• Michelle Routhenstein, RD

Best Diet for Fatty Liver

One third of the general population in western countries have non-alcoholic fatty liver disease (NAFLD). NAFLD occurs about 60% more in people with diabetes and 70% more in people with obesity. More than 90% of individuals with severe obesity have NAFLD.

The first line of fatty liver disease reversal is through weight loss by lifestyle modifications, specifically optimal nutrition and increased physical movement. Some studies have shown that just 7% weight loss positively and significantly changes the fat composition of the liver. This blog post is going to dive into this a little bit further to discuss the best diet for fatty liver, and fatty liver foods to avoid.

Let’s first understand, what is fatty liver disease?

Fatty liver disease is when fat accumulation surrounding the liver is at or above 5%. There are two types of fatty liver disease that is caused by lifestyle behaviors:

1) Non-alcoholic fatty liver (NAFL) is when you have 5% or more fat accumulation surrounding the liver with minimal inflammation or liver cell damage.

2) Non-Alcoholic Steatohepatitis (NASH) is when you have 5% or more fat accumulation surrounding the liver with inflammation and liver damage that can cause scarring of the liver. NASH can lead to liver failure and liver cancer.

Who is at risk? What causes fatty liver disease?


The following is a list of risk factors that may increase your risk of having NAFLD or NASH. NAFLD and NASH are lifestyle induced conditions and therefore can be preventable through science based nutrition and lifestyle medicine.

  • Overweight or obese (defined as a BMI above 25)

  • Increased waist circumference (at or above 35 inches for a woman, at or above 40 inches for a man).

  • Insulin Resistance

  • Abnormal lipid panel including:

  • High triglycerides (above 150mg/dL)

  • High LDL cholesterol (above 100mg/dL), low HDL levels (below 40mg/dL)

  • Metabolic Syndrome

  • Type 2 diabetes

  • High Blood Pressure (above 120/90mmHg)

  • Family history of fatty liver disease

How is fatty liver disease detected?

NAFLD does not cause symptoms in most cases, and it is oftentimes detected after evaluation by a doctor, whether they find elevated liver enzymes, palpitate an enlarged liver, or have reason to suspect fatty liver given your risk factors, as mentioned above.

To be proactive, I recommend you know your liver enzyme and function tests, and assess your risk factors from the list above. If you suspect you may have fatty liver disease or are at high risk for it, ask your doctor for an ultrasound, or a specific non-invasive ultrasound for the liver called a FibroScan, which measures fat accumulation in the liver and the degree of scarring.

If these tests come back without concise results, your doctor may recommend a liver biopsy to remove a sample of the liver tissue for further examination.

Is fatty liver disease reversible?

YES! The good news is that fatty liver disease can be reversed and even cured if you take action immediately, through science based nutrition and lifestyle intervention. There are no surgeries or medications that can reverse fatty liver – it has to be through your diet and lifestyle!

While the mainstream recommendation is to decrease weight loss by 7-10%, there are a lot of therapeutic foods to include in your diet, along with foods to substantially decrease. This blog post will address fatty liver foods to avoid and the best diet for fatty liver.

It is also important to note that weight loss above 1-2 pounds weekly can worsen fatty liver disease, and steady and slow weight loss is optimal.

How long does it take to reverse fatty liver?

Fatty liver reversal can take anywhere from a couple months to even years depending on the amount of fat that is deposited on the liver. It is super important to take action immediately to avoid progression of fatty liver disease to avoid increased scarring and potential liver failure/cancer.

Connection between fatty liver disease and heart attacks and stroke

Before we talk about the best diet for fatty liver disease, I want to bring up an important topic dear to my heart (and the reason why I am even writing this blog post).

Heart disease is the number one killer in patients with fatty liver disease. There are many research studies that point to having NAFLD as a mega-risk factor for cardiovascular disease. This may be because when someone has NAFLD, they already have many other risk factors that overlap in both cardiovascular disease and NAFLD. To learn more about risk for heart disease click here.

