How to Prevent Non-Alcoholic Fatty Liver Disease

How to Prevent Non-Alcoholic Fatty Liver Disease
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Avoid sugary and cholesterol-laden foods to reduce the risk of our most common cause of chronic liver disease.

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In the documentary Super Size Me, Morgan Spurlock eats exclusively at McDonald’s for a month, and predictably his weight, blood pressure, and cholesterol go up—but so do his liver enzymes, a sign his liver cells are dying and spilling their contents into the bloodstream. His one-man experiment was actually formally replicated. A group of men and women agreed to eat two fast food meals a day for a month, and most of their liver values started out normal—under 30 here for men. But within just one week, most were out of whack: a profound pathological elevation in liver damage.

What’s happening is NAFLD, non-alcoholic fatty liver disease, the next global epidemic. Fatty deposits in the liver can result in a disease spectrum—from asymptomatic fat buildup, to NASH, nonalcoholic steatohepatitis, which can lead to liver scarring, and cirrhosis, which can result in liver cancer, liver failure, and death.

It’s now the most common cause of chronic liver disease in the U.S., affecting 70 million Americans—that’s like one in three adults. And fast food is a great way to bring it on, since it’s associated with the intake of soft drinks and meat. One can of soda a day may raise the odds of fatty liver 45%, and those eating the equivalent of 14 chicken nuggets’ worth of meat a day have nearly triple the rates of fatty liver, compared to seven nuggets or less.

It’s been characterized as a tale of fat and sugar—but evidently, not all types of fat. Those with fatty hepatitis ate more animal fat and cholesterol, and less plant fat, fiber, and antioxidants, which may explain why adherence to a Mediterranean-style diet—characterized by high consumption of foods such as fruits, vegetables, whole grains, and beans—is associated with less severe non-alcoholic fatty liver disease, perhaps because of its anti-inflammatory and antioxidant effects. Maybe it is also because of specific phytonutrients, like the purple, red, blue anthocyanin pigments in berries, as well as in grapes, plums, red cabbage, red onions, and radicchio. These anthocyanin-rich foods may be promising for the prevention of fatty liver, but that’s mostly based on Petri dish experiments. There was one clinical trial that found that drinking a purple sweet potato beverage seemed to dampen liver inflammation.

A more plant-based diet may also improve our microbiome, the good bacteria in our gut. The old adage, “we are what we eat,” may be changing to “we are what our bacteria eat.” And when we eat fat, we may facilitate the growth of bad bacteria, which can release inflammatory molecules that increase the leakiness of our gut and contribute to fatty liver disease.

Fatty liver disease can also be caused by cholesterol overload. The thought is that dietary cholesterol, found in eggs, meat, and dairy, oxidizes and then upregulates liver X receptor alpha, which can upregulate something else called SREBP, which can increase the level of fat in the liver.

Cholesterol crystals alone cause human white blood cells to spill out inflammatory compounds, just like uric acid crystals in gout. That’s what may be triggering the progression of fatty liver into serious hepatitis, the accumulation of sufficient concentrations of free cholesterol within fatty liver cells to cause crystallization of the cholesterol—one of several recent lines of evidence suggesting that dietary cholesterol plays an important role in the development of fatty hepatitis.

In a study of 9,000 American adults followed for 13 years, they found a strong association between cholesterol intake and hospitalization, and death from cirrhosis and liver cancer, as dietary cholesterol can oxidize and cause toxic and carcinogenic effects. To limit the toxicity of excess cholesterol derived from the diet, the liver tries to rid itself of cholesterol by dumping it into the bloodstream. And so, by measuring the non-HDL cholesterol in the blood, one can predict the onset of fatty liver disease. If you subtract HDL from total cholesterol, none of the hundreds of people they followed with a value under 130 developed the disease. Drug companies view non-alcoholic fatty liver disease as a bonanza, as is the case of any disease of affluence, considering its already high and rising prevalence, needing continuous pharmacologic treatment. But maybe it’s as easy as changing our diet—avoiding sugary and cholesterol-laden foods.

The unpalatable truth is that non-alcoholic fatty liver disease could almost be considered the human equivalent of foie gras, as we “force-feed” ourselves foods that can result in serious health implications. However, having such a buttery texture in human livers is not a delicacy to be enjoyed by liver doctors in clinical practice, as it can have serious consequences.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

In the documentary Super Size Me, Morgan Spurlock eats exclusively at McDonald’s for a month, and predictably his weight, blood pressure, and cholesterol go up—but so do his liver enzymes, a sign his liver cells are dying and spilling their contents into the bloodstream. His one-man experiment was actually formally replicated. A group of men and women agreed to eat two fast food meals a day for a month, and most of their liver values started out normal—under 30 here for men. But within just one week, most were out of whack: a profound pathological elevation in liver damage.

What’s happening is NAFLD, non-alcoholic fatty liver disease, the next global epidemic. Fatty deposits in the liver can result in a disease spectrum—from asymptomatic fat buildup, to NASH, nonalcoholic steatohepatitis, which can lead to liver scarring, and cirrhosis, which can result in liver cancer, liver failure, and death.

It’s now the most common cause of chronic liver disease in the U.S., affecting 70 million Americans—that’s like one in three adults. And fast food is a great way to bring it on, since it’s associated with the intake of soft drinks and meat. One can of soda a day may raise the odds of fatty liver 45%, and those eating the equivalent of 14 chicken nuggets’ worth of meat a day have nearly triple the rates of fatty liver, compared to seven nuggets or less.

It’s been characterized as a tale of fat and sugar—but evidently, not all types of fat. Those with fatty hepatitis ate more animal fat and cholesterol, and less plant fat, fiber, and antioxidants, which may explain why adherence to a Mediterranean-style diet—characterized by high consumption of foods such as fruits, vegetables, whole grains, and beans—is associated with less severe non-alcoholic fatty liver disease, perhaps because of its anti-inflammatory and antioxidant effects. Maybe it is also because of specific phytonutrients, like the purple, red, blue anthocyanin pigments in berries, as well as in grapes, plums, red cabbage, red onions, and radicchio. These anthocyanin-rich foods may be promising for the prevention of fatty liver, but that’s mostly based on Petri dish experiments. There was one clinical trial that found that drinking a purple sweet potato beverage seemed to dampen liver inflammation.

A more plant-based diet may also improve our microbiome, the good bacteria in our gut. The old adage, “we are what we eat,” may be changing to “we are what our bacteria eat.” And when we eat fat, we may facilitate the growth of bad bacteria, which can release inflammatory molecules that increase the leakiness of our gut and contribute to fatty liver disease.

Fatty liver disease can also be caused by cholesterol overload. The thought is that dietary cholesterol, found in eggs, meat, and dairy, oxidizes and then upregulates liver X receptor alpha, which can upregulate something else called SREBP, which can increase the level of fat in the liver.

Cholesterol crystals alone cause human white blood cells to spill out inflammatory compounds, just like uric acid crystals in gout. That’s what may be triggering the progression of fatty liver into serious hepatitis, the accumulation of sufficient concentrations of free cholesterol within fatty liver cells to cause crystallization of the cholesterol—one of several recent lines of evidence suggesting that dietary cholesterol plays an important role in the development of fatty hepatitis.

In a study of 9,000 American adults followed for 13 years, they found a strong association between cholesterol intake and hospitalization, and death from cirrhosis and liver cancer, as dietary cholesterol can oxidize and cause toxic and carcinogenic effects. To limit the toxicity of excess cholesterol derived from the diet, the liver tries to rid itself of cholesterol by dumping it into the bloodstream. And so, by measuring the non-HDL cholesterol in the blood, one can predict the onset of fatty liver disease. If you subtract HDL from total cholesterol, none of the hundreds of people they followed with a value under 130 developed the disease. Drug companies view non-alcoholic fatty liver disease as a bonanza, as is the case of any disease of affluence, considering its already high and rising prevalence, needing continuous pharmacologic treatment. But maybe it’s as easy as changing our diet—avoiding sugary and cholesterol-laden foods.

The unpalatable truth is that non-alcoholic fatty liver disease could almost be considered the human equivalent of foie gras, as we “force-feed” ourselves foods that can result in serious health implications. However, having such a buttery texture in human livers is not a delicacy to be enjoyed by liver doctors in clinical practice, as it can have serious consequences.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

182 responses to “How to Prevent Non-Alcoholic Fatty Liver Disease

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  1. And all this leads straight into T2D, if we let it. I chose to change and am happy about that. No one else appears to be interested in fixing their health and I don’t get it. Not when it’s this easy and tasty.

    I chuckled when Dr. G mentioned anthocyanins exactly when I had a mouth full of blueberries this morning.

    1. Wade, here’s what I was eating: a bit of granola with strawberries, blueberries, hemp hearts, sunflower seeds, flax seed meal, homemade soy yogurt and almond milk. Oh, and the tea I was drinking was made with fresh ginger, green and Earl Grey teas, turmeric and a touch of black pepper. All delicious and 11 of my 24 items on Dr G’s app!

      1. Rebecca, all right, except using soy, soy causes hypothyroidism, it disturbs the hormones, on babies, children, men and female adults. It is worse if it’s GMO because, adding, all of the above said, it’s full of toxic pesticides, larvicides and herbicides, cancer causers. Eat organic/bio, but avoid soy and its products.

        1. Paz Paz, I used to think as you do, and I still don’t eat things like TVP and other highly processed soy, nor do I eat soy that is not organic. I’m well aware of the dangers of GMO foods.

          However, after reading many articles about research on soy, I’ve come full circle in my thinking.

          Research now shows that soy helps prevent and heal breast cancer, and that women who have had breast cancer live longer when they consume soy. Though the breast cancer I had didn’t have estrogen receptors, most breast cancers do, so I think it’s wise to include some organic soy.

