Fatty Liver Diet: Best Foods, Supplements, & Lifestyle Changes

Dr. Group
by Dr. Edward Group DC, NP, DACBN, DCBCN, DABFM
Published on
A garlic clove and bulb. Garlic can be part of a fatty liver diet.

As the most common chronic liver disease in the West, non-alcoholic fatty liver disease (NAFLD) is a scary-sounding diagnosis. People with this condition are at a higher risk of developing cardiovascular disease, liver failure, hepatitis, and diabetes. But the good news is that you can manage NAFLD with dietary and lifestyle changes.

Unfortunately, most people wait until they're diagnosed with NAFLD to take positive steps to improve their health. One of the best ways to reduce the chance you will get fatty liver disease, lessen its symptoms, or reverse its impacts involves following a plant-based diet.

In a nutshell, shifting to a healthier diet not only reduces your risk of this condition, but it can also help you manage its symptoms. Studies found that people with NAFLD who ate a vegetarian diet had less severe fibrosis (a symptom of fatty liver) compared with those who consume meat.[1] We will discuss the ideal diet tailored for people with non-alcoholic fatty liver disease.

What Is Non-Alcoholic Fatty Liver Disease?

Affecting approximately 25 percent of Americans, NAFLD occurs when fat accumulates in the liver, causing enlargement of this critical organ that supports digestion, removes toxins, and stores energy. Most people have small amounts of fat in their liver, but if it rises to more than 5 to 10 percent of the liver's weight, you have NAFLD. The disease is mostly diagnosed in people between age 40 to 60 but can occur at any age.

If you do not deal with NAFLD early on, it may develop into non-alcoholic steatohepatitis (NASH), a more severe type of inflammation that can lead to a variety of health problems, mostly in the liver.

How Does Alcoholic Fatty Liver Disease Differ From NAFLD?

Alcoholic fatty liver disease is related to excess alcohol intake, while NAFLD is not. Studies have shown that many people who engage in heavy drinking every day or almost every day will develop fatty liver disease.[2] Around 40 percent of people with moderate alcohol intake (defined as one to two drinks daily) also show changes associated with fatty liver disease.

Fortunately, this condition can usually be reversed by limiting or eliminating alcohol and improving one's diet. On the other hand, NAFLD can be caused by diet and lifestyle and is influenced by genetics. Scientists believe that when the process by which the liver produces bile acids is affected, it can lead to the development of both diseases.

What You Can Eat

Changing to a healthy diet is key to fighting NAFLD, reducing its symptoms, and getting your liver health back on track. Strive for a plant-based diet that's high in fiber and rich in fresh fruits and vegetables, nuts, and seeds. A registered dietitian or nutritionist can help you create a new diet plan, but here are some suggestions on which foods to eat and which to avoid.

Whole Grains

Unprocessed or minimally processed whole grains, including oats, brown rice, and quinoa (technically a seed), are best on this diet. If bread is labeled as whole grain, check the ingredients to make sure the first ingredient listed is a grain. Oatmeal is particularly good on this diet because it reduces LDL (low-density lipoprotein) cholesterol — also known as the "bad" type of cholesterol.

Green Vegetables

Leafy green vegetables like spinach, bok choy, kale, collards, cabbage, arugula, and watercress pack a powerful antioxidant punch. Cruciferous vegetables (broccoli, cauliflower, and horseradish) appear to reduce the amount of fat the liver absorbs.

Legumes

Beans are good for your heart, the more you eat, the more you... help your liver. Legumes, such as chickpeas, lentils, green peas, kidney beans, black beans, pinto beans, navy beans, and peanuts, are great sources of fiber, complex carbohydrates, and protein, and can help control cholesterol and blood sugar levels.

Walnuts & Other Nuts

Tree nuts provide beneficial omega-3 fatty acids, which improve liver fat levels and HDL cholesterol (the "good" cholesterol) in people with NAFLD. Walnuts, in particular, are high in omega-3s. A study published in the World Journal of Gastroenterology showed that eating walnuts improved liver function in one group of patients.[3]

Good Fats

You can eat good, healthy fats on a plant-based diet designed for fatty liver disease. Monounsaturated fats are an excellent source of healthy omega-3s and are found in olive, peanut, and canola oils, as well as avocados and most nuts. Sources of polyunsaturated fats include avocado, flaxseed, walnuts, and peanut oils. For saturated fats, only use coconut oil — which may benefit a fatty liver — and avoid animal fats and palm oil. Use organic, non-GMO, cold-pressed oils.

Coffee

While more research is necessary to draw solid conclusions, preliminary studies suggest that drinking coffee may reduce symptoms of NAFLD, including fibrosis of the liver. Several possible mechanisms by which this occurs include antioxidative, anti-inflammatory, and anti-fibrotic effects.[4]

Foods to Avoid

Take these foods off your shopping list. They can lead to inflammation, and increase your calorie, bad fat, and sugar intake unnecessarily.

Processed Foods & Empty Carbs

A diet that's high in starches and sugars makes NAFLD worse by increasing blood glucose, insulin, and triglycerides. In one study, patients who restricted their carbohydrate intake to 40 percent of calories had significantly lower levels of liver enzymes than those with a high-carb diet, even though each group lost the same amount of weight. Avoid sugar, especially white sugar, white potatoes, white rice, and processed grains. Eliminate white bread, pasta, and pastries. No more than 10 percent of your daily calorie intake should come from simple carbohydrates.[5]

Meat

I don't recommend any meat consumption; red meat and processed meat are particularly harmful. Many studies have shown that eating meat increases the risk of heart disease, stroke, type 2 diabetes, obesity, and morbidity. Animals raised for meat are usually given hormones and antibiotics and fed unnatural corn diets versus being grass-fed. Factory-farmed meat, in turn, negatively affects your health.

Bad Fat

Studies have shown that a diet high in saturated fat can increase the risk of developing NAFLD and make the disease worse. Experts recommend you replace most saturated fat with monounsaturated and polyunsaturated fat. It's also smart to avoid fish oil, which can be high in mercury. Overall, you should get 25 to 30 percent of your daily calories from fat.

Fried Foods

Because they're usually fried in processed, GMO cooking oils, fried foods are especially high in bad fat. They also add extra calories and salt to your diet. You can steam or bake most foods that you typically fry, using spices and herbs to heighten their flavor.

High-Fat Dairy

High-fat dairy products contain high levels of unhealthful saturated fat. I recommend skipping dairy altogether and opt for coconut milk or other non-dairy varieties. You can drink organic coconut or almond milk, use them in smoothies or coffee, or buy nut-milk yogurt.

Alcohol

Without exception, experts recommend that patients with NAFLD consume no alcohol at all.[6] A study published in Clinical Gastroenterology and Hepatology found that drinking even a modest amount of alcohol can make it impossible for the condition to improve.[7]

Salt & Sugar

In general, limit salt intake to 1,500 milligrams daily because it makes your body retain water. Also avoid added sugar, which increases fat levels in your liver. That means you should avoid soda, fruit juice, and many packaged foods. Sugar hides in a lot of items, so read the nutritional labels of all foods carefully!

Example a of Non-Alcoholic Fatty Liver Diet Menu

In general, you want to follow a diet that is low in calories, carbs, sugar, and saturated fat, and high in dietary fiber, omega-3 fatty acids, and monounsaturated and polyunsaturated fats.[8] Some experts recommend the Mediterranean diet — or a plant-based version of it. Not only will this way of eating reduce your bad fat consumption, but it can also help you better manage blood sugar issues or diabetes, improve cardiovascular health, and reduce cholesterol levels. Here is an example meal plan that could work for you.

