Why a meal plan for fatty liver disease is crucial
Let food be thy medicine
Unlike most other diseases and disorders, nonalcoholic fatty liver disease (NAFLD) does not have a list of drugs made specifically for the condition. A healthy diet and weight loss are the best methods to manage it. This article provides information on NAFLD itself and optimal foods to include in a meal plan for fatty liver.
Nonalcoholic fatty liver disease defined
Nonalcoholic fatty liver disease (NAFLD) dates back just over 40 years and is a buildup of fat in the liver.1 Diagnosis occurs through the use of imaging or tissue samples, and also when other causes are nonexistent. Those causes include chronic liver disease, excess alcohol consumption, medication, and diseases like autoimmune conditions.2
Prevalence of NAFLD
The estimated prevalence of NAFLD across the globe is 25%. Research shows the highest rates of up to approximately 30% in South America and the Middle East regions.3
NAFLD in the United States
In the United States alone, 80-100 million people are affected by nonalcoholic fatty liver disease.2 As I write this article, the current U.S. population is 330,259,336 per the U.S. and World Population clock at www.census.gov. That means 24.2-30.3% of people in this country are experiencing a form of NAFLD. WOW!
NASH, The next stage of NAFLD
Nonalcoholic steatohepatitis, also known as NASH, is the stage where fat buildup exists, and inflammation and cell degeneration are present.1 About 25% of the population with NAFLD advance to this stage.2
Cirrhosis and advanced stages
There is an estimation that up to one-fourth of people with NAFLD ending up with liver cirrhosis, and 7% progressing to a diagnosis of end-stage liver disease.1 Scar tissue has formed, ultimately damaging the organ.
Several conditions are considered risk factors and are commonly seen in people with NAFLD. These include obesity, type 2 diabetes, polycystic ovarian syndrome (PCOS), dyslipidemia, and metabolic syndrome, among others.2
Diet according to the research
Studies demonstrate that nonalcoholic fatty liver disease can result from excess intake of meat, refined and/or highly processed grains, sugar, and fats (primarily from saturated fat sources).5 Many conditions result from this (see Risk Factors), so it becomes clear as to why they are often seen together. At this point, you’re probably asking yourself, what is an ideal meal plan for fatty liver and what do I include?
Fatty liver meal plan overview
A NAFLD meal plan is recommended to help form healthy eating habits that will last long-term. The goal is to prevent NAFLD from progressing and improve your health. Because of this, It should not be a short-term solution or something based on a “fad diet.”
Most importantly, a meal plan for NAFLD should not be too restrictive. In fact, too much weight loss too soon can worsen inflammation. As the saying goes, “slow and steady wins the race!”
We now know why food choices are important, but what makes up a healthy diet for fatty liver disease? There are actually several components that can help manage weight, lower glucose and lipid levels, and reduce inflammation. Let’s take a look.
Macronutrients in your diet
Macronutrients include carbohydrates, proteins, and fats. All are important in a meal plan for fatty liver, but there are better options than others in each category.
While there are low-carb and “keto” foods everywhere lately, carbohydrates should not be eliminated. In fact, eating certain kinds can help promote satiety and help with weight loss, lower LDL cholesterol, and decrease insulin resistance.
Because they are higher in whole grains and fiber, complex carbohydrates take longer to break down in the body. For example, whole fruits and vegetables are complex carbohydrates.
Whole grain breads also fall into the category. Whole wheat, multigrain, rye and pumpernickel varieties are best. Likewise, brown rice, wild rice, barley, and quinoa are good grain options.
Simple carbohydrates break down quickly and do not provide the same benefits. These include white bread, baked goods, sweets, and juices. Once in a while it is okay to have a food like this, but the goal is to get at least half of your daily grains from whole grain foods.
It is important not to cut out all fats from the diet, but saturated fats should be limited.
These may be referred to as “healthy fats.” They contribute to good cardiac health and improving cholesterol levels. There are two types – monounsaturated and polyunsaturated fats.