        2. I call hogwash. Billions of Chinese, Japanese, and others thrived for thousands of years eating lots of soy with no issues of hypothyroidism that I am aware of. I am confident that meat contributes to more arteriosclerosis and sugar to more diabetes than soy does hypothyroidism, and by many orders of magnitude – if at all – which again I will say I am highly skeptical of.

      1. Thanks. I find bypass surgery, stints, insulin injections, chemotherapy, side-effects, and related ambulatory/obesity issues to be much less palatable than the delicious black beans and broccoli I just prepared and “choked down”.

        Just get frustrated trying to get anyone to listen. The skinny have become the minority, look at any gallery/audience/gathering of “Mericans.

        Fat and Sick and Medicated R US.

    2. People have the right to destroy their own health I guess. Sadly, western dietary choices have other more profound ill effects.

      1. It could be much different if we weren’t kept ignorant of all the REAL nutritional information, some of which has existed for DECADES. A downfall of capitalism may be the ability of the companies to get so big as to control/confuse such information, and for the medical establishment to appear to be in cahoots. What reduction would we have in our death rates if magically one could erase all “diseases of affluence”? Maybe then our “aging population” wouldn’t be such a burden on society. Maybe medical and disability insurance would be such a big expensive deal. Funny how everything is connected.

        1. We all have the same goal of a society full of healthy people. However, I must disagree that a sick society is the fault of capitalism. In the USA today we don’t really have pure capitalism, but rather a corrupted form which some people call “crony-capitalism”. To me, it’s more like “socialism-lite” where big government, big business, and the news media all collaborate to to impose their will on the people. And I think things would be much worse in a full socialist society. History has shown that socialism doesn’t work. Just take a look at all the failed attempts (Cuba, Soviet Union, Venezuela, etc., etc.) I certainly wouldn’t want the government (some faceless bureaucrat) telling me what I can or cannot eat. I like my freedom to choose! I think the real solution is through education, much like this website is doing. What we really need is more websites like NutritionFacts.org where the truth can be exposed. And as more and more people convert to WFPB and become healthy, word will spread. I can already see this in my community where large WFPB clubs are forming. (Sorry for the off-topic response, but couldn’t let your comment on capitalism go unanswered.)

          1. …yet some form of ‘crony capitalism’ follows from making profit one’s bottom line. While not of course inevitable, it’s most likely, and emerged quickly.
            And many people in Europe find a degree of ‘socialist’ practice much more congenial. The ‘failed attempts’ mentioned are fairly similar, and dissimilar to that wide European experience.
            As to faceless bureaucrats, only anarchy avoids government, and most humans are simply unready to live without government. I’d welcome you to the anarchy that dwells within a meter of me, but alas the net doesn’t allow that.

              1. Thanks, I hadn’t come across Scott, being tutored in Leach’s structural ways.
                A reconstruction of the origins of Israel, with aid of Israel Finkelstein’s archeology, suggests that before the refugees from the Philistine coast developed the Moses myth, they lived in quasi-anarchy.under Judges. One of many OT tidbits mostly ignored by believers is that their god/s opposed forming a state…but the people insisted, and th/s/he/y yielded, with dire prophecies that of course came true.

                  1. ..that calls up yet another, I vow my last: the Gauls, before Caesar beat them and removed their ears for a body count while crafting empire, had what one archeologist called heterarchy– in different institutions, different folk might rule, so power was distributed. They were still fools enough to war, but like those who walked the Oregon Trail, they’d learned summat.

          2. That’s fine I don’t care what labels are used, it’s rich getting richer and doing whatever it takes to do such-in the form of corporate entities and in the guise of “capitalism” in this country. Works similarly everywhere else. Speaks to the nature of man and the limitations that such nature impose upon us. There is no easy answer and to think that there is one, is folly itself. I used the label because of my familiarity with it, but know that I’m divorced from politics.

            Good and Bad on every side and human nature is the ultimate culprit.

            1. No problem, I know there is a lot of confusion over the terms. In fact, there are many young people I have talked to who don’t seem to understand what capitalism is. They have just been taught in school that capitalism is bad and socialism is a panacea that will solve all the world’s problems. I am old enough to have lived under both socialism and capitalism and can say that I believe that even partial capitalism is far better than socialism. Capitalism to me essentially equates to individual responsibility and private ownership. I own my own little house with a small vegetable garden and really enjoy taking care of both. And I have worked hard over many years to be able to own these things. Public housing, no thanks! I agree with you that human nature is the ultimate culprit and there will always be greedy people under any system.

              1. There are so many things to say about your conclusions, but they’d likely start a never-ending thread not quite what most here look for. Instead, a fairy tale reflecting on “And I have worked hard over many years to be able to own these things”:
                Jack and his ma lived on the edge– their hard-working father-husband gone, all they had was their home, their land, their crops, and the spread’s animal life. (This was dirt-poverty as conceived in the High Middle Ages.) At last young Jack, still not up to taking over the spread’s upkeep, had to SELL the cow, source of so much if only you put your back into it!
                The rest of the tale is only marginally relevant: intercepted before being fleeced by the Market, the beans that reached the sky, the cruel giant who lived there and stole all the peasant’s surplus, and his downfall– a socialist idyll, if you will.
                But labor aside, Jack and his ma though dirt poor, seen by an older age, were far richer than one
                who “worked hard over many years to be able to own these things”–they had them all from the first, only needing a man’s labor to sustain them.
                How poor the Market would have left them, and (for this site) how rich the beans made them!

    3. A lot of people I’ve met think think that a vegetarian diet is limited and austere. “You can’t eat meat cheese eggs or fish?? Well, what else is left? (and you don’t want sugar or soda, white flour or processed food that came in a box?) That means you can’t eat anything but lettuce! No thanks, a veggie diet is not for me!” Sadly, in their kitchen I probably wouldn’t want to eat anything but the lettuce, and I’d look askance at that (not organic enough, sniff).

      But I have taken the most rabid anti-vegite (in this example my then boyfriend’s roomate), offered him a few meals, at first firmly and rudely refused! (don’t waste time arguing btw) , but time and again I’d be in the kitchen with my boyfriend when he got home from work, hungry and tired. It was like taking to a child: “Would you like some tacos?” No! Next time “Would you like some spaghetti, Mark?” No! Then one day I asked, “Would you like some mashed potatoes and gravy?” He said Vegetarians can’t eat gravy! It’s made from meat!” I said “I make it from mushrooms and onions, it tastes just the same as you’re used to.” Pretty soon he’s shoveling down forkfuls between shouts of “I didn’t know vegetarian food tasted like this!” and “More please!!” Ah lightbulb moment. Problem solved. Now if only we could reach 10 to 25% of the population similarly. I think word would get around.

      1. oH Iilyroza, I have tears in my eyes! That’s has to be one my top 10 favorite stories here and so funny. I think you are spot on about everything.

    4. Most people are just trying to live their lives. They eat what is easy, tasty, and available, and fast food and processed food companies have spent billions to develop and market their products. It also doesn’t help that most people don’t think about health until there is a problem, they’ve been told meat is healthy and all other garbage food is OK in “moderation”, and all that garbage food has been made inexpensive by farm subsidies such that if you want to eat healthy, you’ve basically got to go out of your way to do it.

      1. I was curious and found a 50gram bag of Doritos online to work with– 3000 Calories would weigh 1.4 lb, not likely to be found in your supermkt, and would likely cost more than you’d imagine, as most heavily processed foods do, though I’m not typing in the university bldg I often use, so there aren’t machines with prices to examine.
        A pound of breakfast cereal usually runs about $4-5, easily beaten by any whole cereal soaked overnight and cooked next morning in minutes (I’ve timed steel-cut oats presoaked with 1t cider vinegar at about 5 minutes to near-burning but edible sooner).

        1. It was a guess. I checked online – WalMart because it came up on a search – a 15.5 oz bag of Doritos, $3, 2400 calories = 800 calories per dollar. Oranges have 47 calories per 100 grams. At 454 grams/pound and 69 cents per pound, which is what I paid two days ago, that comes to 307 calories per dollar. You get 2.6 times more calories per dollar with Doritos than oranges.

          I agree that eating “healthy” does not have to cost more than eating junk food. In fact, bulk oats, beans, and rice can be dirt cheap, but that brings up other obstacles – namely time, skill, and knowledge. I don’t know how to overcome this multifactorial problem. I don’t see Americans looking forward to homecooked bean and rice dinners. I see them going for fried chicken and pizza and promising themselves they’ll eat a granola (candy) bar and a glass of OJ for breakfast to make up for it.

          1. Time and knowledge– I see why it made you think of Great Depression II, which the planet has barely emerged from. Rulers seem not to want the knowledge and won’t take time to forestall the next collapse, which if the 1930s are a guide should be apparent in January, with perhaps the most ignorant person in history presiding over the debacle.

    5. I work with both medical professionals and epidemiologists. None of them believe in or have adopted a whole foods, plant-based diet. A million dollars to whoever can find a reason for this because if we can’t convince our own kind, then how are we going to convince the average person? #CognitiveDissonance

    1. Good catch Miroslav.
      Avoiding starch per se really doesn’t tell us much though. If you have a bowl of whole grains or truly whole grain bread for a meal you will have a high starch healthy meal. White rice or white bread will also give you a high starch meal with little or no fiber and little phyto nutrient quality other than the amalose (starch). As with whole fruit v filtered fruit juice or indeed Coke or the like, the real issue is the total nutrition picture along with the glycemic index.

      Mark Hyman recommends a high carb diet which pretty much necesarily means a high starch diet. Just leave off the white bread and other refined starches.

