What to Eat to Reverse Fatty Liver Disease, from a Registered Dietician
Fatty Liver is a condition where fat deposits build up in the liver, one of the most important organs in the body, responsible for filtering and clearing all the various foods and chemicals that enter your body. When your liver is healthy, you never really think about it, but when it gets clogged up with fat it can cause problems that have far-reaching health ramifications.
Nonalcoholic Fatty Liver Disease (NAFLD) can impair normal metabolic function and lead to more serious diseases and eventually liver failure. When not related to alcohol consumption, a fatty liver often shows up in people with type 2 diabetes and obesity but it can also be tied to a high-fat, high-sugar diet.
It is estimated that 30 to 40 percent of adults in the United States have fatty liver disease, which is more than one-third of all the people you know. Given how common fatty liver is, everyone needs to understand what the liver does, what fatty liver disease means, and how to treat it, as well as what you can do to prevent it.
Fatty Liver is largely influenced by lifestyle choices and what you eat can play a big role in reversing it. That's good news since it means we can influence the amount of fat in our livers by what we eat, drink, and our daily physical activity. Studies have shown that a high-fiber diet of fruit and vegetables can help prevent and reverse fatty liver disease. All you need to do is to eat more plant-based.
What does the liver do?
To understand what fatty liver is, we first have to understand the role of a normal, functioning liver. The liver is the largest internal organ of the body (after the skin) and is located on the upper-right side of the abdomen, above the stomach. It actually has more than 500 vital functions, however, the two main functions of the liver are to:
- Remove toxins from the blood
- Process food nutrients. Blood from the digestive system travels to the liver first, before being sent elsewhere in the body.
The liver is like a filter. As blood leaves the stomach and intestines it passes through the liver, which filters this blood and helps to remove toxins that could be harmful and break down nutrients, sorting these nutrients to be carted off and used by the rest of the body.
What is fatty liver disease?
Fatty liver is simply a condition where there is excess fat being stored in your liver cells. Although it is normal to have a certain amount of fat in the liver, the liver is considered fatty if it is more than 5 percent fat. This also causes inflammation, so treating fatty liver means eating foods that lower fat accumulation in the liver and also lower inflammation in the liver.
In most cases, fatty liver doesn’t prevent your liver from functioning. However, it can progress to more concerning states over time. Doctors may warn you that if you don't get it under control, as the liver attempts to repair and replace damaged cells, scar tissue can form, and when extensive scar tissue replaces healthy liver tissue, this "fibrosis of the liver" can lead to cirrhosis of the liver. This is when liver failure can happen.
What are the symptoms of fatty liver disease?
While it’s possible to have no noticeable symptoms of NAFLD, your doctor can take a blood test to measure markers for the disease. Symptoms of fatty liver disease can be any combination of these, according to the Cleveland Clinic
- Abdominal pain or fullness on your upper right side
- Nausea, loss of appetite, or weight loss
- Yellow skin or jaundiced whites of the eyes
- Swollen abdomen and legs
- Extreme tiredness or mental fogginess
- Weakness in your muscles
Causes and risk factors of fatty liver disease
In addition to genetic factors, you have a great risk of developing fatty liver if you are experiencing any of the following:
- Alcohol Consumption Alcoholic fatty liver is the accumulation of fat in the liver as a result of heavy drinking, defined as having more than 2 drinks in a 24-hour period. The first thing your doctor may do is tell you to quit alcohol to see if this clears it up.
- Obesity and Type 2 Diabetes Statistically, 70 to 80 percent of people who are obese have fatty liver. It's especially prevalent among those who have high levels of body fat around the abdominal area.
- High Blood Sugar or Insulin Resistance You are far more likely to have fatty liver if you are diabetic, prediabetic, or have insulin resistance. The liver tends to store more fat when you are resistant to insulin.