Day One

  • Breakfast: Oatmeal with blueberries and chopped almonds on top; coffee
  • Lunch: Avocado, low-fat cheese, and sprouts on whole grain toast; carrot sticks; apple slices
  • Snack: Almond butter on apple slices
  • Dinner: Cold sesame peanut noodles; steamed spinach with a touch of olive oil and roasted garlic

Day Two

  • Breakfast: Bananas in low-fat plain yogurt; whole grain toast with peanut butter; green tea
  • Lunch: Lentil soup
  • Snack: Carrot sticks and hummus
  • Dinner: Broccoli slaw salad with tofu, ginger, sesame seeds, carrots, green pepper, cilantro, sesame seeds with olive oil/vinegar/sesame oil dressing; avocado

Day Three

  • Breakfast: Kashi with fresh peaches; black tea with lemon
  • Lunch: Green salad with hummus; a cup of raspberries
  • Snack: Trail mix of sunflower seeds, almonds, walnuts and cashews
  • Dinner: Cauliflower crust pizza with olive oil, goat cheese, basil, and fresh, chopped tomatoes; roasted asparagus with lemon juice

Herbs & Supplements That May Help

If you have NAFLD or any condition, consult your healthcare professional before you start taking any supplements or herbal remedies. Some can harm the liver or interact with medication. However, some supplements have shown promising results as specialized nutrition for the liver.

Carnitine

Carnitine, an amino acid that plays a crucial role in the body's energy production, may slow down NAFLD's progression.[9] Studies have found that this supplement may work particularly well for diabetics with NAFLD.[10]

Curcumin

As the most active nutrient in turmeric, curcumin contains powerful antioxidants. One study found that people who took curcumin had significantly lower liver fat content compared with those who did not — a 78.9 percent reduction in liver fat compared to only 27.5 percent.[11]

Garlic & Garlic Oil

Studies show that garlic can reduce liver injury and the buildup of fat and collagen. It may reduce liver inflammation as well. Garlic oil also may help with weight loss, and it reduces systemic redness and swelling in the body.[12]

Glutathione

In one study, thirty-four patients who took 300 milligrams of glutathione daily for four months showed a decrease in alanine aminotransferase levels, and also in triglycerides, non-esterified fatty acids, and ferritin — a blood cell protein that contains iron.[13]

Green Tea Extract

The key enzyme in green tea may slow the development and progression of NAFLD.[12] Green tea is a source of polyphenols, which have an anti-inflammatory effect.

Zinc & Selenium

NAFLD can cause mineral deficiencies in blood and the liver. An early study on animals showed that zinc and selenium supplementation may normalize disease symptoms but did not prevent its onset.[14]

Vitamins

Several vitamins may provide benefits for people with a fatty liver, or those looking to prevent it. Vitamin C and vitamin E are antioxidants that block reactive oxygen species (ROS) in the body. One animal study found they helped prevent the progression of fatty liver disease.[15] New studies associate deficiency of vitamin D, an important nutrient, with NAFLD.[16]

Address Fatty Liver Disease With Lifestyle Changes

If you have NAFLD, you may want to consider making lifestyle changes that will propel you forward on your journey to greater health. In addition to changing your diet, one of the most important changes you can make is increasing your physical activity. Studies found that when patients with NAFLD engage in aerobic exercise or weight resistance, it reduced their risk of getting diabetes by 35 percent and cardiovascular disease by 49 percent.[17]

Studies have shown that even minimal physical activity can have a positive impact on NAFLD.[18] Consider working with a physical trainer to help you devise an appropriate workout plan.

A good nutritionist or registered dietitian can help tailor a diet for your specific needs. However, go slow with the weight loss as rapid weight loss through extreme low-calorie intake or fasting can make NAFLD worse. Experts recommend that you lose weight gradually and by following a healthy diet. Aim to lose seven percent of your body weight in regular increments over a year.[19]

Points to Remember

If you want to reduce your risk of developing the disease or manage its symptoms, your best bet involves enacting appropriate lifestyle changes, especially following a diet tailored to NAFLD. I recommend you follow a whole food, plant-based diet. Eat fresh vegetables, fruits, and whole grains. Avoid alcohol, red meat, fatty, and processed food.

