Your doctor says you have fatty liver disease. Now what?
A healthy diet, regular exercise and losing excess body weight can help reverse fatty liver disease. Here are some tips for daily life.
Getting a diagnosis of fatty liver disease can come as a shock. You had no symptoms, perhaps you received your diagnosis after an ultrasound for a completely different matter. In fact, around one in three Australian adults has fatty liver – which means fat makes up more than five to 10% of their liver’s total weight. Left untreated, fatty liver can lead to serious conditions like cirrhosis, liver failure and, liver cancer.
Australia has seen a rise in rates of fatty liver disease since the Covid pandemic, where many Australians found themselves at home eating poor quality food, drinking more alcohol and not getting enough exercise, says Liver Foundation Director and Sydney hepatologist Professor Simone Strasser.
Obesity, overweight and sedentary lifestyles, and alcohol, together or separately, cause fat to accumulate in the liver, she says.
“That build-up of fat over time actually disrupts (liver) function and some people can go on to develop serious disease.”
Today, fatty liver disease is the number one reason Australians need a liver transplant.
Meanwhile, the leading causes of death in people with fatty liver disease are cardiovascular disease and cancers.
“Fatty liver disease is the canary in the coal mine”
“So having fatty liver is like a canary in the coal mine,” Associate Professor Strasser says. “It’s an early warning sign that a person is at risk of future health problems like diabetes or heart disease.”
The good news is that a healthy diet, regular exercise, and losing excess body weight can help reverse fatty liver disease. Liver Foundation has launched The Fatty Liver Diet — a simple, evidence-based guide to eating well and being active for people living with Metabolic dysfunction–Associated Fatty Liver Disease (MAFLD).
See The Fatty Liver Diet
The Fatty Liver Diet
What should I eat?
A healthy, balanced diet that is low in processed foods and sugar including fructose (fruit sugar) can help reduce fat in the liver. An example is the Mediterranean Diet, which consists of lots of vegetables, fruit, unprocessed cereals, legumes, olive oil and nuts and seeds; moderate quantities of fish, seafood, eggs, cheese, yoghurt and poultry; and minimal amounts of red meat, processed meats (like salami and ham) and sweets.
Healthy liver daily menuPoultry, fish, seafoods and lean meat
Poultry, fish, seafoods and lean meat are all important for people with fattly liver because they contain protein and important vitamins to keep you well. They are also good to build muscle strength.
Aim to eat fish or seafood twice a week. Just eat a moderate amount of poultry or other protein foods like lean meats, eggs, cheese and yoghurt.
Try to avoid processed meats like sausages, ham and bacon.
Fruit and vegetables
Aim for five or more serves of vegetables per day. One serve is a half-cup of cooked vegetables or beans or one cup of salad. They are high in fibre and nutrients. Try to prepare for a mix of fresh green, red, purple and orange vegetables each day but frozen is a good option when time is short.
Fruit provides important vitamins and fibre but also contains fructose (fruit sugar) which increases liver fat. So limit fruit to a maximum of two pieces per day.
Legumes
Legumes are beans, lentils, chickpeas and soy products such as tofu and tempeh. They make a great alternative to meat, as they are high in fibre and protein and low in fat. Try substituting black beans for mince in tacos or swapping tofu for chicken in a stir fry.
Cereals
Your cereal choices include oats, buckwheat, quinoa, barley, millet and polenta. Buy wholegrain breads and pasta and replace white rice with brown or wild rice.
Nuts and seeds
Nuts and seeds provide protein and healthy oils. Nut butters and tahini are great alternatives to butter. Try snacking on pumpkin seeds, walnuts, almonds, pecans and Brazil nuts.
Oils and fats
Extra virgin olive oil, avocadoes, nuts and seeds and the oils in salmon and sardines are essential for health and will not increase liver fat. In fact, you can have up to 3 tablespoons of olive oil per day
Cooking with olive oil is recommended. Other suitable cooking oils are canola, sunflower, peanut or soybean.
Dairy
Dairy foods are rich in calcium and protein but should be eaten only in moderate amounts. For example:
- Cheese two slices– two to four times a week
- Milk – ½ cup to 1 cup once per day
- Unsweetened yogurt – ½ cup-1 cup four to six times a week.
Avoid or limit cream, butter and ice-cream which are high in calories.
Healthy liver shopping listCan I still eat eggs?
Eggs are high in cholesterol, so best to be cautious and limit intake to no more than four eggs a week.
What about coffee?
There is good news for coffee drinkers with fatty liver. Research suggests drinking three to four cups of coffee is beneficial, reducing your risk of dying from cardiovascular disease, diabetes and liver disease and preventing progression of some serious complications of fatty liver. Just be careful not to exceed the recommended amount of milk.
“Drinking up to 4 cups of coffee a day can prevent cirrhosis and reduce the risk of developing liver cancer.”
What types of food should I avoid?
Eating for liver health means avoiding saturated fats, trans fats and sugars. This means limiting processed foods including biscuits, cakes, burgers, chips, fried snacks, pastries, pies, processed meats, pizza and frozen meals. Fats to avoid include coconut oil, palm oil, butter, cream, lard and some margarines.