- High Triglyceride Levels
Triglycerides are the major form of fatty acids in the blood cells, whether they are getting transported for use or for storage. The liver is the central organ for fatty acid metabolism, so high triglyceride levels can be a clue that you have fatty liver disease.
Is there a diet that reverses fatty liver disease?
Research suggests that adhering to a healthy, mostly plant-based diet, low in sugar and animal fat, is associated with a lower risk of fatty liver. This could be true for several reasons. A review of studies showed that a Mediterranean-style diet was effective in reducing the risk of NAFLD, since the diet centers around plant-based foods that are high in fiber and low in added sugar and refined carbs.
High Fiber diets have been shown to reduce the progression of fatty liver disease. Fiber, found in plant-based foods like vegetables, legumes, fruit, and whole grains, helps to manage high blood sugar and treat insulin resistance, and therefore reduced symptoms of fatty liver disease. Fiber (which is not present in any animal-based food) also helps keep us satisfied, by making us feel full longer, so it helps us eat less and lose weight.
Keep in mind: Fiber is only found in plant foods! Eat a high-fiber diet of salads, vegetables, fruit, legumes like beans and chickpeas, and whole grains like oatmeal to lower your risk of NAFLD and to reverse it if you have it. Plant-based foods also tend to be anti-inflammatory. When the liver is fatty, it is often inflamed. So choose foods that have been shown to boost liver health and lower NAFLD in studies.
10 Plant-based foods that help fight fatty liver disease
Soy protein has been shown to help reduce fatty liver. A review from 2019 found that soy protein reduced fat buildup in the liver. Soy protein contains antioxidants called isoflavones that help improve insulin sensitivity. Improving insulin sensitivity helps to reduce overall body fat and fat buildup in the liver.
Whole or minimally processed soy protein examples include:
- Soy Milk
- Miso soup
Soy contains a high content of the protein β-conglycinin — a common protein in legumes noted for its ability to help lower triglyceride levels and protect against visceral fat buildup. Additionally, tofu is a low-fat food that is a good source of protein, making it an ideal choice if you’re trying to limit your fat consumption.
Coffee consumption appears to have a protective impact on NAFLD and liver fibrosis, though researchers warn that the topic needs further study. In a review of 11 studies of coffee drinkers, regular coffee consumption was associated with a significantly reduced risk of NAFLD.
Coffee also was shown to lower the risk of fibrosis in patients already diagnosed with NAFLD. Be aware that adding spoonfuls of sugar and full-fat creamers may negate this benefit since fatty liver is made worse by added sugar and fat in the diet.
Spinach is high in antioxidants and polyphenols that have shown protective effects against liver diseases in experimental studies. One study put 225 newly diagnosed NAFLD patients ages 20 to 60 years on a diet high in raw spinach. The researchers found an inverse association between spinach intake and symptoms of NAFLD, meaning the more spinach they ate, the less likely they were to have NAFLD.
Legumes and Beans
Legumes, which include beans, lentils, soybeans, chickpeas, lupins, and peas, are rich sources of complex carbohydrates, proteins, dietary fiber, and minerals. Resistant starches in the legumes are converted into short-chain fatty acids (SCFA) by the gut microbiota, which has been shown to have positive effects on glucose and lipid metabolism.
In a small randomized controlled trial of 42 premenopausal women with obesity, a diet rich in legumes showed a significant improvement in fat metabolism after 6 weeks. A separate case study showed a significant association between patients who ate a greater intake of legumes and a lower risk of NAFLD.
You know Brussels sprouts and broccoli are good for you, but they also appear to help block fatty liver as well as fight tumor cells growth, at least in animal studies. Brussels sprouts and broccoli sprout extract were given to mice in the lab and shown to boost levels of detoxification enzymes and protect the liver. In the same study, when mice were given broccoli, they developed less fatty liver disease and fewer tumors than mice that were not fed broccoli. So eat your broccoli!