In addition, perform a liver cleanse two or three times a year, stay active, exercise regularly, and maintain a healthy body weight. Supplements such as garlic oil, curcumin, carnitine, or green tea extract may provide targeted nutrition to the liver. With the appropriate steps and guidance from your healthcare practitioner, you can point your liver health in the right direction.

References (19)
  1. Chiu TH, et al. Vegetarian diet, food substitution, and nonalcoholic fatty liver. Tzu Chi Medical Journal, v.30(2); Apr-Jun 2018 PMC5968737.
  2. Bellentani S, et al. Drinking habits as cofactors of risk for alcohol induced liver damage. Gut. 1997;41:845–850
  3. Gupta V, et al. Oily fish, coffee and walnuts: Dietary treatment for nonalcoholic fatty liver disease. World J Gastroenterol. Oct 7, 2015; 21(37): 10621-10635Published online Oct 7, 2015.
  4. Chen S, et al. Coffee and non-alcoholic fatty liver disease: brewing evidence for hepatoprotection. J Gastroenterol Hepatol. 2014;29(3):435-41.
  5. Appendix 7. Nutritional Goals for age-sex groups based on dietary reference intakes and dietary guidelines recommendations. Office of Disease Prevention and Health Promotion. Accessed 29 Oct. 2018.
  6. Liangpunsakul S, Chalasani N. What do we recommend our patients with NAFLD about alcohol use? Am J Gastroenterol. 2012;107(7):976-8.
  7. Ajmera Vi, et al. Among patients with nonalcoholic fatty liver disease, modest alcohol use is associated with less improvement in histologic steatosis and steatohepatitis. Clinical Gastroenterology and Hepatology, September 2018 Volume 16, Issue 9, Pages 1511–1520.e5.
  8. Romero-Gomez M, et al. Treatment of NAFLD with diet, physical activity and exercise. J Hepatol. 2017;67(4):829-846.
  9. Lim CY, et al. Effects of carnitine on peripheral blood mitochondrial DNA copy number and liver function in non-alcoholic fatty liver disease. Korean J Gastroenterol. June 2010.
  10. Alavinejad P, et al. Evaluation of L. carnitine efficacy in the treatment of nonalcoholic fatty liver disease among diabetic patients: A randomized double-blind pilot study. Journal of Gastroenterology and Hepatology Research, vol. 5 no. 5 (2016).
  11. Rahmani S, et al. Treatment of non-alcoholic fatty liver disease with curcumin: a randomized placebo-controlled trial. Phytother Res. 2016;30(9):1540-8.
  12. Eslamparast T, et al. Recent advances in dietary supplementation, in treating non-alcoholic fatty liver disease. World J Hepatol. 2015;7(2):204–212.
  13. Honda Y, et al. Efficacy of glutathione for the treatment of nonalcoholic fatty liver disease: an open-label, single-arm, multicenter, pilot study. BMC Gastroenterol. 2017;8;17(1):96.
  14. Shidfar F, et al. Regression of nonalcoholic fatty liver disease with zinc and selenium co-supplementation after disease progression in rats. Iran J Med Sci. 2018;43(1): 26–31.
  15. Oliveira CP, et al. Vitamin C and vitamin E in prevention of nonalcoholic fatty liver disease (NAFLD) in choline deficient diet fed rats. Nutr J. 2003; 2:9.
  16. Eliades M, Spyrou E. Vitamin D: A new player in non-alcoholic fatty liver disease?World J Gastroenterol. 2015 Feb 14; 21(6): 1718–1727.
  17. Nseir W, et al. Role of diet and lifestyle changes in nonalcoholic fatty liver disease. World J Gastroenterol. 2014;20(28):9338–9344.
  18. Kwak MS and Kim D. Non-alcoholic fatty liver disease and lifestyle modifications, focusing on physical activity. Korean J Intern Med. 2018;33(1):64-74.
  19. Ahmed A, et al. NAFLD review: diagnosis, treatment and outcomes. Clin Gastroenterol Hepatol. 2015;13(12):2062–2070.

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