If you've been told you have fatty liver or non-alcoholic fatty liver disease, don't panic, because the good news is it's fully reversible. In this post, I'll go over the exact steps you need to take, not only reverse it, but to do it quickly and start seeing changes in weeks. I will also go over actionable advice on the foods you need to eat and the foods you need to stay away from to fix your liver.
How to Reverse Fatty Liver with Diet
At the end of this post, I will talk to you about other steps you can take to improve your liver health and we'll also go over the best supplements you can take to help your liver recover and go back to normal.
To better understand how to reverse fatty liver, we first have to identify what causes it in the first place, and it's pretty simple. Fatty liver is caused by, for the most part, overconsumption of sugars, specifically, fructose and sucrose.
With sucrose being just table sugar that breaks down into fructose and glucose. The consumption of both fructose and sugar sets off a whole cascade of changes in our bodies that leads to not only fatty liver, but also to other conditions like diabetes, heart disease, dementia, and even many cancers. What makes fructose unique is that, it doesn't stimulate leptin.
Leptin is a hormone that is released in our bodies after a meal that signals satiety or fullness to our brains. So consuming fructose doesn't generate a normal response in our brain that tells us that we're full. So it makes it very easy to overeat.
If that wasn't bad enough, continued consumption of fructose drives the development of leptin resistance, which results in persistent hunger and impaired satiety, even with other foods, not just fructose. A study published in the American Journal of Clinical Nutrition found that just seven days of high fructose diet increased lipid deposition in the liver and decreased liver insulin sensitivity.
Now, how do we avoid fructose? Fructose is a simple sugar that's usually found in honey, fruits, and root vegetables. Humans have been consuming those food for hundreds or thousands of years. But it did not pose a health risk until we started eating manufactured fructose and sugar at large quantities. Now, most fruits and vegetables contain fructose.
However, our intestines can inactivate about 45 grams of fructose, which is the amount we usually get from vegetables. We get a little bit more fructose from fruits. However, fruits, like vegetables, are also consumed with a lot of fiber, which slows down the absorption of the excess fructose.
In addition to that, many fruits are also rich in vitamin C, which blocks some of the effects of fructose and really negates any of the adverse effects of fructose that we get from fruit.
So this brings us to the first food group that we need to avoid to reverse your fatty liver. And that is sugary drinks. We all know about the dangers of sodas and soft drinks. But the sneaky drinks that contain a lot of sugars are juices, which are often promoted as healthy and frequently given to kids.
If you drink orange juice, apple juice, tomato, cranberry, or any type of juice, please look at the ingredient label and see how many grams of sugars you get just from one serving.
Do not be fooled by statements like it contains natural sugars or it has zero grams of added sugars. It may be natural, but it's still highly concentrated and it's consumed without the fiber that you would normally get if you were eating a whole fruit and it's a lot easier to overconsume sugars if we're getting it in liquid form as opposed to eating a fruit itself.
Other drinks that are notorious for just being loaded with sugars are sports drinks and energy drinks. Now, the American Heart Association recommends eating less than 24 to 36 grams of sugars per day. But if you suffer from fatty liver disease, I would recommend you to abstain from all drinks that contain sugars.
Along the same lines, I would also avoid eating dry fruit like dates or raisins or prunes. Yes, they're natural and do not contain added sugars, but those natural sugars are very concentrated and do not have the volume of the original fruit, which makes it much easier to overwhelm our GI tract and later our liver with fructose and sugars.
To support that, a study published in JAMA in 2019 noted that just eight weeks of restricting sugars in adolescent boys to less than 3% of daily calories has shown significant improvement in hepatic steatosis.
Another way to fix your fatty liver is to eat more protein. It's especially important to eat more protein for breakfast or whatever your first meal of the day happens to be. A recent study published in Obesity looked at over 9,000 Australians and found that getting enough protein, especially for the first meal of the day, had profound effects on what people ate later in the day.
Eating higher levels of protein for breakfast translated to consuming less food over the course of the rest of the day. But people that had a low-protein breakfast were found to eat more energy-dense processed foods and foods that were high in sugars.
So if you find yourself constantly craving for those sugary or processed foods, foods that will make your fatty liver worse, try to up your protein intake, especially for breakfast, and aim to get at least 25 to 35 grams of protein per meal if you're getting three meals a day.
Getting enough protein will help you eat less sugar and will help you lose weight, and weight loss has been shown to be one of the most effective ways to improve your fatty liver. In fact, just 5% of total body weight loss can decrease hepatic steatosis, and losing 7% of total body weight can lead to complete resolution of non-alcoholic steatohepatitis, or NASH, which is a more severe form of fatty liver.
As you increase your protein intake, you have to be careful about what kind of fats you're getting in the process. Animal meats and dairy products are wonderful sources of protein. However, we do have to watch our intake of saturated fats, and those are usually found in red meat, processed meats, butter, ice cream, as well as in many fried foods.
Eating red meat is a controversial topic, and I happen to fall in the camp of, it's okay to consume red meat in moderation, but that's a whole other conversation for another day.
