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Fatty liver disease — also known as nonalcoholic fatty liver disease — is the accumulation of fat in the liver.
This fat damages the liver and prevents it from working as well as it should.
Fortunately, you can reverse fatty liver disease through diet.
This article explains how to reverse fatty liver disease with diet and which foods to eat and avoid for liver repair.
What is fatty liver?
Your liver removes toxins from your body’s blood supply, maintains healthy blood sugar levels, and supports digestion, among many other functions that help keep your body healthy.
The accumulation of fat in your liver from fatty liver disease can prevent your liver from optimally carrying out these tasks.
Fatty liver is a common condition that affects up to 46% of the general population worldwide (1).
Risk factors linked with fatty liver development include:
- overweight and obesity
- high cholesterol or triglycerides
- type 2 diabetes
- metabolic syndrome
- Wilson’s disease
- alcohol use, but not heavy use
- hemochromatosis, or iron overload
These factors increase the delivery of fats to your liver, increase the production of fats in your liver, or decrease the use of excess fats for energy production (1).
Fatty liver presents no symptoms and can advance to more severe forms of liver disease like liver cirrhosis if left untreated (2).
How to reverse fatty liver with diet
It’s possible to reverse fatty liver with diet, but you generally cannot reverse liver cirrhosis.
Therefore, it’s important to treat fatty liver before it advances to liver cirrhosis and causes significant health problems.
The time it takes for fatty liver to advance to liver cirrhosis depends on many factors but it can take up to several years.
The primary and most effective way to treat fatty liver is with diet.
Of the various diets examined for treating and reversing fatty liver disease, the Mediterranean diet has proven to be the most effective.
The Mediterranean diet is a way of eating based on the traditional cuisine of the people who live in the countries along the coast of the Mediterranean Sea, including Greece, Italy, southern France, Crete, and Spain (3).
It emphasizes fresh fruits and vegetables, whole grains, nuts, legumes, fish, and olive oil, and limits red meats, sweets, and other refined grains.
One study in people with fatty liver disease showed that the Mediterranean diet reduced liver fat by 39% after six weeks compared with just 7% with a low-fat diet (7).
Foods good for liver repair
The Mediterranean diet is rich in foods that can help repair your liver.
These foods include:
- Fruits: apples, avocado, bananas, berries, cherries, grapes, kiwifruit, mandarins, melons, oranges, peaches, pears, watermelon, etc.
- Vegetables: artichoke, asparagus, beetroot, broccoli, carrots, celery, cucumbers, fresh herbs, garlic, kale, mushrooms, onions, tomatoes, etc.
- Whole grains: amaranth, barley, farro, millet, oats, quinoa, rice, spelt, and wheat
- Legumes: black-eyed beans, chickpeas, lentils, lima beans, lupins, navy beans, peas, pinto beans, soybeans, and peanuts
- Nuts: almonds, Brazil nuts, cashews, hazelnuts, macadamia nuts, pine nuts, pistachios, and walnuts
- Oils: extra virgin olive oil
- Beverages: water, black coffee, and unsweetened tea
The diet also allows moderate amounts of dairy products, fish, eggs, and other meats (8).
The beneficial effects of these foods on treating fatty liver are thought to be due to their content of healthy fats, fiber, and healthy plant compounds called polyphenols (9).
Foods to avoid or limit
It’s important to avoid or limit foods that may worsen your condition and prevent your liver from recovering.
Red meats are not completely off the table, but you should reserve red meat for special occasions or limit one serving or less per week.
A standard serving size is three ounces (85 grams) cooked — about the size of a deck of playing cards.
Choose cuts of beef that have the word “loin” and “round,” as these are leaner options.
Examples include sirloin, tenderloin, round steak, and eye of round roast.
Processed meats are meats that have been smoked, cured, dried, or salted.
This includes sausages, salami, ham, hot dogs, bologna, deli meat, and cured bacon.
Eating these meats in excess may increase your risk of heart disease and diabetes or worsen these conditions if already present (10).
Added sugars are sugars that are added to foods and drinks during the manufacturing process.
These are different than foods that naturally contain sugar like fruits, vegetables, and dairy products.
Consuming excess calories from added sugars increases insulin resistance and raises triglyceride levels, which can worsen fatty liver disease (11).
Examples of added sugars to limit include soda, sports drinks, specialty coffee drinks, most breakfast cereals, desserts, candy, and other sweets.
Moderate wine drinking is part of the Mediterranean diet, you should avoid consuming alcohol of any type or amount with fatty liver (12).
And, even in moderation, it’s possible that alcohol can worsen liver function and cause liver injury.
Sample fatty liver diet menu
Here is a one-day sample fatty liver diet menu that includes plenty of fruits, vegetables, whole grains, legumes, and nuts.
Breakfast: oatmeal topped with fresh blueberries and a sprinkle of cinnamon
Snack: Greek yogurt, apple slices, and walnuts
Lunch: grilled chicken salad with romaine lettuce leaves, diced cucumbers, diced tomatoes, sliced red onion, sliced avocado, and topped with an extra virgin olive oil-based vinegarette
Snack: bean salad made with chickpeas, whole cherry tomatoes, diced onions, extra virgin olive oil, and a squeeze of lemon juice
Supper: grilled lemon-pepper salmon, brown rice, and roasted green beans
This sample meal plan may include foods that you don’t have regular access to or items that are not within your budget.
However, what matters most is that you aim to include fruits, vegetables, whole grains, and healthy sources of protein like fish or legumes with most meals.
Supplements for fatty liver
While diet should be the primary focus in treating fatty liver disease, some supplements may offer additional benefits.
L-carnitine is an amino acid derivative that transports fatty acids into your cells to be processed for energy.
In fact, people with a condition known as primary L-carnitine deficiency typically have fatty liver disease due to having a deficiency in l-carnitine (17).
Most studies use a form of carnitine called acetyl-L-carnitine in a dose of 300–750 mg per day.
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Fish oil is rich in omega-3 fatty acids, which have been shown to lower triglyceride levels.
A review of 18 studies involving 1,424 people with fatty liver disease found that fish oil supplementation significantly decreased liver fat, insulin resistance, and improved liver function (18).
The average dose of fish oil in these studies was about 3 grams per day for six months.
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Vitamin D plays an important role in bone health, blood sugar control, blood pressure regulation, and immune function, among others (x)
Most people lack sufficient vitamin D levels, including people with fatty liver disease (19).
A review of 10 studies involving 544 people with fatty liver indicated that vitamin D supplementation significantly improved insulin resistance, reduced triglyceride levels, and improved liver function (20).
A daily dose of 2,000 IU (50 mcg) of vitamin D3 is sufficient for most people (21).
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The bottom line
Fatty liver disease causes fat to build up in your liver.
Over time, fatty liver disease can advance to more severe forms of liver disease and cause significant health problems.
Fortunately, you can reverse fatty liver and improve your liver function by following a Mediterranean-style diet that emphasizes fruits, vegetables, whole grains, legumes, fish, olive oil, and limits red meats, sweets, processed meats, and alcohol.
In addition to your diet, supplements like L-carnitine, vitamin D, and fish oil can further improve liver function and decrease liver fat.