The liver is a powerful organ. It filters the blood, helps maintain sugar levels, stores energy and plays an essential role in digestion.
A poor diet, a lack of exercise and other medical conditions can contribute to liver disease and liver cancer, both of which are on the rise globally. It is often possible to prevent liver disease, or even reverse it, through diet and lifestyle changes alone. Here is what helps, and which habits may be doing harm.
The worst habits
Drinking too much alcohol tops the list. Regular alcohol consumption, metabolic dysfunction, or a combination of both, can lead to a condition known as steatotic liver disease, in which fat accumulates in the liver and can cause inflammation, scarring and cirrhosis, according to Dr Zobair Younossi, chair of the Global Center for Liver Outcomes and Policy Research at Georgetown University School of Medicine. In people with metabolic issues such as type 2 diabetes, high blood pressure or excess abdominal fat, even modest alcohol consumption can compound liver damage, Younossi said, with binge drinking, defined as five or more drinks on one occasion, the most harmful pattern. For people with advanced liver disease, doctors recommend avoiding alcohol altogether. With milder or no disease, up to one drink a day may be acceptable, though Dr Mary Rinella, director of metabolic and fatty liver disease at the University of Chicago, said none is better still.
Overdoing it on sugar is another major risk factor. Sugar acts as a building block for fat formation in the liver, and too much of it stresses liver cells as "the machinery gets overwhelmed," Rinella said. Insulin resistance, which can develop with chronic overconsumption of sugar, also contributes to fat buildup in the liver. Shira Zelber-Sagi, a clinical dietitian and epidemiologist at the University of Haifa in Israel, said there is a wealth of evidence linking high sugar intake, particularly from sugary drinks, to metabolic dysfunction-associated steatotic liver disease, or MASLD. Added sugars such as high-fructose corn syrup, common in many ultra-processed foods and sodas, are especially damaging to the liver. Guidelines recommend women consume no more than 25 grams and men no more than 36 grams of added sugar daily. Zelber-Sagi tells patients they can have the occasional slice of cake, but should avoid sugar-sweetened drinks altogether, since these create habits that are simply unnecessary.
Relying on supplements is a third common pitfall. Dawn Anderson, a clinical dietitian at Virginia Commonwealth University, said patients often ask her about liver cleanses, detoxes and supplements such as milk thistle and mushroom coffee. Experts say there is little evidence that these unregulated products offer any liver benefit. "Your liver is already your body's detoxification system," Anderson said, adding that it does not need a cleanse, and that such products may even cause harm if they contain unknown ingredients or excessive quantities of certain compounds.
The best habits
Exercising and maintaining a healthy weight can meaningfully reduce fat buildup, inflammation and scarring in the liver. A weight reduction of just 3% can improve liver health markers, though 10% or more is needed to reverse scarring. GLP-1 drugs such as Wegovy, approved to treat an advanced type of MASLD, have proven to be what Zelber-Sagi called "a game changer." However, they need to be combined with exercise, particularly strength training, since muscle loss can worsen outcomes in people with the condition. At least 150 minutes of aerobic activity a week, along with strength training twice a week, helps reduce abdominal fat and insulin resistance, Zelber-Sagi said.
Aiming for a Mediterranean-style diet, built around fresh fruit, vegetables, fish and legumes and rich in healthy fats, has been shown to reduce the risk of cardiovascular disease, a leading cause of death among people with non-alcoholic liver disease. The diet is low in the saturated fats found in red meat, dairy and palm oil, which can raise fat levels in the liver. Experts acknowledge it is not always practical to follow strictly. Anderson said many of her patients follow a traditional Southern American diet but can still incorporate Mediterranean elements, drawing on vegetables such as collard greens, cabbage, courgette, cucumber and onion. For protein, she suggests fish or white meat over fatty cuts of red meat, grilling rather than frying, and using butter sparingly, for flavour rather than as a cooking fat. Coffee, up to four cups a day, has also been shown in animal studies to reduce fat and scar formation in the liver, and is associated in humans with a lower risk of cirrhosis, Rinella said.
Staying up to date with primary care matters too. Hepatitis B and hepatitis C remain significant drivers of liver disease worldwide, and both are treatable. The US Centers for Disease Control and Prevention recommends that all adults be screened at least once for both conditions, and that those not vaccinated against hepatitis B as babies receive the vaccine, according to Rinella. Primary care doctors can carry out these screenings and can estimate liver disease risk using routine lab results. People with type 2 diabetes should ask their doctor about liver stiffness testing, which can detect progressing liver disease.
Source: The New York Times