      1. I think Mark Hyman is a high fat, low carb, low protein (treat protein as a ‘condiment’) person. I have heard him say that the fatty liver foie gras produced by the gavage feeding (forced feeding with whole grain) of geese just shows what happens when we over feed on carbs.

          1. What he mentions and emphasizes is that whole wheat bread or potatoes turn into sugar very quickly in your bloodstream and affect your glycemic load. He is very pro leafy greens, avocados, olives, chia, hemp, flax seeds, etc. I won’t eat just a pile of even brown rice. I put green leafies in it, olives, soy sauce, vinegar. Some sour will lessen glycemic load and green leafies help in many ways.
            John S

            1. If you are eating brown rice and greens you are eating better than 99% of Americans and will be OK whether or not the rice is “better” than potatoes, which I suspect is probably not the case.

            2. If you are non-diabetic, why are you worried with glycemic load? Potatoes and brown rice aren’t causing diabetes, heart disease or obesity… I’m all for adding a variety of foods… but where is the evidence against brown rice and potatoes??

              1. The thinking of Hyman et al is that inflammation is implicated in almost all chronic disease situations. If you are asking me personally, I have had a pre-diabetes warning in the past and I don’t want to go back to it.

                1. Inflammation I agree with. Brown rice and/or potatoes causing inflammation? I’m not so convinced…

                  And I totally commend you on committing to change your health around :)

      1. This is the problem with Hyman, he used to promote a healthy diet, then found it was more profitable to use fake science and tell people low carb is the way.

    2. Hyman is WRONG about avoiding starch, unless he is talking specifically about processed starches. I and many many others have reversed T2 diabetes and many other health issues by eating the diet Dr McDougall recommends…high complex carb, low fat, whole foods. T2 is known to be caused by too much FAT in the cells, and the excess sugar is the result of insulin not being able to do it’s job of allowing entry of glucose into the cells as fuel. Since it can’t get into the cell it stays in the blood and is filtered by the kidneys…high glucose from ingesting carbs is a SYMPTOM, not the cause. (See Walter Kempner’s rice diet, which cured high blood pressure, diabetes, etc. in the 1940’s for an extreme proof of concept!)

          1. Hi T, here is some clarification. Starches are long chains of sugars. Therefore starches are made of sugars, but sugars are not necessarily in the form of starches. All food is composed of fats, protein, and/or carbohydrates. Starches and sugars are kinds of carbohydrates.

          2. They are sugars? A sugar is a sweet short-chained soluble carbohydrate. Usually glucose or fructose. Starches are long chains of glucose joined by glycosidic bonds.

            1. Starches are polymerized sugar molecules (glucose)… you break starches down and you get glucose back.

              The reason plants store sugars as starch/cellulose instead of glucose is that they are insoluble and don’t attract water which would lead to bursting the cell wall. Think about how brown sugar naturally attracts and absorbs water… if that happened in the plant cells, the plant cell walls would attract water and burst due to the resulting osmotic pressure.

      1. Not necessary true, if a person has crohn’s disease or SIBO, which are cause by fungi and parasites in the small intestine. A person with such concerns should avoid complex carbs, like sweet potatoes, otherwise he/she feeds those parasites. Ideally simple sugars. http://www.siboinfo.com/

    3. Just read a bunch of his articles. He took data on HFCS and extrapolated that to include starches (which are completely different). He cites this study-
      http://www.ncbi.nlm.nih.gov/pubmed/23482247

      Which specifically says a high-fat diet alone (even without sugar) also starts FLD… then he says the exact opposite… It would seem he didn’t even read the study he cited…?

        1. An optimist outlook for which I applaud you… however the dissemination of unsubstantiated nutritional ideas is why so many are confused in the first place…

    4. I don’t listen to Hyman because in my view he changes his mind about what is “good” and “bad” in what looks like a quest for the best money-making gimmick.

  2. I think stress is also implicated. I don’t think food on it’s own would cause this kind of damage, but stress and poor food is a killer.

    1. Just eating junk increases your stress level. And not getting B complex and other vitamins and minerals from your food means you will probably handle stress poorly Then add to that other daily stresses and people become a mess.

    2. I guess I’m not seeing what leads you to that conclusion (that food alone won’t cause this response.) The lab results showing profound liver damage in the group of men and women eating two fast food meals a day for a month showed exactly that.

      From personal experience being on the South Beach Diet and ending up with a massive heart attack, my health didn’t improve until I went whole-food vegan. Yes, stress is a risk factor which likely is why Dr Ornish incorporates meditation on his cardio-rehabilitation regimen.

      But fundamentally, food is what the body has to work with. Given a choice between low stress + crappy food and high stress + whole-food vegan fare, I’ll literally bet my life on the second option.

      But, high stress doesn’t mean helpless… I use a regular practice of 40-minutes of meditation and daily 4-mile walks to counteract the stress I do find in mt life.

      1. This video of Dr. G. is very educational and has brought about such a great discusion. That is great that you have made a dietary change that has improved your health. The practice of meditation and walks are also great decision well done and keep on the good work.

      2. That’s a fair point. Long term though i think you might see a big difference between even people who are eating a good diet, between those who are stressed and those who aren’t. Food can help to heal the damage though, i agree.

      3. RalphRhineau: Your comment reminded me of a comment that I believe I heard Dr. Lisle say. I can’t remember which video the comment is in, but Dr. Lisle is one of the doctors featured on Forks Over Knives and I believe he works at the True North Health Center. (Don’t quote me on that.)

        Anyway, at one point, he said something like, “You don’t think the poor people in rural China have stress?!?” Their lives are filled with stress and they still don’t get say heart disease if they eat a traditional diet. The point is similar to what you are saying, I think. That stress can be a risk factor for some health problems, but for some of those problems, stress is only a risk factor in conjunction with a bad diet or the main risk factor (which in the case of heart disease would be cholesterol).

        1. Moderate stress is probably only a risk factor for your health if it changes the way you eat and behave. Many concentrationcamp surviviors lived long lives afterwards – and they have endured the most stress a human can experience. If stress makes you eat unhealthy, drink too much alcohol, sleep less, smoke and so on, it will be bad to your health, but if you eat healthy, keep a good spirit, dont smoke and dont abuse alcohol, the impact on your health will probably not be that high.

  3. As usual, my psyche is always quickly peaked during the majority of Dr. Greger’s most interesting and useful CLINICAL NUTRITIONIST teaching presentations. This one is especially important to me since tests at the V.A. have recently indicated the onslaught of Fatty Liver Disease. I would sure like to shake your hand Dr. Greger and properly express my thanks. But this will have to do . . . THANK YOU my friend, THANK YOU FOR ALL YOUR WORK ! !

    1. Yes, I agree I enjoyed learning about the mechanisum and the pathways that Dr. G. explains in this segment.

  4. I knew a guy that had a transplant and almost immediately after, he was eating junk such as pizza in thdme hospital and he got sick. Do they want to drain the system or what…

  5. I have read something regarding choline deficiency an NAFLD online. I have been vegetarian since I was 12 yrs old (over 20 years) and recently went vegan. Had a nutritionist friend tell me I would become deficient in choline which would cause “problems” and that I needed to at least eat eggs for the choline or supplement. Can someone shed light on this subject or is it nothing to worry about?

    1. Choline is in many plant foods and should not be of any concern. Many nutritionists have antiquated dietary info that has been proven invalid.

    2. Veggiehead: Great question. This is something I’m a little concerned about. The AI of choline a day are 425 mg (women) and 500 mg (men). Based on the list of plant foods rich in choline in Becoming Vegan (Davis and Melina), I’m not sure if one could get enough choline day after day by eating plant foods only or by taking supplemental choline. Human body can make choline, but the process requires vitamin B12, folic acid, and methionine. Folic acid is plentiful in vegan diet; B12 is absent but most vegans take B12 supplements. Vegan diet, however, doesn’t have much methionine, which is, as Dr. Greger has discussed, is a good thing in other ways but makes endogenous choline an unreliable source of choline for vegans.

      1. I feel many more people are having the ‘meat and soft-drink induced version of NAFLD’ and looking for an excuse to keep eating eggs… More humans in industrialised countries are dying from excess… not deficiencies….

      2. There are people who have genetic mutations in various genes: PEMT, MTHFD1, CHDH that make them more likely to become choline deficient, especially if they are vegan. Taking a high quality lecithin supplement can be helpful, especially for men and postmenopausal women, as estrogen helps in upregulation of choline synthesis.

        1. Yup, when women hit menopause they produce less choline as estrogen is intimately linked to the production of choline. Lecithin can be an important supplement as it can be challenging to get enough choline through diet alone.

    3. Hi, As Vege- tater mentioned there are many plant food that do contain choline. Choline can appear in food in many forms, including as just choline (also known as free choline), phosphatidylcholine (also known as lecithin), sphingomyelin, glycerophosphocholine, and phosphocholine). Also a while back I noticed Dr. G. had a video on Choline I thought you might like to see that too.

      Eggs, Choline, and Cancer

      1. good video, but what about soy consumption, Asian cultures are based on soy diet and soy is loaded with choline, but no/low cancer.

      1. Poetically called the Silence of the Lambs (how beautiful and peaceful that sounds, they must be sleeping), when what actually tramatised Clarice was the Screaming of the Lambs during their slaughter. But if the book movie were called the Screaming of the Lambs, I doubt that it would have been popular, because the title would, well it would give it away, but also it would turn people off. Interesting how that is, and how the concept of slaughter was used so effectively in a horror movie, and yet people go on and on, paying for ever worse forms of it, and ridiculing and condemning vegetarians.

