The Hidden Metabolic Cause of Fatty Liver Disease

Mar 9, 2026

Dr. Karen Jerome-Zapadka, a gastroenterologist using ketogenic care to reverse metabolic liver disease, and Dr. Amy Goss, a pediatric nutrition scientist studying low-carb effects on liver fat, discuss why metabolic dysfunction drives rising fatty liver rates. They explore carbohydrate restriction, ketogenic nutrition, pediatric trials, clinical reversals, comparisons with other treatments, and practical metabolic care steps.

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INSIGHT

Fatty Liver Is A Metabolic Disease

MASLD is primarily driven by metabolic dysfunction rather than alcohol consumption.
Karen Jerome-Zapadka highlights insulin resistance and excess starches/sugars as central drivers and says over 5% liver fat defines steatotic liver disease.

INSIGHT

Low Carb Reduces Liver Fat Independent Of Weight

Carbohydrate restriction appears to reduce liver fat beyond effects of weight loss alone.
Amy Goss's pediatric pilot found liver fat and insulin sensitivity improved on low-carb even after adjusting for modest weight loss.

ADVICE

Use Feeding Studies To Isolate Diet Effects

Try tightly controlled dietary interventions to test composition effects without weight loss confounding.
Amy Goss's NIH-funded R01 is feeding families for 12 weeks to keep adolescents weight-stable while comparing low-carb versus low-fat liver outcomes.

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Can you reverse fatty liver disease with a ketogenic diet?

Fatty liver disease is now one of the fastest-growing liver conditions in the world, affecting roughly 30% of adults and an increasing number of children. And in many cases, it’s driven by metabolic dysfunction and insulin resistance.

In this conversation, Dr. Bret Scher speaks with Dr. Amy Goss (University of Alabama at Birmingham) and Dr. Karen Jerome-Zapadka (Trajectory Health Partners) about the growing epidemic of metabolic dysfunction–associated steatotic liver disease (MASLD) and why carbohydrate restriction and ketogenic nutrition may be powerful tools for addressing it.

In this interview, you’ll learn:

What MASLD (formerly NAFLD) is and why it’s becoming so common
How insulin resistance and excess carbohydrates contribute to fatty liver
New research showing how carbohydrate restriction can reduce liver fat
Why ketogenic and low-carb diets may improve liver metabolism beyond weight loss
The clinical experience of reversing fatty liver through metabolic therapy
Why lifestyle approaches often receive less attention than medications

Dr. Amy Goss and her team at the University of Alabama at Birmingham are currently conducting a large NIH-funded clinical trial investigating how carbohydrate restriction affects liver fat and insulin sensitivity in adolescents with fatty liver disease.

At the same time, Dr. Karen Jerome-Zapadka is applying these metabolic principles in clinical practice at Trajectory Health Partners, helping patients reverse steatotic liver disease through carbohydrate reduction and comprehensive metabolic care. Together, their research and real-world clinical experience are helping advance a deeper understanding of how targeting metabolic dysfunction may transform the way fatty liver disease is treated.

Curious about the safety of ketogenic therapy? Visit our Is Keto Safe topic page to see all of our top content on the topic: https://www.metabolicmind.org/resources/topics/is-keto-safe/

🔎 Have questions about how to apply metabolic therapies effectively? Submit them at metabolicmind.org/questions to be featured in a future Metabolic Mailbag episode.

#MetabolicMind #KetogenicTherapy #MASLD #FattyLiver

Expert Featured:

Dr. Amy Miskimon Goss

Dr. Karen Jerome-Zapadka

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Our courses have been made FREE by grants from Baszucki Group, so we can spread these powerful therapies as widely as possible. Earn CME/CNE credits: https://www.metabolicmind.org/for-clinicians/trainings-courses/?utm_medium=organic-social&utm_source=youtube&utm_campaign=cme-yt

Follow our channel for more information and education from Bret Scher, MD, FACC, including interviews with leading experts in Metabolic Psychiatry.

Learn more about metabolic psychiatry and find helpful resources at https://metabolicmind.org/

About us:

Metabolic Mind is a non-profit initiative of Baszucki Group working to transform the study and treatment of mental disorders by exploring the connection between metabolism and brain health. We leverage the science of metabolic psychiatry and personal stories to offer education, community, and hope to people struggling with mental health challenges and those who care for them.

Our channel is for informational purposes only. We are not providing individual or group medical or healthcare advice nor establishing a provider-patient relationship. Many of the interventions we discuss can have dramatic or potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications.