As a type 2 diabetic, I've been on a low carb diet for about a decade. Recently I learned that I have fatty liver. The low carb diet hasn't helped me to lose weight, and I'm obese, though the diabetes hasn't gotten worse.

My dilemma is new information that "dietary fat and free fatty acids (FFAs) impair insulin sensitivity and increase glucose production". I already know that free fatty acids are toxic. One gets free fatty acids in the blood when your fat cells are already maxed out, as mine are, and you eat fats. There's also the information that "fatty liver … may actually have an independent role in the development of type 2 diabetes".

Losing weight is a solution that often can reverse fatty liver if it's not advanced.

So it's now just as important to limit the fats in my diet as the carbohydrates. But there are only three sources of calories protein, fat, and carbohydrates. One can't just eat protein and low carb fruits and vegetables. First, it seems eating even more protein than I already am might raise the risk of ketosis.

Second, a diet deficient in fat causes health problems. I'd have to be careful not to overdo fat restriction. People can actually die from a diet with adequate protein but insufficient fat. I remember reading about people starving when their only meat was rabbit, because rabbit is much leaner than other meats.

I get fat mainly from frying food, salmon, nuts, and very dark chocolate. For example for breakfast I just ate tofu and egg substitute fried in extra virgin olive oil, and berries. I fry tilapia in olive oil once or even twice a week. I want to stop the fatty liver and lose weight, so I'm ready to cut back on lipids. But I'm also a little scared, because a high protein low fat and low carb diet is even more radical than what I've been doing.

I'd seek the guidance of a dietician, but I don't trust most American dietician's training. I don't think they're even aware of such scientific literature, much less integrating it into their practice for diabetics.

I'll start by keeping a diary of what I eat, to keep the excess lipids under control. Any suggestions?

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It seems they're telling you to go back to the diet that mainstream medicine usually recommends for diabetes, which is high in complex carbs, low glycemic index, low fat, and moderate protein. 

You might try the lowfat vegan diet, e.g. http:/ - this kind of diet has been tried for people with diabetes with good results, getting a lot of people off insulin.  Perhaps because it's very bulky and people tend to lose weight on it since it's so lowfat. 

The professionals who promote this kind of diet would have experience in transitioning diabetics from a lowcarb diet to the lowfat vegan diet (which is a radical change).  Dr. Mcdougall has retreats where people are initiated into the lowfat vegan diet, probably with medical supervision.

Also possibly the forums at would offer support - there are surely other diabetics who've been through this. 

I couldn't handle a vegan diet, but thanks for your suggestion and your concern, Luara.

There are version that aren't vegan, like the Ornish diet that includes dairy, and the Pritikin diet that includes small amount of lowfat meat.  They are similarly, high in complex carbs and lowfat. 

By the way ... 99% fat free does NOT mean that 1% of the calories are from fat.  Actually it has a higher % of calories from fat.  93% fat free turkey has 12% calories from fat. 

You can look up food compositions in the USDA nutrients database, if you click on "Full Report" it will give you info on how much saturated fat and trans fat is in the food. 

Any kind of fat will have some saturated fat in it, so if you are eating a highfat diet, it's likely to have a good deal of saturated fat. 

Oops, I meant 93% fat-free turkey has 50% calories from fat. 

"93% fat-free" means that 7% of the weight of the turkey is fat. 

What a shock. Thanks for that information. I've been eating 93% lean ground turkey for a long time. I tried 99% fat free with some added olive oil the other day and it seemed OK. Maybe that will be my new favorite. I knew it was by weight, but didn't realize that half of the calories were in that fat.

Yes, the 90-x fat-free thing is an advertising gimmick ...

Cron-o-meter is a program that can track your nutrient intakes, so you see what you're actually getting.  Probably still free.  

Upon further investigation, it turns out I don't need to restrict all lipids to reduce fatty liver, only saturated fat and trans fat (never touch that anyway). So I'll just have to eat less dairy fat, to start. Tomorrow I try 99% lean ground turkey with a little olive oil mixed in. I usually ate 93% lean. I already eat very little red meat, and I'll cut out mayo and commercial salad dressing. Then the big problem will be to exercise more. My goal is to go from 197 lbs to 177 lbs by losing no more than 2 lbs a week.

Wish me luck.

Just reporting in. I managed to eliminate most saturated fat from my diet. I'm substituting a mixture of olive oil with sesame tahini solids for margerine, making my own salad dressing, avoiding red meat, etc. Today I'm feeling great. Olive oil is strongly anti-inflammatory and it's keeping my arthritic fingers happy as well as suppressing pinched nerve pain.

The liver specialist says that my liver enzymes are back to normal, and I won't need a liver biopsy or even a return visit. Just lose more weight.

With fewer aches that's beginning to seem possible, though I've only lost a couple of pounds so far.

Thanks for your support!


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