Can You Eat Fruit with Nonalcoholic Fatty Liver Disease (NAFLD)?

When someone gets a diagnosis of nonalcoholic fatty liver disease (NAFLD), a condition where fat builds up in the liver over time that’s not due to excessive alcohol consumption, one of the first things they might be told is to cut down their sugar intake. Cookies, cakes and candies – these items are definitely worth cutting back on. But should someone stop eating fruit for NAFLD? Firstly, let’s do a quick refresh on what our liver actually does for our health.

A liver refresh

The liver is your body’s built-in detoxifying device that helps remove harmful substances from your blood. It also plays a crucial role in creating energy from the food you eat and stores key nutrients. The liver is one of the body’s most important organs, so it is vital that you do what you can to keep it working well.

However, it is easy for fat to build up in the liver and prevent the liver from doing its job. NAFLD is a silent disease that tends to sneak up on people. It is one of the most common liver diseases in the United States. You may be at a higher risk for NAFLD if liver disease runs in your family, if you are living with obesity, type 2 diabetes or have more fat around your stomach.

Eating too much sugar is one factor that may lead to a fatty liver, which is why type 2 diabetes (and other metabolic issues) are risk factors for NAFLD. Insulin resistance, typically seen in those living with obesity and type 2 diabetes, causes the body to struggle to regulate the amount of sugar and fat in the body and promotes the storage of fat in the liver.  

Fruit contains fructose: does that matter for NAFLD?

The body breaks down sugar so it can be used for energy, but when you eat too much sugar it gets stored in the liver as fat. Simple sugars such as fructose and sucrose are commonly recommended as foods to reduce to prevent and manage NAFLD. 

Fructose is found in fruits, fruit juices, sugar sweetened beverages and honey. Sucrose, on the other hand, is regular table sugar that gets broken down into glucose and fructose by the body. While fructose is almost exclusively metabolized in the liver, glucose can be metabolized by the brain and muscles as well. For this reason, it was thought that fructose damages the liver more than glucose because technically speaking, it can be more taxing on the liver. But don’t go tossing out your apples in favor of that chocolate bar just yet – this theory doesn’t play out in practice.

New research is suggesting that consuming high-sugar foods in excess is the real problem – not the type of sugar. This means that you should be mindful of the biggest sugar culprits such as highly-processed foods, sugar-sweetened beverages, condiments, cakes, sweet breads and candies. While this might lead some to believe that they should also omit all sources of fructose, such as fruits, that’s actually not the case since fruit contains a wealth of antioxidants and dietary fiber.

Fruit and NAFLD: A surprising find

A review of 33 studies that looked at the dietary habits of those living with NAFLD, and those without, found that those with NAFLD actually had lower fruit intake than those without. The authors discussed that fruits (and vegetables) can help prevent NAFLD because they are high in fiber and antioxidants. This is the perfect combination for helping manage the metabolic and inflammatory issues associated with NAFLD! Because fruit contains these additional nutrients, the body benefits from fruit more than sweet foods such as cookies and sodas. 

Similar findings were also noted in another systematic review and meta-analysis from 2020, which looked at 24 studies. In this review, fruits and vegetables showed to help reduce the occurrence of NAFLD. Although research in this field is generally based on looking at a tiny snapshot of a person’s entire diet and lifestyle, the overall evidence suggests that you shouldn’t avoid fruit completely to prevent or manage NAFLD – on the contrary, eating fruits is actually encouraged.

As part of the dietary guidelines for preventing and managing NAFLD, it is encouraged to eat a well-balanced diet that includes plenty of fruits and vegetables. The Mediterranean diet is commonly recommended to help patients lose weight and improve insulin resistance. The Mediterranean diet consists of plenty of whole grains, vegetables, healthy fats, nuts, seeds – and yes, fruit as well.

Quantity matters

When you turn fruit into a villain, you’re not only missing out on a wide range of healthy snack options but you’re also missing out on all of the vitamins, phytochemicals, antioxidants and fiber that fruit has to offer. 

Having said that, it’s important to note that one can definitely consume too much sugar from fruit, especially when it is blended in a smoothie or juiced. Eating whole fruit in moderation is the key, and that can include one to three servings of fruit on a daily basis.

A look at the whole picture

Due to the close relationship between insulin resistance and NAFLD, it’s easy to look at fruit as a culprit because it is a source of sugar. However, NAFLD is preventable and manageable with a healthy lifestyle that includes fruit. Here are my top five tips for preventing and managing NAFLD that don’t include completely giving up mangos:

1. Weight loss: Through diet and exercise, weight loss can play a large role in helping the body metabolize sugar and fat to help manage and prevent NAFLD. Even just 5% weight loss results in improved sugar metabolism.
2. Eat more fiber: A diet high in fiber can help your body metabolize fat and cholesterol, so consider stocking up on oatmeal, berries and vegetables.
3. Combine protein with your fruit for snacks: To help keep your blood sugar in check, try combining your fruit with protein – think apple and almond butter, or berries with cottage cheese. This helps to blunt the insulin response in the body and also helps maintain lean muscle mass. 
4. Stick to whole fruits: Smoothie bowls and fruit juices can be misleading. One on hand, you are receiving lots of vitamins and minerals from consuming the fruits. However, you’re also consuming way more sugar than you would typically eat if you were having the whole fruit, which can spike your blood sugar. You’re better off eating one whole fruit instead of 2 cups of assorted fruits blended in a smoothie.
5. Try low-sugar fruits: Fruits are highly recommended as part of a healthy diet, but some fruits have more sugar than others. If you’re concerned about your overall sugar intake due to NAFLD, try focusing on low-sugar fruit options such as berries and melons. Compared to 1 medium-sized banana, 2 cups of raspberries contain about the same amount of sugar.

You might also be interested in How to Eat Well for Nonalcoholic Fatty Liver Disease and Recipes for Nonalcoholic Fatty Liver Disease.