How to Eat Well for Nonalcoholic Fatty Liver Disease

A properly functioning liver is key to your health. Your liver completes more than 500 different tasks to keep your body working. This includes essential functions of metabolism and digestion of nutrients and removing toxins. But acute or chronic diseases of the liver are common, and can either be inherited or acquired. Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease among people in developed countries. In fact, nearly 1 in 3 adults and 1 in 10 children in the United States has it.

Fatty liver disease is an accumulation of fat deposits in the cells of the liver. This makes it more difficult for the liver to function properly over time. The fatty buildup leads to inflammation and swelling of the liver. Without changes, this can lead to scarring of the liver tissue, called cirrhosis. And cirrhosis can lead to liver failure or liver cancer. 

There are two types of fatty liver disease. Firstly, alcoholic liver disease is a result of overconsumption of alcohol. Secondly, nonalcoholic fatty liver disease occurs in people who aren’t heavy drinkers and the exact cause is unknown. But nearly all people who acquire NAFLD have one or more of the following risk factors:

• obesity with a high amount of abdominal fat
• high blood pressure, high cholesterol or diabetes
• postmenopausal women
• of Hispanic or Asian descent
• obstructive sleep apnea
• metabolic syndrome

The best treatment for NAFLD is to make some changes to your diet. This can be extremely successful in slowing or reversing the progression of liver damage.  

What to eat to reverse nonalcoholic fatty liver disease

Following the same food guidelines as someone diagnosed with type 2 diabetes can also improve NAFLD. (This applies whether or not you have diabetes.) See our article on How to Eat Well for Type 2 Diabetes here. Following those guidelines and these can reverse nonalcoholic fatty liver disease. 

Plant-based foods

An eating plan that focuses on high-fiber plant-based foods (such as vegan, vegetarian or flexitarian) can be beneficial. This includes eating vegetables, fruits, beans, nuts, healthy oils and whole grains. Also incorporate dark green vegetables like broccoli, kale, spinach and Brussel sprouts. These foods can help block the buildup of fat in the liver and improve weight loss. Walnuts have been connected to improved liver function and weight loss, as have sunflower seeds, avocados, oats, beans, garlic and olive oil. 

Healthy fats 

Though it may sound counterintuitive, eating some fat is helpful and necessary for people with fatty liver disease. Since your body doesn’t process fat as efficiently as someone without NAFLD, it’s important to replace unhealthful fats (highly processed oils and trans fats) with healthful whole-food sources. Focus on getting fat from olive or coconut oil, nuts and seeds, avocados, fatty fish and grass-fed beef. 

Pescatarian or Mediterranean

Following a mostly plant-based diet that incorporates fish and seafood plus healthy fats (such as the Pescatarian diet or Mediterranean diet) has been shown to be beneficial for people with NAFLD. This includes vegetables, fruits, nuts, healthy oils such as olive, combined with fatty fish that is rich in omega-3s, such as salmon, tuna, trout, sardines, herring, oysters and mackerel. This eating style can reduce liver inflammation and decrease fatty buildup in the liver. 

Green tea and coffee

Caffeine and antioxidant compounds in coffee and green tea have been connected to decreased fat absorption and lowered levels of abnormal liver enzymes. Additionally, some studies have shown that people with NAFLD who also drink coffee or green tea have less liver damage than those who don’t.

Foods to reduce when you have nonalcoholic fatty liver disease

Simple carbohydrates

Research shows that the type of carbohydrate matters more than the amount of carbohydrate for people with NAFLD. Diets rich in processed grains, high fructose syrups and other added sugars are associated with insulin resistance and increased fatty deposits on the liver. Avoid high glycemic processed grains, such as white bread, white pasta, white rice and rice-based gluten-free products. Remove any sources of high fructose syrups, such as soda, some sweetened yogurts and salad dressings. And cut back on added sugars in cereals, baked goods, candy, packaged snacks, condiments and sauces, beverages and low-fat products. See How to Eat Well for Type 2 Diabetes for more on identifying added sugars and finding better alternatives. 

Trans fats

Just like carbs, the types of fats consumed is a more important factor for people with NAFLD than the amount of fat eaten. Trans fatty acids are strongly associated with increased liver inflammation, plus higher plasma triglycerides and cholesterol. Aim to replace any sources of trans fat with a healthier type of fat, such as those listed above. Artificial trans fats have been banned by the FDA. However, foods with less than 0.5 grams trans fat per serving can list 0 grams trans fat on the label. While this amount is small, it can add up quickly. Trans fats exist mostly in packaged baked goods, some margarine and vegetable shortenings, some microwave popcorns, fried fast food, non-dairy creamers, and refrigerated doughs and biscuits. If a product contains “partially hydrogenated oil” that’s a good indication it has trans fats. 

