistance continuum. His framework clarifies that the problem isn't the fat you're eating, but the body's broken carbohydrate-processing machinery, which leads to high insulin and forces the liver to store fat. The solution, in his view, is to address the root cause—insulin resistance—by lowering carbohydrate intake.
• Thomas DeLauer: He adds important nuance to the cholesterol conversation. He explains that on a high-carb diet, people tend to have more small, dense LDL particles, which are more easily oxidized and linked to arterial plaque. In contrast, the LDL increase sometimes seen on keto is often of the large, buoyant particle type, which is considered less harmful. He also notes that a temporary rise in triglycerides can be a sign of fat mobilization, as your body releases stored fat from its tissues to be used as energy.
• Dr. Georgia Ede: She offers a direct and empowering message that helps dismantle the fear of "unhealthy" keto foods. She states clearly that the damage causing metabolic dysfunction is not coming from red meat, cholesterol, or saturated fat. Instead, she identifies the primary culprits as refined carbohydrates and industrial seed oils (like soy, corn, and canola oil).
• Dr. Siobhan Deshauer (Violin MD): She presents the findings from a Lancet study that created concern, showing a link between low-carb, animal-based diets and higher mortality. However, her practical takeaway offers a path forward for those who are still worried: if you choose to do keto, the study's recommendations suggest you should focus on plant-based proteins and fats, such as nuts, vegetables, and healthy oils like olive oil.

Make your next meal an act of healing for your liver. Eliminate all sugar, bread, pasta, and rice. Instead, build your plate around non-starchy vegetables (like a large salad), a moderate portion of protein, and cook with or add a healthy fat like olive oil, avocado oil, or butter. This is the first and most critical step in lowering the insulin that is driving fat storage in your liver.

• Mistake: Combining high fat with high carbs. This is the worst possible combination, as it keeps insulin sky-high and tells your body to store all the dietary fat you're eating.
  Fix: When you increase healthy fats, you must drastically reduce carbohydrates. You have to pick one primary fuel source.
• Mistake: Using poor quality fats. Eating a diet high in inflammatory processed seed oils will not promote healing.
  Fix: Replace all corn, soy, canola, and safflower oils with stable, healthy fats like olive oil, avocado oil, butter, ghee, tallow, and coconut oil.
• Mistake: Equating fatty liver with dietary fat.
  Fix: Understand that NAFLD is a disease of insulin resistance driven by carbohydrates. Reframe your thinking: the fat on your plate is not the problem; the sugar and starch are.

• "After 4 months on a well balanced Keto diet... I have fully recovered from fatty liver which I have had for over 15 years."
• "I had both PCOS and fatty liver, and my body worked everything out with just a diet change."
• "Was diagnosed with hepatic steatosis... I took out ALL carbs that were not incidental, i took out all sugars including fruit. In two weeks i lowered my AST from 46 to 33, my ALT from 105 to 55…."
• "I’m down 70lbs on keto! I have been able to get off several meds and correct my fatty liver"
• "Keto Diet May Cause Fatty Liver & Insulin Resistance -- is this caused only by the heavy saturated fat from MEAT and does the PLANT BASED VERSION AVOID FATTY LIVER AND INSULIN RESISTANCE?"

The fear of eating fat when you have a fatty liver or high cholesterol is understandable, but it is based on an outdated understanding of metabolism. The sources strongly indicate that the primary driver of these conditions is not dietary fat, but rather chronic overconsumption of carbohydrates and resulting high insulin levels. A well-formulated ketogenic diet, by lowering insulin, switches your body from fat-storage mode to fat-burning mode, allowing your liver to finally heal itself from the inside out.