What to Eat When You Have Fatty Liver Disease
Dietary Recommendations for Better Management
Verywell / Lara Antal
Medically reviewed by Sonal Kumar, MD
Fatty liver disease is characterized by the presence of abnormal amounts of fat in the liver, which is called steatosis. If you have fat in your liver but no other damage, you are thought to have metabolic dysfunction-associated steatotic liver disease (MASLD, formerly known as nonalcoholic fatty liver disease or NAFLD).
If left untreated, inflammation and liver cell damage can occur, causing a disease called metabolic dysfunction-associated steatohepatitis (MASH, formerly known as nonalcoholic steatohepatitis or NASH).
People with MASH are at risk for developing fibrosis (or scarring) in the liver. Fibrosis is staged from 0 to 4, with stage 4 being cirrhosis. Cirrhosis is associated with end-stage liver disease, and liver transplantation. MASH itself is associated with cardiovascular-related diseases.
Dietary changes inducing weight loss and adding nutrient-dense, antioxidant-packed foods, such as fruits and vegetables, can reverse or prevent the progression of the disease. Limiting refined carbohydrates, simple sugars, high-frustose corn syrup, fried foods, processed foods, and foods high in saturated fat is also important.
Weight loss, particularly in the abdominal or adipose tissue, can help reduce fat in the liver. Because fatty liver disease is often associated with obesity, insulin resistance, metabolic syndrome, and increased risk of cardiovascular disease, weight loss is one of the primary goals—and diet can help with this.
Related: How to Choose Good Foods for Your Liver
Benefits
The cornerstone of any treatment regimen for patients with MASLD is lifestyle modification focused on weight loss, exercise, behavior modification, and improving insulin sensitivity. Slow and steady weight loss, as opposed to rapid weight loss, is recommended. Research suggests that rapid weight loss can actually worsen fatty liver disease.
Diet plays an essential role in weight loss, and specific nutrients are of focus for those with fatty liver disease. Reducing simple carbohydrates and saturated fat can reverse or prevent the progression of the disease.
Most of the time, there are no symptoms of fatty liver disease, but it is often associated with central obesity, dyslipidemia, hypertension, hyperlipidemia, and insulin resistance. These health issues can initiate a host of other symptoms such as lack of energy, fluctuations in mood, and disrupted sleep. Weight loss can help to improve these symptoms and conditions.
A large randomized control trial found that those participants who lost greater than or equal to 7% of their body weight had significant improvements in steatosis, lobular inflammation, and MASLD activity score. Losing 10% of body weight is associated with improvement in fibrosis.
Researchers suggest that as little as 5% weight loss can yield improvements. It is advised to avoid rapid weight fluctuations and to initiate a weight loss of about 1 to 2 pounds per week (which means decreasing daily calories by 500 to 1000).
How It Works
Specific macronutrient recommendations will likely vary from person to person. However, some studies have shown that people with fatty liver disease benefit from eating a lower carbohydrate/ higher fat diet (focusing on unsaturated fats).
In fact, in a study where people with MASLD were randomized to lower-calorie diets with the same amount of calories but different macronutrient ratios, those receiving the lower carbohydrate (40% versus 60%) and higher fat (45% versus 25%) diet had improved liver function tests.
Some research suggests that following a lower carbohydrate diet with lower-glycemic index (GI) carbohydrates can improve MASLD. Glycemic index can be a tricky concept to follow, but simply choosing lower-glycemic index foods (rather than counting glycemic load) may help reduce blood sugars and hyperinsulinemia, too.
Polyunsaturated fats (omega 3s and omega 6s) are also a focus, due to their anti-inflammatory and lipid-lowering capabilities. Fatty fish and walnuts are examples of foods that are recommended.
A Mediterranean diet also has good data to suggest it reduces hepatic steatosis.
Duration
An individualized meal plan based on dietary preferences and lifestyle is important because this is not a temporary diet, but a lifestyle change. If the diet is too restrictive and only followed for a period of time, old eating patterns will restart and you will gain weight back, putting yourself at risk of having fatty liver and its associated diseases again.
