Diet and the Liver: How to Protect Against Liver Disease

Your liver does a great deal for your body. It detoxifies many substances that could be harmful to you, makes new proteins, fats, sugars, and digestive enzymes, and performs many other vital functions.[1] So, if anything compromises your liver health and it can’t do its job properly, you’re in serious trouble.

Your Liver Needs Nutrition to Stay Healthy

Your liver needs nutrients just like all the other organs in your body. Eating the right foods can support your liver in performing its functions. Certain nutrients are particularly good for liver health. But, to understand why these nutrients have protective or healing properties, we must first understand what can go wrong with the liver.

Which Foods Can Cause Liver Damage?

“Fibrosis” is a frequently used term in relation to liver disease. Fibrosis is when tissue has thickened and scarred—usually in response to injury. When a tissue is damaged, it responds by trying to heal itself. The more severe the damage, the more a tissue will have to repair itself, and the more likely it is that scarring will occur.

For example, a severe burn on your hand is more likely to leave a scar after it heals than a slight surface scratch. It’s no different for the cells of your liver than for the skin cells on your hand. Tissue damage triggers healing, which can lead to fibrosis (scarring) when the cells aren’t able to fully form in exactly the same way as the original cells. Thus, anything that causes liver damage can lead to liver fibrosis.

Can any foods cause liver damage? One of the most damaging substances that many adults consume regularly is alcohol. When you drink alcohol—especially in excess—it damages the cells lining your liver and triggers inflammation.[2],[3] Your liver cells respond in a way that results in fibrosis—they recruit even more inflammatory cells to the liver, which triggers the release of fibrogenic growth factors.[4]

Of course, many other drugs can cause liver damage. But liver damage and fibrosis caused by alcohol is so common that it has its own clinical diagnosis: alcoholic fatty liver disease (AFLD). This is when fats start to accumulate inside your liver as a result of excessive alcohol consumption. AFLD can progress to more serious clinical conditions, including cirrhosis (liver cell death), liver cancer, and premature death.[5]

What about foods that can cause liver damage? Dietary sugars, particularly refined sugars, found in desserts, soft drinks, sugary snacks, and confectionary are the biggest threat to your liver.[6] Fructose, a natural sugar found in honey and fruit, and high-fructose corn syrup (HFCS) that is added to many sweetened foods, increase risk of liver disease risk by encouraging fat to accumulate in the liver.[7] They do this by causing your body to produce more fats (yes, your body can synthesize fats) and by impairing your body’s ability to break down and eliminate fats.[8]

What Is Fatty Liver Disease?

Fatty liver disease is the accumulation of fat inside the liver. It can lead to many long-term complications if not effectively managed. The range of possible complications include liver fibrosis (scarring), advanced fibrosis, liver cirrhosis (cell death), liver cancer, and even liver failure.[9],[10],[11]

What happens if your liver fails? You’ll need a liver transplant or you’ll die prematurely—yes, it’s scary! Your body can’t function properly without a healthy liver to effectively metabolize and remove toxins from your body. If you no longer have this critical defence mechanism in place, you become extremely vulnerable to disease, and possibly death.

There are two types of fatty liver disease:

  1. Alcoholic fatty liver disease (AFLD) is caused by excessive alcohol consumption.
  2. Non-alcoholic fatty liver disease (NAFLD) is caused by factors other than excessive alcohol consumption.

NAFLD affects approximately 10–40% of adults worldwide, because it’s strongly related to metabolic syndrome, which is very common.[12] Syndromes are a group of symptoms that commonly occur together. The symptoms or clinical markers that are indicative of metabolic syndrome are the following:[13]

  • Insulin resistance
  • Diabetes
  • Dyslipidemia (abnormal blood fat levels)
  • Obesity

When non-alcoholic fatty liver disease (NAFLD) is left untreated, it can progress to non-alcoholic steatohepatitis (NASH), which is much more serious.[14] “Steatohepatitis” means that the liver isn’t only fatty, it’s also inflamed. Inflammation is one of the factors that causes fibrosis by damaging liver cells. That’s why NASH is a very serious problem—the damage occurring to the liver is continuous and self-perpetuating.[15],[16],[17]

How Are Diet and Liver Health Related?

If non-alcoholic fatty liver disease (NAFLD) isn’t caused by alcohol, then what are its causes? Are any of them dietary?

