Fatty Liver Management

1.     Get evaluated for:

·      Other causes of liver disease 

·      Metabolic syndrome (obesity, dyslipidemia, insulin resistance, hypertension)

·      If appropriate: thyroid disease, polycystic ovarian syndrome, sleep apnea

2.     Determine severity of fatty liver disease (“fibrosis” or scarring that has occured)

·      Liver ultrasound 

·      NAFLD fibrosis score

·      FIB-4

·      FibroScan

3.     Consider liver biopsy if your non-invasive scores show advanced disease

4.     Get vaccinated for Hepatitis A & B

5.     Discuss with family members as there is a genetic component

6.     Limit alcohol use (wine preferable)

·      Men: <14 drinks per week or <4 drinks a day

·      Women: <7 drinks per week or <3 drinks a day

7.     Weight loss 

·      Diet

o  Low calorie: Reduce daily calorie intake by 750-1,000 kcal

o  Mediterranean diet (see below for details)

- Fruits, vegetables, whole grains, legumes/beans, nuts, seeds, olive oil, fish, poultry

- Avoid red meat, butter, fake or processed food, dairy

- Food should be steamed, grilled, sautéed, baked, broiled, roasted but NOT fried

o  Coffee: Up to 3 cups a day, regular or decaffeinated 

·      Exercise

o  30 minutes a day, 5 times a week (150 minutes/week)

o  Sweat! Ride a bike, fast walk, dancing/zumba, yoga (Vinyasa)

·      Weight loss goal

o  5% of body weight improves fat in liver 

o  10% needed to improve fibrosis (scarring) and inflammation

o  Goal= lose 1-2lbs/week

o  If you do not meet weight goals within 6 months, consider medications

o   f liver enzymes don’t normalize (ALT <20 for women; <30 for men) after achieving weight loss goal, consider additional weight loss 

8.     Cholesterol 

·      Omega-3-fatty acids should be considered for high triglycerides (TG>150)

·      Consider statin therapy

·      Goal:

o  TG<150

o  HDL (“good cholesterol”) >40 in men/>50 in women

o  Discuss LDL (“bad cholesterol”) goal with PCP/cardiologist

9.     Insulin resistance/Diabetes

·      Consider Metformin 

·      Goal: fasting sugar <100 or A1c <5.7% 

10.  Hypertension

·      Goal: <130/85


The Mediterranean Diet for Fatty Liver Management

Fruits & Vegetables: Eat them all!

Nuts & Seeds: Eat them all!

·      Almonds, cashews, pistachios and walnuts are best

·      Natural peanut, almond butters (no added hydrogenated fat)

·      Avoid candied or honey-roasted or heavily salted nuts

Legumes: Eat them all!

·      Hummus, tahini, white/black beans, chickpeas, lentils, soy/tofu/tempeh

Whole Grains

·      Whole grain pasta, brown rice, farro, quinoa, oats/oat bran, spelt, buckwheat

·      Whole grain bread - eat plain, with peanut/almond butter or dipped in olive oil

Olive oil 

·      "Extra-virgin" and "virgin" olive oils best (least processed, most antioxidants)

·      Canola oil OK 

Fatty fish 

·       Mackerel, lake trout, herring, sardines, tuna, salmon, arctic char

·       “Wild-caught” preferred over farm-raised


·       Organic free-range lean chicken, duck, turkey, quail

·       Organic free-range eggs

Milk/dairy alternatives

·       Oat milk, almond milk, soy milk, coconut milk –based products

Spices, herbs, and condiments: Fresh herbs, dried spices, condiments without sugar/additives 

Drinks: Coffee (black, regular or decaf), unsweetened green/black tea, water/lemon juice/agave

Sweets (sparingly!)

·       Dark chocolate, almond/soy/coconut-based ice cream

·       Agave syrup or maple syrup for sweeteners 

Wine (sparingly!) 

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