When your liver is compromised by NASH, make it work less

We start with the fact that the fundamental problem is the bio-chemical flow between the liver and fat cells. When diet is poorly balanced, over time fat accumulates in the liver and by itself is rather benign but when other chemistries like insulin management begin to degrade you get inflammation which leads to fibrosis and if not stopped progresses to cirrhosis. Since there is no treatment your tool is diet and the question is to avoid anything that stresses the liver and load up on anything that is protective. Easy peasy right. Well let's take a look

  • eliminate all alcohol
  • eliminate most saturated fat and no red meat
  • eliminate all non skim dairy products
  • eliminate trans-fat and all hydrogenated oils
  • eliminate all high fructose corn syrup
  • eliminate most sodium -- the goal 1,500 mg of salt or less.
  • eliminate all added dietary sugar
  • eliminate processed grains, no white flour or white rice
  • Avoid most products hustled by the supplement industry
  • Make sure that any medications you take are not harming your liver

Oh my god. That is a terrible list. Not possible to live that way. OK, take a breath. The goal is to take as much pressure off the liver as possible, provide molecules from your diet that are protective and don't stimulate the stellate cells to initiate scaring, but still provide proper nutrition. So what do you do?

  • For oil get 60 ml, that's 1/4 cup, a day of extra virgin olive oil
  • Take one tablespoon per day of refined fish or salmon oil
  • Don't buy prepared foods without reading the label, there isn't actually much that you can buy
  • Eat lots of fruits and vegetables but remember the salt limit
  • Learn to like kale, lima beans, brussel sprouts, etc.
  • Look for fiber like whole wheat bread no white breads and use brown rice
  • Eat fatty fish like salmon at least a few times a week
  • Eat skinless chicken or turkey and lean pork, fresh pork not processed like ham
  • Explore new foods like quinoa as a grain
  • Eat plenty of vegetable protein like beans.
  • Take 400 mg to 800 mg of vitamin E
  • Drink 3 to 4 cups of paper filtered coffee daily
  • Be aware that eating out is tough as very little of it is good for you

You get the idea. you might call this a type of Mediterranean diet but the excess olive oil is specifically a medicine. The rest is mostly nutrition. The fish oil is to get a significant source of omega 3 oil to balance the omega 6 you routinely get in food. The salt limitation is good for you and lowers your blood pressure.

So why should you think this might work for you? Without getting too technical your energy systems are built around triglycerides. Any oil can be used by the body to make them but if made with unsaturated oil they are better for the body. More importantly olive oil is mostly an omega 9 fatty acid. Good olive oil is a complex mixture of around 30 oils and phyto chemicals which support liver function and soothe activated stellate cells which cools inflammation. Good olive oil causes a burning feeling at the back of your throat. Those are the phyto chemicals and more is better if you ever go to an oil tasting bar.  The omega 3 reduces the amount of inflammation caused by omega 6 and is required for good health even if you don't have liver disease.

Click here for a more general discussion about diets.

If you are interested in the science of liver disease here is a link to our educational videos.

DISCLAIMER: Be aware that I am not a doctor.  I cannot give medical advice.  I am a cirrhosis patient and I have apparently halted the progression of my disease following this strategy. You must not assume that this advice will necessarily apply to your situation and you must work closely with your physicians as your situation is unique to you.

Please note that everyone has different a different culture and diet preferences.  We cannot provide a diet plan that suits everyone so we offer you the general guidelines but each person has to look at their personal food choices and modify them to be as kind as they can to their liver.  There is no one size fits all plan.

