Does the Mediterranean Diet Combat Fatty Liver Disease?

Fatty liver, also known as hepatic steatosis, is a condition in which fat accumulates in the liver. Both alcohol-associated liver diseases and nonalcoholic fatty liver disease (NAFLD) fall under this umbrella.

Too much fat in the liver can lead to inflammation and potentially irreversible liver damage that alters the liver’s function — and therefore blood sugar regulation and fat breakdown (1).

But this fat accumulation may be prevented, stopped, and even reversed through the help of healthful eating habits.

The Mediterranean diet is rich in whole grains, olive oil, fruits, vegetables, fish, nuts, and legumes and low in added sugars and processed meats. It’s one of the most researched diets (2, 3).

And now, research indicates that following a Mediterranean diet may also be beneficial for fatty liver (4).

This article takes a look into the research behind the Mediterranean diet and fatty liver, tips for following this eating pattern, and other lifestyle considerations for fatty liver.

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Does the Mediterranean diet help prevent fatty liver?

Although this is an emerging area of research, evidence indicates that following a Mediterranean diet may help prevent NAFLD.

A study including 548 people at risk of NAFLD found that higher adherence (closely following principles of a Mediterranean diet) was preventative of NAFLD (5).

Another study evaluating the dietary intake of 3,220 adults in Iran found that following a Mediterranean diet seemed connected to a decreased likelihood of NAFLD (6).

The effect was most pronounced in women and in those who didn’t carry “excess” weight around their midsection (6).

The Mediterranean diet may have this protective effect against NAFLD due to its proven track record for improving many of the risk factors associated with the condition, including: (7)

• obesity
• type 2 diabetes
• metabolic syndrome
• cardiovascular disease

In addition, many of the individual foods included in the Mediterranean diet, such as olive oil, nuts, non-starchy vegetables, whole grains and fruit, have been found beneficial for preventing or treating NAFLD (4).

Olive oil

Olive oil is high in monounsaturated fatty acids and beneficial plant compounds called polyphenols, which have antioxidant effects in the body.

Consumption of monounsaturated fats like olive oil is associated with favorable cholesterol, triglyceride, and blood sugar (glucose) levels, as well as favorable waist circumference (8, 9).

Fatty fish

The Mediterranean diet is rich in omega-3 fatty acids — a type of polyunsaturated fat — from seafood like salmon, mackerel, and tuna.

A diet low in omega-3s and high in omega-6s — another polyunsaturated fat typically found in refined vegetable oils — is a risk factor for NAFLD (10, 11).

And a diet high in omega-3 fats can decrease other risk factors for NAFLD, including improving blood sugar regulation, inflammation, and oxidative stress (8, 12).

Whole grains

Whole grains contain more fiber and polyphenols than their refined — or “white” — counterparts.

Fiber does not get broken down in the digestive tract and therefore doesn’t supply the body with any calories. It plays an important role in weight loss by supporting feelings of fullness in a reduced-calorie diet (4, 13).

For people living with obesity, weight loss is often a recommended measure to prevent NAFLD (14).

Fruits and vegetables

Fruits and vegetables are nutrient-dense foods, meaning they contain many health-promoting compounds for few calories.

They are good sources of fiber, vitamins, minerals, and polyphenols. People who consume high amounts of fruits and vegetables have a lower risk of heart disease and type 2 diabetes (4).

SUMMARY

Eating foods traditionally included in Mediterranean diets may help prevent NAFLD by decreasing major risk factors of the condition including excess weight and type 2 diabetes.

Can the Mediterranean diet improve fatty liver?

There is also research to support following a Mediterranean diet for those living with fatty liver.

There are currently no medications that directly target lowering fat in the liver, so the main therapeutic approach for both alcohol and non-alcohol-induced fatty liver is to focus on lifestyle (15).

Weight loss — even losing just 5–10% of body weight — is the most established way of improving fatty liver outcomes in those with overweight. But healthy eating, even in the absence of weight loss, may also benefit fatty liver (4).

The Mediterranean diet in particular includes foods that can slow the accumulation of fat in the liver and actually reduce the fat stored there, potentially reversing the disease progression (1, 8).

One study comparing how three types of Mediterranean diets affected folks with metabolic syndrome found that all three were associated with improvement of symptoms, while a low glycemic index Mediterranean diet seemed to produce the most improvement (16).

And a 2021 study including 294 people found a significant reduction of liver fat in those following a Mediterranean diet paired with exercise (17).

A greater benefit was seen in those who supplemented their Mediterranean diet with extra plant polyphenols from walnuts, green tea, and duckweed (17).

