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if you've been told you have fatty liver or non-alcoholic fatty liver disease the good news is it's fully reversible and in this video I'll go over the exact steps you need to take to not only reverse it but to do it quickly and start seeing changes in weeks I will also go over actionable advice on the foods you need to eat and the foods you need to stay away from to fix your liver and at the end of the video I will talk to you about other steps you can take to improve your liver health and we'll also go over the best supplements you can take to help your liver recover and go back to normal.
Hi, I'm Dr. Leonid Kim, and on this channel I discuss the most up-to-date and evidence-based information on the topics of weight loss, metabolic health, and longevity. Let's get into it.
Now, to better understand how to reverse fatty liver, we first have to identify what causes it in the first place, and it's pretty simple. Fatty liver is caused, for the most part, by over-consumption of sugars, and specifically fructose and sucrose, with sucrose being just table sugar that breaks down into fructose and glucose. The consumption of both fructose and sugar sets off a whole cascade of changes in our bodies that leads not only to fatty liver but also to other conditions like diabetes, heart disease, dementia, and even many cancers.
Now, what makes fructose unique is that it doesn't stimulate leptin, and leptin is a hormone that is released in our bodies after a meal that signals satiety, or fullness, to our brains. So consuming fructose doesn't generate a normal response in our brain that tells us that we're full, so it makes it very easy to overeat. If that wasn't bad enough, continued consumption of fructose drives the development of leptin resistance, which results in persistent hunger and impaired satiety, even with other foods, not just fructose. A study published in the American Journal of Clinical Nutrition found that in just seven days, a high-fructose diet increased lipid deposition in the liver and decreased liver insulin sensitivity.
Now, how do we avoid fructose? Fructose is a simple sugar that's usually found in honey, fruits, and root vegetables, and humans have been consuming those for hundreds of thousands of years, but it did not pose a health risk until we started eating manufactured fructose and sugar in large quantities. Now, most fruits and vegetables contain fructose; however, our intestines can inactivate about four to five grams of fructose, which is the amount we usually get from vegetables. We get a little bit more fructose from fruits; however, fruits, like vegetables, are also consumed with a lot of fiber, which slows down the absorption of the excess fructose. In addition to that, many fruits are also rich in vitamin C, which blocks some of the effects of fructose and really negates any of the adverse effects of fructose that we get from fruit.
That brings us to the first food group that we need to avoid to reverse your fatty liver, and that is sugary drinks. Now, we all know about the dangers of sodas and soft drinks, but the sneaky drinks that contain a lot of sugars are juices, which are often promoted as healthy and frequently given to kids. If you drink orange juice, apple juice, tomato, cranberry, or any type of juice, please look at the ingredient label and see how many grams of sugars you get from just one serving. Do not be fooled by statements like "it contains natural sugars" or "it has zero grams of added sugars." It may be natural, but it's still highly concentrated and it's consumed without the fiber you would normally get if you were eating a whole fruit, and it's a lot easier to over-consume sugars when we're getting them in liquid form as opposed to eating a fruit itself. Other drinks that are notorious for being loaded with sugars are sports drinks and energy drinks.
The American Heart Association recommends eating less than 24 to 36 grams of sugars per day, but if you suffer from fatty liver disease, I would abstain from all drinks that contain sugars. Along the same lines, I would also avoid eating dried fruit like dates, raisins, or prunes. Yes, they're natural and do not contain added sugars, but those natural sugars are very concentrated and do not have the volume of the original fruit, which makes it much easier to overwhelm our GI tract and later our liver with fructose and sugars. To support that, a study published in JAMA in 2019 noted that just eight weeks of restricting sugars in adolescent boys to less than three percent of daily calories showed significant improvement in hepatic steatosis.
Another way to fix your fatty liver is to eat more protein, and it's especially important to eat more protein for breakfast, or whatever your first meal of the day happens to be. A recent study published in Obesity looked at over 9,000 Australians and found that getting enough protein, especially for the first meal of the day, had profound effects on what people ate later in the day, and eating higher levels of protein for breakfast translated to consuming less food over the course of the rest of the day. People who had a low-protein breakfast were found to eat more energy-dense processed foods and foods high in sugars. So if you find yourself constantly craving sugary or processed foods, foods that will make your fatty liver worse, try to up your protein intake, especially at breakfast, and aim to get at least 25 to 35 grams of protein per meal if you're eating three meals a day. Getting enough protein will help you eat less sugar and will help you lose weight, and weight loss has been shown to be one of the most effective ways to improve your fatty liver. In fact, just five percent of total body weight loss can decrease hepatic steatosis, and losing seven percent of total body weight can lead to complete resolution of non-alcoholic steatohepatitis, or NASH, which is a more severe form of fatty liver.
Now, as you increase your protein intake, you have to be careful about what kind of fats you're getting in the process. Animal meats and dairy products are wonderful sources of protein; however, we do have to watch our intake of saturated fats, which are usually found in red meat, processed meats, butter, ice cream, as well as many fried foods. Eating red meat is a controversial topic, and I happen to follow the camp that it's okay to consume red meat in moderation, but that's a whole other conversation for another day.
