Healthy food

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 Associate 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.

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 menu
Poultry, 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 list
Can 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 disease

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.

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