Overview

This is an open-label, randomized study comparing a monitored ketogenic diet intervention using standard ketogenic diet (SKD) and standard of care (SOC) dietary recommendations for 16 weeks. Subjects enrolled in the standard of care group will receive a voucher to Weight Watchers after study completion.

Eligibility

Inclusion Criteria:

1. NASH cirrhosis (criteria in Appendix 1) with obesity (BMI >30 kg/m2).
2. Age 18 and greater

Exclusion Criteria:

1. Actively participation in investigational drug treatment for non-alcoholic fatty liver disease
2. Currently taking medications for weight loss or have joined a supervised weight loss program prior to enrollment
3. Have hepatocellular carcinoma and are undergoing therapy
4. Women who become pregnant or plan to become pregnant prior to the study date; female subjects who become pregnant during the study will be withdrawn from the study
5. Pacemaker or implantable cardioverter devices
6. History of hepatic surgery
7. Current significant alcohol consumption, defined as more than 20 grams per day in females or 30 grams per day in males
8. Presence of ascites or hepatic encephalopathy
9. Symptomatic gastroparesis
10. Uncontrolled diabetes, as defined by a HgbA1C >11%
11. Uncontrolled congestive heart failure
12. Active infections
13. Child Turcotte Pugh score > 6
14. MELD score >12
15. Unwilling to undergo an MRI or have contraindications to an MRI