What to Eat When You Have Fatty Liver Disease

Dietary Recommendations for Better Management

In This Article

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 nonalcoholic fatty liver disease (NAFLD). If left untreated, inflammation and liver cell damage can occur, causing a disease called nonalcoholic steatohepatitis (NASH). NASH is associated with cirrhosis, end-stage liver disease, and liver transplantation, and is often associated with cardiovascular-related diseases.

Dietary changes inducing weight loss, adding nutrient-dense, antioxidant-packed foods, such as fruits and vegetables, can reverse or prevent the progression of the disease. Weight loss, particularly in the abdominal or adipose tissue can help to reduce fat in the liver.

Limiting refined carbohydrates, simple sugars, fried foods, processed foods, and foods high in saturated fat will also be important in treatment. Because fatty liver disease is often associated with obesity, insulin resistance, metabolic syndrome, and increased risk of cardiovascular disease, slow and controlled weight loss is one of the primary goals.

Benefits

The cornerstone of any treatment regimen for patients with NAFLD 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 percent of their body weight had significant improvements in steatosis, lobular inflammation, and NAFLD activity score.

Researchers suggest that as little as 5 percent of weight loss can yield improvements, however, an initial of 10 percent weight loss is typically recommended and supported by the clinical guidelines published by the National Heart, Lung, and Blood Institute–National Institute of Diabetes and Digestive and Kidney Diseases. It is advised to avoid rapid weight fluctuations and to initiate a weight loss of about 1 to 2 pounds per week (decreasing daily calories by 500 to 1000).

Example

If you are a person who weighs 250 pounds and need to lose 10% of your body weight, you should aim for a total weight loss of about 25 pounds. Losing 1 to 2 pounds per week, for instance, would take three to six months, or 12 to 25 weeks.

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 NAFLD were randomized to lower-calorie diets (measuring the same amount of calories) containing different macronutrient ratios, those receiving the lower carbohydrate diet (40 percent verse 60 percent) and higher fat (45 percent verse 25 percent) had improved liver function tests.

Some research suggests that following a lower carbohydrate diet with lower glycemic index carbohydrates (they raise blood sugar at a slower rate than higher glycemic index foods) can improve NAFLD. Glycemic index can be a tricky concept to follow but simply choosing lower glycemic index foods (rather than counting glycemic load) may help to reduce blood sugars and hyperinsulinemia, too.

Animal studies have also shown a correlation between decreasing saturated fat intake and improved liver function. Replacing saturated fats with monosaturated fats is likely to be ideal. Pay specific attention to olive oil, the main oil in the Meditteranean diet, as a replacement for saturated fats.

Polyunsaturated fats (omega 3 and omega 6) are also a focus, due to their anti-inflammatory and lipid-lowering capabilities. It has been suggested that people with fatty liver disease increase their intake of fatty fish and walnuts.

Duration

An individualized meal plan based on dietary preferences and lifestyle is important because this is not a temporary diet, rather a lifestyle change. If the diet is too restrictive and only followed temporarily, old eating patterns will restart and you will gain weight back and can put yourself at risk of having fatty liver and its associated diseases again.

What to Eat

Generally, according to the American Academy of Nutrition and Dietetics, a healthy diet will include:

  • 2-4 servings of fruit
  • 3-5 servings of vegetables or 2-3 cups
  • Whole grains: 6 servings
  • Lean meat 3-6 oz (cooked) 2-3 servings
  • Low-fat dairy 2-3 servings
  • Fat/oils 2 servings
  • Nuts, seeds 3-4 servings/wk Include
  • Sweets, limited- 0 servings

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, and 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, proscuitto

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 help to 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 and wound healing.

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. Some studies have shown that supplementing with vitamin E (found in many vegetables, like spinach) can help to reduce fatty liver disease. Before starting any supplementation, discuss with your physician. Always focus on food first. In addition, 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 to reduce triglycerides and lipids. They can also reduce inflammation. Aim for raw, unsalted whenever possible.

Lean protein: Protein is important for muscles and helps to keep you full. Lean protein is lower in calories and saturated fat. Choosing lean protein versus higher fat protein can result in 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 play a role in modifying the bacteria in the gut which may play a role in the development of NAFLD and progression to NASH.

Fatty fish: Rich in omega 3 fatty acids, fatty fish like salmon may help to reduce triglycerides and fat in the liver.

Fruit: Fruit, such as berries and kiwi are rich in vitamin C, filling fiber, and antioxidants. People who eat more fruits and vegetables are more inclined to maintain healthier weights and achieve a lower body mass index.

Herbs and spices: Add flavor and are rich in inflammation-fighting antioxidants. They are low in calories and have zero fat, too.

Recommended Timing

There are no specific dietary guidelines, meal time recommendation, or schedule that should be followed. Rather, this should be a full lifestyle change tailored to specific needs, with a focus on weight loss.

Most people who are trying to lose weight typically require three meals and one-to-two snacks per day to receive adequate nutrition and prevent overeating. Meals and snacks should contain fiber and protein which will help 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, farrow, 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, cheese, and full-fat milk should be limited or avoided.

Flavoring food with fresh and dried herbs and spices is also recommended. Herbs and spices are rich in antioxidants which fight inflammation. They are also low in calories, have zero fat, and add a ton of flavor and color. Some animal studies have shown that ginger may improve insulin sensitivity and decrease liver fat content.

Modifications

A healthy diet for 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, DASH and 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 or 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, for those people with diabetes who also have NAFLD, lowering carbohydrate will cause a reduction in blood sugar and therefore they should monitor their blood sugars regularly and keep in contact with their physicians to prevent hypoglycemia. 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 or specific diet for fatty liver disease; rather, a diet that induces weight loss that is sustainable and turns into lifestyle change is advised. This type of dietary patter is the same as a generally-recommended healthy eating plan, such as the USDA MyPlate guidelines. It focuses on non-starchy vegetables, whole grains, lean protein, and healthy fats.

Sustainability

Because there are no forbidden foods on this diet, rather a focus on healthier foods choices, this diet is sustainable.

Flexibility

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 to aim 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 those choices. If you are not keen on cooking, healthy meal delivery options and meal replacements are also an option.

Energy and General Health

Cutting back on refined carbohydrates, processed foods, and saturated fats, and eating more fiber, fruits, vegetables, and lean protein will yield weight loss, increase energy levels and improve overall health.

A Word From Verywell

A healthy eating pattern for someone with fatty liver disease is one that is designed to induce slow and steady weight loss (no more than 1 to 2 pounds per week), while incorporating nutrient-dense whole foods, such as fruits, vegetables, lean protein, nuts, seeds, legumes. It is designed to reduce simple carbohydrates, added sugars, and processed foods.

This type of eating plan is more of a lifestyle change, one that includes behavior modification, exercise, and goal setting. The exact macronutrient distribution will depend on a variety of factors, including pre-existing health conditions, age, activity level, weight, etc. The good news is that this type of eating pattern is sustainable, flexible, and when done right, delicious.

Start slowly and give yourself time to make substitutions. As you continue to replace unhealthy food choices with healthier ones, you will feel energized and want to keep it up.

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