Grapefruit has been shown to lower lipids in the blood as well as reduce inflammation, which is helpful in the case of fatty liver. The antioxidants in grapefruit, along with other citrus fruits, cranberries, and grapes, all are known as hepatoprotective phytochemicals that help protect the liver from fat buildup.
Two specific antioxidants in grapefruit, naringenin and naringin, have been shown in animal studies to be beneficial for the treatment of obesity, diabetes, hypertension, and metabolic syndrome, all of which increase risk of fatty liver disease. Researchers have shown that grapefruit extract, given to mice on a high-fat diet, boosted the enzymes needed to burn fat, and help prevent fat from getting clogged in the liver.
People who eat more whole grains and unrefined flour, such as oats, quinoa, rye, barley, and farro, were able to prevent and reverse NAFLD. In a study where two groups of participants were given either whole grains or regular cereal (made with refined flour), and after 12 weeks, the ones eating the diet with whole grains did better. The study “demonstrated that consumption of whole grains for 12 weeks had beneficial effects on hepatic steatosis and liver enzymes concentrations in patients with Non-Alcoholic Fatty Liver Disease” the researchers wrote.
Foods high in omega-3 fatty acids have been shown to reverse fatty liver in studies. A meta-analysis review of studies in 2016 suggested that consuming omega-3 fatty acids improves levels of liver fat and raises HDL (aka good) cholesterol levels in people with non-alcoholic fatty liver disease. These are heart-healthy fats from plant-based sources such as nuts, seeds, and algal oil, derived from algae.
Good sources of omega-3 fatty acids include:
- Flax seeds
- Hemp seeds
- Chia seeds
- Algal oil
Another review of studies done in China in 2019 found that people who ate a diet rich in nuts had a decreased risk of nonalcoholic fatty liver disease.
Nut consumption has been associated with a lower risk of type 2 diabetes, metabolic syndrome, and insulin resistance, all of which raise your odds for NAFLD. The researchers found that diets with a higher intake of nuts are associated with a decreased risk of NAFLD, particularly in men.
The flavanoidsd in tea are helpful to help flush fat out of the liver, studies have found. Research has suggested that a higher flavonoid intake is associated with a lower likelihood of fatty liver, across various ethnicities. Flavonoids are plant chemicals (or phytonutrients) that provide health benefits through cell signaling pathways and antioxidant effects. Flavonoid-rich foods are foods of a plant origin and include:
- Tea, especially green tea
- Fruit, specifically apples, cherries, and citrus
- Vegetables, especially leafy veggies and onions
What to avoid with fatty liver disease
A review from 2019 noted that saturated fat intake from meat increases the amount of fat that builds up in and around the organs, including the liver.
This one is obvious, but alcohol is the most common cause of fatty liver disease. A person with fatty liver should reduce their intake of alcohol or remove it completely.
Sugar that occurs naturally in fruit or whole foods (such as vegetables) is not a bad thing since it comes with fiber. However, we want to avoid added sugars, as they can contribute to high blood sugar levels and excess fat in the liver. Studies suggest that high fructose intake is associated with a fatty liver. But don’t give up fruit since fruit is packed with nutrients and fiber, and is a minor source of fructose. The biggest source is high-fructose corn syrup. Get rid of all sweetened drinks, pastries, cookies, desserts, and breakfast cereals.
Salt and Hidden Sodium
A recent study suggests that high salt intake is associated with elevated risks of developing NAFLD. A Korean study in PLOS One measured salt in the urine for 24 hours and high levels correlated with markers for fatty liver disease. This could be because salt disrupts the blood pressure system, which impacts the liver, or because salt is prevalent in high-fat, high-energy foods, most likely to cause fatty liver.
Bottom Line: You can get rid of fatty liver
If you can remember the acronym SOF, for Soy, Omega 3’s, and Flavonoids, when planning your whole-food, plant-based diet, you're on your way. Cut out all alcohol and added sugar and you have a very good chance of reversing or preventing fatty liver!
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