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New research has established a link between the food we eat and the development of chronic liver disease. Dr Tanujaa Rajasekaran explains more.

Liver disease is a global health epidemic that afflicts millions of people worldwide, with more than 2 million deaths caused by chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC), the most common type of primary liver cancer¹.

There are many types of liver disease, which can be caused by infections, obesity and misuse of alcohol. Over time, liver disease may lead to scarring and more serious complications. Early diagnosis and treatment can help heal the damage and prevent liver failure.

The incidence of chronic liver disease is increasing in developed countries. The most common cause of chronic liver disease is a fatty liver. Fatty liver disease is caused by having too much fat build-up in your liver. A healthy liver contains a small amount of fat. It becomes a problem when fat reaches 5% to 10% of your liver’s weight.

In most cases, fatty liver disease does not cause any serious problems or prevent your liver from functioning normally. But in about 30% of people with the condition, fatty liver disease gets worse over time. Fatty liver can cause liver inflammation (swelling) which damages the liver tissue. Scar tissue forms where your liver is damaged. This process is called fibrosis. Extensive scarring of the liver can lead to liver cirrhosis (hardening of the liver).

Cirrhosis of the liver is a result of severe damage to the liver. The hard scar tissue that replaces healthy liver tissue slows down the liver’s functioning. Eventually, it can block liver function entirely. Cirrhosis can lead to liver failure and liver cancer.

Eating excess calories can cause fat to build up in the liver. Fortunately, you can reduce your risk of developing fatty liver, chronic liver disease and liver cancer by leading a healthy lifestyle and making informed diet choices.

What to eat

A Mediterranean Diet is recommended for a healthy liver. The Mediterranean Diet is a way of eating that emphasises plant-based foods and healthy fats.

In general, if you follow a Mediterranean Diet, you will eat:

• Lots of vegetables, fruit, beans, lentils and nuts
• Lots of whole grains, like whole-wheat bread and brown rice¹
• Plenty of extra virgin olive oil as a source of healthy fat
• A moderate amount of fish, especially fish rich in Omega-3 fatty acids
• A moderate amount of cheese and yogurt

Compounds known as antioxidants can help protect liver cells from damage. Antioxidants can be found in coffee, green tea, raw garlic and foods containing vitamin E (e.g. sunflower seeds, almonds).

What to avoid

If you eat a lot of red meat and processed meat, it is recommended that you cut down as some meats contain high levels of cholesterol and saturated fats that contribute to increased fat intake and fat build-up in the liver.

There is also a strong relation between red meat and processed meat consumption with a high risk of obesity and diabetes — which are known cancer risk factors — as well as gastrointestinal diseases including liver disease.

You do not have to completely avoid eating red meat as it can be a valuable source of nutrients — in particular, protein, iron, zinc and vitamin B12. If you eat red meat, limit consumption to no more than about three portions per week (equivalent to 350 – 500 g of cooked weight²). Choose lean cuts over fatty cuts. Consume very little, if any, processed meat.

The human body handles glucose and fructose — the most abundant sugars in our diet — in different ways. Virtually every cell in the body can break down glucose for energy. About the only ones that can handle fructose are liver cells. When there is excess fructose in the diet, the liver stores it as fats. Thus, it is one more reason to limit foods with added sugars, such as sugary drinks, pastries, and candy.

Exercise

150 minutes of moderate to intense aerobic activity per week is recommended for a healthy liver.

Aerobic exercise can actually cut the amount of fat in your liver. Resistance or strength training exercises, like weight lifting, can reduce fat in the liver. Aim for 30 to 60 minutes or more of mid-to high-level aerobic exercises at least 5 days a week and mid-to high-level strength training exercises 3 days a week.

Conclusion

As liver disease continues to afflict millions worldwide, it is an urgent matter that requires immediate attention and prevention. There is clear evidence demonstrating the negative impact of an unhealthy lifestyle on overall health, and its impact on the growing epidemic of chronic liver disease.

Dietary factors play an important role in reducing risk of liver disease. In particular, consumption of a Mediterranean Diet and incorporating exercise into our busy schedules, can go a long way in tackling this global health epidemic.

¹Lin L et. al. “The Burden and Trends of Primary Liver Cancer Caused by Specific Etiologies from 1990 to 2017 at the Global, Regional, National, Age, and Sex Level Results from the Global Burden of Disease Study 2017”. Liver Cancer 2020 . 9:563 – 582.
²World Cancer Research Fund International, 2023