NAFLD is usually also coupled with systemic inflammation, along with metabolic syndrome leading to plaque formation in the arteries, which is the number 1 reason for heart attacks and strokes.

The good news is that we can reverse this together! I am happy to help, and here are a couple suggestions to get you started:

5 Fatty liver foods to avoid:

1. Soda: is high in high fructose corn syrup. High fructose corn syrup has been linked to high fat accumulation and storage in the liver, inflammation, and a large contributor to fatty liver disease. High fructose corn syrup can be found in other foods so reading and understanding your food labels is important.


2. Fried chicken: is high in saturated fat and can promote fat accumulation around the liver. Consuming more than 7% of your daily consumption from saturated fat not only increases fat accumulation around your liver (what you are trying to avoid), it also builds up plaque in your arteries increasing your risk of a heart attack and stroke.


3. Orange juice: is high in refined sugar which worsens insulin resistance, causes inflammation, and promotes fat storage = promotion of fatty liver disease. Refined sugar ingestion sets off many pathways that push fatty liver disease from increasing insulin resistance in fat tissues, to raising blood sugar levels, to causing inflammation, to creating a negative gut environment.


4. Soy sauce: is high in salt, which may cause a dysregulation of the renin-angiotensin system that may be one of the key components to the development of NAFLD. And unfortunately, even soy sauce that is labeled “low sodium” is still high in salt.


5. Coffee-mate Creamer: contains trans fat which increases oxidative stress, inflammation, and promotes fat accumulation in the liver. In 2015, the FDA banned trans fat in the food supply. This was done because they wanted to lower the amount of deaths due to heart disease in the population, along with curb the increasing amount of people with diabetes, dementia and other metabolic diseases. The clause to this rule states that there is 0.5% or less per serving of trans fat, it does not need to be listed on the label. Therefore, many companies decided to decrease their serving size to abide by this law. Food companies like trans fat because it helps increase their shelf life. One way to decrease trans fats in your diet is to avoid any foods with “hydrogenated oils,” or “partially hydrogenated oils” in the ingredient list.

Best diet for fatty liver:

I have had a lot of people ask me about the keto diet for fatty liver disease reversal, so I want to take a couple months to address it.


Is the Keto diet the best diet for fatty liver?

a) What is it? The Ketogenic diet is when 75% of your diet is from fat – and there is no definition of what kind of fat, about 20% from protein, and about 5% from carbohydrates. Your brain’s primary fuel is from carbohydrates and when your body cannot get it from carbohydrate sources, it breaks down fat to turn into carbs which produces ketones, hence where the title keto/ketogenic diet came from.

b) Is it good or bad for fatty liver disease reversal? Consuming more than 7% of your daily consumption from saturated fat not only increases fat accumulation around your liver (what you are trying to avoid), but it also builds up plaque in your arteries, increasing your risk of a heart attack and stroke. While monounsaturated fats have been shown to be effective in reducing liver fat, the type and amount really matters!

The best diet for fatty liver disease is one that addresses insulin resistance and inflammation, protects your heart, and can be sustained for the long term. Given lifestyle medicine is the ONLY treatment for fatty liver disease this needs to be sustained for LIFE.

Here is a list of some food for fatty liver disease that research shows may be therapeutic.

Food for fatty liver disease:




1. Olive Oil: is rich in monounsaturated fats which studies show play a beneficial role in lipid metabolism in the liver and in abdominal fat tissue. Since they are oxidized quicker than saturated fats, they may help to avoid the ability of fat to deposit in the liver, causing less fat accumulation.


2. Green Tea: is rich in Epigallocatechin‐3‐gallate (EGCG), about 200-300mg in one brewed cup of green tea. It is a potent antioxidant, which studies show may be beneficial for NAFLD because of its anti-inflammatory properties along with its improvement in lipid oxidation, insulin resistance, and activation of energy and lipid metabolism.


3. Raspberries: is rich in insoluble fiber that helps generate short chain fatty acids, like butyrate, in the gut, which has been shown to be beneficial in reversal and prevention of fatty liver disease.