Showing 29 reactions

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  • Robert Goodban II
    commented 2020-06-19 00:18:07 -0600
    Besides Vitamin E I also take phosphytidyl choline and milk thistle. Am I wasting my money?
  • Tesa Sironen
    commented 2019-09-23 01:00:39 -0600
    Wayne ,
    The educational information is so beneficial. Thank you for all you do!
  • Misty Williams
    commented 2018-12-22 03:58:24 -0700
    Additionally, I have a blog (midliferevelations.com) that I will be updating in January with how I am doing, recipes I find that were tasty and didn’t bother my liver, etc I am no nutritionist and I’m not trying to make money, mostly document what I am doing to try and help others.
  • Misty Williams
    commented 2018-12-22 03:54:27 -0700
    I actually might be able to give you some insight into this. I too have always had normal liver enzymes (I have just tested again very recently). I asked my new doctor (a hepatologist) how that is possible with my diagnosis of NASH/Cirrhosis and was told that it has to do with the cause of your liver condition. Hepatitis shows up more easily on tests (panels, ultrasound, etc.). NASH (non-alcoholic) has a different effect on the liver that often does not show up on these tests. Are you experiencing swelling in the stomach, legs, or feet? That’s a huge sign there is an issue. I noticed that my liver reacts poorly to high-fat cheeses and eating a lot of carbs (including starchy vegetables, brown rice, etc.) but everyone is different. My new doctor is a gastroenterologist who specializes specifically on the liver (hepatologist) and I would recommend that highly. He has changed my diet to low carb with a salt restriction (due to swelling). My husband and I are going to start Atkins on Jan 1. I know how you feel as I am a huge sweet freak, but at the end of the day, it’s not worth your life. I considered Keto but for me, it’s too much fat (although a lot of Keto recipes can be used or modified for Atkins). I will give the new diet a month and post on here how I’m doing if that will help.
  • Susantodd Martin
    commented 2018-12-15 19:51:08 -0700
    I was told a couple(10) years ago with fatty liver disease. I was a raging addict and alcoholic for 23 years and was diagnosed with hep C at age 35 which was sucessfully treated with Interferon Ribivarin Recombinant theapy Which caused a whole host of painful conditions. I have been clean and sober for 18 years, but LOVE sweets. I really have to battle with myself. I am obese, but exercise. All this said I now feel tender and swollen in my liver area all the time, especially after meals… How long do I have? A week, maybe? Oh boy, I know thats a dumb question. They check my liver enzymes frequently and always say they are fine, but I am worried. Oh, the Hep C was diagnosed and treated in 2001-2002… Is it time to see a new Gastroenterologist? Or rather, should I go see a Gastroenterologist?
  • Wayne Eskridge
    commented 2018-11-25 10:04:53 -0700
    Hi Misty
    Multiple questions there. People can have a wide variety of bio-chemistries so there is no one diet fits all, but as you think about nutrition, it is good to keep the basics in mind. If you are concerned about liver health the first question is what food is easiest for the liver to manage. Keep in mind that over 50% of the energy used by the body is fat. The heart, as just one example, burns only fat. All low-fat diets force the liver to convert sugars into fats. Is that your goal? Keto forces the liver to manufacture ketones for the brain. Is that of concern? One place to start might be to read about how the body actually processes fats. You might start here as just one suggestion.


    There are passionate advocates for all kinds of diets. If the science we rely on to support our approach is of interest you can start here to study that.


    You may have some nutrition concern that pushes you in a different direction but go there based upon research if you can. Our message is whatever approach you take work your liver as little as possible if you have a liver disease.
  • Misty Williams
    commented 2018-11-25 08:44:25 -0700
    One other question, is Keto actually good for Cirrhosis? I would think the fat levels are way too high.
  • Misty Williams
    commented 2018-11-25 08:39:01 -0700
    I’ve been diagnosed with Cirrhosis (3rd Stage). I’ve had it for a year now and have reversed quite a bit (at first, they thought I was end stage and now the doctors say I am in no imminent danger of liver failure). I could really use some help to stay committed:

