The Best Diet for Fatty Liver Disease
By Dawn Anderson, MS, RDN, CIP
Clinical Dietitian
VCU Health
Stravitz-Sanyal Institute for Liver Disease and Metabolic Health
What is the best diet for patients with fatty liver disease?
Spoiler alert: It’s everything you would expect a dietitian to recommend.
The best diet for treating and preventing fatty liver disease focuses on whole foods, high fiber, lean proteins and healthy fats. It reduces added sugars, refined carbohydrates and saturated fats.
If you want to label it, this diet is similar to the Mediterranean diet and the DASH diet, both known for helping liver health. The Mediterranean Diet includes a high intake of fruits, vegetables, whole grains, along with moderate consumption of fish and poultry and limited red meat. The diet also emphasizes healthy fats from olive oil, nuts and seeds.
The DASH diet (Dietary Approaches to Stop Hypertension) emphasizes fruits, vegetables, whole grains, lean protein and low-fat dairy. It limits salt, added sugar and saturated fats.
These eating patterns are effective for treating and preventing fatty liver disease by their ability to reduce insulin resistance. Insulin resistance is a key factor in developing non-alcoholic fatty liver disease (NAFLD), now known as MASLD or metabolic dysfunction–associated steatotic liver disease. Diets high in refined carbohydrates and added sugars can worsen insulin resistance, leading to more fat in the liver.
In contrast, the high fiber content from fruits, vegetables, and whole grains in the Mediterranean and DASH diets helps stabilize blood sugar levels and improve insulin sensitivity. This reduction in insulin resistance helps prevent excess fat in the liver, lowering the risk and severity of fatty liver disease. Both diets align with the American Diabetes Association's nutrition guidance.
In addition to improving insulin sensitivity, the Mediterranean diet's emphasis on healthy fats plays a crucial role in liver health. Monounsaturated fats, such as those found in olive oil, avocados and certain nuts, have anti-inflammatory properties that help reduce liver inflammation and prevent liver damage.
Omega-3 fatty acids, found in fatty fish, such as salmon and mackerel, also have anti-inflammatory effects and have been shown to reduce liver fat content and improve liver enzyme levels.
By reducing inflammation and promoting a healthy balanced intake of fats, the Mediterranean diet supports liver health and function.
Both diets are rich in antioxidants and phytonutrients, compounds found in plants which help protect the liver from oxidative stress. Oxidative stress occurs when there is an imbalance between free radicals (molecules that cause damage) and antioxidants in the body, leading to cellular damage. Foods such as berries, leafy greens and nuts are packed with antioxidants that neutralize free radicals and support the liver’s natural detoxification processes. By enhancing the liver's ability to detoxify and repair itself, these nutrient-dense foods help prevent and manage fatty liver disease.
Additionally, both the DASH diet and the Mediterranean diet are associated with a decreased risk of heart disease, including reduction in blood pressure and bad (LDL) cholesterol. Both heart disease and diabetes are strong risk factors for fatty liver disease, so any reduction to these risks is important to liver health.
Overall, the plant-forward comprehensive approach to nutrition found in the Mediterranean and DASH diets addresses multiple underlying factors of fatty liver disease, including insulin resistance, inflammation, and oxidative stress. By focusing on whole foods and healthy fats while reducing added sugars, these eating patterns not only help treat existing liver conditions but also serve as a preventive measure to support long-term liver health.
Want to know more? Contact your VCU Health hepatology provider to schedule a nutrition appointment with a registered dietitian.
References:
- EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. Journal of Hepatology. 2016;64(6):1388-1402. doi: https://doi.org/10.1016/j.jhep.2015.11.004
- Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the Clinical Assessment and Management of Nonalcoholic Fatty Liver Disease. Hepatology. 2023;77(5):10.1097/HEP.0000000000000323. doi: https://doi.org/10.1097/HEP.0000000000000323