Alcohol

Quitting alcohol is an important treatment for people with alcoholic fatty liver disease, and the same is true for people with NAFLD. If you do consume some alcohol, removing it completely is a good idea since your liver health is compromised.

Supplements that can help with nonalcoholic fatty liver disease

Several vitamins, herbs and other supplements have been connected to improvements in NAFLD. However, toxicity risk is higher for people with compromised liver conditions. Always consult a qualified healthcare provider before starting a new supplement. 

Vitamin E

Supplementation with the antioxidant vitamin E has been studied most in relation to NAFLD, with positive results at counteracting the oxidative stress of liver disease progression. In multiple studies, improvements were shown with a high-dose treatment of 800 to 1,000 IU of vitamin E. Be sure to discuss taking high doses with your doctor. (It can increase risk of stroke in some patients with liver disease.)

Vitamin D

Researchers are still studying the effect of vitamin D supplements in people with NAFLD, but deficiency in vitamin D has been established as a risk factor in NAFLD, as well as the severity of liver disease. Several experimental studies point towards a direct role of vitamin D in reversing liver inflammation. Taking a vitamin D supplement could improve outcomes for people with NAFLD. This also applies to those with type 2 diabetes, insulin resistance and cardiovascular disease, which often present and exacerbate together. Discuss dosage with your doctor. 

Omega 3s

Recent studies testing the effects of omega-3 fatty acids in NAFLD are showing promise and suggest that EPA and DHA may be useful in the treatment of NAFLD.

Synbiotics

Both human and animal studies have connected the alteration of gut microbiota to the development of NAFLD, and beneficial effects have been shown with taking synbiotics (both prebiotics and probiotics) to improve obesity-related NAFLD. Synbiotics can also be helpful since antibiotics are often given to patients with NAFLD to treat inflammation. However, it can cause side effects and potential “good” bacterial resistance. 

Herbs

Several herbal supplements have displayed a strong antioxidant effect in people with NAFLD, including milk thistle, turmeric, ginger and ginseng. Depending on the herb, concentrated amounts could be harmful for people with liver disease or react with other medications. Always discuss type and dosage with your doctor. 

Have nonalcoholic fatty liver disease? Do this first.

Weight loss is the most common recommendation for people with fatty liver disease, and studies have shown that sustained weight loss of 5 percent or more of your body weight decreases steatosis (fatty deposit buildup in the liver). In a normal weight range? Eat and drink fewer simple carbohydrate foods (see above) while eating more plant-based foods high in fiber. 

What else to know about nonalcoholic fatty liver disease

To treat NAFLD, combine the above recommended changes to your diet with the following in mind. 

Medication

There are currently no approved drugs to treat NAFLD, but prescribing antibiotics, vitamin E and/or medications commonly used to treat type 2 diabetes, high cholesterol and high triglycerides is a frequent strategy of healthcare providers.

Get moving

Even outside of the weight loss benefits often associated with physical fitness, it is well established that being active can favorable modify lipids in the body and enhance insulin sensitivity, which is of importance for people with NAFLD. Combined exercise (aerobic plus resistance training) five days per week has been shown to be more effective than aerobic exercise alone. This decreases inflammation and cardiovascular risk factors in obese patients. 

Early detection

NAFLD is a progressive disease, and the earlier it is treated with lifestyle changes, the less liver damage that will be done. People with NAFLD typically do not have symptoms. If you have any of the risk factors listed above, ask your doctor to test your liver enzyme levels. If abnormal levels are present, your doctor may order further scans or biopsies of the liver. In some cases, symptoms could include pain in the upper right abdomen, nausea or loss of appetite, yellowing in the whites of the eyes, weakness, or extreme exhaustion and mental confusion. 

Changes can work

The good news about NAFLD is that lifestyle changes – especially positive changes in diet and movement – can preserve liver health for a long time. And if NAFLD is detected early enough, you may even be able to reverse any liver damage.

Try our one-day sample meal plan to control nonalcoholic fatty liver disease.

For more on liver health, read 7 Foods to Protect Your Liver and What’s Your Liver Got to Do with Losing Weight? Only Everything.