A study published in Diabetes and Metabolism showed that while overfeeding with either saturated fats or fructose both increase liver fat, the group that was overfed with saturated fats increased liver fat to a much greater degree than the group that was overfed with fructose. There are at least four human intervention studies that have confirmed the harmful effects of saturated fat on hepatic steatosis, but the one I want to highlight is a double-blind randomized controlled trial in which lean individuals were overfed with muffins high in either saturated fatty acids, in this case palm oil, or polyunsaturated fatty acids, in this case sunflower oil. What they found was that just seven weeks of overfeeding resulted in a marked increase in liver fat in the saturated fat group, whereas the polyunsaturated group caused a nearly threefold larger increase in lean tissue, or fat-free mass, without an effect on the liver.
So it's important not to overeat saturated fats, and I emphasize not overeating, as it's okay to eat saturated fats in moderation. Eating more than about five percent of our calories from saturated fats is when we start getting into trouble. What that would look like is eating less fat that comes from processed meats, eating less store- or restaurant-bought fried foods or pastries, and being careful with ice cream or cheeses. At the same time, we need to eat more of the good fats, the poly- or monounsaturated fats that come from fish, nuts, and avocados. When it comes to oils, using olive oil is preferred to using saturated fats like coconut or palm oil.
The type of fat we eat is especially important for those on very low-carbohydrate or ketogenic diets, where a lot of the energy has to come from fats. Keto is a very effective way to lose weight and improve metabolic health, and it's very safe as long as the majority of the fat content comes from polyunsaturated or monounsaturated fats as opposed to saturated fats. Many people have been successful using ketogenic diets to reverse fatty liver; however, for just as many people, that degree of severe carbohydrate restriction is just not sustainable long term. The good news is that cutting out carbs is not a requirement for fatty liver reversal, and it's the quality and type of carbohydrates we consume that play a larger role in the treatment of fatty liver. Eating carbs that have a low glycemic index, meaning they do not cause wild swings in your blood sugar, is much better for your liver health than eating carbs that are high on the glycemic index. So while lowering our carbohydrates is generally a good idea for most people, I wouldn't worry as much about consuming lower glycemic index carbohydrates that come from legumes, dairy, vegetables, or fruits, and I would stay away from high glycemic index carbohydrates like white bread, white rice, most breakfast cereals, and processed potatoes like french fries or chips.
To wrap this up, other things that are highly beneficial in reversing fatty liver disease are abstaining from alcohol. In addition to that, getting at least 150 minutes of moderate-intensity activity per week and making sure to include resistance training or muscle-building exercises at least two days a week will also help restore your liver to good health. If you do all of the things I mentioned in the video, you will see changes in your liver biomarkers in a matter of weeks, as seen in the studies we discussed earlier, and you will eventually fully reverse your fatty liver. It is important to do these as soon as possible, before your liver turns into a more severe form of fatty liver like NASH or steatohepatitis, and eventually to fibrosis and even cirrhosis, at which point a liver transplant is our only option.
Now, if you'd like to enhance your recovery, you can also try adding supplements to the food changes we discussed. To be clear, you do not need any supplements to fix your fatty liver as long as you eat the right things and use real whole foods as your medicine. However, there are supplements that show some promise and could be useful in expediting recovery. First, therapy with vitamin E at 800 international units a day was associated with a significantly higher rate of improvement of steatohepatitis compared to placebo. I would, however, discuss vitamin E supplementation with your doctor first, as high doses of vitamin E, meaning greater than 400 international units per day, have been inconsistently associated with an increase in all-cause mortality as well as an increase in the rate of prostate cancer. The recommendation to supplement vitamin E is usually reserved for patients with more advanced fatty liver disease.
Second, I would also consider taking omega-3 fatty acids. A meta-analysis published in Clinical Nutrition in 2018 showed that supplementation with omega-3s, especially fish oils like DHA, was associated with an improvement in liver markers like ALT and AST, as well as a reduction of liver fat.
Lastly, choline has been gaining in popularity as a treatment for fatty liver, and a recent case-control study showed that people who consumed high intake of choline and betaine had an associated 81 percent reduction in hepatic steatosis. However, we still need more conclusive research on whether supplementation with choline is actually beneficial for most people and not just those who are deficient, and at what dose we actually get any kind of therapeutic benefit. Until we get more data, I would make sure you get enough choline from your food, which means eating plenty of eggs with egg yolks in them, lean meats, and dairy, as well as getting enough seafood, which also happens to be very rich in omega-3 fatty acids. If you don't eat meat, I would focus on getting your choline from yogurt, sunflower seeds, and cruciferous vegetables like broccoli, cauliflower, or cabbage.
This is not a full list of supplements commonly used to treat fatty liver, but I will make a separate video on that down the road, as it does deserve quite a bit more attention. I hope this video was helpful, and I will see you in the next one.