4. Organic Tofu: is rich in soy protein, which studies show may significantly reduce fat around the liver of overweight/obese individuals, by restoring partial function of the liver’s key signaling pathways.


5. Garlic: Studies show that garlic reduces fatty liver, insulin resistance, and inflammation, and may improve the gut microbiota in those with insulin resistance. An imbalanced microbiota may also be another risk factor for fatty liver disease.

*The amount and dosage will depend on the other nutrients found in your typical diet.

Science and Personalization: There is no one food that will cure, reverse or prevent fatty liver disease, your whole diet and lifestyle needs to be optimized.

In my VIP results-driven 3 month program, I evaluate all my clients to create a customized nutrition guide and meal plan that merges science based nutrition with personalization to yield long term results.

If you are interested in learning more, let’s speak over a 15 minute complimentary discovery call, so I can learn more about you and you can learn more about me. I would love to help you on your journey to a healthier life!

I look forward to speaking with you soon!


In Health & Happiness,


Michelle Routhenstein,


MS, RD, CDE, CDN


Preventive Cardiology Dietitian


Owner of Entirely Nourished, LLC


P: (646) 979-0328


A: 276 Fifth Avenue, Suite 704,

New York NY 10001

(currently 100% virtual due to COVID)


E: Michelle@EntirelyNourished.com


http://www.entirelynourished.com 


Instagram: Heart.Health.Nutritionist


** This article is for informational purposes only and not a substitute for individualized medical advice or treatment. Always seek the advice of a qualified health professional with any questions you may have regarding your health. 

References:

1. Basaranoglu M, Basaranoglu G, Bugianesi E. Carbohydrate intake and nonalcoholic fatty liver disease: fructose as a weapon of mass destruction. Hepatobiliary Surg Nutr. 2015;4(2):109-116. doi:10.3978/j.issn.2304-3881.2014.11.05

2. Chen C, Liu Q, Liu L, Hu YY, Feng Q. Potential Biological Effects of (-)-Epigallocatechin-3-gallate on the Treatment of Nonalcoholic Fatty Liver Disease. Mol Nutr Food Res. 2018;62(1):1700483. doi:10.1002/mnfr.201700483

3. Chitturi S. Treatment options for nonalcoholic Fatty liver disease. Therap Adv Gastroenterol. 2008;1(3):173-189. doi:10.1177/1756283X08096951

4. Hussein O, Grosovski M, Lasri E, Svalb S, Ravid U, Assy N. Monounsaturated fat decreases hepatic lipid content in non-alcoholic fatty liver disease in rats. World J Gastroenterol. 2007;13(3):361-368. doi:10.3748/wjg.v13.i3.361

5. Jensen T, Abdelmalek MF, Sullivan S, et al. Fructose and sugar: A major mediator of non-alcoholic fatty liver disease. J Hepatol. 2018;68(5):1063-1075. doi:10.1016/j.jhep.2018.01.019

6. https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/definition-facts

7. Mirmiran P, Amirhamidi Z, Ejtahed HS, Bahadoran Z, Azizi F. Relationship between Diet and Non-alcoholic Fatty Liver Disease: A Review Article. Iran J Public Health. 2017;46(8):1007-1017.

8. Sullivan S. Implications of diet on nonalcoholic fatty liver disease. Curr Opin Gastroenterol. 2010;26(2):160-164. doi:10.1097/MOG.0b013e3283358a58

9. Yamazaki T, Li D, Ikaga R. Effective Food Ingredients for Fatty Liver: Soy Protein β-Conglycinin and Fish Oil. Int J Mol Sci. 2018;19(12):4107. Published 2018 Dec 18. doi:10.3390/ijms19124107

10. Zhou L, Yang Y, Feng Y, et al. Association between dietary sodium intake and non-alcoholic fatty liver disease in the US population. Public Health Nutrition, 1-8. Doi: 10.1017/S136898001900483X

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