Diet for Fatty Liver Disease

Non-alcoholic fatty liver disease, NAFLD for short, is on the rise. It’s the most common form of liver disease in the developed world and afflicts 1 in 3 American adults. It’s on my radar because it tends to travel with other health problems I see a lot. Your risk is high if you have prediabetes, diabetes, metabolic syndrome or obesity. We’ll get to diet for fatty liver disease in a bit.

The number of cases of NAFLD has doubled in the last 20 years. Researchers say it may soon surpass hepatitis C infection to become the number one cause of liver transplantation in the US. This is an alarm bell that we really need to sound. Even about 10% of children over the age of 2 have NAFLD.

What is Non-Alcoholic Fatty Liver Disease?

Whether we are talking about alcoholic fatty liver disease or non-alcoholic fatty liver disease, it is the buildup of excess fat in the liver. The difference between the two is nothing more than the cause. One is caused by drinking too much alcohol. The other is usually the liver manifestation of insulin resistance or metabolic syndrome. About 90% of people with severe obesity and at least 50% of individuals with type 2 diabetes have NAFLD. Other less common causes of NAFLD include medications, dietary and herbal supplements, infections, genetic abnormalities, malnutrition and even rapid weight loss.

Keep in mind that excess weight often leads to insulin resistance and that both prediabetes and type 2 diabetes are characterized by insulin resistance. This is how obesity, prediabetes and type 2 diabetes are linked to NAFLD. Without lifestyle changes, NAFLD can progress to inflammation and scarring of the liver to cirrhosis and even liver cancer. By the way, there are no approved medications for NAFLD.

NAFLD is also related to heart disease. Heart disease is the #1 killer of people with NAFLD. It’s also the #1 killer of people with diabetes, which is why you hear me say ALL THE TIME that prediabetes and type 2 diabetes are more than blood sugar problems.

That’s all the bad news. Now comes the good news.

Lifestyle and Diet for NAFLD

The really good news is that the same lifestyle interventions that treat other conditions associated with insulin resistance are what you need to dial back fatty liver.

Lose weight if necessary. Even moderate weight loss improves NAFLD, but the more excess weight you lose, the greater you can expect your results. If you’re overweight, aim to lose about 7 to 10% of your starting weight. Once you hit that, you can decide if you want to work on further weight loss.

A word of caution though: A lot of people get hyper-motivated with a new diagnosis and take drastic measures. It’s better to make gradual changes and to find diet and lifestyle changes that you can stick with. Rapid weight loss of more than 3.5 pounds weekly causes a flood of fatty acids into the bloodstream and may actually worsen fatty liver. And my experience tells me that drastic plans lead to only temporary results.

Eat wholesome foods. Don’t put your energies and time into following restrictive diet rules. Instead focus on eating health-boosting foods in the proper amounts for weight management. That’s the best diet for fatty liver disease. Some research suggests that a Mediterranean-style diet is helpful. In a small study, it led to improved insulin resistance and less fat in the liver even without weight loss.

A few other things:

• Avoid sugary beverages such as sodas, sweet tea and lemonade.
• Some studies suggest that drinking coffee might help.
• Alcohol is a bit tricky. In general, drinking small amounts of alcohol is associated with less insulin resistance, but research doesn’t clearly show if this helpful or harmful for people with NAFLD. It’s smart to discuss this with your healthcare provider.
• Instead of looking for a best diet, make your food choices based on nutrient density and wholesomeness. Check out my 3 key takeaways from the US News Best Diet rankings (I proudly sit on their expert panel, by the way). Please resist the temptation to carb count (unless you also have diabetes) or worry about macros. This is not what is most important. What I recommend about carbs is the same that I recommend with protein and fat. Choose wisely: Eat black beans, not jelly beans. Choose whole grain toast with peanut butter over toaster pastries. It’s not the carbs (or fat); it’s the food with its nutrients or lack of nutrients and the total amount that you eat. Balance your plate with a variety of food groups; aim for a variety of wholesome foods within food groups; and avoid eating too much. If you do this consistently, your macros will fall into place, and you’ll be in the position to dial back prediabetes, insulin resistance, fatty liver, and more.
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Get a move on. All types of exercise improve insulin resistance and NALFD. Try to be active everyday. Make time for regular sessions of strength training as well as aerobic exercise. Avoid sitting for long stretches at a time.

Since there are usually no symptoms associated with early NAFLD, ask your healthcare provider if you should be screened for it. Screening involves a blood test to measure liver enzymes, but diagnosis requires imaging, usually by ultrasound.

Bottom line about lifestyle: You already know that being active, eating nutrient-dense foods at least 90% of time, getting adequate sleep, and managing stress affect nearly every aspect of your life. They make a difference with NAFLD too. So the best diet for fatty liver disease is the wholesome diet you can stick with. More health-boosting foods, calorie control, and less nutrient-poor food.