    1. Yes, almost as high in Omega-3 but Chia seeds are much higher in Vitamin K, so be careful if taking blood thinners.

  6. I have been a strict vegan for the past 18months, and restrict all wheat, sugar and dairy. My diet is mainly vegetables and fruits with small amounts of grains and nuts, so imagine my surprise when a recent ultrasound showed that I have NAFLD!! I don’t drink, I don’t smoke, and I exercise well, myself and doctors are perplexed as to why I would have this? I am currently being looked at for an immune disorder, could NAFLD be a symptom of the immune system considering my very healthy lifestyle? Surely I don’t have to give up the small amount of nuts I eat also? I barley have fat in my diet.

    1. What was your diet like prior to the past 18 months?

      While I haven’t been diagnosed with NAFLD, I have a hunch that I have fat to lose from my liver. My experience has been that while I’ve lost significant weight over the past couple of years, my visceral fat has been tougher to lose. It took me years to get into this condition, and I’m prepared for the fact it’s likely going to take me a while to unwind this.

    2. What were your triglyceride levels?
      Have you tested B12 (+ homocysteine and MMA) and possible iodine and choline levels?

    3. Certainly, it is known that the immune system plays a part in NAFLD.
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005965/

      However, the comments by moderator Renae and RR are relevant. Cholesterol plays a key role. Some people have genetically high cholesterol. Further, it is often hard to reverse all the consequences of a lifetime of poor dietary choices in a year or two.

      Also, I am not clear about your diet – you say that you have been a “strict vegan” yet you go on to say that you merely “restrict” dairy. You might have some scope for further fine-tuning your diet?

    4. Maybe too much fruit? Too much HFCS in soft drinks leads to fatty liver. Although fructose in fruit is packaged with all kinds of goodies like fiber, vitamins and phytonutrients, there still may be too much fructose for your liver to process. Try eating whole fresh fruits with less fructose and more nutrients like berries instead of those higher in fructose like bananas, mangoes, pineapple. For carbs, maybe sweet potatoes, winter squash, peas, corn would be good non-fructose options. Make sure to add some beans too.

    5. The mayo clinic says there is no cure for NAFLD, so maybe you had it before your vegan diet began, one third of adults have it after all.

  7. NAFLD is what killed my paternal grandfather. At autopsy, it was found he had cirrhosis of the liver, and he was a strict non-drinker. Alcohol of any form was not allowed to cross his threshold. The doctors were astonished and somewhat disbelieving that he did not drink. However he loved fatty meat and sweets, and had a seriously large appetite. Little wonder his liver was shot.

  8. Amazing coincidence that this was today’s video, because I happened to tune in to the documentary “Sugar Coated” on Netflix. Yes, I realize this documentary promised to deliver a biased low-carb message, but I enjoy viewing these things to see what the “other side” is saying. Prominent in the video was a connection they attempted to draw between fatty livery disease and sugar. As expected, the documentary failed to point out ANY connection between cholesterol and fatty liver disease, which would appear to be a much more significant factor than sugar consumption.

  9. Up to 2010, I was grossly overweight. Had serious health problems, and one of the many consequences was a cholecystectomy. I started losing weight but anytime an ultrasound was done, fatty liver was noted. The video seems to discuss prevention. What about reversal? I have been vegan for 5 months. I exercise regularly. Is reversal possible? I’ve read that hepatic regeneration is possible but it takes a long time. Since 2010 I continued with meat consumption. Would cholesterol consumption negate all the dietary changes and exercise I’ve been doing to try to reverse the fatty liver? Can a vegan diet do it? Also, switching to vegan, I have gained weight???? Not sure why. I would say 90% of my diet is whole food. My only weakness is bread, both multigrain and plain white. Could this be a culprit for the weight gain and the sustained fatty liver?

    1. You may be sensitive to wheat as it can cause increased appetite, weight gain and other problems in some people. I always gain weight and over eat when I eat wheat. Try eliminating wheat (especially the white bread!) and gluten for awhile and see how you feel and how your weight responds. Also try to eat the whole grain, not bread, like buckwheat groats, oat groats, whole millet etc.

      1. When I do cut out white bread, I stick to a rye bread that is made with flax seeds and no yeast/oil/eggs/dairy. I make open face veggie sandwiches using Rapini, green beans, Kale, sauerkraut, olives and tomatoes. I have one slice per day. All the other breads that I find are whole grain and gluten free but made with oil and I believe that Dr. Greger has shown that even plant oils, especially if exposed to cooking temperatures are not good( eg sunflower oil). Can’t think of any better way to have this. Any bread ideas?
        Any recommendations for vegan recipe books.

        1. Mmm, your open faced sandwiches sound yummy. Personally I find it easier just to avoid bread altogether and stick with whole grains and starchy veggies. When I do make bread I use this recipe for gluten free sourdough which is oil-free. I sub in whole oat and millet flour for the less nutritious corn starch and potato starch. https://www.youtube.com/watch?v=P4JyNzJ-_nw

    2. HI Pat, I recently attended a medical conference where a totally conventional gastroenterologist presented a case of fatty liver. Following diagnosis, he said that the patient went on a vegan diet, and on follow up some months later the liver ultrasound was clear. I suspect that if you had a lot of weight to lose, the fatty liver was there for a long time and if now exercising moderately (which you are) and eating a whole foods plant based diet, your condition will not progress, and really should improve. Regarding bread, white bread is pretty much equivalent to sugar and I would really avoid it. Multigrain may not be whole grain, and if you want to continue to improve, it is important to learn to read labels and be sure of getting truly whole wheat. If you do eat bread, Dr Neal Barnard of PCRM (Physicia Committee for Responsible Medicine) recommends rye as causing less of a blood sugar spike. It is worth also learning about the concept of calorie density. Jeff Novick is a great resource on that, as is Dr Joel Furhman. Best diet eliminates oils (even olive oil), limits seeds and nuts, which are extremely calorie dense. Flour products are also very calorie dense when compared with cooked whole grains such as brown rice, quinoa etc. FIll up on leafy greens and non starchy vegetables, also beans. Very worth looking up Dr John McDougall, one of the best resources out there. In addition there is True North Health in California which is residential and offers wonderful nutrition education, great food, cooking classes and the opportunity to do some fasting if relevant. All medically supervised. Hope that is helpful! It is great to remove the animal products but equally important to make sure of the healthfulness of the vegan food that you do eat, and get the right proportions.

  10. I am at or below my ideal weight and jog as my exercise routine. Could long exercise regimens also stress the liver? Dr. Natasha Turner’s book “the Hormone Diet” states anything more than 30-45 minutes of exercise creates inflammation. Just wondering if this too, like cholesterol and simple carbs could slow down or halt the reversal process of fatty liver? I’ve been told the fatty liver looks about the same since 2010.

    1. Congratulations on the many positive changes you have made to improve your health!! One thing I noticed you said, is that the FL looks the same as it did in 2010. That means it didn’t progress!! Likely your lifestyle changes have arrested the progression of FL before it got more serious leading to the NASH and cirrhosis. The damage that occurs from cirrhosis is not reversible. The liver does regenerate and you may find over time that the FL does improve. With regard to exercise, here is a nice description of the effect of exercise on inflammation. It summarized that acute unaccustomed exercise can cause an inflammatory response, but as the body adapts to ongoing exercise, it starts to block the inflammatory response and reduces inflammatory markers.

      Dr. Greger has a great app that utilizes his daily dozen recommendation. It is great at looking over your food choices and balancing. I too gained weight when I started a vegan diet, but my choices were more starchy and less vegetables. This app has helped me by bringing my starch choices in better proportion to the vegetable/greens.

      Hope this helps!! Congratulation again on all the many positive changes you are making!!

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320801/

  11. Thank you for all your informative videos Dr. Greger. I appreciate your explanations and thorough review of the literature. I have a more general question relating to the China Study that made Dr. T. Colin Campbell well-known in the world of nutritional research and also the vegan community. It seems that the documentary Forks over Knives is largely based on the China Study and that Campbell’s book has become sacred for some vegans as it echoes the message that animal products are bad. However, I have looked into criticism on the China Study by Chris Masterjohn and the blogger Denise Minger. It left me confused since these criticisms pointed out some seemingly very weak aspects of the China Study, which made me question the whole book. My question to you is: what is your view on the China Study? Does the book provide reliable interpretations of its data (as I found critics showing other correlations with the same data)?

    1. Daan, T. Colin Campbell lead the Oxford, Cornell, Beijing China study. When doing her critique, Denise Minger was a 23 year old college graduate with an English major. Chris Masterjohn is a major contributor to the Weston A Price foundation which is an unapologetic defender and promoter of the chemical and meat industry. Scarcely credible scientific sources in either case.

      Having said that, there might be some real issue that should be considered even though the sources of criticism could not be taken seriously by any serious individual. Unfortunately I gotta go do my morning run so I’ll come back to this later.

      Sure glad you posed this question.

      1. Hadn’t seen that Alan. Glad you pointed it out. Just saved me some trouble. Great read by Dr Campbell as well as a great introduction by Vegsource. Can’t cite that source too much.

      2. Alan: Thanks for this link!! I had heard of Campbell’s response to Minger before, but I could never find it. Thank you.

    2. No serious scientist let alone one connected with the China study itself (the actual study not the book by Campbell) has disputed Campbell’s summary of the study’s findings. The only people who have are paleo, low carb and “saturated fat is good for you” bloggers. These agenda-driven individuals can say “the world is flat” or “the China Study has been debunked” as often as they like. That doesn’t make it true.
      In particular, the statistical aspects of the China study were conducted by the the world-famous medical statistics team at Oxford University. Neither Masterjohn nor Minger are epidemiologists or biostatisticians and I do not give any credence to their opinions or opinions. They have extracted raw data and interpreted it to serve their own purposes but they are simply not credible sources of information.
      In any case, it is not as though the case for a whole food plant based diet rests solely on Campbell’s book. It is merely one strand in an extremely large web of interconnected evidence comprising observational and experimental studies, plus studies that demonstrate the mechanisms by which animal and processed/refined foods damage human health. And of course, studies showing mechanisms by which whole plant foods positively affect human health. Many of these are discussed in detail on this site.
      Additionally other observational studies from both China and elsewhere tend to back up Campbell’s interpretation of the data eg
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900847/
      http://archinte.jamanetwork.com/article.aspx?articleid=1710093

    1. That is what this entire website is about. A Whole Food Plant Based diet will help you fix/improve existing NAFLD along with a lot of other diseases.