    1. I am looking for a GOOD diet with recipes that meet the dietary restraints for Cirrhosis.
    2. A GOOD salt substitute (Mrs. Dash just doesn’t cut it and Accent is only slightly better).
    3. Would an air fryer be a good investment for someone with Cirrhosis?
    4. Finally, if you HAVE to choose between a product with more fat or more added sugar, which would be the lesser of the two evils? Any help is massively appreciated!
  • Mary Lambert
    @maryelambert tweeted link to this page. 2018-10-05 04:34:13 -0600
    When your liver is compromised, make it work less https://www.fattyliverfoundation.org/nash_diet?recruiter_id=1524
  • Wayne Eskridge
    commented 2018-06-20 15:37:00 -0600
    Please note that everyone has different a different culture and diet preferences. We cannot provide a diet plan that suits everyone so we offer you the general guidelines but each person has to look at their personal food choices and modify them to be as kind as they can to their liver. There is no one size fits all plan.
  • Brian Hilvers
    commented 2018-06-20 15:22:27 -0600
    Is there a link on the foods that I can eat
  • Sherry Hobbs
    commented 2018-05-24 09:46:40 -0600
    This is really great info, thanks! I accidentally found this site. Unfortunately there’s no place to find this type of info, you just have to do a lot of research & also explore websites.
  • Dorne Gould
    commented 2018-05-15 14:22:02 -0600
    I still eat fruits and veggies. Only eat veggies like a rabbit not like a goat. Like I used to. I know KETO is not for everyone. Now that my liver is healthy after hepatitis C treatment. Trying new ways to be as healthy possible
  • Wayne Eskridge
    commented 2018-05-15 13:26:12 -0600
    one problem with KETO and no carbs is that you really need insoluble fibers in your diet. Those provide food for the colon bacteria which produce butyrate which is vital for a healthy colon. You also have to remember that the liver has to work to make all the ketones so it puts a different kind of stress on the liver which can have consequences.
  • Wayne Eskridge
    commented 2018-05-15 13:17:53 -0600
    Here is a discussion of olive oil. The important thing to know is that there is a lot of fake oil on the market. See the UCDAVIS studies on this page https://www.fattyliverfoundation.org/olive_oil
  • Dorne Gould
    commented 2018-05-14 16:15:30 -0600
    I get my olive oil from Cararrabas restaurant. $10.00 a bottle. Authentic EVOO
  • Linda Law
    commented 2018-05-14 16:03:36 -0600
    What is the right olive oil to buy?
    What about coconut oil and avacado oil. Thanks
  • Dorne Gould
    commented 2018-05-14 15:49:30 -0600
    I believe in Keto diet. Since carbs turn to sugar and sugar will kill you. Think what carbs are doing to your liver. Just my thoughts. So I say no carbs and lots of prayers.
  • Wayne Eskridge
    commented 2018-03-17 09:42:25 -0600
    The medical profession gets little nutrition training so at best they tend to report the USDA recommendations which are not really ideal for a liver disease patient. One of the key science arguments for providing much of your energy as extra virgin olive oil is because it is mostly oleic acid. Here is a link to the research about that which we believe supports the use in our suggested diet https://www.ncbi.nlm.nih.gov/pubmed/23329830
  • Linda anne clarke
    commented 2018-03-17 07:39:53 -0600
    So having read this , first off i have been living with ALD / cirrhosis 10yrs now. Last November was told i now have fatty liver.. i have always eaten well or so i thought…
    I am f4 end stage fibrosis now. Was not given any advice by hepatologist apart from plenty of veg lean meats of which i eat anyway and all things in moderation, i have such a sweet tooth!! I have at least a bar and i mean a 100g bar of choc per night. I dont drink and dont smoke either.
    I am not overweight but i do have a large tummy 😏. Can’t exercise much due to osteopenia in right hip with onset of osteoarthritis and i have two prolapse disc in my lower back. Surely this choc alone couldn’t just be the cause of fatty liver? Was never picked up precious. I don’t use oils at all apart from low cal olive oil ?
  • Linda Law
    commented 2018-03-06 22:24:10 -0700
    Thank you. Whats the best olive oil? What about coconut oil?
  • Emmajean Hicks
    commented 2018-01-24 05:47:48 -0700
    Wow thanks for the advise I am trying to feel better I was diagnosed with Fatty liver in 1996 but the Doc never acted as if this was an issue so I have been walking around doing all the wrong thins for over 20 yrs… I have had a heavy ache in my back for over a year now and never really thought it could be my liver I thought I had strained my back… off to do some research.
  • Betty Glover
    commented 2017-05-14 17:53:42 -0600
    Thank you!! I learned a lot in this article.I did not know about the olive oil,Today I change my oils!!!
  • Wayne Eskridge
    commented 2017-01-15 09:02:31 -0700
    The latest research on RoundUp is worrying. The report is that very low levels of exposure lead to fatty liver in rats. A challenge is that animal results don’t always translate to humans and mouse results tend to be closer to human responses but it certainly is a caution for anyone suffering from liver disease.

  • Dorne Gould
    commented 2017-01-15 05:20:35 -0700
    Judith as far as I’m concerned Monsanto should be put out of business. Only my thought.
  • Dorne Gould
    commented 2017-01-15 05:18:04 -0700
    Very good advice I follow most of your path and yes my cirrhosis has been reversed. I don’t see how anyone could go wrong with your program. Only thing I could add would be having faith in the Lord.
  • Dorne Gould
    commented 2017-01-15 05:16:17 -0700
    Very good advice I follow most of your path and yes my cirrhosis has been reversed. I don’t see how anyone could go wrong with your program. Only thing I could add would be having faith in the Lord.
  • Judith Volpe
    commented 2017-01-15 01:38:29 -0700
    Avoid all non-organic food – Monsanto’s Roundup is driving the current epidemic of NASH.
  • Dorne Gould
    commented 2017-01-14 12:50:47 -0700
    Very good advice I follow most of your path and yes my cirrhosis has been reversed. I don’t see how anyone could go wrong with your program. Only thing I could add would be having faith in the Lord.

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