Fatty liver disease and diet: Foods to eat and avoid

Last updated Feb. 15, 2024, by Marisa Wexler, MS
Fact-checked by Inês Martins, PhD

Changes in diet are a critical part of management for fatty liver disease, which is marked by the accumulation of excess fat in the liver.

Diet has a major effect on liver health, and also is a key determinant of the amount of fat that’s stored in the body. The overall aim of a fatty liver disease diet is to reduce the amount of fat available in the body, and therefore in the liver, which can help to manage and sometimes reverse fatty liver disease.

The term fatty liver disease is broadly used to refer to a few different conditions characterized by abnormal amounts of fat in the liver. The most common disease type is called metabolic dysfunction-associated steatotic liver disease (MASLD) — a condition in which the buildup of liver fat is related to other metabolic issues such as diabetes, high blood pressure, or high cholesterol levels. There’s robust evidence that dietary changes can help to reduce the severity of MASLD. For other types of fatty liver disease, the effects of diet aren’t as clear.

MASLD previously had been called NAFLD (nonalcoholic fatty liver disease), but this nomenclature was updated in 2023 with the goal of improving accuracy and removing stigma. In some people with MASLD, the disease progresses to cause inflammation; this was previously called NASH (nonalcoholic steatohepatitis), but now is known as metabolic-associated steatohepatitis, or MASH.

How diet affects the liver

The liver assumes a pivotal role in regulating the body’s metabolism to meet ongoing energy demands. For instance, it can store sugars — the body’s primary source of energy — following a meal, and then release them during periods of starvation to maintain blood sugar at optimal levels.

The organ also is integral in the production of bile, a fluid required for the digestion and absorption of certain fats and fat-soluble vitamins — such as vitamins A, D, E, and K. People with liver disease often experience alterations in their nutrient metabolism and challenges in absorbing these essential vitamins, leading to certain nutrient deficiencies that may require supplements.

However, diet also is a key determinant of liver health. Adopting a healthy, well-balanced diet, particularly incorporating nutrients such as antioxidants, vitamins, and omega-3 fatty acids, represents a proactive approach to ensure the liver functions as efficiently as possible, and to prevent liver disease. Not eating a healthy diet, and in particular eating a large amount of fried or processed foods, can conversely have a detrimental effect on liver health.

The liver typically contains a modest amount of fat, but complications may arise when fat constitutes 5% or more of the organ’s total weight. Treatment approaches for fatty liver disease generally consist of lifestyle changes, such as exercise and a fatty liver disease diet that provides the body and liver with essential nutrients. Together, these behavioral changes also promote weight loss and reduce the total amount of fat in the body — thereby decreasing fat levels in the liver.

The American Association for the Study of Liver Diseases recommends that people with MASLD aim to lose a minimum of 3% to 5% of their total body weight, which is proven to reduce some liver fat and alleviate disease symptoms. However, for individuals in more advanced stages of fatty liver, a more substantial weight loss may be necessary — typically ranging from 7% to 10% for those with MASH, and 10% or more for patients with liver fibrosis, or scarring.

Importantly, sudden weight loss can pose health risks of its own, so it’s important that people with fatty liver disease lose weight in a healthy manner, not exceeding about 1 kg (2.2 pounds) per week.

Foods to eat

The Baylor College of Medicine, in Texas, offers a free, in-depth dietary guide for people with fatty liver disease. It generally recommends a diet that prioritizes whole foods and fiber-rich foods that contain high amounts of vitamins and antioxidants along with minimal levels of fats or simple carbohydrates.

Whole grains

Whole grains are those that have not been modified or processed to remove specific components of the original grain. They are a good source of fiber and contain complex carbohydrates, which can make people with fatty liver feel full and energetic for longer periods of time, and aid in their weight loss journey. Whole grain foods include:

whole wheat bread or pasta
brown or wild rice
quinoa
air popped popcorn
non-instant oatmeal.

These foods are generally preferable to refined grains, which contain simple carbohydrates that cause blood sugar spikes and are more likely to be converted to fat in the liver.

Non-starchy vegetables and low sugar fruits

Incorporating daily servings of fruits and vegetables into one’s diet is a fundamental aspect of healthy eating for virtually everyone, as these foods are excellent sources of essential nutrients.

For people with fatty liver disease, the recommendation is to prioritize non-starchy vegetables that are low in simple carbohydrates. Examples include:

artichokes, asparagus, and celery
baby corn, bell peppers, and tomatoes
broccoli, cauliflower, and Brussel sprouts
cucumbers, zucchini, and eggplant
salad greens, spinach, cabbage, and leeks
turnips, radishes, beets, and carrots.

Patients also should prioritize whole fruits with lower natural sugar content, such as:

blueberries, raspberries, and strawberries
cherries and grapes
cantaloupe, honeydew, and watermelon
oranges and other citrus
peaches and plums.

Healthy fats

While fat is an essential part of a person’s overall diet, trans fats and saturated fats are associated with a higher risk of developing metabolic issues. Thus, people with fatty liver disease are encouraged to choose foods containing so-called healthier, unsaturated types of fats, such as omega-3 fatty acids. These foods may include:

olives or extra virgin olive oil
canola oil
avocado
full-fat yogurts
eggs
fatty fish, such as salmon or tuna
seeds, nuts, and nut butters.

Lean protein

Protein is a crucial component of any diet, but certain protein sources may also contain high levels of fat. It’s generally advised that individuals with fatty liver disease prioritize lean meats and plant-based sources of protein, including:

skinless poultry
fish, such as cod or tilapia
lean cuts of beef
beans, lentils, and other legumes
nuts and seeds
tempeh or tofu.

