Diets for fatty liver: Which is best for reversing NAFLD?

Fatty liver is a common problem throughout the World, including the United States. Generally speaking, fatty liver disease is either driven by alcohol consumption OR what is called non-alcoholic fatty liver disease(NAFLD).

NAFLD refers to fatty liver not attributed to alcohol. The most common drivers of NAFLD are Type 2 diabetes or obesity, but medications, starvation, and a lack of certain nutrients can also cause it. In fact, NAFLD is also referred to as metabolic dysfunction associated liver disease, or MAFLD.

Currently, there are no effective medical treatments for fatty liver. Alcohol-related liver disease clears up with abstinence from alcohol, while NAFLD clears up with lifestyle interventions that lead to weight loss.

In either case, it’s a good idea to address fatty liver before it leads to bigger problems. A recent paper finds that people with NAFLD have a 93% increased risk of dying over 14 years.

The risk of death increases with severity, but even those with mild NAFLD have a 71% increased risk of death. Interestingly, most of the deaths from NAFLD were gastrointestinal and uterine cancers, even moreso than cirrhosis. And once cirrhosis sets in, the damage is permanent.

Therefore, getting rid of excess fat in your liver while you can is very important if you have it. But are there diets for fatty liver that provide better results than others? To figure that out, it’s a good idea to discuss how fatty liver develops.

How fatty liver develops

It’s easy to look at NAFLD as driven by excess energy, but it’s actually the opposite. It’s true that excess energy intake leads to fatty liver, but we don’t use food directly for energy. Instead, we metabolize food to make something called adenosine triphosphate, or ATP.

ATP is what our cells use for energy, and when we do that we end up with adenosine diphosphate(ADP) or adenosine monophosphate(AMP). When we metabolize food, we recharge our ATP stores by converting ADP and AMP back into ATP.

So if NAFLD is actually about excess energy, we would expect to see higher ATP in a fatty liver. Unfortunately, the opposite is true; people with NAFLD have a lower ATP generating capacity in their liver than healthy people.

This is because mitochondrial dysfunction is a common feature of NAFLD, and we recharge more than 90% of our ATP in our mitochondria. Unfortunately, fat is exclusively metabolized in the mitochondria.

Liver cells with mitochondrial dysfunction can’t metabolize fat properly, so they store it. This happens in both NAFLD as well as fatty liver caused by alcohol consumption.

A common link between NAFLD and alcohol related fatty liver is leaky gut. And recent evidence indicates that leaky gut may cause mitochondrial dysfunction in the liver by disrupting circadian rhythms.

Diets for fatty liver

There are many different diets for fatty liver, each with their own pros and cons. Many people feel a Ketogenic diet is best, while others feel a Carnivore diet is. And don’t forget the Vegan Diet or Paleo Diet.

Which diet works best in the long run depends on the person and the situation. Ultimately, if trying to reverse fatty liver, the most important factor is that the diet leads to some level of caloric restriction.

The easiest way to determine this is if the diet leads to weight loss. Calorie restriction leads to weight loss in the overweight and obese and improves leaky gut. Any diet that leads to weight loss leads to a decrease in fatty liver, and possibly leaky gut.

Whether you get to calorie restriction by going Low Carb, Carnivore, or Vegan really doesn’t matter as much as getting in to actual calorie restriction. So the best diets for fatty liver are the ones that lead to calorie restriction with the least effort from you

This means if you can stick to Keto or Carnivore and lose weight, it will work for fatty liver. If you want variety in your diet, Mediterranean works too.

One caveat is that if you currently have fatty liver, you may want to reduce fructose intake. In the above mentioned study showing fatty liver leads to lower ATP recharging capacity, ATP was assessed after a fructose challenge. Over the long haul, calorie restriction should get you there regardless of fructose intake, however.

Another dietary factor that may help is increasing choline or folate intake. Deficiency in both of these nutrients promotes fatty liver, and many people are deficient in at least choline.

Adequate daily intake of choline is 550mg/day for men and breastfeeding women and 425mg for women.


Of the many different diets for fatty liver, pretty much any is effective provided it leads to calorie restriction. This is fantastic, as it allows people to choose the diet of their liking provided it satisfies them enough to lead to calorie restriction.

Additionally, exercise is another useful tool for putting yourself in to a calorie restricted state. On top of that, exercise independently decreases liver fat by increasing fat oxidation and blocking fat synthesis and storage. Both exercise and diet are a homerun when combined to address NAFLD.

Fatty liver is a problem you should deal with early on to reverse the damage associated with it, especially in terms of the gut. Since a fatty liver generates less ATP, it will be less effective at producing bile acids, detoxifying environmental chemicals, and detecting and clearing bacteria and viruses that enter from the gut.

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