      1. Yes, have been vegan for years, and still have NAFLD. Asking in case there are particular whole plant foods to focus on.

  12. People around me started commenting how yellow my hands and feet are. I eat a lot of carrots, tomatoes, lettuce, butternut squash etc. My numbers on Cron-o-meter for vitamin A are always ver high. Can too much of vitamin A from plant foods cause any damage to my health?

    1. According to the US National Institutes of Health:
      “diets with high levels of carotenoid-rich food for long periods are not associated with toxicity. The most significant effect of long-term, excess beta-carotene is carotenodermia, a harmless condition in which the skin becomes yellow-orange [1,22]. This condition can be reversed by discontinuing beta-carotene ingestion.”
      https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/

    1. I think you missed the bit where it says “The feed, usually corn boiled with fat (to facilitate ingestion), deposits large amounts of fat in the liver,”

      In any event, what are you implying? Force feeding with fat would not cause fatty liver? Because if you are talking about animal models, this is most definitely not true:

      “Animal models of NAFLD/NASH provide crucial information, not only for elucidating the pathogenesis of NAFLD/NASH, but also for examining therapeutic effects of various agents. A high-fat diet is widely used to produce hepatic steatosis and NASH in experimental animals. Several studies, including our own, have shown that long-term high-fat diet loading, which can induce obesity and insulin resistance, can also induce NASH and liver tumorigenesis in C57BL/6J mice.”
      http://www.mdpi.com/1422-0067/14/11/21240

      1. There are some people that believe simple insulinogenic carbs help to fatten animals and people faster than fat (e.g. ‘grain finishing’ beef to get a fattier, heavier more marbled meat and the goose liver example. Fuhrman emphasizes avoiding processed carbs and focusing on veggies. Dr Greger seems to target fat and protein as the major culprits. Obviously force feeding excess everything is going to be drive obesity and fatty liver the most.

        1. Obviously using grain is cheaper than using fat or protein to fatten livestock (although beans and animal protein are widely added to animal feed – and this added animal protein is what drove the BSE epidemic). The fact is though that researchers investigating conditions like obesity, diabetes and NAFLD preferentially use high fat diets to induce these conditions in test animals. This is because they find this is the approach that works best and quickest.

          I know that there are people out there who want to believe that high fat diets are harmless. The evidence suggests otherwise. The fact that junk carbs are unhealthy does not in any way detract from the fact that high fat diets, especially high saturated fat diets, have adverse health effects for the great majority of people.

          Dr G promotes diets based on whole plant foods – he does not advocate junk carbs, processed foods of any kind or oils. As for the “simple insulogenic carbs” claim, it need to be noted that populations eating traditional high carb diets such as rural Africans, Asian, Europeans etc simply did not experience type 2 diabetes. But as populations eat more saturated fat, animal foods and processed carbs, rates of diabetes shoot up. Pretending that (saturated) fat is not a key factor in diabetes and obesity ids reality-denying.
          http://nutritionfacts.org/video/diabetes-as-a-disease-of-fat-toxicity/
          http://www.nel.gov/evidence.cfm?evidence_summary_id=250189

            1. That has nothing to do with the cost of livestock feed as far as I can tell.

              However, with humans, calorie for calorie, it may well be cheaper to eat eg McDonald’s and other junk foods than it is to eat whole plant foods. Although beans, cabbage and potatoes are pretty cheap. But it is also much much easier to overconsume calories on high (saturated) fat diets than it is eating boiled potatoes, beans and cabbage.

              None of which, however, proves high fat foods are healthy or that they do not promote obesity, diabetes and NAFLD. The evidence shows that they do – which is precise;y why researchers use high fat diets to fatten test animals

              As I wrote previously, there are definitely people out there who for whatever reason (Volek and Phinney are financially associated with the Atkins Diet empire for example) want to give the impression that high (saturated) fat diets are harmless and they come up with increasingly bizarre and largely irrelevant arguments for eating these foods. You have repeated a number of them here … like the statement that ducks and geese are fattened with corn to make foi gras. Factually correct but the argument is quite deceptive because the fact that the corn is boiled in oil is deliberately omitted. And that livestock is fattened by cheap grain rather than, what, oil? steak? Also true but meaningless. Overconsumption of calories will induce obesity and the fact that cattle or ducks can be fattened on large amounts cheap corn does not mean that high fat diets are harmless. This claim or implication is simply a non sequitur.

                1. No, I had not seen it but thanks for the link. It is an interesting read although it did not seem to state the number of calories consumed by each group, merely the macronutrient profile.

                  However, I do not think that there is anything dramatically new here. It has been known for a long time that people with damaged metabolic and endocrine systems (ie people who are clinically obese and people with insulin resistance) respond to food differently.than “normal” people.
                  “diets low in saturated fat and cholesterol are less effective in the obese. The most effective way for obese people to normalize their blood lipids is to lose weight.. ”
                  http://www.ncbi.nlm.nih.gov/pubmed/16256004

                  “The greater rate of hepatic cholesterol synthesis in obese individuals suppresses the expression of hepatic LDL receptors (LDLR), thereby reducing hepatic LDL uptake. Insulin resistance develops as a result of adipose-tissue induced inflammation, causing significant changes in enzymes necessary for normal lipid metabolism. In addition, the LDLR-mediated uptake in obesity is attenuated by alterations in neuroendocrine regulation of hormonal secretions (e.g. growth hormone, thyroid hormone, and cortisol) as well as the unique gut microbiota, the latter of which appears to affect lipid absorption. Reducing adipose tissue mass, especially from the abdominal region, is an effective strategy to improve the lipid response to dietary interventions by reducing inflammation, enhancing insulin sensitivity, and improving LDLR binding. Thus, normalizing adipose tissue mass is an important goal for maximizing the diet response to a plasma cholesterol–lowering diet.”
                  http://advances.nutrition.org/content/2/3/261.full

                  We even saw this with the Twinkie Diet. Weight went down, lipids improved and glucose improved.
                  http://edition.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/
                  http://www.huffingtonpost.com/david-katz-md/chewing-on-the-twinkie-di_b_782678.html

                  Note also that Gardner’s are short term studies that show improvements in biomarkers in clinically obese (and insulin resistant people). Physicians largely do not recommend low carb diets (or Twinkie diets) because of the long term health effects. They increase risk for heart disease and cancer and have been shown to result in increased mortality.
                  http://www.bmj.com/content/344/bmj.e4026
                  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989112/
                  http://jaha.ahajournals.org/content/3/5/e001169.full
                  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555979/

                  The other issue is of course that in normal weight people diets high in saturated fat significantly increase risk for diabetes as well as CVD etc

                  “The relationship between dietary fat and glucose metabolism has been recognized for at least 60 years. In experimental animals, high fat diets result in impaired glucose tolerance. This impairment is associated with decreased basal and insulin-stimulated glucose metabolism. Impaired insulin binding and/or glucose transporters has been related to changes in the fatty acid composition of the membrane induced by dietary fat modification. In humans, high-fat diets, independent of fatty acid profile, have been reported to result in decreased insulin sensitivity. Saturated fat, relative to monounsaturated and polyunsaturated fat, appears to be more deleterious with respect to fat-induced insulin insensitivity.”
                  http://www.sciencedirect.com/science/article/pii/S0021915099005043
                  http://care.diabetesjournals.org/content/31/Supplement_1/S61.full
                  http://www.ncbi.nlm.nih.gov/pubmed/24910231
                  http://www.nature.com/nutd/journal/v4/n2/full/nutd20142a.html

  13. Infotainment I know, but I often see “fat pride” type articles on Huffington Post. I agree with a post below that fat is becoming the new norm. Anti “fat shaming” is a thing. Fat as beautiful is a thing. I just hope we figure out how to correct course. We have already become fodder for future generations. We are in a deep hole and I would really like to see us stop digging before our society mirrors the plot of “Idiocracy”. Unfortunately I think we are well on our way, and if we don’t wise the hell up we may very well wake up one fine day to discover that we are already there.

  14. I would like to suggest that Dr. Greger do a video or maybe even just explain in his blog how he chooses the studies he cites, and also explain a bit about the different types of scientific methods that researchers use to study nutrition, i.e. clinical trials, cross-sectional studies, etc. I have seem him explain this information in the odd you-tube interview, but it would be handy to have one place on the website to refer to where this is laid out methodically. Nutritional science can be baffling and highly controversial, so understanding how scientists gather their evidence and interpret it is crucial. Perhaps he’s already done this and I have missed it, but I have been following this website for many years and don’t recall seeing this issue covered.

  15. oh boy I’m SUBSCRIBED NOW!, again, so happy I was able to accomplish that. Now to be an active participant oh boy oh boy and get …oh wait I ALREADY get a box full of NF.O information on a regular basis.

    1. Click ‘view transcript’ and a fair few are listed :)

      In short- avoid animal products and soft drink and ‘junk food’

      Include more- fruit, vegetables, wholegrains and legumes, especially those with red pigment :)

  16. More confirmation that to avoid fatty liver disease (and heart disease), we should take special care to avoid meat and dairy (from Science Daily 10 June 2016):

    “A UCF College of Medicine researcher has identified for the first time a tiny liver protein that when disrupted can lead to the nation’s top killer — cardiovascular disease — as well as fatty liver disease, a precursor to cancer.

