Fatty liver diet: 8 foods to eat—and 8 to avoid

What is fatty liver disease? As the name suggests, it’s a medical condition caused by a buildup of fat cells in the liver. There are two main types: alcohol-induced (caused by excess alcohol consumption) and nonalcoholic (occurs even if you’ve never had a drink). About 5% of the United States population have alcoholic fatty liver disease. And approximately 100 million people in the U.S. have nonalcoholic fatty liver disease (NAFLD); it’s the most common liver disease in children. The more severe form is called nonalcoholic steatohepatitis (NASH), which may progress to more serious conditions such as cirrhosis of the liver and liver cancer. 

Is fatty liver dangerous? Although 1 in 5 heavy drinkers with fatty liver disease will develop alcoholic hepatitis, most NASH and NAFLD patients won’t experience any major issues. And the good news is that it doesn’t have to be a permanent condition. If you’re wondering how to reverse fatty liver disease, lifestyle changes—including losing weight, avoiding alcohol, and eating a fatty liver diet—are your best bet.

How to manage fatty liver with diet

There are certain risk factors beyond your control that increase your likelihood of developing fatty liver disease. According to the Mayo Clinic, they include:

• High cholesterol, or high levels of triglycerides in the blood
• Metabolic syndrome
• Obesity (especially with fat buildup around the abdomen)
• Polycystic ovary syndrome
• Sleep apnea
• Type 2 diabetes
• Insulin resistance
• Underactive thyroid (hypothyroidism)
• Underactive pituitary gland (hypopituitarism)

However, there are steps you can take to improve the condition—regardless of the cause. When it comes to fatty liver disease treatment, it’s essential to make strategic and lasting dietary changes, rather than just avoiding or integrating random foods here and there. “The most important part of these changes is that they should be sustainable,” says Aymin Delgado-Borrego, MD, pediatric and young adult gastroenterologist and public health specialist at Kidz Medical Services in Florida. So what foods are good for liver repair? Generally, the best NAFLD diet and NASH diet include:

• Adequate fiber
• Lots of fruits, vegetables, and nuts
• Whole grains
• Very limited saturated fats from animal products
• Very limited salt and sugar
• No alcohol

The American Liver Foundation recommends restricting calorie intake and modeling your eating habits after the Mediterranean diet to manage the liver condition. For a balanced diet, Dr. Delgado-Borrego says half of any plate of food you are eating should be fruits and vegetables, one quarter should be protein, and the other quarter should be starches.  You can always reference the foods to eat and avoid, or just remember these two main rules to improve fatty liver: 

1. Opt for low-calorie, Mediterranean-style choices. Eat lots of plant-based foods, whole grains, extra virgin olive oil, and fish—with poultry, cheese, and other dairy in moderation. 
2. Avoid added sugars, processed meats, and refined grains. 

“The best way to ensure significant resolution or even cure [fatty liver disease] is losing approximately 7%–10% of your body weight,” explains Sanaa Arastu, MD, a board-certified gastroenterologist with Austin Gastroenterology in Texas.

8 foods to eat

Experts recommend these foods in particular for a healthy liver:

1. Almond milk or low-fat dairy: Dr. Delgado-Borrego says adults and children with fatty liver disease need to pay attention to calcium consumption. “There is some emerging evidence over the last couple of years that adequate calcium and vitamin D intake may help to prevent the development of fatty liver disease,” she explains and adds that further investigation is needed. “In addition, patients with advanced liver disease have problems due to multiple nutritional complications and can develop early osteopenia and osteoporosis. Fatty liver disease does not necessarily diminish calcium absorption. Calcium is simply important to all.” Drink up to three glasses of either of these kinds of milk per day, or take calcium and vitamin D supplements (calcium dosing is usually 1,000-1,200 mg while vitamin D is 2,000-5,000 IU if you are deficient).
2. Coffee: Without added sugar or creamers, coffee has been shown to be one of the most effective ways at present to improve fatty liver. “It appears that coffee may reduce the permeability of the gut, making it more difficult for people to absorb fats,” explains Dr. Delgado-Borrego. “However, this is still under investigation and the answer to this question is not yet completely known. Nevertheless, there is growing evidence that coffee has beneficial effects in helping to reduce fatty liver disease.” Multiple cups of coffee might be recommended, depending on the patient.
3. Foods rich in vitamin E, including red bell peppers, spinach, peanuts, and nuts: Dr. Delgado-Borrego recommends these types of foods, rich in vitamin E, as a great addition to fatty liver diets. While more studies are needed, one study concludes that the vitamin shows modest improvement for people who have NAFLD or NASH. The recommended dose is 400-800 IU daily.
4. Water: Experts recommended sticking to this beverage as much as possible over sugary and high-calorie alternatives. The average person, with no medical conditions that would limit fluid intake, should drink between a half ounce and an ounce of water for every pound of body weight daily to avoid dehydration and its negative effects on the liver.
5. Olive oil: Certain oils can provide healthy fats, such as olive oil and avocado oil. These help with feelings of satiety and reduce liver enzyme levels. Other types of oil that are high in monounsaturated fats include sesame, peanut, sunflower, canola, and safflower oil.
6. Flax and chia seeds: These are plant sources of omega-3 acids. Registered dietician Sandy Younan Brikho, MDA, RDN, recommends these acids for both nonalcoholic and alcoholic fatty liver, as they may reduce the fat content in the liver. 
7. Garlic: One study suggests that upping your garlic intake (specifically through garlic powder but other forms work, too) over a 15-week period led to decreased body fat mass in people with NAFLD and also reduced the fat in the liver and prevented the progression of the disease
8. Soy: Some evidence suggests that soy products, such as soy milk or tofu, may improve fatty liver. One study says that research has shown improvements in the metabolic parameters in people with NAFLD.