As we discussed earlier, dietary sugars—especially refined sugars, fructose, and HFCS—pose the biggest threat to your liver.[18] That’s why a high-sugar diet is so closely associated with the onset of NAFLD.[19]

Does this mean that by reducing your intake of sugary foods, you can help prevent NAFLD? Yes! Research suggests that if you consume less foods and drinks that are high in sugar, it may reduce fat accumulation in your liver, protecting you from NAFLD.[20]

How can you cut back on your overall sugar intake? Hidden or added sugars can creep into your diet in numerous ways. We’ve already mentioned fruit and honey. Many people disregard their sugar content because they’re natural and less processed. However, these foods are primary sources of fructose.

Another common category to watch out for is canned foods. Always be sure to check the sugar content on food labels to see how many grams of sugar a food contains per 100 grams (i.e. the percentage sugar). For example, if a serving size is 55 grams and there are 15 grams of sugar in each serving, that food is 27% sugar (15 divided by 55, multiplied by 100). That’s pretty high! Ideally, you want to choose foods that are less than 5–10% sugar to protect yourself against NAFLD.

Can You Improve Your Liver Health With the Right Diet?

Is there such a thing as nutrition for cirrhosis? Or a diet that’s ideal to prevent or reverse fibrosis before it progresses to cirrhosis?

Research suggests that dietary antioxidants, such as β-cryptoxanthin and astaxanthin, may be effective in preventing or treating NAFLD .[21] This is because oxidative stress is a key factor in the development and progression of NAFLD.[22] Oxidative stress happens all the time in human metabolism and is a natural part of the aging process. However, if your liver isn’t getting the antioxidants it needs to counterbalance it, oxidative stress can damage liver cells, leading to fibrosis and cirrhosis.[23]

Are there any other nutrients that can improve liver health? Research has shown that vitamin E therapy is effective at reducing steatosis (the amount of fat in the liver) and inflammation when given alongside pioglitazone (a type 2 diabetes medication).[24] Vitamin E is actually used as a first-line pharmacological treatment for NASH because it’s a strong antioxidant.[25] However, long-term use of Vitamin E does have potential side effects, such as increasing the risk of prostate cancer and hemorrhagic stroke (a stroke caused by a ruptured blood vessel in the brain).[26] Therefore, it’s best to consult with a qualified nutrition expert or naturopathic doctor before taking vitamin E to protect or heal your liver.

Diets rich in fibre and omega-3 fatty acids may also be good for your liver.[27],[28] Fibre is thought to have beneficial effects on gut flora (bacteria that lives in the gut) that reduce the amount of fats made within the liver.[29],[30] Omega-3 fats also appear to reduce fat production in the liver, as well as protecting the liver by reducing inflammation and helping to get rid of excess liver fat.[31],[32]

Other nutrients that have been shown to heal or protect the liver include beta-carotene, vitamin B12, lycopene, and milk thistle extracts.[33]

The Top 29 Foods to Eat for Liver Health

As we just learned, the best foods to support liver health have one or more of the following properties:

  • They protect against oxidative stress
  • They reduce inflammation (directly or indirectly)
  • They increase the breakdown of fats in the liver
  • They reduce the production of fats in the liver

So, what are the top foods for liver health? Which foods contain abundant liver-protective or liver-healing nutrients?

The strongest antioxidants that can prevent non-alcoholic fatty liver disease (NAFLD) or stop it from progressing to non-alcoholic steatohepatitis (NASH) are found in vegetables, fruits, and pink-coloured seafood.[34] The best anti-inflammatory foods contain omega-3 fatty acids. And, anything you eat that feeds beneficial gut flora or encourages them to grow (namely, prebiotic and probiotic foods) will also protect and support your liver.[35]

Based on the above criteria, the following are the top 29 foods for liver health:[36],[37],[38],[39]

Vegetables

Jerusalem artichoke, onion, tomato, pepper, pumpkin, winter squash

Fruits

Apricot, banana, papaya, persimmon, red grapefruit, tangerine, watermelon

Animals

Beef, clam, kidney, liver, lobster, salmon, sardine, shrimp, trout, tuna

Dairy and eggs

Egg, milk, kefir (fermented milk beverage), yogurt (no added sugar)

Other

Chicory root, kombucha (fermented tea beverage)

References

[1] Lala V, Minter DA. Liver Function Tests. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020. http://www.ncbi.nlm.nih.gov/books/NBK482489/. Accessed March 8, 2020.