A study published in Diabetes and Metabolism showed that while overfeeding with either saturated fats or fructose both increased liver fat, the group that was overfed with saturated fats increased liver fat to a much greater degree than the group that was overfed with fructose.
There are at least four human intervention studies that have confirmed the harmful effects of saturated fat on hepatic steatosis, but the one I want to highlight is a double-blind, randomized controlled trial in which lean individuals were overfed with muffins high in either saturated fatty acids, in this case palm oil, or polyunsaturated fatty acids.
This study used sunflower oil, and what they found was that just seven weeks of overfeeding resulted in a marked increase in liver fat in the saturated fat group, whereas the polyunsaturated group caused a nearly three-fold larger increase in lean tissue or fat-free mass without an effect on the liver.
So it's important to not overeat saturated fats, and I emphasize not overeating, as it's okay to eat saturated fats, but in moderation. Eating more than about five percent of our calories from saturated fats is when we start getting into trouble.
What that would look like is eating less fats that come from processed meats, or eating less store or restaurant bought fried foods or pastries, as well as being careful with ice cream or cheeses. At the same time, we need to eat more of the good fats or poly or monounsaturated fats that come from fish, nuts, and avocados. And when it comes to oils, using olive oil is preferred to using saturated fats like coconut or palm oil.
The type of fat we eat is especially important for those that are on very low carbohydrate or ketogenic diets, where a lot of the energy has to come from fats. Now keto is a very effective way to lose weight and improve metabolic health, and it's very safe as long as the majority of the fat content comes from polyunsaturated or monounsaturated fats as opposed to saturated fats. Many people have been successful using ketogenic diets to reverse fatty liver.
However, for just as many people, that degree of severe carbohydrate restriction is just not sustainable long term. But the good news is that cutting out carbs is not a requirement for fatty liver reversal, and it's the quality and the type of carbohydrates that we consume that plays a larger role in the treatment of fatty liver. Eating carbs that have a low glycemic index, meaning they do not cause wild swings in your blood sugar, are much better for your liver health than carbs that are high in the glycemic index.
So while lowering our carbohydrates is generally a good idea for most people, I wouldn't worry as much about consuming lower glycemic index carbohydrates that come from legumes, dairy, vegetables, or fruits. And I would stay away from high glycemic index carbohydrates like white bread, white rice, most breakfast cereals, and processed potatoes like french fries or chips.
To wrap this up, other things that are highly beneficial in reversing fatty liver disease is abstaining from alcohol. In addition to that, getting at least 150 minutes of moderate intensity activity per week and making sure to include resistance training or muscle building exercises at least two days a week would also help to restore your liver to good health.
If you do all of the things I mentioned in this post, you will see changes in your liver biomarkers in a matter of weeks, as seen in the studies we discussed earlier. And you will eventually fully reverse your fatty liver.
It is important to do those things as soon as possible before your liver turns into a more severe form of fatty liver like NASH or steatohepatitis, and eventually to fibrosis and even cirrhosis, at which point a liver transplant is our only option.
How to Reverse Fatty Liver with Supplements
Now if you'd like to enhance your recovery, you can also try adding supplements to the food changes we discussed. To be clear, you do not need any supplements to fix your fatty liver, as long as you eat the right things and you use real, whole foods as your medicine.
However, there are supplements that actually show some promise and could be useful in expediting recovery. First, therapy with vitamin E at 800 IU a day was actually associated with a significantly higher rate of improvement of steatohepatitis compared to placebo. I would however recommend you to discuss vitamin E supplementation with your doctor first, as high doses of vitamin E, high meaning greater than 400 IU per day, have been inconsistently associated with an increase in all-cause mortality, as well as an increase in the rate of prostate cancer. So the recommendation to supplement vitamin E is usually reserved to patients with a more advanced fatty liver disease.
Second, I would also consider taking omega-3 fatty acids, a meta-analysis published in Clinical Nutrition in 2018 showed that supplementation with omega-3s, especially fish oils like DHA, was associated with an improvement in liver markers like ALT and AST, as well as with a reduction of liver fat.
Lastly, choline has been gaining in popularity as a treatment for fatty liver, and a recent case control study showed that people that consumed high intake of choline and betaine had an associated 81% reduction in hepatic steatosis.
However, we still need more conclusive research on if the supplementation with choline is actually beneficial for most people, and not just those that are choline deficient, and at what dose do we actually get any kind of therapeutic benefit.
Until we get more data, make sure you get enough choline through your food, which means eating plenty of eggs with egg yolk in them, lean meats, dairy, as well as getting enough seafood, which also happens to be very rich in omega-3 fatty acids. And if you don't eat meat, then I would focus on getting your choline from yogurt, sunflower seeds, and cruciferous vegetables like broccoli, cauliflower, or cabbage.
Now, this is not a full list of supplements that are commonly used to treat fatty liver, but I will make a separate post on that down the road, as it does deserve quite a bit more attention. I hope this post was helpful, and I will see you in the next one.