A tightly controlled clinical trial found a ketogenic diet cut liver fat by about 67% and helped many people move out of prediabetes, even when weight loss matched other diets.
Story Snapshot
- Ketogenic diet reduced liver fat by about 67% in adults with fatty liver disease.
- About half on keto no longer met prediabetes criteria after the plan.
- Mediterranean and low-fat plant-based diets cut liver fat by about 45%.
- All groups lost about 10% of their body weight, so diet composition drove the differences.
Trial compared three diets head-to-head under equal weight loss
The study followed adults with obesity, prediabetes, and fatty liver disease for roughly five months. Researchers assigned participants to one of three diets: ketogenic, Mediterranean, or low-fat plant-based. All groups lost about 10% of their body weight.
Despite equal weight loss, the ketogenic group saw a much larger drop in liver fat, about 67%, while the other two groups averaged about 45% reductions. This design helps separate diet composition from simple calorie loss as drivers of liver changes.
The ketogenic plan also improved liver insulin sensitivity more than the other diets, suggesting a stronger effect on how the liver handles sugar and fat. Reports describe a two- to threefold greater gain in liver insulin sensitivity on keto than in the comparison groups.
That matters because fatty liver and prediabetes both track closely with insulin resistance in the liver. Improving that function can lower fasting sugar, tame post-meal spikes, and ease fat buildup in liver cells.
Prediabetes remission signals a clinically meaningful shift
About half the people on the ketogenic diet finished the trial without meeting prediabetes criteria. That compared with about 29% on the Mediterranean diet and about 7% on the low-fat plant-based diet. For patients, that means fewer doctor warnings and less risk of sliding into type 2 diabetes.
For clinicians, the message is practical: when weight loss is equal, very low-carbohydrate eating may deliver a greater metabolic payoff in this population.
METABOLIC PERK: A clinical trial found the keto diet slashed liver fat by 67% — nearly double the reduction seen with Mediterranean and low-fat diets — in adults with obesity and prediabetes who all lost the same amount of weight.
Registered dietitian Ilana Muhlstein told Fox… pic.twitter.com/f1DuQotlTt
— Fox News Health (@foxnewshealth) September 3, 2026
Americans want results that show up in the lab and on the scale. This trial shows both. Equal weight loss across plans removes the usual “they just ate less” excuse. The macronutrient mix mattered.
Cutting carbohydrates low enough to enter ketosis appears to drive faster liver fat use, better glucose control, and sharper insulin action. That aligns with prior reviews that found ketogenic and very low-carbohydrate diets reduce liver fat beyond what weight loss alone would explain.
What this means for patients and doctors right now
Primary care clinics see waves of people with prediabetes and fatty liver disease. Many have tried “eat less, move more” and stall out. This trial supports a short-term ketogenic option for motivated adults who need a strong metabolic reset, with regular lab checks and coaching.
A practical playbook looks like this: set a window of a few months, aim for whole-food fats and proteins, keep carbohydrates very low, monitor glucose and liver enzymes, and adjust medicines if needed.
Policy and payer systems favor approaches that quickly and clearly cut risk. A diet that reduces liver fat by two-thirds in months and helps many leave prediabetes status fits that bill. It may also reduce future costs from diabetes and liver complications.
One caveat applies: the trial appears small and short, so long-term maintenance still needs study. But for patients on the edge today, acting on strong short-term data can be wiser than waiting years for perfect answers.
How keto may deliver bigger liver gains, even with equal weight loss
Very low carbohydrate intake lowers insulin levels, which frees fat from the liver for burning. The liver also produces ketones, which tissues use for energy when carbs are scarce. This shift reduces new fat formation in the liver and increases fat export and oxidation.
Reviews and clinical reports support these mechanisms and outcomes: sharper reductions in intrahepatic fat, improved triglyceride levels, and gains in insulin sensitivity with ketogenic approaches in fatty liver disease.
Sources:
foxnews.com, sciencedaily.com, pmc.ncbi.nlm.nih.gov, sciencemediacentre.es
