Mediterranean Diet for Fatty Liver: How It Helps & Foods to Focus On

Nonalcoholic fatty liver disease (NAFLD) is one of the most common liver conditions in the United States, affecting around 1 in 4 adults. It occurs when excess fat accumulation is noted in your liver. People with fatty liver disease tend to have only a few or no symptoms at all.

While researchers are still uncovering the potential causes, some factors like obesity, insulin resistance, or metabolic syndrome, certain lifestyle factors, and even genetics are known to play a role in the development of this condition. NAFLD should not be confused with alcoholic fatty liver disease. Alcohol-related liver disease is specifically associated with long-term excessive alcohol consumption.

If left unmanaged, nonalcoholic fatty liver disease can progress to more serious conditions, including chronic inflammation, liver fibrosis (scarring), or long-term liver damage. This is why early intervention is key.

While weight loss remains one of the central strategies in most cases for managing the condition, as a nutritionist, I’m often asked which diet may support liver health to some extent. Even though there is no one-size-fits-all answer and a perfect healthy-liver diet does not exist, the Mediterranean diet (Med diet) is often mentioned for its focus on whole foods and antioxidant-rich ingredients.

In this article, I’ll break down what the Med diet is, why it’s often linked with nonalcoholic fatty liver disease management, what the science says about its potential effectiveness, and how you could incorporate dietary principles in everyday life to support overall health.

How the Mediterranean diet impacts fatty liver

While this diet is one of the most researched eating patterns, it’s important to approach any claimed benefits with realistic expectations. As a nutritionist, I always remind people that no diet can ‘cure’ NAFLD. This condition is complex and affected by many factors, including genetics, lifestyle, and overall health.

However, this diet seems to show quite promising results in terms of liver health support for some people. There are many proposed mechanisms by which the Med diet may benefit liver health, including the management of triglycerides (the type of blood lipids), lowering the overall fatty liver index, and even playing a role in supporting insulin sensitivity. Now, let’s look at what the research has to say about the Med diet’s potential in the management of fatty liver disease.

What does the research say?

One meta-analysis analyzed 10 randomized controlled trials involving individuals with liver disease. The study revealed that the Med diet may provide desirable effects on NAFLD by reducing triglyceride levels and liver stiffness. Although the diet was noted to show a tendency to improve liver enzyme profile, such as serum alanine aminotransferase and total lipid (fat) profile, the authors conclude that such results were not significant.

Another meta-analysis, which included six randomized controlled trials with 250 participants with liver disease who followed the Med diet ranging from six weeks to six months, highlighted that following this dietary pattern helped to lower the fatty liver index compared to the control group and supported improvements in insulin sensitivity.

Finally, a meta-analysis focusing on the comparison of low-fat and Med diets noted that both of these dietary patterns may provide similar results. This gives us valuable insights that not a specific dietary pattern may play a role in the management of NAFLD, but food choices, a balanced diet, and overall dietary quality may matter most in managing this condition.

While the proposed results seem promising at first glance, most of the studies included in these meta-analyses used different definitions of the Med diet, included relatively small sample sizes, and had a relatively short duration of the intervention.

With that being said, more long-term studies are needed to understand whether the Med diet could be implemented for all individuals with NAFLD to support overall liver health long-term.

Key foods to include in your Mediterranean diet

The Med diet offers a variety of nutritious foods with the key principles of increasing monounsaturated fats while limiting saturated fat intake, including adequate intake of dietary fiber sources and focusing on whole foods.

This dietary principle encourages you to:

• Focus on whole grains and legumes. Include brown rice, beans, lentils, chickpeas, quinoa, and oats throughout the daily meals.
• Incorporate vegetables with every meal. Vegetables such as raw spinach, tomatoes, zucchini, eggplant, bell peppers, broccoli, and other fresh, seasonal vegetables could be easily added to salads, side dishes, and stews.
• Have 2–3 servings of fruits, nuts, and seeds daily. Almonds, walnuts, chia seeds, sunflower seeds, nut butter, apples, oranges, grapes, berries, and pomegranates are just some examples you could use sprinkling on top of the meal, preparing dressings, or enjoying as a healthy snack.
• Emphasize healthy fats. Include olive oil, the primary fat source in this diet, avocados, nuts, and seeds. Drizzle some oil alongside balsamic vinegar over the salad, and experiment with herbs and spices to make a delicious dressing.
• Include some dairy products. Unsweetened yogurt, milk, and cheese may be incorporated into daily meals and used alongside fruits, vegetables, nuts, and seeds for balanced breakfast options.
• Prioritize fatty fish and seafood. Include salmon, sardines, mackerel, trout, tuna, or shrimp with various legumes or whole grain options.
• Add some lean protein in moderation. Poultry like chicken or turkey can occasionally be used as an alternative to red meat in meals.

How might specific foods impact the liver?

While there are no specific ‘liver healthy’ foods, certain foods recommended in the Med diet, such as grains, legumes, vegetables, fruits, nuts, and seeds, are widely recognized as beneficial for overall health due to their nutrient composition.