    The chief culprit in disabling the protein’s delicate mechanics is a fatty acid found in red meat and butter………………..”
    https://www.sciencedaily.com/releases/2016/06/160610140704.htm

    1. Thanks for your question Penny.

      According to the the NHS “The damage caused by cirrhosis can’t be reversed”. However, “it’s possible to manage the symptoms and any complications, and slow its progression.”

      I highly recommend you to read and explore this short summary to learn how to promote liver health. In case you or anyone familiar to you has a specific condition, it is essential to follow up dietary changes with an appropriate health professional.

      Hope this answer helps!

      1. Yes I knew that answer. I was hoping for a different one… I did my own search online. I know that there is lots of misinformation out there. And if you look online for answers, you will probably find that eating a whole food plant based diet is good for you, and bad for you. That’s why I asked the question on this site, which I trust for having better information.

  17. My school is telling me that to much fructose from fruitjuices will be converted to cholesterol by the liver. I personally think they dont make the difference between fabricated an natural fructose, does someone have a link to scientific studys?

  18. I have been diagnosed with fatty liver. Is there a way to reverse it via diet, or am only able to keep it from growing worse?

  19. Hmm, the article cited for low carb promoting NAFLD gives 3 references for this claim:

    One is actually about soft drinks
    http://www.journal-of-hepatology.eu/article/S0168-8278(09)00532-7/fulltext

    One mentions meat, but not specifically in the context of low carb
    http://www.journal-of-hepatology.eu/article/S0168-8278(07)00427-8/abstract

    One is a mouse study examining NAFLD and hepatic insulin resistance, but not a low carb diet per se
    http://www.pnas.org/content/108/14/5748

    This doesn’t sound really solid!

  20. I’m new to Dr. Greger’s work, and I find myself very confused about a number of things. For example, one commonly cited cause of NAFLD is choline deficiency. See, for example, https://chriskresser.com/why-you-should-eat-more-not-less-cholesterol/
    and http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518394/. But in other videos here on nutritionfacts.org, choline is treated with suspicion, as possibly a causal contributor to some cancers, such as prostate cancer. Dr. Greger cites dietary cholesterol as a cause of NAFLD, whereas Dr. Kresser claims that cholesterol-rich foods may be the solution, due to their choline content. Dr. Greger doesn’t mention choline at all in connection with NAFLD, even though the Nutrition Today article specifically says, “However, studies in patients receiving low-choline solutions
    intravenously determined that endogenous synthesis was insufficient to
    prevent liver and muscle dysfunction characteristic of choline
    deficiency,” and “One of the first clinical signs of dietary choline deficiency is the
    development of fatty liver (hepatosteatosis) resulting from the lack of
    phosphatidylcholine to package and export very-low-density lipoproteins.” So the dilemma appears to be: Get plenty of dietary choline and risk cancer or avoid it and risk NAFLD. I hope Dr. Greger will address this dilemma at some point.

  21. Hello,

    I hope someone with extensive experience can help. My father (65 years old) has been following this diet for the last 5 years. He is a type 2 diabetic and lost over 40 pounds, dramatically changing his lifestyle. He never drinks, or smokes, and eats a low oil, plant, vegan mostly indian based diet. He takes Vitamin D and B 12. He’s the healthiest guy I know. He stopped taking his diabetes meds.

    Last week he fell and shattered his shoulder and had to get a reverse replacement shoulder surgery. The doctors were all concerned he had stopped the diabetes meds and gave him insulin. He is recovering.

    This week we discovered he has a large amount gall stones and had to remove his gall bladder. Upon doing this the nurse discovered he has NASH. How can this be from a man who eats this diet, exercises and never drinks?!

    Please advise. I am at a loss and could really appreciate understanding why this is happening. Although he suffered testicular cancer back in 1981, the only thought I can think of is exposure to radiation.

    Sincerely,

    Namita

  22. I hope someone with extensive experience can help. My father (65 years old) has been following Dr. Greger’s diet for the last 5 years. He is a type 2 diabetic and lost over 40 pounds, dramatically changing his lifestyle. He never drinks, or smokes, and eats a low oil, plant, vegan mostly indian based diet. He takes Vitamin D and B 12. He’s the healthiest guy I know. He stopped taking his diabetes meds 5 years ago even though he has been type 2 diabetic for 15 years.

    Last week he fell and shattered his shoulder and had to get a reverse replacement shoulder surgery. The doctors were all concerned he had stopped the diabetes meds and gave him insulin. He is recovering.

    This week we discovered he has a large amount gall stones and had to remove his gall bladder. Upon doing this the nurse discovered he has NASH. How can this be from a man who eats this diet, exercises and never drinks?!

    Please advise. I am at a loss and could really appreciate understanding why this is happening. Although he suffered testicular cancer back in 1981, the only thought I can think of is exposure to radiation.

    Today I hear eating too much Spinach and Kale can cause calcium deposits. I am so confused.

  23. Hey I would really appreciate some help… I tested the vegan diet for one month and got a blood test and had a massive drop in my LDL… but my HDL dropped under the recommended amount and my triglycerides shot up higher, almost doubling, but didn’t go over the recommended range. What should I do and what does this mean?

    Also, probably my major concern is my liver seems to be damaged with my ALT, AST, and Uric Acid shooting up over the recommended range. I feel bad please help… is there anyway to reverse this damage?

    And if you could point me to any more information about this issue I’d appreciate it a lot.

    1. Jared Chan: I forwarded your post onto our medical moderators. They are not able to answer every question, however, and I have some thoughts for you on the HDL change. So, I thought I would reply in the hopes of being helpful.
      .
      Note that I can’t comment on your concerns for your liver as I don’t have knowledge of that area. NutritionFacts has several videos on say the topic of Uric Acid. Maybe if you watched some of these videos, it would give you some helpful ideas? http://nutritionfacts.org/?fwp_search=uric+acid&fwp_content_type=video
      .
      Below is the information I have gathered about HDL. I’m hoping it will be helpful to you.
      **********************
      I am not an expert on the topic of HDL, but some of my favorite experts have had a thing or two to say on the matter. I synthesize the information below to mean we do not need to worry about HDL levels or HDL falling in the context of a whole plant food based diet, when LDL goes down or is at a healthy level.
      .
      In other words, if you have high/unsafe cholesterol levels (total and LDL) overall, then also having high HDL can be protective. But in the fact of healthy LDL levels, the HDL level doesn’t seem to matter. I may be wrong about this, but see what you think.
      .
      First, check out the following article from heart health expert Dean Ornish. He does a great job of explaining the role of HDL and when we need to worry about it’s levels vs when we do not. http://www.huffingtonpost.com/dr-dean-ornish/cholesterol-the-good-the-_b_870655.html “A low HDL in the context of a healthy low-fat diet has a very different prognostic significance than a low HDL in someone eating a high-fat, high-cholesterol diet.”
      .
      WHICH MATTERS MORE, LOW LDL OR HIGH HDL?
      Moderator Rami found some great information for us. Here is what he shared with us some time ago:
      “Low LDL matters far more than raised HDL. 108 randomized trials involving nearly 300k participants at risk of cardiovascular events. HDL levels found to play no significant role in determine risk. Primary goal remains to lower LDL.
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645847/
      Genetic studies of high HDL, high LDL, and low LDL. High genetically raised HDL not protective, while high LDL is damaging. Low LDL is protective
      http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960312-2/fulltext
      http://www.ncbi.nlm.nih.gov/books/NBK174884/
      http://www.sciencedirect.com/science/article/pii/S0735109712047730
      http://www.nejm.org/doi/full/10.1056/NEJMoa054013#t=articleTop
      In this animal model study, atherosclerotic lesion growth regressed in a low LDL environment, but did not with high HDL.
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3098380/
      Quote from the comment: http://nutritionfacts.org/2016/03/22/the-effects-of-dietary-cholesterol-on-blood-cholesterol/#comment-2630127562
      .
      WHAT ABOUT TRYING TO INCREASE HDL?
      There are healthy ways to increase HDL (such as through exercise) and unhealthy ways to increase HDL (such as through eating saturated fat–see explanation from Ornish above). Exercise is a great idea for a bazillion reasons and may be helpful in a heart protective way if someone is having trouble getting to healthy cholesterol levels. However, in general, increasing HDL does not “…reduce the risk of coronary heart disease events, coronary heart disease deaths, or total deaths.”
      .
      That quote is from Darryl, a well-respected and knowledgeable, long time participant here on NutritionFacts. I found a post complete with lots of references from Darryl on this topic. Here is another quote: “Two big meta-analyses from 2009 strongly question the therapeutic utility of increasing HDL, and the value of even measuring triglycerides.” To see the full post: http://nutritionfacts.org/video/bold-indeed-beef-lowers-cholesterol/#comment-1076732894
      .
      WHAT ABOUT FALLING HDL?
      When some people switch to a WFPB diet, both their LDL and their HDL goes down. Do people need to worry about HDL going down? I thought that Dominic (a participant on this site) had a really great post on this topic. Here’s a quote I find compelling: “In populations where CAD is just about nonexistent, people have both low LDL and HDL levels. These populations follow diets that are higher in whole plant foods and lower in fat and saturated fat than the typical western diet. Studies have shown that it does not appear that low HDL levels provide any vascular risk in individuals who attain very low concentrations of LDL – through diet alone or on extensive statin therapy.3,4.” To see the full post: http://nutritionfacts.org/video/paleo-diets-may-negate-benefits-of-exercise/#comment-1849535796 This post also includes a guideline (not sure where it came from) on how to better judge your cholesterol numbers rather than worrying about HDL levels by themselves.
      .
      Dr. McDougall also has an article on the topic in one of his older newsletter articles: https://www.drmcdougall.com/misc/2003nl/sep/030900pugoodcholesterolworsens.htm The article includes these quotes:
      .
      “Worldwide (comparing people who eat different diets) those who have the lowest HDL levels (like people in rural Japan, China, and Africa) have the lowest rate of heart disease…”
      and
      “HDL cholesterol is a risk factor – not a disease. No one dies of low HDL – they die of rotten arteries.”
      and
      “When you adopt the McDougall Program, you will watch your total cholesterol fall dramatically. As it does, both LDL and HDL levels will drop, as well. And as they do, so too will your risk of heart disease. And your health will improve dramatically. Unfortunately, because HDL doesn’t go up with a healthy diet some unenlightened physicians – acting like puppets for the pharmaceutical industry – give their patients a totally undeserved hard time.”
      .
      I hope this information is helpful in allowing you to judge your own situation.

