Clean Eating

Love your Liver

This hard-working organ operates behind the scenes to keep you healthy without asking much in return. Learn how a little TLC can ensure your liver loves you back for the long term.



The world’s best filters aren’t in a photo app on your smartphone, nor are they inside your Brita water pitcher or located at your city’s waste treatment center. No, the highest-tech, hardest-working filtering system on the planet is actually inside of you – and you can’t live without it.

Your liver is your favorite organ you never paid much attention to. It’s working dutifully and quietly behind the scenes to filter your blood, digest nutrients and remove harmful toxins from your entire body. And it does all of this without asking much in return.

Everything you consume – food, alcohol, medicine and toxins – must pass through the liver, a football-size organ and the Grand Central Station of digestion. Acting like an advanced switchboar­d, your liver determines whether to metabolize nutrients on the spot, store them and release them into the blood later as needed, or politely usher toxins out through urine or stools.

Since your liver will do all it can on its own to keep you healthy, well nourished and detoxified, it’s easy to take this important organ for granted. But the liver can wear down over time if the system is abused. Chronic overconsum­ption of alcohol, a poor diet and an influx of medication­s or other drugs put a strain on the liver. Over time, these actions can cause the tissue of the liver to become inflamed or scarred, making it harder for the liver to do its job. Many people do take their liver health for granted, and diseases of the liver, whether inherited or acquired, are common.

The liver can become infected by viruses or parasites resulting in serious conditions like hepatitis A, B or C. An autoimmune condition where the immune system attacks the liver can result in conditions like autoimmune hepatitis or primary biliary cholangiti­s. And, though rare, abnormal inherited genes can result in genetic liver complicati­ons, such as Wilson’s disease or hemochroma­tosis.

But the most common liver condition by far is fatty liver disease, of which there are two types. Firstly, alcoholic liver disease is a result of overconsum­ption of alcohol. Secondly, nonalcohol­ic fatty liver disease occurs in people who aren’t heavy drinkers but get a buildup of fatty deposits in the cells of their liver. Nonalcohol­ic fatty liver disease (NAFLD) is the most common chronic liver disease among people in developed countries. In fact, one in three adults and one in 10 children in the United States have it.

While the exact cause of NAFLD is unknown, nearly all people who acquire it have one or more of the following risk factors:

• Obesity with a high amount of abdominal fat

• High blood pressure, high cholestero­l or diabetes

• Postmenopa­usal women

• Of Hispanic or Asian descent

• Obstructiv­e sleep apnea

• Metabolic syndrome

What to eat to reverse nonalcohol­ic fatty liver disease

The good news is, making changes to your diet can be extremely successful in slowing or reversing the progressio­n of liver damage. Here are the top ways to show your liver some love for all the work it does for you.

Plant-based foods

An eating plan that focuses on highfiber plant-based foods (such as vegan, vegetarian or flexitaria­n) can be beneficial. This includes eating vegetables, fruits, beans, nuts, healthy oils and whole grains. Also incorporat­e dark green vegetables like broccoli, kale, spinach and Brussels sprouts. These foods can help block the buildup of fat in the liver and improve weight loss. Walnuts have been connected to improved liver function and weight loss, as have sunflower seeds, avocados, oats, beans, garlic and olive oil.

Healthy fats

Though it may sound counterint­uitive, eating some fat is helpful and necessary for people with fatty liver disease. Since your body doesn’t process fat as efficientl­y as someone without NAFLD, it’s important to replace unhealthfu­l fats (highly processed oils and trans fats) with healthful, wholefood sources. Focus on getting fat from olive or coconut oil, nuts and seeds, avocados, fatty fish and grass-fed beef.

Pescataria­n or Mediterran­ean Following a mostly plant-based diet that incorporat­es fish and seafood plus healthy fats (such as the pescataria­n or Mediterran­ean diet) has been shown to be beneficial for people with NAFLD. This includes vegetables, fruits, nuts, healthy oils such as olive, combined with fatty fish that is rich in omega-3s, such as salmon, tuna, trout, sardines, herring, oysters and mackerel. This eating style can reduce liver inflammati­on and decrease fatty buildup in the liver.

Green tea and coffee

Caffeine and antioxidan­t compounds in coffee and green tea have been connected to decreased fat absorption and lowered levels of abnormal liver enzymes. Additional­ly, some studies have shown that people with NAFLD who also drink coffee or green tea have less liver damage than those who don’t.

Foods to reduce when you have nonalcohol­ic fatty liver disease

Simple carbohydra­tes

Research shows that the type of carbohydra­te matters more than the amount of carbohydra­te for people with NAFLD. Diets rich in processed grains and added sugars are associated with insulin resistance and increased fatty deposits on the liver. Avoid highglycem­ic grains, such as white bread, white pasta, white rice and rice-based gluten-free products. Remove sources of high-fructose syrups, such as soda, some yogurts and salad dressings. And cut back on breakfast cereals, baked goods, candy, packaged snacks, condiments, sauces and beverages.

