Nutrition Tips for Non-Alcoholic Fatty Liver Disease

Stock Photo non-alcoholic fatty liver disease

Have you heard of Non-alcoholic fatty liver disease (NAFLD)? It is a condition that everyone needs to know about because it’s becoming much more common, and it’s possible that you or someone you know is developing this condition right now. NAFLD is a form of liver disease that is caused by diet and lifestyle and the prevalence is increasing. If ignored, it can become quite serious. This condition affects all income levels, all ages, and all weight ranges, although being overweight is an additional risk factor. The good news is that diet and lifestyle can reverse NAFLD if it is caught early.

Fatty liver disease is a silent epidemic that ranks as the second leading cause of liver transplants in the US. (1) Its the most prevalent chronic liver disease among children and adolescents and it doesn’t discriminate by age, even affecting infants born to mothers with gestational diabetes. (3) This disease spans a wide spectrum of ages, making it a significant concern across generations.

(3 ) Currently, twenty-five percent of the world’s population grapples with NAFLD. (1) A 2019 review suggested this number might be as high as 35% for Americans and 30% of the world-wide population. Whether you’re overweight, underweight, or within a healthy weight range, this condition can affect you.

Non-alcoholic fatty liver disease has now been renamed to Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) to emphasize that this is a metabolic disease which includes insulin resistance and cardiometabolic risk factors such as elevated triglycerides and cholesterol. Of course, the gut microbiome is involved, and the microbiome is affected by the type of foods we eat.

MASLD is not just about a little fat in the liver; it’s a complex condition that can snowball into serious complications like steatohepatitis (inflammation and damage in the liver that is due to an excess of fat in the liver ⁷, fibrosis (excessive formation of scar tissue in the liver as it tries to repair itself) ⁷, and cirrhosis (when a large amount of scar tissue has replaced normal functioning liver tissue)⁷. (2) Yet, there is hope for reversal of MASLD in its early stages. (1) This article uses MASLD and NAFLD interchangeably to discuss the same condition.

Tips for Diet and Lifestyle Change

Choosing to improve your diet is a powerful way to shield yourself from MASLD and potentially steer it away in its early phases. Use the following tips to lower your risk. While supplements might offer a helping hand, the real game-changers reside in your daily habits. A functional medicine dietitian can offer additional strategies to combat MASLD and get you back on track to a healthier liver.

1. Embrace a Whole Foods/Mediterranean Style Diet. Prioritize meals cooked from scratch and use unprocessed food ingredients (within reason) as much as possible. This shift can drastically decrease the intake of detrimental components found in processed foods and their plastic packaging, potentially flipping the script on MASLD. A review in 2018 revealed that omega-3 fatty acids from fish oils and nutrients in olive oil, combined with specific nutrients found in the Mediterranean style of diet, may help protect the liver. (3) Laden with antioxidants and vital nutrients, the bountiful array of fruits, vegetables, legumes, and whole grains in the Mediterranean style diet nourishes and protects not just your liver, but all your vital organs.

The Mediterranean style of diet can be adjusted to many different ethnic cuisines. If you’re not familiar with this diet, I suggest reaching out to a registered dietitian for help with meal planning.

Below are approximate servings of the Mediterranean style diet. The portion sizes need to be adjusted individually based on age, muscle mass, activity, calories needed, gender, and height.

Foods in Mediterranean Style Diet:

Nuts/Seeds: Daily
Fruit: Daily (Fruit is NOT associated with MASLD, but fruit juice is)
Non-Starchy Vegetables: Daily
Legumes/beans: Almost daily
Fish: Several times weekly
Dairy: Several times weekly
Poultry: Several times weekly
Olive Oil (from California): Daily
Anti-inflammatory Fats: Olive, nuts, seeds. Avocadoes are not Mediterranean but still healthy fat choice.
Starches/Whole Grains: The amount of these foods should be individualized for your own metabolic needs.
Fermented foods for the microbiome: This is my own addition here, but these are a part of most ethnic cuisines.

Please schedule an appointment here if you need help with diet.

2. Drink Coffee. Unlock the potential of your daily coffee and enjoy more than two cups per day. Surprising as it may sound, various studies have unveiled coffee’s impact – not only aiding in weight management but also decreasing the genetic predisposition to obesity. (2) Delving deeper, coffee has been proven to enhance insulin secretion and sensitivity, which can offer a shield against the onset of NAFLD. (2,4) But thats not all; it appears that coffee may improve liver enzyme tests, reduce the risk of fibrosis, cirrhosis, liver cancer, and even mortality rates. (5)

For those dealing with high blood pressure, anxiety, or caffeine sensitivity, I recommend drinking decaffeinated coffee or a mix of half-caffeinated and half-decaffeinated coffee. If it’s available to you, I recommend opting for organic coffee to decrease toxins and reconsider sweetening your cup – even a teaspoon of sugar adds in 5 grams of added sugar, a crucial point to ponder as we delve into our next topic. If you must add a sweetener, consider monk fruit extract or stevia instead of sugar.