What to Eat
Following healthy dietary patterns are important for everyone, but people with fatty liver disease need to be particularly careful to watch what they eat.
Federal dietary guidelines, jointly published by the U.S. Departments of Agriculture and Health and Human Services, recommend that people keep the following dietary principles in mind when making food choices:
Half of your plate at a meal should be fruits and vegetables. Focus on whole fruits and vary vegetables.
Half the grains eaten should be whole grains.
Vary your protein sources.
Move to fat-free or low-fat milk and yogurt (or lactose-free, fortified versions).
Choose foods and beverages with less added sugars, saturated fat, and sodium.
Compliant Foods
Whole grains: oats, 100% stone-ground wheat, barley, bulgur, farro, wheat berries, brown rice
Legumes: beans, lentils, chick peas (preferably dried and not canned)
Starchy vegetables: sweet potato, turnips, yams
Nonstarchy vegetables: broccoli, spinach, kale, onions, leeks, asparagus, artichokes, peppers, onions, mushrooms, carrots, tomatoes, cauliflower
Nuts and seeds: walnuts, sunflower seeds, almonds, cashews, pistachios
Healthy fats: extra virgin olive oil, avocado
Lean protein: white meat chicken, turkey, eggs, pork, vegetarian protein
Fatty fish: salmon, tuna, sardines
Fruit: berries, kiwi, apple, orange, lemon
Low-fat dairy: low-fat Greek yogurt, low fat kefir
Herbs: basil, cilantro, parsley, rosemary, thyme, oregano, lemongrass, lavendar
Non-Compliant Foods
Refined carbohydrates: white bread, white rice, bagels, white pasta, prepared boxed foods
Sweeteners: high fructose corn syrup, maple syrup, sugar
Trans fat and saturated fat: margarine, processed baked goods, fried foods, pastries, high-fat beef, full-fat cheese, packaged/boxed foods
Refined snack foods: chips, pretzels, crackers, rice cakes
Sugary beverages: soda, juice, sports drinks
Sweets: cookies, cakes, ice cream, donuts, desserts
Processed high-fat meats: sausage, bacon, bologna, liverworst, prosciutto
Whole grains: Whole grains—specifically those that are lower in glycemic index, such has whole oats—are rich in vitamins, minerals, and filling fiber. They aid in satiety and bowel regularity, and are a wonderful replacement for white, refined carbohydrates.
Legumes: A vegetarian source of protein and fiber, legumes are a complex carbohydrate that help to keep you full and reduce large blood sugar fluctuations. They are also low in fat.
Starchy vegetables: These complex carbohydrates are also rich in phytonutrients, fiber, and vitamins, such as vitamin C. Vitamin C is a powerful antioxidant which is also important for boosting immunity.
Non-starchy vegetables: Full of filling fiber and low in calories, non-starchy vegetables should be the base of most meals. They are voluminous and are rich in nutrients. Vegetables such as artichokes, leeks, and garlic, which are rich in oligofructose, may reduce triglycerides and serum glucose levels.
Nuts, seeds, walnuts: Rich in omega 3 fatty acids, nuts like walnuts may help reduce triglycerides and lipids. They can also reduce inflammation. Aim for raw, unsalted options whenever possible.
Lean protein: Protein is important for muscles and helps to keep you full. Compared to higher-fat protein, lean protein is lower in calories and saturated fat, which can help with weight loss. For example, swapping 3 ounces of ground beef for 3 ounces of chicken can save you about 150 calories.
Low-fat yogurt, kefir: Rich in calcium, vitamin D, and probiotics, low-fat dairy can be a healthy option. Research has shown that probiotics can help modify bacteria in the gut that may play a role in the development of MASLD and progression to MASH.
Fatty fish: Rich in omega-3 fatty acids, fatty fish like salmon may help reduce triglycerides and fat in the liver.
Fruit: Fruit, such as berries and kiwi, is rich in vitamin C, filling fiber, and antioxidants. People who eat more fruits and vegetables tend to maintain healthier weights.
Herbs and spices: Herbs and spices add flavor and are rich in inflammation-fighting antioxidants. They are low in calories and have zero fat, too.