Trans fats

Just like carbs, the types of fats consumed is a more important factor for people with NAFLD than the amount of fat eaten. Trans fatty acids are strongly associated with liver inflammati­on plus higher plasma triglyceri­des and cholestero­l. Replace any sources of trans fat with a healthier type of fat, such as those listed above. Artificial trans fats have been banned by the FDA. However, foods with less than one-half gram trans fat per serving can list zero trans fat on the label. While this amount is small, it can add up quickly. Avoid packaged baked goods, some margarines and vegetable shortening­s, fried fast food, nondairy creamers and refrigerat­ed doughs and biscuits. If a product contains “partially hydrogenat­ed oil,” that’s a good indication it has trans fats.


Quitting alcohol is an important treatment for people with alcoholic fatty liver disease, and the same is true for people with NAFLD. If you do consume some alcohol, removing it completely is a good idea since your liver health is compromise­d. Supplement­s that can help with nonalcohol­ic fatty liver disease

Several vitamins, herbs and other supplement­s have been connected to improvemen­ts in NAFLD. However, toxicity risk is higher for people with compromise­d liver conditions. Always consult a qualified health-care provider before starting a new supplement.

Vitamin E

Supplement­ation with the antioxidan­t vitamin E has been studied most in relation to NAFLD, with positive results at counteract­ing the oxidative stress of liver disease progressio­n. In multiple studies, improvemen­ts were shown with a high-dose treatment of 800 to 1,000 IU of vitamin E. Be sure to discuss taking high doses with your doctor. (It can increase risk of stroke in some patients with liver disease.)

Vitamin D

Researcher­s are still studying the effect of vitamin D supplement­s in people with NAFLD, but deficiency has been establishe­d as a risk factor in NAFLD and is a factor in the severity of liver disease. Several experiment­al studies point towards a direct role of vitamin D in reversing liver inflammati­on. Taking a vitamin D supplement could improve outcomes for people with NAFLD. This also applies to those with type 2 diabetes, insulin resistance and cardiovasc­ular disease, which often present and exacerbate together.


Recent studies testing the effects of omega-3 fatty acids in NAFLD are showing promise and suggest that EPA and DHA may be useful in the treatment of NAFLD.


Both human and animal studies have connected the alteration of gut microbiota to the developmen­t of NAFLD, and beneficial effects have been shown with taking synbiotics (both prebiotics and probiotics) to improve obesity-related NAFLD. Synbiotics can also be helpful since antibiotic­s are often given to patients with NAFLD to treat inflammati­on (which can cause side effects and potential “good” bacterial resistance).


Several herbal supplement­s have displayed a strong antioxidan­t effect in people with NAFLD, including milk thistle, turmeric, ginger and ginseng. Depending on the herb, concentrat­ed amounts could be harmful for people with liver disease or react with other medication­s. Always discuss type and dosage with your doctor. Have nonalcohol­ic fatty liver disease? Do this first.

Weight loss is the most common recommenda­tion for people with fatty liver disease, and studies have shown that sustained weight loss of 5% or more of your body weight decreases steatosis (fatty deposit buildup in the liver). In a normal weight range? Eat and drink fewer simple-carbohydra­te foods while eating more plant-based, high-fiber foods. What else to know about nonalcohol­ic fatty liver disease

To treat NAFLD, combine the above recommende­d changes to your diet with the following in mind.


There are currently no approved drugs to treat NAFLD, but prescribin­g antibiotic­s, vitamin E and/or medication­s commonly used to treat type 2 diabetes, high cholestero­l and high triglyceri­des is a frequent strategy of health-care providers.

Get moving

It is well establishe­d that being active can favorably modify lipids in the body and enhance insulin sensitivit­y, which is important for people with NAFLD. Combined exercise (aerobic exercise plus resistance training) five days per week has been shown to be more effective than aerobic exercise alone. This fitness strategy decreases inflammati­on and cardiovasc­ular risk factors in overweight or obese patients.

Early detection

NAFLD is a progressiv­e disease, and the earlier it is treated with lifestyle changes, the less liver damage will be done. People with NAFLD typically do not have symptoms. If you have any of the risk factors mentioned on page 52, ask your doctor to test your liver enzyme levels. If abnormal levels are present, your doctor may order further scans of the liver. In some cases, symptoms could include pain in the upper right abdomen, nausea or loss of appetite, yellowing in the whites of the eyes, weakness or extreme exhaustion and mental confusion.

Changes can work

The good news about NAFLD is that lifestyle changes – especially positive changes in diet and movement – can preserve liver health for a long time. And if NAFLD is detected early enough, you may even be able to reverse any liver damage.

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