3. Have a Reality Check With Sugar. Let's get real about sugar – it's time to drastically cut it down if you’re showing risk factors for fatty liver. This includes cutting out artificial sweeteners. High fructose corn syrup (now parading under the name 'corn sugar' to sound more innocuous), can wreak havoc on your liver, but it's not only about fructose. Total sugar consumption affects fatty liver, and the saga involves complexities including genetic factors, gut health, and your microbiome. (3) Studies point to the potent impact of reducing sugary beverages and fructose-laden added sugars in curbing the buildup of liver fat, while sounding the alarm on fructose's association with risks like gout due to uric acid. (3)

The troubles don't stop there; fructose can sabotage the gut's integrity, causing leaky gut issues and allowing endotoxin (toxins from bacterial cells) to sneak into the portal vein, triggering the onset of fatty liver. (3) Experiments suggest that reducing endotoxemia with antibiotics could alleviate fatty liver,(3) but personally, I'd opt for kicking the sugar to the curb rather than resorting to antibiotics.

The World Health Organization’s sugar guidelines recommend limiting added sugars to 50 grams for adults and 30 grams for kids, this includes the sugar in fruit juice. I suggest writing this number down and keeping it handy to refer to. Start scrutinizing labels, especially on beverages like coffee concoctions, juices, smoothies, as well as honey, molasses, yogurt, cereal, candy, pastries, cookies, cake, granola bars, and snack foods. You might be shocked when you start adding up the grams of sugar in your diet.

Fruit in its natural, whole form is NOT associated with fatty liver, but fruit juice is a different story thanks to its concentrated fructose content. (3) If you’re unsure how many grams of sugar you consume, you can use a diet tracker to help add them up.

Excessive intake of starch and grains can raise blood sugar and insulin levels, thus increasing your risk of MASLD. These include pizza crust, bread, tortillas, cereal, potatoes, pasta, rice, crackers, and chips. This is an area where it can be helpful to work with a dietitian to customize a meal plan that allows the right amount of these foods in your diet, so they can be eaten in a health supportive manner instead of leading to MASLD.

4. Control Blood Sugar and Strive for a Healthy Body Weight. I suggest avoiding fad diets and instead consulting a dietitian for professional care. If you feel that you binge eat or eat compulsively and can’t stop, maybe it is time to consider addressing this with professional help from an eating disorder center or a dietitian and therapist who are trained in binge eating. If you’re considering a ketogenic diet, note that a such a high fat diet can contribute to fatty liver. (3) However, a lower carbohydrate Mediterranean-style diet can be designed to help you control your blood sugar and insulin levels. You can also talk to your doctor about ordering you a continuous glucose monitor and working with a dietitian to learn how different foods and food combinations affect your blood sugar. Once again, consult a dietitian who can individualize a healthy diet for you.

5. Engage in Joyful Exercise. Even those at a 'normal' weight can grapple with fatty liver. Get moving daily in a way that sparks joy and builds muscle mass. Why? Because movement not only invigorates you but also plays a crucial role in escorting excess fat out of your liver. Building muscle mass is the key to changing your metabolism. Please consult your doctor and a personal trainer before starting a new exercise program.

6. Sleep for 7-8 Hours. Better sleep is associated with reversing fatty liver. If you can’t sleep, talk to your doctor about screening you for things such as sleep apnea or other potential causes of poor sleep. Consider seeing a functional medicine dietitian as we have safe products that can promote deep sleep.

7. Greatly Decrease the Amount of Alcohol You Drink. Alcohol ingestion is well known to induce fatty liver and chronic liver disease. (3) Alcohol combined with high fructose/sugar intake can greatly worsen metabolic disease and may be associated with high blood lipids (fats) such as cholesterol and triglycerides. (3) New research shows there is no safe level of alcohol and guidelines of what constitutes a safe level differs between countries. The United States Center for Disease Control (CDC) recommends consuming less than one drink per day for women and less than 2 drinks per day for men, however newer research suggests a safer level is two or less alcoholic drinks per week for both women and men. Stay tuned as more research becomes available on alcohol.

8. Pay Attention to Plastic/BPA in the Food Packaging and Other Toxins. It’s possible that in the future we will have more evidence that toxins play a role in developing fatty liver. This might take 20-50 years, so in the meantime I suggest decreasing your exposure to toxins, especially plastics, as much as possible. Decrease the use of beverages that come in plastic containers and cans as much as possible. Cans are lined with bisphenol A (BPA), an industrial chemical used in plastics, which is thought to be an endocrine disruptor and increases the risk of metabolic disease. For more info on BPA and plastics, please visit ewg.org.

Buy organic food when you can. Most of us realize that organic food is a privilege, and it’s ultimately more important to eat healthy unprocessed foods made from scratch.

Consider not using chemicals on your lawn as well as switching up your home cleaning chemicals, body hygiene products, and makeup to safer, to less toxic alternatives.