  24. I started taking care of my health about a year and a half ago, became vegan 3 months ago and i eat predominately wholefoods now. The problem i have is, due to recent blood tests, my liver actually has MORE fat than when i was 25-30kgs heavier and eating a standard western diet. I’m baffeled..? Everything else has improved dramatically and i love eating wholefood and plant based but i cant work out whats going on with my liver. Any idea?

  25. A recent study shows that chronic exposure to even ultra-low dose of RoundUp (which are found in most GMOs found resistant to RoundUp) generates non-alcoholic fatty liver diseases on rats …

    Multiomics reveal non-alcoholic fatty liver disease in rats following chronic exposure to an ultra-low dose of Roundup herbicide
    http://www.nature.com/articles/srep39328

  26. Kate,

    Ah…. how to get a point across….forgive my slight snarky response to your husband.

    I would first agree that between the choices, indeed the prior is better than the latter GIVEN the assumption that the fried chips were made with crappy oil and fried and the salad was organic and the fish was low in mercury and……

    An analogy is in order. Would you put gas in your car knowing it was less than the octane indicated and may even have some water in the mix or would you find better gas ?

    Change the conversation to how not to be in this predicament as would it not be ideal to have the optimal options ?

    Clearly we have the capability of prior planning preventing this poor nutritional performance. Map out a way to address this by having lots of great WF choices in the house and checking when your out for options. There are vegetarian restaurant apps and many restaurants will cater to your needs.

    Dr. Alan Kadish moderator for Dr. Greger

  27. Dr. Greger, is there some reliable research on the effect of milk thistle on liver health? Please, would it be possible to look into this topic in the future?

  28. Hello Len,

    I am a medical moderator volunteer helping Dr. Greger answer questions. I am also a whole foods plant based dietitian nutritionist located in Scottsdale, Arizona. To answer your question, I went to my go-to clinical resource, “The Clinician’s Handbook of Natural Medicine” (Pizzorno, Murray, Joiner-Bey, 2008, Churchill Livingstone/Elsevier publishers). Dr. Pizzorno is the founder of Naturopathic Medicine College Bastyr University, (Kenmore, WA) and I am a graduate with dual MS degrees in Nutrition and Clinical Health Psychology. The naturopathic MDs alongside whom I worked used milk thistle for liver health promotion, recovery and used this handbook as a protocol for care and dosing. Dr. Pizzorno et al discuss therapeutic considerations and dosing in the chapter entitled Hepatitis. It is a great evidence based resource and standard of care for NDs.

    Good luck, and be well.
    Lisa Schmidt, MS, CN

  29. FOIE GRAS ARE A RESULT OF FORCE FEEDING CORN TO THE POOR DUCKS. THINK PLANT BASED AGAIN? HMMM DR. MARK HYMAN HAS A COMPLETELY DIFFERENT VIEW. HE SAYS IT’S THE GRAINS AND SUGARS. I EAT A WHOLE FOOD VEGAN PLANT BASED DIET OF WHOLE GRAINS, BEANS VEGGIES, SOME FRUIT AND SMALL AMOUNTS OF NUTS AND SEEDS INSTEAD OF OILS . THATS IT. YEARS LATER I NOW HAVE NAFLD. MUST BE THE WHOLE GRAINS AND BEANS. I’M REASSESSING MY DIET BELIEFS NOW . MAYBE CUTTING THE GRAINS AND BEANS OUT AND JUST EATING HEALTHY ANIMAL PRODUCTS, NO SUGAR, LOTS OF VEGGIES AND FRUIT WILL REVERSE THE DAMAGE, THEN I WILL KNOW IT WAS THE DIET.

    NEVER HAD FATTY LIVER BEFORE THE WFPBD:(.

    1. Jen…I have the same exact experience as you it seems. I went wfpb…high “healthy” carb, followed Forks over knives exactly. Beforehand, lost nearly 40 lbs on the dash diet…reasonable eating plan. All health markers were excellent. I was at my ideal, goal weight. Then, I decided to do FOK. Sugar cravings and sweet tooth came back from doing their standards raisins in oatmeal and dares in smoothies…even though I just had those foods a few times a week. Felt bloated. Stomach started to distend. Gained all my weight back while thinking this was aheajthy way of living. While on that plan, I was diagnosed with early stages of non alcoholic fatty liver (I do not drink alcohol). Seems to me a diet like dash that emphasizes a small amount of grains, reasonable carbs (50 percent), correct amount of protein and fat is better than one that’s 70 to 80 percent carb and 10/10 protein and fat. At least it was for me! Going back to doing the Dash plan and just healthy eating. None of this fad stuff!

      1. One thing to stress…I was at that healthy weight for a year before trying FOK. Before that, while I was at goal, I did have an ultrasound for a kidney stone that formed. I’m prone to them, no matter how much water I drink! That ultrasound showed perfect liver size, “nothing remarkable”. Fast forward to the time I’ve been doing wfpb w high seemingly good carbs…gained weight, but books said not to width if u gain weight…eat as much oatmeal and bananas every day for breakfast (author stated sometime they have two bowls…which I would occasionally)…you will b healthy on the inside nevertheless. Last month, had another ultrasound for a second kidney stone I developed since last one…and the liver showed up as fatty. So, want to stress it was NOT fatty before going on this fad, high carb diet…

  30. I can’t understand why I have developed non alcoholic fatty liver with elevated alt eating a strict no oil, no sugar, no processed vegan diet. I eat lots of veggies and some quinoa, beans, nuts and seeds, just a small amount and some fruit. How did this happen. Maybe it is the grains and beans after all.So upset. Questioning this whole food plant based diet. My doc wants me off all grains and beans.

    1. Hi Jen: I’m so sorry to hear you’re dealing with this. It’s difficult for us to provide specific individual medical advice, but it’s important to know that there can be a number of causes and risk factors for nonalcoholic fatty liver disease. Some causes are linked to overweight or obesity (particularly in the abdomen), insulin resistance, high blood sugar (indicating prediabetes or type 2 diabetes), and high levels of triglycerides in the blood. Other risk factors can include high cholesterol, metabolic syndrome, polycystic ovary syndrome, sleep apnea, underactive thyroid, and even an underactive pituitary gland. A diet rich in whole grains, beans, fruits, and vegetables is usually used as a treatment for nonalcoholic fatty liver disease – so whole grains and beans should not be an issue if you want to still consume these foods. Making an appointment with a registered dietitian might be helpful. They will be able to review your full medical history and make appropriate food recommendations to help you manage your condition. In the meantime, you can find more information here. Hope this helps!

  31. QUESTION: When Dr. G mentioned in the video that people with under 130 cholesterol “minus HDL” do not get fatty liver does this mean LDL cholesterol levels?

    1. Hi Pusheen: Thanks for your question! Dr. Greger seems to be referring to your “non-HDL cholesterol level”. This number is found by subtracting your HDL cholesterol from your total cholesterol – after this you would be left with a calculation of your “bad” LDL cholesterol and also your triglycerides. Hope this helps!

  32. What about links (if any) between oral contraception and liver tumor? Can you share any reputable research or articles on this topic? Thanks!

  33. Hi I understand that you support a plant-based diet for many reasons (reduction of TMAO, saturated fats, etc), but I was wondering about specifically the impact of white meat on NAFLD.

    Is it really the white meat that is the problem? Is the increase in NAFLD (due to the chicken nuggets) because of the meat or because of the saturated fat and oxidized inflammatory omega-6 oils in the breading around the chicken? My understanding is that chicken nuggets are fried and the breading isn’t too healthy either because it causes an insulin response which in above normal situations triggers fat storage in the liver and else where.

    How much research is there that isolates white meat or animal based protein like whey when looking at NAFLD? It would be good if you could reference them. The reason I ask this is because while, not directly testing NAFLD this study on favorable liver parameters casts doubt on your claim about meat in the context of NAFLD. It says the following:
    “Several plausible mechanisms, including fat, iron, heterocyclic amines, and N-nitroso compounds, link meat intake with chronic liver disease (CLD) and hepatocellular carcinoma (HCC). Few studies have investigated these associations.”…
    “Our results suggest that red meat and saturated fat may be associated with increased CLD and HCC risk, whereas white meat may be associated with reduced risk.” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935477/)

    This implies that your claim that it is meat which you infer from the chicken nuggets should maybe be more specifically about red meat and saturated fat? Any additional information or counterpoints would be helpful as right now I’m not sure if I should cut out meat in general or if I should just cut out red meat and meats high in saturated fat while treating my NAFLD. Thank you.

