The Mediterranean diet is among the most popular diets today, inspired by the eating habits of people who live near the Mediterranean Sea. Large amounts of whole grains, fresh fruits and vegetables, a moderate amount of seafood, and healthy fats characterize it.
Here we explore why the Mediterranean diet might help treat fatty liver. We will also discuss helpful tips for incorporating more Mediterranean-style eating into your meal routine and other lifestyle changes for fatty liver improvement.
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The Mediterranean diet was first defined as low in saturated fat and high in vegetable oils in the 1960s. Its definition later evolved to better describe the food groups highlighted in this diet.
Its general characteristic involves eating foods that are low in saturated and trans fats. It limits or avoids red and processed meats and dairy while focusing on fresh whole foods and healthy oils, such as vegetables, fruits, legumes, extra virgin olive oil, nuts, and seafood.
In many cases, this diet also includes a moderate amount of red wine with meals and coffee.
This diet encourages consuming healthy unrefined carbs, unlike many other popular diets that attempt to limit carbs, such as the keto diet.
Various components of the Mediterranean diet may help treat fatty liver. However, more research is needed before any conclusive claims can be made.
Research on the association between the consumption of fruits and vegetables and the risk of developing a non-alcoholic fatty liver is inconclusive.¹
Some studies suggest that no significant correlation exists between vegetable and fruit intake and non-alcoholic fatty liver disease (NAFLD). Other studies reported that consuming fruits and vegetables significantly reduced the possibility of developing NAFLD. This is potentially due to their high fiber content and antioxidants, such as polyphenols, which may help prevent NAFLD.
Additionally, increasing your intake of fresh fruits and vegetables could reduce the chances of developing the risk factors associated with fatty liver, such as obesity and high cholesterol.²
For example, increased vegetable intake has been repeatedly linked to a reduced risk of weight gain and being overweight or obese. Replacing sugary snacks like candy with fruit can keep you fuller for longer due to their high fiber content.³
Likewise, studies have suggested that multiple servings of fruits and vegetables daily can result in lower serum total cholesterol and LDL cholesterol.⁴
Fish is considered a lean protein and a healthy alternative to red or processed meats.
Red or processed meats are often high in cholesterol and saturated and trans fats, which can negatively impact the liver and worsen NAFLD.
Research investigating the correlation between the intake of red or processed meats and non-alcoholic fatty liver has found that their consumption was associated with an increase in the likelihood of fatty liver as a result of increased hepatic lipid accumulation, oxidative stress, and insulin resistance. On the other hand, fish is rich in omega-3 fats and other good fats (unsaturated fatty acids).⁵
Research has found that oily fish shows promise in their beneficial effects on non-alcoholic fatty liver. Some studies even suggest that long-chain omega-3 polyunsaturated fatty acids could potentially be a simple and effective alternative therapy for fatty liver. This is due to the many benefits that fats from fish and other seafood offer, including reducing insulin resistance, blood pressure, inflammation, oxidative stress, and dyslipidemia.⁶ ⁷
If you want to improve your eating habits for fatty liver disease, consider fatty fish such as salmon, tuna, or swordfish for a great protein option.
Incorporating whole grains and cereals into your diet may be beneficial for fatty liver. Research has indicated various potential mechanisms where whole grains may reduce the risk of conditions associated with non-alcoholic fatty liver diseases, such as diabetes, obesity, and cardiovascular diseases.⁸
Additionally, whole grains are rich in phytochemicals. They can change and stimulate the gut microbes to increase the production of short-chain fatty acids, which have amazing anti-inflammatory and liver protective effects. A higher intake of legumes like beans and lentils was also found to be associated with a lower incidence of developing fatty liver disease.⁹
Therefore, if your diet is rich in processed and refined carbohydrates, it may be worth switching over to primarily whole grains and increasing your intake of legumes.
This vegetable oil has shown benefits for many aspects of human health, particularly for helping to prevent metabolic and cardiovascular diseases.¹⁰
Research has found that decreasing total fat consumption and switching to monounsaturated fatty acids found in olive oil may decrease plasma lipid concentrations and fat retention in the liver, which can benefit individuals with fatty liver.¹¹
Nuts are a crucial part of the Mediterranean diet and have shown promise in reducing certain conditions associated with NAFLD, such as cardiovascular disease, obesity, diabetes, and dyslipidemia.¹²
Studies in the general healthy population have reported that higher consumption of nuts is associated with a significant reduction in the risk of developing NAFLD. This was found to be particularly true in the case of men.¹³ ¹⁴
However, more research is still needed to investigate the beneficial effects of nuts on the liver in those already diagnosed with liver diseases such as NAFLD. This is because of the nuts' aflatoxin (AF) contamination.
Aflatoxin is a fungal metabolite largely found in many agricultural products. It is known to have some carcinogenic properties if taken in large quantities. Hence, it can theoretically increase the risk of hepatocellular carcinoma in NAFLD patients.
People with NAFLD are advised to include nuts only in small to moderate amounts and as a part of an overall healthy Mediterranean diet. This is especially true for those who are already at higher risk than the normal population for developing hepatocellular carcinoma.