What drinks should I avoid?
Sugary drinks contribute to fatty liver. Avoid soft drinks, cordial, sports drinks and fruit juice, which is loaded with fructose. ‘Diet’ and ‘no added sugar’ soft drinks can be used in moderation.
Alcohol
If you have fatty liver disease it is better to avoid alcohol, however this is something to discuss with your doctor.
What about the Keto diet?
There are concerns that the keto diet could make fatty liver disease worse, so it’s not recommended.
Should I try intermittent fasting?
Intermittent fasting, restricting eating to set time periods, has become a popular way to lose weight. It may be suitable for you but discuss this with your GP first.
Exercise
It’s very important to keep exercising regularly while you’re losing weight. This is so you don’t lose muscle rather than fat.
There is no set ‘dose’ of exercise to reduce fatty liver. But aim for 30 to 45 minutes of moderate intensity exercise five times a week. This might include swimming, brisk walking and dancing. Include resistance training, such as push-ups, squats or lifting weights, at least twice a week.
Getting a fatty liver diagnosis can be considered a wake-up call. While it is never welcome news, by making healthy lifestyle changes you can reduce liver fat and your risk of developing serious disease.
Read more about fatty liver diseaseWatch Rob’s story – reversing fatty liver disease
Transcript
I was a little bit in shock and a little bit scared. I didn’t really understand how I was living my life and I didn’t realise that the things I was doing were so dangerous to my health.
I’ve been working as a mechanic for probably the last 25 years. It wasn’t really something I ever wanted to do, but kind of fell into it and loved the kind of environment that I found myself in with the people, the kind of workshop vibe.
Growing up in western suburbs, of course, soccer was my number one. I’m a big A.S. Roma fan. Dedicated most of my time to watching games at four in the morning.
I remember the day I was diagnosed with fatty liver. My local GP gave me a call, told me to come in and he showed me that my liver numbers were a little bit too high.
So GP sent me for a couple of other tests and we sat down. I didn’t really know what fatty liver was or how serious it was. He helped me understand that this was actually good news. It was reversible with a couple of simple changes to my lifestyle.
I worked in the music industry, performing live since the early 2000s, where it was an industry that we smoked and we drank a lot. And I thought quitting smoking, replacing that with eating sweets, was a healthier option. And it just gave me a different type of health concern which could potentially be even more dangerous.
I needed to change and I’d had a severe back injury which kept me off work for a year and a half. And at its worst point, I was ordering a lot of fast food.
I decided to change my diet, get to real foods, preparing my meals at home, simplified it. Lots of veggies, lots of good lean proteins, lots of healthy fish, olive oils. I decided to exercise, a lot of resistance training and I focused on healthy relationships in my life and I just took care of myself a little more than I had for the past few years.
With the right support at work, all my workmates, we’ve made some changes, we prepare real foods, lean proteins, healthy vegetables and we enjoy it all together.
So after three months, I went back and did the next round of blood tests with the doctor and he gave me a high five. And he said that the numbers were right within the regular zone that he liked and he was really, really happy and he couldn’t believe that I’d done it so easily.
I was pretty lucky, I found it pretty early. I got really strict, I cut out refined carbs and cut out sugars completely and I felt like the exercise and the training helped me more than anything.
The advice I’d give to anybody who’s been diagnosed with fatty liver is don’t be embarrassed. Like one in three Australians struggle with some form of liver disease.
It’s really normal, it’s not your fault.
Make changes, do it for yourself. Do it for you. You’ll enjoy the changes you make and you’ll be really proud of yourself.
And this time in a week, I’m going to be standing in the middle of the Stadio Olimpico, cheering on Roma instead of being in the hospital somewhere.
References
Aboubakr A, Stroud A, Kumar S, Newberry C. Dietary Approaches for Management of Non-Alcoholic Fatty Liver Disease: A Clinician’s Guide. Curr Gastroenterol Rep. 2021 Oct 15;23(12):21. doi: 10.1007/s11894-021-00827-0.
Anania C, Perla FM, Olivero F, Pacifico L, Chiesa C. Mediterranean diet and nonalcoholic fatty liver disease. World J Gastroenterol. 2018 May 21;24(19):2083-2094. doi: 10.3748/wjg.v24.i19.2083.
Department of Health and Aged Care. (2021). Physical Activity and Sedentary Behaviour Guidelines – adults 18-64 factsheet.
Mazidi M, Mikhailidis DP, Banach M. Adverse impact of egg consumption on fatty liver is partially explained by cardiometabolic risk factors: A population-based study. Clin Nutr. 2020 Dec;39(12):3730-3735. doi: 10.1016/j.clnu.2020.03.035
Queensland Department of Health. Metabolic Associated Fatty Liver Disease (MAFLD).
Queensland Department of Health. Mediterranean-style diet.
Sofi F, Casini A. Mediterranean diet and non-alcoholic fatty liver disease: new therapeutic option around the corner? World J Gastroenterol. 2014 Jun 21;20(23):7339-46. doi: 10.3748/wjg.v20.i23.7339.