[2] Albillos A, de Gottardi A, Rescigno M. The gut-liver axis in liver disease: Pathophysiological basis for therapy. J Hepatol. 2020;72(3):558-577. doi:10.1016/j.jhep.2019.10.003

[3] Altamirano-Barrera A, Barranco-Fragoso B, Méndez-Sánchez N. Management strategies for liver fibrosis. Ann Hepatol. 2017;16(1):48-56. doi:10.5604/16652681.1226814

[4] Younossi Z, Henry L. Contribution of Alcoholic and Nonalcoholic Fatty Liver Disease to the Burden of Liver-Related Morbidity and Mortality. Gastroenterology. 2016;150(8):1778-1785. doi:10.1053/j.gastro.2016.03.005

[5] Jensen T, Abdelmalek MF, Sullivan S, et al. Fructose and sugar: A major mediator of non-alcoholic fatty liver disease. J Hepatol. 2018;68(5):1063-1075. doi:10.1016/j.jhep.2018.01.019

[6] Jensen T, Abdelmalek MF, Sullivan S, et al. Fructose and sugar: A major mediator of non-alcoholic fatty liver disease. J Hepatol. 2018;68(5):1063-1075. doi:10.1016/j.jhep.2018.01.019

[7] Jensen T, Abdelmalek MF, Sullivan S, et al. Fructose and sugar: A major mediator of non-alcoholic fatty liver disease. J Hepatol. 2018;68(5):1063-1075. doi:10.1016/j.jhep.2018.01.019

[8] Jensen T, Abdelmalek MF, Sullivan S, et al. Fructose and sugar: A major mediator of non-alcoholic fatty liver disease. J Hepatol. 2018;68(5):1063-1075. doi:10.1016/j.jhep.2018.01.019

[9] Kitade H, Chen G, Ni Y, Ota T. Nonalcoholic Fatty Liver Disease and Insulin Resistance: New Insights and Potential New Treatments. Nutrients. 2017;9(4). doi:10.3390/nu9040387

[10] Kolodziejczyk AA, Zheng D, Shibolet O, Elinav E. The role of the microbiome in NAFLD and NASH. EMBO Mol Med. 2019;11(2). doi:10.15252/emmm.201809302

[11] Brunt EM, Wong VW-S, Nobili V, et al. Nonalcoholic fatty liver disease. Nat Rev Dis Primer. 2015;1:15080. doi:10.1038/nrdp.2015.80

[12] Brunt EM, Wong VW-S, Nobili V, et al. Nonalcoholic fatty liver disease. Nat Rev Dis Primer. 2015;1:15080. doi:10.1038/nrdp.2015.80

[13] Brunt EM, Wong VW-S, Nobili V, et al. Nonalcoholic fatty liver disease. Nat Rev Dis Primer. 2015;1:15080. doi:10.1038/nrdp.2015.80

[14] Jensen T, Abdelmalek MF, Sullivan S, et al. Fructose and sugar: A major mediator of non-alcoholic fatty liver disease. J Hepatol. 2018;68(5):1063-1075. doi:10.1016/j.jhep.2018.01.019

[15] Kitade H, Chen G, Ni Y, Ota T. Nonalcoholic Fatty Liver Disease and Insulin Resistance: New Insights and Potential New Treatments. Nutrients. 2017;9(4). doi:10.3390/nu9040387

[16] Kolodziejczyk AA, Zheng D, Shibolet O, Elinav E. The role of the microbiome in NAFLD and NASH. EMBO Mol Med. 2019;11(2). doi:10.15252/emmm.201809302

[17] Brunt EM, Wong VW-S, Nobili V, et al. Nonalcoholic fatty liver disease. Nat Rev Dis Primer. 2015;1:15080. doi:10.1038/nrdp.2015.80

[18] Jensen T, Abdelmalek MF, Sullivan S, et al. Fructose and sugar: A major mediator of non-alcoholic fatty liver disease. J Hepatol. 2018;68(5):1063-1075. doi:10.1016/j.jhep.2018.01.019

[19] Jensen T, Abdelmalek MF, Sullivan S, et al. Fructose and sugar: A major mediator of non-alcoholic fatty liver disease. J Hepatol. 2018;68(5):1063-1075. doi:10.1016/j.jhep.2018.01.019

[20] Jensen T, Abdelmalek MF, Sullivan S, et al. Fructose and sugar: A major mediator of non-alcoholic fatty liver disease. J Hepatol. 2018;68(5):1063-1075. doi:10.1016/j.jhep.2018.01.019

[21] Kitade H, Chen G, Ni Y, Ota T. Nonalcoholic Fatty Liver Disease and Insulin Resistance: New Insights and Potential New Treatments. Nutrients. 2017;9(4). doi:10.3390/nu9040387