Takeaway
Some studies have shown that supplementing with vitamin E can help reduce fatty liver disease. Before starting any supplementation, discuss with your physician. Always focus on food first; spinach is a good option.
Recommended Timing
There are no specific dietary guidelines, meal time recommendations, or schedules that should be followed. Rather, this should be a full lifestyle change tailored to your specific needs with a focus on weight loss.
Most people who are trying to lose weight typically require three meals and one or two snacks per day to receive adequate nutrition and prevent overeating. Meals and snacks should contain fiber and protein which to keep you full and prevent large blood sugar swings that lead to cravings and overeating.
Practicing the plate method can be helpful. It allots half of your plate to non-starchy vegetables, one-quarter of your plate lean protein like white meat chicken, fish, lean pork, turkey, and one-quarter of your plate a starchy vegetable or whole grain.
Some examples of appropriate starch portions include: 1 medium potato, 2/3 to 1 cup of a whole grain like brown rice, quinoa, farro, bulgur, wheatberries, or 1 whole-grain wrap.
Cooking Tips
Lower-fat cooking methods should be used. These include grilling, baking, broiling, poaching, and sautéing. When cooking vegetables, marinating protein, or dressing salads, aim to use unsaturated fats such as extra-virgin olive oil, avocado oil, and canola oil. Saturated fats, such as butter, cream, and full-fat milk should be limited or avoided.
Flavoring food with fresh and dried herbs and spices is also recommended.
Modifications
A healthy diet that induces weight loss will subsequently reverse fatty liver or prevent progression. It will also likely lead to a drop in blood pressure, cholesterol, lipids, and blood sugar.
The exact diet you choose can vary. A Mediterranean-style diet, the DASH diet, and a lower carbohydrate diet can work. Some people, particularly those with diabetes, may also benefit from a ketogenic diet (however, this type of eating plan has not been studied specifically for people with fatty liver disease and should be guided by a professional).
Some contraindications may exist depending on whether or not you take certain medications. For example, people who take Coumadin (warfarin) are advised to eat a consistent vitamin K diet and, therefore, need to monitor their intake of non-starchy vegetables rich in vitamin K, such as spinach, broccoli, collard greens, etc.
In addition, people with diabetes who also have MASLD should monitor their blood sugars regularly and keep in contact with their physicians to prevent hypoglycemia, given that lowering carb intake will cause a reduction in blood sugar. Most of the time, weight loss and a reduction in carbohydrates will indicate a need to reduce or change diabetes medications.
Considerations
There is no one-size-fits-all approach or specific diet for fatty liver disease. Your eating plan should induce weight loss and be a part of an overall lifestyle change that you carry on for the rest of your life.
Finding what works for you and committing to it can be challenging and take some time. Seeking help from a nutritionist or dietitian can help set you up for success.
Sustainability and Flexibility
Because there are no outright forbidden foods on this diet, rather a focus on healthier foods choices, this diet is sustainable.
Start slowly and give yourself time to make substitutions. As you continue to replace unhealthy food choices with healthier ones, you will feel more energized and healthier overall, which will likely encourage you to keep up your efforts.
You can follow this type of eating plan on-the-go, at work, and at home. The key to this type of eating plan is aiming to eat whole foods as much as possible.
Today, healthy food choices are available wherever you go, whether it be the airport, the convenience store, or the supermarket. You can always find something once you focus on the choices you are making.
If you're unsure of your access to appropriate foods when you are out, consider grabbing some snacks from home before you head out. For example, put some raw almonds in a bag and tuck it into your pocket.
Healthy meal delivery services can be great options if you are not keen on cooking or you're short on time.
A Word From Verywell
The exact macronutrient distribution of your diet will depend on a variety of factors, including pre-existing health conditions, age, activity level, weight, etc. But the aims of a healthy eating pattern for someone with fatty liver disease remain the same no matter what: induce slow and steady weight loss (no more than 1 to 2 pounds per week), incorporate nutrient-dense whole foods, and reduce simple carbohydrates, added sugars, and processed foods.
As you work to make these diet changes, put attention toward behavior modification, exercise, and goal setting as well. A healthier lifestyle begins today.
Read the original article on Verywell Health.