  34. Hi Nicholas and thanks for your question. Whole food plant based diet is best for treatment of metabolic syndrome and NAFLD. Health=Nutrients/Calories per Dr. Joel Fuhrman which puts plant foods highest on the list. See these attached resources for more discussion on dietary patterns for treatment of NAFLD and why chicken may be detrimental when trying to reverse this problem: https://www.drmcdougall.com/misc/2002nl/jun/theliversaviorfromourabuses.htm
    https://nutritionfacts.org/video/chicken-big-poultry-and-obesity/

    1. Thank you for the links. I looked at the footnotes in the McDougall newsletter and I see that there are maybe two studies that relate to my question about whether chicken protein is detrimental to the process of healing NAFLD. Those are the studies done on people with Hepatic Encephalopathy and people with high amino acid concentrations who have some sort of liver disease. I am having trouble drawing a cause and effect conclusion that animal protein would be detrimental to someone with NAFLD from these studies. I was hoping for something more direct. The McDougall’s newsletter says “The time-honored diet for all liver ailments has been a high-carbohydrate, low-fat, low-protein diet. During my medical school training, more than 30 years ago, I recall prescribing this kind of diet for patients with all kinds of liver illnesses from acute hepatitis to chronic liver failure.” That would indicate that there must be a body of research somewhere that supports this sort of intervention. It leaves also the question of why are they prescribing this sort of intervention. Is it to reduce the toxic bi-products in the blood for someone with advanced liver issues who has no chance of reversing thei NAFLD or is it being prescribed to reverse NAFLD for people who have mild steatosis? If you know of any such studies that support the latter, I would love to hear about them.

      Still let’s try to work with what you have given me and see what other useful information can be learned. Let me try and see if I understand the logic of these two studies. Could you then please tell me what I have right and what I have wrong?

      1.) The newsletter states that “Carbohydrates are the energy sources most easily utilized by the liver; in addition, a high-carbohydrate diet limits the intake of proteins, which can be toxic to the body.” The foot note that supports this statement is “A balanced 5:1 carbohydrate:protein diet: a new method for supplementing protein to patients with chronic liver disease.” ( https://www.ncbi.nlm.nih.gov/pubmed/11197057 ) My understanding is that in cases that have liver disease, plasma amino acid levels would be elevated because the liver is not properly breaking down protein.
      This study is saying that mixing a moderate amount of protein with carbohydrates, rather than just eating high protein did not increase the amount of plasma amino acids meaning the carbohydrates helped the liver break down the protein. Given that logic, the statement “a high-carbohydrate diet limits the intake of proteins, which can be toxic to the body.” Could we say that translates to carbohydrates have a blocking effect which limits the liver from processing the proteins or maybe the carbohydrates help the liver process protein better? I assume large amounts of amino acid concentrations can be toxic which this study indirectly indicates because the point of the study is to treat people with pre-existing liver damage but this study does not directly deal with the statement that doctor is making in his newsletter which is that animal proteins are hard on the liver not that the bi-products of a damaged liver are hard on the rest of the body. So I’m not really able to draw many useful conclusions. Is the elevated plasma amino acid levels a cause of liver disease or is it the result of liver impairment by other causal factors that limit the liver’s ability to break down proteins? Clearly elevated levels are a danger but the study doesn’t demonstrate a causative effect. It also does not help me answer questions about the role of protein in the context of NAFLD which was the question I originally posted.

      2.) He goes on to say that “Vegetable protein is more easily tolerated by a person with impaired liver function.” Which is supported by the following study: “Treatment of chronic portal–systemic encephalopathy with vegetable and animal protein diets. A controlled crossover study.” ( https://www.ncbi.nlm.nih.gov/pubmed/6756833 ) My understanding is that Hepatic encephalopathy is a situation where the bi-products of protein and other nutrients not being correctly processed in the liver result in toxic effects on the brain? If that is the case, this study shows that vegetable based protein is better tolerated in cases with encephalopathy because the liver despite reduced function is still able to break down the protein with less toxic bi-products. While interesting this does not help me draw cause and effect conclusions about whether eating isolated meat based protein has negative effects on developing NAFLD. When someone with mild NAFLD eats meat do these nasty bi-products appear? Do these bi-products advance the state of the disease? Perhaps I am missing some other study referenced in the newsletter that indicates the role of animal protein in developing

      3.) Finally, the chicken video you sent. I am able to draw some cause and effect relationship using your chicken video. The number one intervention one can do if they have NAFLD is to reduce their weight and exit a hypercaloric state. I assume that you are implying by providing a link to this video that since people statistically have had trouble losing weight on chicken they would have a harder time following the prescription to lose weight? Do I have that right?

      Thank you for your response and I hope to hear more from you. I realize what I put forth is rather demanding, so I appreciate any elaborations you could provide.

  35. One of the videos on Tumeric/Curcumin talked about not using Curcumin if you have Non-Alcoholic Fatty Liver Disease. I forgot which one it was. Can someone help me find it? Thanks.

    1. Hi I’m a RN health support volunteer. I’m not aware of any research saying Curcumin is risky to the liver. Are you thinking of Coumarin found in some types of Cinnamon? That is referenced in this video:
      https://nutritionfacts.org/video/the-safer-cinnamon/
      According to this info, curcumin is beneficial for liver health:
      https://nutritionfacts.org/topics/liver-disease/
      Dr. Greger does have a video about who should no consume curcumin, but I don’t believe liver disease is mentioned:
      https://nutritionfacts.org/video/who-shouldnt-consume-curcumin-or-turmeric/

      Thanks.
      NurseKelly

  36. I recently had some blood work done. Everything was normal, except my liver enzyme levels and LDL cholesterol levels.

    AST is 145 and ALT is 111. LDL cholesterol is 135. My doc then tested me for Hep C, which was negative.
    HDL levels were 28, and somehow, my total cholesterol reading was 184, which the printout I got says is within normal range. He didn’t diagnose me with it, or even mention it, but I’m pretty sure these things point to NAFLD.

    How can I significantly reduce the liver enzyme levels, specifically? Is it as simple as avoiding soft drinks and fast food, and eating leafy green vegetables?
    I’ve read good things about watermelon, which has a lot of glutathione, and milk thistle supplements. Should I try those things as well?

    I’m 6’2″ 240, with a BMI of 31.7. I actually began a plant-based lifestyle a week ago, and it’s incredibly difficult to stay disciplined. I feel like I’m going to starve, when I’m eating potatoes, broccoli, arugula, etc.

    Any tips for getting through this ‘transition’ phase successfully?

    1. Hi, Chris! There are many reasons that liver enzymes AST and ALT may be elevated; they include acute hepatitis, exposure to drugs or other toxins to the liver, decreased blood flow to the liver, certain liver diseases and cancers, blocked bile ducts, cirrhosis, and heart or muscle injury. If you have taken statin drugs for your cholesterol those also carry potential risk for liver damage and possible elevated liver enzymes. Of course diet can play a significant role as well.

      A whole food plant-based diet has been shown to be very effective in the promotion of liver health and the prevention and treatment of non-alcoholic fatty liver disease. Avoiding animal fat, cholesterol, added sugar, and excessive calories can help greatly. This translates into focusing on obtaining your calories from nutrient-dense whole plant foods (fruits, vegetables, whole grains, and legumes) and avoiding animal products, processed foods, and anything with added oils and/or sweeteners. Specifically, oatmeal, green tea, cruciferous vegetables, Indian gooseberries, turmeric, whole grains, chlorella, and broccoli are all foods that have been shown to promote liver health. Black beans, cranberries, coffee, and dietary phytates (found in beans, whole grains, nuts, and seeds) are likely especially helpful as well. For more information, I would definitely recommend checking out the liver health topic page: https://nutritionfacts.org/topics/liver-health/.

      Watermelon is great; however I would not recommend milk thistle supplements as they are often contaminated with certain compounds such as mycotoxins which are actually toxic to the liver.

      In addition to promoting liver health, whole food plant-based diets are very supportive of healthy cholesterol levels. If you’re interested in tips for lowering your cholesterol, you may enjoy this article. You may find the topics pages on total cholesterol, LDL cholesterol, and HDL cholesterol helpful as well.

      Incorporating new dietary changes can often come with challenges. Because whole plant foods are highly nutrient-dense (richer in nutrients and lower in calories), you may need to eat a larger quantity of food than you were when you were consuming an omnivorous diet. Fiber, which is naturally abundant in whole plant foods, will help with satiety and feeling fuller longer. Drinking plenty of water is important too! You may find including more whole grains and legumes in your diet to be helpful as well. I would also recommend considering meeting with a registered dietitian, who will be able to provide you with more individualized advice and can help with things such as meal planning.

      Plant-based dietitian Julieanna Hever has a great article on tips for transitioning to a whole food plant-based diet that you may enjoy: http://plantbaseddietitian.com/how-to-make-plant-based-super-simple/

      Best of luck to you!

  37. Can NASH be reversed? I was diagnosed in 2004 with a liver biopsy. I remained obese but started WFPB, low fat 14 weeks ago and am losing weight and my liver enzymes went from the 70’s to the 20’s as well as my lol going from 220 to 110.

    1. Yes, it can, and it sounds like your’e doing it! Great work, stick with it.

      -Dr Anderson, Health Support Volunteer

  38. It depends on the cause of the NASH, but being overweight can be a cause, so eating unprocessed WFPB can reverse NASH. Keep up with good work and watch your calorie density as your calories burned can decrease as you lose weight (it sounds like you’re doing that already with your low fat comment). Lower calorie density foods will help lose weight and keep it off. Don’t forget that simply getting on a scale is not an accurate means of measuring body fat. As you approach your target weight, you may need DEXA or other medical means to determine your body fat %. Also keep in mind that if you lose weight very rapidly that can drive your liver enzyme levels up as well, so don’t fret if they are elevated in a case like this. You can always stabilize your weight for a few months and reassess.

    Dr. Ben

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