[22] Kitade H, Chen G, Ni Y, Ota T. Nonalcoholic Fatty Liver Disease and Insulin Resistance: New Insights and Potential New Treatments. Nutrients. 2017;9(4). doi:10.3390/nu9040387

[23] Kitade H, Chen G, Ni Y, Ota T. Nonalcoholic Fatty Liver Disease and Insulin Resistance: New Insights and Potential New Treatments. Nutrients. 2017;9(4). doi:10.3390/nu9040387

[24] Oseini AM, Sanyal AJ. Therapies in non-alcoholic steatohepatitis (NASH). Liver Int Off J Int Assoc Study Liver. 2017;37 Suppl 1:97-103. doi:10.1111/liv.13302

[25] Oseini AM, Sanyal AJ. Therapies in non-alcoholic steatohepatitis (NASH). Liver Int Off J Int Assoc Study Liver. 2017;37 Suppl 1:97-103. doi:10.1111/liv.13302

[26] Oseini AM, Sanyal AJ. Therapies in non-alcoholic steatohepatitis (NASH). Liver Int Off J Int Assoc Study Liver. 2017;37 Suppl 1:97-103. doi:10.1111/liv.13302

[27] Suárez M, Boqué N, Del Bas JM, Mayneris-Perxachs J, Arola L, Caimari A. Mediterranean Diet and Multi-Ingredient-Based Interventions for the Management of Non-Alcoholic Fatty Liver Disease. Nutrients. 2017;9(10). doi:10.3390/nu9101052

[28] Eslamparast T, Tandon P, Raman M. Dietary Composition Independent of Weight Loss in the Management of Non-Alcoholic Fatty Liver Disease. Nutrients. 2017;9(8). doi:10.3390/nu9080800

[29] Suárez M, Boqué N, Del Bas JM, Mayneris-Perxachs J, Arola L, Caimari A. Mediterranean Diet and Multi-Ingredient-Based Interventions for the Management of Non-Alcoholic Fatty Liver Disease. Nutrients. 2017;9(10). doi:10.3390/nu9101052

[30] Eslamparast T, Tandon P, Raman M. Dietary Composition Independent of Weight Loss in the Management of Non-Alcoholic Fatty Liver Disease. Nutrients. 2017;9(8). doi:10.3390/nu9080800

[31] Suárez M, Boqué N, Del Bas JM, Mayneris-Perxachs J, Arola L, Caimari A. Mediterranean Diet and Multi-Ingredient-Based Interventions for the Management of Non-Alcoholic Fatty Liver Disease. Nutrients. 2017;9(10). doi:10.3390/nu9101052

[32] Eslamparast T, Tandon P, Raman M. Dietary Composition Independent of Weight Loss in the Management of Non-Alcoholic Fatty Liver Disease. Nutrients. 2017;9(8). doi:10.3390/nu9080800

[33] Kitade H, Chen G, Ni Y, Ota T. Nonalcoholic Fatty Liver Disease and Insulin Resistance: New Insights and Potential New Treatments. Nutrients. 2017;9(4). doi:10.3390/nu9040387

[34] Kitade H, Chen G, Ni Y, Ota T. Nonalcoholic Fatty Liver Disease and Insulin Resistance: New Insights and Potential New Treatments. Nutrients. 2017;9(4). doi:10.3390/nu9040387

[35] Albillos A, de Gottardi A, Rescigno M. The gut-liver axis in liver disease: Pathophysiological basis for therapy. J Hepatol. 2020;72(3):558-577. doi:10.1016/j.jhep.2019.10.003

[36] Kitade H, Chen G, Ni Y, Ota T. Nonalcoholic Fatty Liver Disease and Insulin Resistance: New Insights and Potential New Treatments. Nutrients. 2017;9(4). doi:10.3390/nu9040387

[37] Kolodziejczyk AA, Zheng D, Shibolet O, Elinav E. The role of the microbiome in NAFLD and NASH. EMBO Mol Med. 2019;11(2). doi:10.15252/emmm.201809302

[38] Suárez M, Boqué N, Del Bas JM, Mayneris-Perxachs J, Arola L, Caimari A. Mediterranean Diet and Multi-Ingredient-Based Interventions for the Management of Non-Alcoholic Fatty Liver Disease. Nutrients. 2017;9(10). doi:10.3390/nu9101052

[39] Eslamparast T, Tandon P, Raman M. Dietary Composition Independent of Weight Loss in the Management of Non-Alcoholic Fatty Liver Disease. Nutrients. 2017;9(8). doi:10.3390/nu9080800

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