Put a reserve osmosis water filter on your tap to filter out toxins that are not yet filtered out of the water in your city. Here in Colorado, we particularly want to pay attention to PFAS and MTBE. The environmental working groups tap water database allow you to enter your zip code and find out what toxins are in your water supply. They have recently completed testing of popular over-the-counter water filters for effectiveness.

Environmental toxins affect all our organs, including our liver. Being intentional about decreasing toxins in your food supply and daily life should be included as part of your plan for improving your health and quality of life.

Risk Factors for Fatty Liver to Discuss with Your Doctor

If you’re curious if you have the risk factors for fatty liver disease you should talk to your doctor. The American Association for the Study of Liver Diseases recommends doctors look at markers such as fasting blood glucose, HbA1C, liver enzymes, serum triglycerides, cholesterol, waist circumference, and ferritin. Your doctor can rule out various causes of elevated liver enzymes and determine whether you need imaging.

If you are found to have high “normal” or high liver enzymes, this article in Medscape suggests that primary care doctors should order an ultrasound, test for celiac disease and hepatitis, inquire about alcohol consumption, check ferritin levels, and consider other testing including autoimmune disease markers.6 It might be wise to also include a few visits to a registered dietitian for help with changing the food you eat.

In summary the best steps for reversing MASLD are to cut out alcohol, lose the processed and sugary foods, and start eating a Mediterranean-style diet comprised of healthy meals prepared from scratch, and with using simple ingredients. Drink coffee, sleep deeply, and exercise. Lastly, olive oil plays a major role in the health benefits of the Mediterranean diet, but there is a vast difference in the quality of olive oil that you can purchase. If you’re interested in choosing a high quality olive oil, Consumer Reports has a few articles on the topic.

For help in designing a Mediterranean style eating plan that fits your lifestyle and food preferences please reach out HERE to schedule a free 15-minute consult.

References

Yuan S, Chen J, Li X, Fan R, Arsenault B, Gill D, Giovannucci EL, Zheng JS, Larsson SC. Lifestyle and metabolic factors for nonalcoholic fatty liver disease: Mendelian randomization study. Eur J Epidemiol. 2022 Jul;37(7):723-733. doi: 10.1007/s10654-022-00868-3. Epub 2022 Apr 30. PMID: 35488966; PMCID: PMC9329390. https://pubmed.ncbi.nlm.nih.gov/35488966/
Zhang Y, Liu Z, Choudhury T, Cornelis MC, Liu W. Habitual coffee intake and risk for nonalcoholic fatty liver disease: a two-sample Mendelian randomization study. Eur J Nutr. 2021 Jun;60(4):1761-1767. doi: 10.1007/s00394-020-02369-z. Epub 2020 Aug 27. PMID: 32856188; PMCID: PMC7910323. https://pubmed.ncbi.nlm.nih.gov/32856188/
Jensen T, Abdelmalek MF, Sullivan S, Nadeau KJ, Green M, Roncal C, Nakagawa T, Kuwabara M, Sato Y, Kang DH, Tolan DR, Sanchez-Lozada LG, Rosen HR, Lanaspa MA, Diehl AM, Johnson RJ. Fructose and sugar: A major mediator of non-alcoholic fatty liver disease. J Hepatol. 2018 May;68(5):1063-1075. doi: 10.1016/j.jhep.2018.01.019. Epub 2018 Feb 2. PMID: 29408694; PMCID: PMC5893377. https://pubmed.ncbi.nlm.nih.gov/29408694/
Kositamongkol C, Kanchanasurakit S, Auttamalang C, Inchai N, Kabkaew T, Kitpark S, Chaiyakunapruk N, Duangjai A, Saokaew S, Phisalprapa P. Coffee Consumption and Non-alcoholic Fatty Liver Disease: An Umbrella Review and a Systematic Review and Meta-analysis. Front Pharmacol. 2021 Dec 13;12:786596. doi: 10.3389/fphar.2021.786596. PMID: 34966282; PMCID: PMC8710778. https://pubmed.ncbi.nlm.nih.gov/34966282/
Wadhawan M, Anand AC. Coffee and Liver Disease. J Clin Exp Hepatol. 2016 Mar;6(1):40-6. doi: 10.1016/j.jceh.2016.02.003. Epub 2016 Feb 27. PMID: 27194895; PMCID: PMC4862107. https://pubmed.ncbi.nlm.nih.gov/27194895/
Skolnik, N. Fatty Liver: A Primary Care Approach. Medscape. 2023, Oct 9.
Retrieved on 11/2/23 from: https://www.medscape.com/viewarticle/996881?ecd=wnl_infocu1_broad_broad_persoexpansion-algo_20231101_etid6012324&uac=142663CR&impID=6012324
Merckmanuals.com. Retrieved on 1/30/24 from: https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/fibrosis-and-cirrhosis-of-the-liver/fibrosis-of-the-liver

Margo GastaFebruary 15, 2024Comment