A Mediterranean diet also improves the body’s sensitivity to insulin, supporting blood sugar management and preventing fat buildup in the liver (18).

That’s important because those living with fatty liver may have a muted response to insulin, the hormone responsible for moving the glucose (or sugar) from the blood to cells to be used for energy.

A muted response to insulin, in addition to high blood sugar levels, means that glucose gets transported to the liver for storage — excess glucose in the liver gets converted into fat (18).

A 2017 study found that closely adhering to a Mediterranean diet was associated with improving insulin response in those with NAFLD (5).

SUMMARY

Following a Mediterranean diet can be a safe and effective way for those living with fatty liver to improve their health. While most of the research has been done in people with NAFLD, it’s likely still an appropriate eating pattern for alcohol-induced fatty liver.

Tips for following the Mediterranean diet for fatty liver

There are no strict rules when it comes to following a Mediterranean diet, as it’s influenced by the cuisines of multiple countries.

The general principles of a Mediterranean eating pattern include an emphasis on whole grains, fruits and vegetables, legumes, fish, and olive oil.

Swap out refined grains for whole grains. Try to keep about half your grains whole. Whole grains include foods like oats, barley, buckwheat, brown rice, and whole wheat bread.

Include two to three servings of fatty fish a week. A serving of fish is about the size of the palm of your hand (or three to four ounces). Focus on those high in omega-3 fatty acids like salmon, mackerel, and sardines.

Eat at least five servings of fruits and vegetables daily. The United States Department of Agriculture (USDA) Dietary Guidelines for Americans advise consuming at least five servings of fruits and vegetables daily. Opt for choices like tomatoes, broccoli, cucumbers, cauliflower, apples, berries, and grapes (19).

Use olive oil daily. Have a bottle of olive oil on hand to use for cooking or as a dressing for salads.

Limit processed and red meat. Mediterranean diets are low in processed and red meat. Frequent consumption of these foods has been tied to heart disease, type 2 diabetes, and elevated cholesterol levels. Choose unprocessed red meat like beef, lamb, or pork, to eat on occasion (4).

Avoid alcohol. While the Mediterranean diet generally includes a moderate amount of red wine, those with fatty liver should avoid alcohol consumption.

Reduce added sugars. High intake of added sugars, especially from table sugar and high fructose corn syrup, is linked to an increased risk of NAFLD and may worsen disease outcomes (4, 20).

Following a Mediterranean-style diet can include non-Mediterranean cultural foods

Choosing an eating pattern rooted in the principles of the Mediterranean diet doesn’t have to mean giving up your cultural foods.

In fact, it’s important that your eating habits incorporate foods that are easy to access locally and meaningful to you culturally or personally.

For example, learn more about giving the Mediterranean diet a Caribbean twist here.

SUMMARY

A Mediterranean diet promotes high consumption of plant foods, is rich in fiber and antioxidants, and limits added sugars and processed meats.

Other lifestyle interventions for fatty liver 

The Mediterranean diet isn’t the only lifestyle approach to benefit fatty liver.

• Weight loss: Weight loss through a combination of diet and exercise is the most established treatment for fatty liver in those with overweight. Consider working with a healthcare professional like a physician or registered dietitian (RD) to establish a safe amount, rate, and method of weight loss. Remember that weight loss at a rate of 5–10% can be effective (4).
• Exercise: Being physically active can improve insulin sensitivity and decrease the formation of fat in the liver (21).
• DASH diet: The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to be beneficial for fatty liver. This eating pattern may be a better choice than the Mediterranean diet for some people, as it is more adaptable to include a variety of foods across cultures (22, 23).

SUMMARY

Achieving or maintaining a healthy weight, being physically active, and eating a plant-based, low-sodium diet are beneficial for fatty liver and overall health.

The bottom line

Following a Mediterranean diet may be beneficial in preventing NAFLD and improving or even reversing the severity of fatty liver. It may also help with other closely associated chronic diseases, such as heart disease and type 2 diabetes.

The effect may be even more profound if it’s part of a reduced-calorie diet paired with physical activity.

While the direct correlation of the diet in relation to NAFLD is still being studied, it may support those with NAFLD or help prevent the condition.

Consider working with a healthcare professional like an RD to determine if the Mediterranean diet is right for you — and remember that an eating plan based on the principles of the Mediterranean diet doesn’t have to exclude foods that are important to your own culture.

Just one thing

Try this today: Since “the Mediterranean diet” is such a broad term, it can be hard to know where to start. Check out this meal plan for inspiration.

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