Dairy products can be a good source of calcium, proteins, and other essential nutrients, but some also contain high amounts of fats. People with fatty liver disease should generally opt for low-fat dairy products, such as:

cottage cheese
Greek yogurt
skim or 2% milk
low-fat cheeses such as goat cheese, ricotta, cheddar, mozzarella, and parmesan.

Low-calorie drinks

Staying hydrated also is an important part of a nonalcoholic fatty liver disease diet. But sodas and fruit juices contain high amounts of sugars that are converted to fat in the liver, so people with fatty liver should give priority to no or low-calorie drinks, such as:

water
seltzer
black coffee
unsweetened tea.

Foods to limit or avoid

As weight loss is the primary goal of a diet for fatty liver disease, dietary plans for these patients should aim to reduce the total amount of calories consumed. This may be achieved in part by reducing portion sizes and eating less. But minimizing high-sugar and high-calorie foods also is an important part.

Sugar

Because simple sugars, or simple carbohydrates, can be rapidly converted to fat and contribute to worsening the severity of fatty liver disease, people with excess fat in their liver should avoid foods that naturally contain high sugar levels or foods with added sugars. These may include:

pastries, such as cookies, cakes, and pies
candy and other sweets
products with added sugar, including some cereals, granola bars, and flavored low-fat or fat-free yogurts
sugary sauces and condiments, such as barbecue sauce, mayonnaise, ketchup, and many salad dressings
sugary drinks like soda, lemonade, energy drinks, and fruit and vegetable juices.

Refined grains

Refined carbohydrates contain more simple sugars and less fiber than whole grains, so it’s generally recommended that people with fatty liver disease minimize consumption of refined grain products. Key among these are:

white bread products
white rice
white pasta
white flour
instant oatmeal.

Starchy vegetables and sugary fruits

While fruits and veggies are an important part of a healthy diet, they also can have a lot of natural sugars. It’s generally recommended that people with fatty liver disease eat less of starchy vegetables and sugary fruits, such as:

potatoes, butternut squash, sweet potatoes or yams
corn, cassava, and chickpeas
apples, apricots, and bananas
mangos, papayas, and pineapples
dried fruits such as raisins.

Saturated fat and trans fat

Saturated and trans fats are specific types of fats that have been strongly linked to heart disease and metabolic problems. In addition to worsening fatty liver disease, these proinflammatory fats also can exacerbate the metabolic conditions that are present in people with MASLD.

Patients are generally advised to avoid foods containing high amounts of these fats, which include:

fatty and red meat, including bacon and chorizo
processed meats, such as hot dogs, pepperoni, and deli meats
high-fat dairy products, such as butter, buttermilk, and ice cream
fatty cheeses, including American, Velveeta, and cream cheese
margarine and palm oil
fast food, fried foods, and processed foods.

Alcohol

In cases where fatty liver disease is caused by excess alcohol consumption, abstaining from alcoholic beverages of any kind is a pivotal aspect of disease management.

However, it’s also recommended that individuals with other forms of liver disease avoid or limit alcohol intake. Even when alcohol is not the primary causative factor, its metabolism can cause additional damage to liver cells, potentially worsening the inflammation and tissue scarring that’s already present.

Patients are advised to consult with their healthcare team to determine whether it’s safe to have any alcohol in their specific situation.

Making lifestyle and dietary changes

Making dietary changes can be difficult, and it’s possible that patients can become overwhelmed by all the recommendations coming at them. For people starting on a fatty liver diet, it’s suggested to first pick just a few things to change — for example, substituting candy or chips with fruit or nuts at snack time, or choosing fish instead of steak when eating out. Then, as these changes become habits, more dietary modifications can be made gradually.

Other diet tips for people with fatty liver disease include eating at the same time every day, planning out meals in advance, and having smaller meals interspersed with snacks throughout the day — which also can help minimize hunger.

As a general rule, a fatty liver diet seeks to decrease daily calorie intake to about 500 to 1,000 calories below the generally recommended amount, which is often effective in facilitating gradual weight loss. Patients are advised to consult with their care team to design a specific dietary plan that will best fit them, considering factors such as personal preferences, finances, logistics, and nutrition goals.

In some cases, patients also may require supplements to ensure they’re receiving appropriate levels of all essential nutrients. But it’s vital they talk to a healthcare provider before trying any new supplement, as some may include substances that can also stress the liver.

There isn’t a specific eating plan that’s considered the best diet for liver disease. Instead, a variety of dietary strategies have been proposed to help people with fatty liver disease lose weight — choosing one depends on what may be best-suited to the individual or a specific dietary goal.

Good options can include low-fat or low-carbohydrate diets, the ketogenic diet, the dietary approaches to stop hypertension (DASH) diet, a vegan or plant-based diet, and the Mediterranean diet. There’s evidence that all these strategies can be effective in some fatty liver cases, and some may even be able to reduce the risk of developing the disease.

Any diet for fatty liver disease should limit or avoid the consumption of alcohol. This is especially important for people with alcohol-associated liver disease, who many want to consider a nonalcoholic fatty liver disease diet.

Importantly, the effectiveness of any diet is highly dependent on the patient’s ability to stick with it. As such, finding a diet that’s sustainable in the long-term is an important factor. Strategies that aim to promote rapid short-term weight loss, or those used for a so-called liver cleanse or liver detox — which aren’t proven by scientific evidence to be helpful — are not recommended.

In addition to adopting the best diet for fatty liver disease, living with fatty liver disease usually also includes other lifestyle modifications such as getting more exercise, quitting smoking, managing stress, or getting enough sleep. These changes can help with symptoms like fatigue and may contribute to preventing the disease from getting worse.

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