8 foods to avoid

The foods to avoid are typically those that can spike blood sugar levels, or lead to weight gain, such as:

1. Juice, soda, sugary beverages, and refined carbohydrates like white bread: Dr. Delgado-Borrego tells her patients to avoid these as “the enemy of the liver are sugars and carbohydrates.”
2. Diet drinks that are low calorie: Dr. Delgado-Borrego says sugar substitutes can also cause more liver damage.
3. Butter and ghee: These foods are higher in saturated fat, which Younan Brikho says has been associated with high triglycerides in the liver.
4. Sweet baked goods and desserts (cakes, pastries, pies, ice cream, cake, etc.): These types of sugary carbs are detrimental to success if you are trying to reverse fatty liver disease. 
5. Bacon, sausage, cured meats, and other types of fatty meat: These are high in saturated fats, and therefore not recommended by our experts.
6. Alcohol: This is not recommended by our experts if you have fatty liver disease that was the result of heavy drinking, as it will simply lead to further liver damage. For those with NAFLD, it’s okay to have a drink once in a while, such as a glass of wine.
7. Salty foods: Some research has suggested that NAFLD is worsened by salt consumption, for two reasons–it typically accompanies higher fat and higher calorie foods, such as some others on this list, and it also can result in dysregulation of the renin-angiotensin system, enhancing your risk of fatty liver.
8. Fried foods: Fried foods like french fries and onion rings are often high in calories, going against expert advice to follow a more calorie-restricted diet.

Fatty liver diet plan PDF Download

4 ways to reverse fatty liver disease

In addition to changing the way you eat, these lifestyle modifications can help to reduce your risk of fatty liver disease and even reverse the condition.

1. Exercise more

Weight loss, nutrition, and other healthy practices can improve liver disease drastically, and work best when you implement them together. Dr. Delgado-Borrego recommends 60 minutes of physical activity each day but encourages people who find this intimidating to split the sessions into smaller increments, such as four 15-minute walks. The U.S. Department of Health and Human Services calls for 150 minutes per week of moderate-intensity aerobic activity and also recommends strength training at least twice per week. 

2. Get more ZZZs

While sleep is important for everyone, it can be even more so for people with liver diseases. “Conditions such as obstructive sleep apnea are common and can worsen liver disease by diminishing oxygen supply to the liver,” Delgado-Borrego says. “People with possible sleep problems should be formally evaluated for them.” The Sleep Foundation recommends seven to nine hours per night for adults. Try gradually going to bed a few minutes earlier each night instead of trying to alter your morning schedule, which might be tougher.

3. Discuss supplements with your healthcare provider

All of our experts recommend consulting with a healthcare provider first before starting any supplements. This is especially true for vitamin E, a commonly used supplement for people with liver issues, because taking too much can result in other health complications such as cardiovascular issues. Supplements should also be used in conjunction with a healthy diet and lifestyle changes for maximum efficacy.

4. Try medication

There are currently no FDA-approved medications for fatty liver disease, according to Harvard Health, although new medications are expected to come on the market in the near future. Medications that have shown some benefit in fatty liver and NASH, include metformin and Pioglitazone (commonly used to treat diabetes)

With persistence and consistency, fatty liver can be reversed and even cured. The length of time often depends on how long it takes a patient to safely lose weight, if necessary. It also depends on how consistent they are with diet and exercise changes. Also consider lifestyle changes that reduce your stress, as one study suggested cellular stress in the brain contributes to fatty liver.

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