Monounsaturated fats include cooking oils (olive, canola, avocado oil), avocados, and nuts. Polyunsaturated fats include fatty fish (salmon, trout, tuna, mackerel). These have a high content of omega-3 fatty acids. In addition, walnuts, seeds, tofu, and soybeans are good sources.
Saturated fats contribute to weight gain, high LDL cholesterol levels, and insulin resistance. They are most often found in animal products. Sources include red meat, visible fat on a steak or pork chop, and skin on poultry. In addition, butter, lard, coconut and palm oils, and full-fat dairy contain saturated fats.
Protein is an extremely important component of a healthy eating pattern. Particularly, it helps you maintain lean muscle mass and to feel satisfied at a meal. Protein should not be the majority of the diet, though; too much protein can contribute to weight gain if consumed in excess. However, it is important to include a variety of sources.
Animal protein consumption is linked with fat consumption. Lean protein sources are best. Examples include turkey and chicken (white meat is preferred), fish, loins of pork or beef, and lean ground beef (the higher the percent lean, the better).
Red meats do not need to be eliminated but should be limited to 1-2 servings weekly. It is beneficial to add fatty fish in a couple of times each week.
Low-fat dairy such as 1% or skim milk, part-skim or fat-free cheese, and low-fat/nonfat yogurts are other good protein sources. Eggs are another great protein food as well.
Plant proteins are foods with a ton of nutrition benefits. They are not just alternate sources of protein; plant proteins provide fiber and other beneficial nutrients as well. Swapping out a weeknight meal of meat/poultry with a meatless meal is a simple way to eat more of these foods.
Beans, lentils, and tofu are just a few of the plant proteins. Additionally, grains can contain protein. For example, quinoa, brown rice, and oatmeal contribute to overall protein content.
Is all sugar bad? Natural versus added sugars
Foods with natural sugars provide many nutrients and should be included. On the other hand, added sugar intake should be limited.
Fruit and dairy have natural sugars. Fructose is the natural fruit sugar, and lactose is the natural sugar found in dairy products. They provide us with nutritional benefits. For example, fruit contains fiber, and dairy has protein and calcium.
Added sugars are literally added in by the manufacturer and generally lack nutrition benefits. Because they may be added to unexpected foods, it is helpful to read nutrition labels to see if they are in them.
Names of some added sugars: sucrose (table sugar), high fructose corn syrup, molasses, honey (yes, honey!), and brown sugar.
Stay tuned for Part 2 of NAFLD Nutrition, which will include specific meal ideas for fatty liver disease.
1. Lindenmeyer CC, McCullough AJ. The Natural History of Nonalcoholic Fatty Liver Disease-An Evolving View. Clin Liver Dis. 2018 Feb;22(1):11-21. doi: 10.1016/j.cld.2017.08.003.
2. Perumpail, B. J., Khan, M. A., Yoo, E. R., Cholankeril, G., Kim, D., & Ahmed, A. (2017). Clinical epidemiology and disease burden of nonalcoholic fatty liver disease. World journal of gastroenterology, 23(47), 8263–8276. https://doi.org/10.3748/wjg.v23.i47.8263
3. Mitra, S., De, A., & Chowdhury, A. (2020). Epidemiology of non-alcoholic and alcoholic fatty liver diseases. Translational gastroenterology and hepatology, 5, 16. https://doi.org/10.21037/tgh.2019.09.08
4. Chalasani, N., Younossi, Z., Lavine, J.E., Charlton, M., Cusi, K., Rinella, M., Harrison, S.A., Brunt, E.M. and Sanyal, A.J. (2018), The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology, 67: 328-357. https://doi.org/10.1002/hep.29367
5. Mirmiran, P., Amirhamidi, Z., Ejtahed, H. S., Bahadoran, Z., & Azizi, F. (2017). Relationship between Diet and Non-alcoholic Fatty Liver Disease: A Review Article. Iranian journal of public health, 46(8), 1007–1017.