Coffee and its impact on health can be controversial due to the association of excess caffeine with insomnia, headaches, and gastrointestinal conditions. However, moderate caffeine consumption has shown promise in exhibiting protective effects against fatty liver, progression of liver fibrosis, and damage in patients with NAFLD. This is potentially due to coffee's anti-inflammatory, antioxidant, and insulin resistance-reducing properties.¹⁵
However, it is important to note that more high-quality, controlled, long-term studies are required before any conclusive claims can be made. This positive effect of coffee on NAFLD could vary based on the amount consumed and the concentration of the active components in the type of coffee used.
While it may seem counterintuitive to consume red wine for fatty liver — considering it is a type of alcohol — studies have suggested that modest red wine consumption (one glass per day, preferably with food) may reduce the prevalence of suspected NAFLD.¹⁶
Like coffee, studies are not fully conclusive. And in a recent high-quality systematic review of the available research, results were found to vary depending on the amount of red wine consumed and the stage of NAFLD in the individual. Individuals with advanced-stage NAFLD with steatohepatitis or advanced fibrosis are advised to avoid all alcohol, including red wine. In contrast, those in early stage NAFLD or fibrosis may benefit from modest red wine consumption.¹⁷
Since research surrounding the Mediterranean diet is still developing, more in-depth and long-term studies involving individuals across various demographics are still needed before conclusive claims can be made.
That being said, many studies have reported this diet's positive impact on fatty liver.
A randomized controlled trial has shown that this diet, both on its own or in addition to antioxidant supplements, has significantly improved insulin resistance and lipid profile while reducing hepatic fat accumulation and liver stiffness in overweight patients.¹⁸
Another study indicated that the Mediterranean diet is effective for liver disease prevention and management, particularly when associated with a degree of calorie restriction.¹⁹
And in a long-term study that followed NAFLD patients who adopted the Mediterranean diet for six years has concluded that this diet could delay or slow the progression of the disease.²⁰
As with all diets, adherence to the Mediterranean diet long enough for its effect to show is key. Watching your overall calorie consumption to ensure achieving and maintaining a healthy weight is also extremely beneficial in managing NAFLD.
It’s also worth letting your doctor know if you’re considering adopting this new diet. They’ll be able to advise you on your liver profile and whether this may be a good option for you.
Adjusting your diet can be relatively tricky, especially if you’ve been eating a certain way for a long time. It’s best to ease into any new diet style slowly to give your body time to adjust to a new way of eating.
Here are some tips for adopting a Mediterranean diet:
Swap out refined grains for the same amount of whole grains
Replace half your red meat consumption weekly with fatty fish
Aim for five servings of fresh fruits and vegetables daily
Replace your cooking oils or fats with olive oil
Limit processed meats to special occasions, although it is advisable to completely avoid all processed meats
Lower your alcohol consumption or avoid it completely if you are in the advanced stage of fatty liver disease
Replace sugary snacks like candy and soda with fresh fruit
Once you’re comfortable replacing foods with healthier alternatives, you can slowly increase your consumption of fruits, vegetables, fish, nuts, and legumes until the Mediterranean style becomes your normal eating habit.
Apart from modifying your diet, you can reduce your risk of developing fatty liver or help you manage the condition in other ways. These factors generally promote a healthy lifestyle and include:
Drinking sufficient amounts of water daily and reducing consumption of sugary drinks and soda
Maintaining a regular exercise routine, aiming for at least 150 minutes of moderate-intensity exercise weekly
Stopping smoking and any recreational drugs
Reducing dietary intake of unhealthy fat, sugar, refined carbs, processed foods, and salt
Maintaining a healthy weight, aiming for a BMI between 18.5 to 24.9
The Mediterranean diet is a popular diet characterized by moderate amounts of fish, olive oil, and high levels of fruits, vegetables, and legumes while limiting or avoiding refined carbohydrates and red and processed meat.
Various research has shown that this diet may lower the risk of developing a fatty liver or improve the management of fatty liver disease, particularly non-alcoholic fatty liver disease. However, more research is required to make a conclusive claim.
If you’re interested in following this diet, it’s best to do it under the care of a health professional. It’s also advised to start slowly and incorporate other healthy lifestyle factors, including weight management and regular exercise.
If you have fatty liver, it’s best to avoid foods that can increase blood sugar. These include:
Foods with excessive amounts of added sugar
Foods with excessive amounts of added salt
Red or processed meat
You can incorporate several lifestyle changes into your daily routine that may contribute to a healthy liver. These include:
Maintaining a healthy weight
Drinking alcohol in moderation
Practicing safe sex
Eating a balanced diet with lots of fresh fruits and vegetables
Following directions and dosages for all medications
The Mediterranean diet is rich in fruits, vegetables, healthy fats, and fish. It’s also low in processed foods. Research has found that this diet has a protective effect against fatty liver due to its liver-protecting effects while lowering several risk factors, including cardiovascular disease, type 2 diabetes, and obesity.²¹