Even if the specific dietary pattern is not something you want to adapt fully, incorporating these foods into the daily diet may support not only general well-being but may also add some support for liver health.

Vegetables and grains provide a good amount of dietary fiber, which may help support blood sugar regulation and liver function. This could potentially contribute to the management of fat buildup associated with fatty liver disease.

Various fruits and vegetables are rich in vitamin C and other antioxidant compounds, which may reduce the risk of high blood pressure. Abnormal blood pressure levels are one of the proposed factors associated with an increased risk of NAFLD.

Finally, sunflower seeds, almonds, and other nuts tend to have higher vitamin E content and a beneficial profile of unsaturated fats. Adequate vitamin E and unsaturated fat intake are linked to a positive impact on the biochemical characteristics of individuals with this condition and a decreased risk of further NAFLD development.

Additionally, fish rich in omega-3 fatty acids, like salmon, mackerel, or sardines, may reduce liver fat by supporting overall improvements in lipid profiles.

Foods to limit or avoid

Like in most chronic condition management, certain foods are generally not recommended to be included in the dietary routine in order to support overall health. Med diet principles also support the limitation of such foods. These foods include:

Refined carbohydrates

People with higher-than-normal blood glucose levels or a diagnosis of type 2 diabetes are associated with a higher risk of NAFLD occurrence.

Simple carbohydrates like those found in white bread, white rice, pasta made from refined flour, and many breakfast cereals tend to have a higher glycemic index and lack dietary fiber, which may increase the instances of blood sugar spikes.

Red and processed meats

These types of foods tend to be higher in saturated fats and salt content. For people with NAFLD, it is recommended to limit their daily saturated fat intake, which can be done by minimizing foods like hot dogs, bacon, or ham in the daily diet.

Moreover, some early studies suggest that high salt intake may also contribute to the prevalence of fatty liver disease and liver function disturbances, especially in people with type 2 diabetes.

Fast and fried foods

Similarly, these foods tend to be higher in salt and saturated fat content, both of which are less desirable in the diet for people with NAFLD.

Try limiting foods such as french fries, deep-fried chicken, burgers, and pizza, to name a few, in order to minimize the intake of undesirable fats and salt in the diet.

Other foods and drinks

Overall, current dietary suggestions for people with NAFLD or increased risk of developing this condition strongly advise limiting processed foods like baked goods, sugary drinks (including fruit juices from concentrates), candies, flavored yogurts, and similar foods.

These foods tend to have higher added sugar content, which may contribute further to blood sugar imbalances. Excess sugar, especially fructose, is linked to increased fat buildup in the liver.

Implementing the Mediterranean diet for fatty liver

As a nutritionist, I often advise individuals that diet is not about perfection but consistency and quality. To adapt Med diet principles into your dietary routine, start with simple steps that feel realistic and appropriate for your case. Some of the practices include:

• Start by embracing core principles. Focus on plant-based foods, include fatty fish regularly, and reduce your intake of heavily modified convenience foods.
• Make simple and practical swaps. Choose unrefined grains instead of simple carbohydrates. For snacks, opt for nuts, seeds, or fresh fruits instead of ultra-processed foods.
• Adapt the diet to personal and cultural preferences. Any diet, especially this particular one, can be flexible and inclusive of your local staples. Remember to experiment with recipes, spices, and herbs to find what works best for you. For example, if you wish to test a diet with more greens, you could look into the green Mediterranean diet.

My experience shows that small, sustainable changes often lead to the most meaningful results for overall health.

Beyond the diet: complementary strategies

While following a healthy and balanced dietary pattern is a strong foundation for overall health maintenance, additional lifestyle habits and other factors should usually work hand-in-hand with your nutrition goals. Some of those factors include:

• Regular physical activity. To support your metabolic health, try to include as many physical activity practices as possible in your case, including walking, swimming, and strength exercises.
• Managing stress levels. Relaxation techniques, quality sleep, and mindful practices can play a role in maintaining overall health and liver function.
• Maintaining body weight. Aiming for gradual, sustainable weight loss, if needed, can meaningfully contribute to liver health.
• Limiting or avoiding alcohol intake. Eliminating undesirable habits can further support overall well-being and protect liver health.

When to seek professional guidance

If you’ve been diagnosed with NAFLD or suspect any potential liver issues, it’s important not to self-manage your condition without support. Liver damage can progress silently, and early dietary interventions may help reduce the risk of complications.

Consulting a registered dietitian or healthcare provider ensures you receive tailored dietary treatment that considers your individual health status, lifestyle, and potential presence of other liver diseases. A professional can help you make sustainable changes, monitor your progress, and ensure your diet supports both liver function and overall well-being.

Final thoughts

Managing fatty liver disease is not about a strict or restrictive diet — it’s about making informed, sustainable changes that support your long-term health. While the Med diet shows some promising results, it’s only a part of the bigger picture. Remember, there is no one-size-fits-all solution to support liver and overall health; thus, seeking professional guidance can ensure that your dietary approach is realistic and adapted to your individual needs.