Fatty liver diet: what to eat and what to change

What is fatty liver, and why has its name changed?

Fatty liver means that fat has built up in the liver. The 2023 international consensus replaced «non-alcoholic fatty liver» with a name centred on metabolic dysfunction [3]. The Spanish guideline uses «metabolic steatotic liver disease» [2].

That name reminds us to look at blood glucose, blood pressure and lipids too. On its own, it does not tell you whether there is inflammation or scarring of the liver. Your doctor makes the diagnosis and assesses fibrosis, the scarring, with the right tests [2]. A blood test that looks normal does not rule it out either [2].

Can you have fatty liver without being overweight?

Insulin resistance makes it harder for the body to use glucose well. It usually goes together with more abdominal fat, changes in glucose or triglycerides, and fat building up in the liver [1]. Weight can have an influence, but you do not need to be obese to have fatty liver [1].

Alcohol matters too. The current definition requires your doctor to assess how much you drink and whether there are other causes of liver damage [3]. In MASLD, the European guideline advises against drinking alcohol, especially if the intake is moderate or high [1]. With advanced fibrosis or cirrhosis it recommends complete and lasting abstinence [1].

Smoking and inactivity add risks that are worth tackling [2].

If your weight worries you, the guide to obesity and diet explains how to plan changes without turning every meal into an exam.

What should you eat to improve fatty liver?

A Mediterranean pattern brings together vegetables, whole fruit, pulses, wholegrain cereals, nuts, fish and olive oil [1]. It can be adapted to your timetable and tastes. The Mediterranean diet guide covers the full pattern.

If your cholesterol is also high, the guide to lowering cholesterol explains how to organise your diet for that goal.

Think about an ordinary meal. A dish of lentils with vegetables and olive oil is a simple way to start. For dinner, you can combine an omelette, a salad and wholegrain bread. None of these dishes requires special ingredients.

It helps to cut back on free sugars, especially those in soft drinks and drinks with added fructose. The European guideline links their intake with more liver fat and recommends avoiding sugary drinks [1]. Whole fruit belongs to a different food context: it provides fibre and is eaten, not drunk like a soft drink.

It also matters that ultra-processed foods high in sugar and saturated fat stop being your usual solution [1]. Look at your real routine. If you get home late, having cooked pulses, frozen vegetables and eggs can sort out dinner better than ordering fast food.

The useful change is the one you can repeat when the week gets complicated.

How much weight do you need to lose to notice a difference?

In adults with MASLD and overweight, the European guideline proposes a sustained loss of at least 5 % of initial body weight to reduce liver fat [1]. It sets 7–10 % as the aim to improve inflammation, and at least 10 % to improve fibrosis [1]. These are clinical targets, not an individual promise.

The aim is not to achieve it quickly. It is better to agree on changes you can keep up without tight, severe restrictions. The assessment of your weight should take into account your history, your relationship with food and the possible loss of muscle.

If you are at a usual weight, we adjust your diet and movement to your case [1]. The guideline recommends both interventions to reduce liver fat, but it has no evidence of benefit for fibrosis or liver clinical outcomes in this population [1].

Your doctor may propose other targets depending on the degree of disease and any other conditions you have. In consultation we work on the nutritional plan alongside that follow-up, without setting the degree of liver damage ourselves.

Does exercise help even if your weight does not change?

Yes. Exercise can reduce liver fat even without a significant weight loss [1]. Brisk walking, cycling or swimming are possible ways to start. Strength training helps you keep muscle while your habits change.

The European guideline suggests adapting movement to each person’s capacity. As a reference adapted to each person, and not as a universal goal, it proposes more than 150 minutes per week of moderate activity or 75 minutes per week of vigorous activity [1]. If you are starting from very little, begin with a walk you can repeat. Then increase the time or intensity gradually.

A day without formal training also counts. You can walk to run an errand, take the stairs if that is comfortable for you, or get up often if you sit at work. What we are after is a routine, not a perfect week.

What should you know about coffee, alcohol and fatty liver?

Coffee has been associated with less liver damage in observational studies [1]. That association does not show that drinking it treats fatty liver. If you already drink it and it suits you, there is no need to stop because of this diagnosis. Nor do we ask you to start drinking it or to drink more cups as if it were a therapeutic dose.

If it disturbs your sleep or causes palpitations, pay attention to how it affects you; if your doctor has given you a different instruction, follow it. Avoid turning coffee into a sugary drink with syrups or large amounts of sugar.

What should you avoid with fatty liver, and what about products that promise to cleanse the liver?

Products that promise to cleanse the liver do not replace changes to your diet or medical assessment. The European guideline does not recommend supplements to treat this disease because there is not enough evidence of their efficacy and safety [1].

A Cochrane review examined a specific plant extract and concluded that its benefits and harms remain unclear [4]. That result cannot be simply extended to all preparations, and this guide does not recommend any extract.

Before taking any preparation, show the label to the healthcare professional who monitors your care. Ask your doctor whether you need that preparation. It is especially relevant if you take medication or already have advanced liver disease. Do not add products on your own.

What we see in consultation

In our appointments we can address these questions. The first is cutting out bread and keeping soft drinks. The second is looking for a very strict plan that does not fit daily life. The third is interpreting normal transaminase levels as a sign that follow-up is no longer needed [2].

For the first, we review what you drink during the week. For the second, we organise ordinary meals that you can repeat. For the third, we ask your doctor to confirm which tests and checks you need. Nobody can work out the degree of fibrosis from how you feel after eating.

What medical follow-up do you need?

Your doctor decides how to confirm the diagnosis and estimate the risk of fibrosis. Spanish societies propose a staged assessment with non-invasive tests and referral when the risk requires it [2]. How often you need follow-up depends on those results and on problems such as diabetes or cardiovascular disease.

Bring to the appointment the ultrasound report, your blood tests and an up-to-date list of medicines. Be frank about how much alcohol you drink. That way other causes of liver damage can be assessed and useful targets agreed. We can adapt your diet to that plan and review with you which changes fit into your routine.