kris ulland

Your Nutrition Partner

Nonalcoholic fatty liver disease affects about one in five Americans. There is no treatment, and over time fatty liver disease can destroy your liver. The good news is you can reverse fatty liver disease with easy lifestyle changes.

Fatty liver disease is just what it sounds like, the buildup of fat inside your liver cells. Fatty liver disease can be caused by alcohol abuse, especially binge drinking. If alcohol is the main cause, it is called alcoholic fatty liver disease.

More commonly, fatty liver is caused by metabolic syndrome, in which case it is called nonalcoholic fatty liver disease, or NAFLD.

Metabolic syndrome is a combination of conditions that include belly fat, high blood pressure, high blood sugar, high levels of a blood fat called triglyceride, and low levels of healthy cholesterol called HDL cholesterol. Metabolic syndrome is increasing in America, so it is not surprising that nonalcoholic fatty liver disease is also increasing. In addition to fatty liver, metabolic syndrome increases your risk for heart disease, stroke, and diabetes.

People with metabolic syndrome tend to be overweight and about 80 percent of people that are severely overweight have nonalcoholic fatty liver disease. You may be at higher risk for metabolic syndrome and nonalcoholic fatty liver disease if you have these risk factors:

  • Older age
  • African American or Mexican ethnicity
  • Obesity
  • A family history of diabetes
  • Smoking
  • Drinking alcohol
  • High-fat diet
  • Inactive lifestyle

The buildup of fat in your liver is just the first stage of fatty liver disease. This stage can last for many years and it can be revered with lifestyle changes.

In about 10 to 20 percent of fatty liver disease, the liver cells become further damaged by inflammation. At this stage the disease is called nonalcoholic associated steatohepatitis or NASH. Steatohepatitis means fatty inflammation. NASH may still be reversible with lifestyle changes but if these changes are not made, the inflammation can lead to scarring of the liver, called cirrhosis. Cirrhosis is not reversible and will lead to liver failure.

Nonalcoholic fatty liver disease has been called silent liver disease because it does not cause symptoms. If fatty liver disease becomes NASH you may start to have symptoms of liver damage. These can include:

  • Yellowing of the skin and eyes
  • Dark urine
  • Loss of appetite, nausea, and weight loss
  • Broken blood vessels beneath the skin
  • Itching
  • Fatigue and weakness

Because nonalcoholic fatty liver disease has no symptoms or warning signs, the diagnosis is usually suspected when routine blood tests of liver function show changes, or an imaging study of the liver done for another reason shows fat.

If you have metabolic syndrome, your doctor may order more blood tests or an imaging study using sound waves (ultrasound) but the surest way to diagnose fatty liver disease is with a liver biopsy.

There is no treatment needed or available for nonalcoholic fatty liver disease other than lifestyle changes. Some medications are being studied for NASH, but none have been approved and there is no cure for NASH. The best treatment for NASH is also lifestyle changes. These include:

  • Losing weight
  • Getting daily exercise
  • Avoiding alcohol
  • Eating a healthy diet to lose weight and increase your HDL cholesterol

Other treatments may be done for metabolic syndrome. These may include taking medication to lower your triglycerides, blood pressure, and blood sugar if needed. The best diet for fatty liver is a Mediterranean diet with more fruits and vegetables, whole grains, nuts, lean meats, olive oil, and less red meat, salt, and sugar. Even better is a vegan diet!

The liver is a multitasker. It is a filter system. It helps your body get rid of toxins while also harvesting nutrients from the foods you eat.

When it comes to liver health, not all foods are created equal. This is especially true if you have a condition like cirrhosis or hepatitis C, which can make it difficult for your liver to filter nutrients and waste as it should.

Eating liver-friendly foods can help lessen the damage caused by liver disease. Remember, before making any big changes to your diet, check with your doctor or a registered dietitian.

Avocados are technically a part of the berry family and offer many health benefits, including improved liver health. Research from 2015 showed that avocado may help lower blood lipids, or fats, and help prevent liver damage. People who eat avocados are more likely to have a lower body mass index (BMI) and waist circumference. According to a 2013 study, they may also have higher levels of HDL cholesterol. Some of these effects are related to the high fiber, healthy fats, and water content of avocados. A 2014 study in rats suggests that avocado oil may help the liver heal from damage.

Coffee may play a critical role to your health. When it comes to your liver health, some studies suggest that coffee reduces the risk of cirrhosis, cancer, and fibrosis in the liver. Regular, moderate amounts may even help slow the course of current liver diseases. Research from 2021 indicates that drinking coffee could reduce your risk of developing liver disease or fatty liver disease by around 20 percent. In the same study, drinking coffee lowered the risk of death from liver disease by 49 percent. All types of coffee — decaf, instant, and ground — had similar effects.

The key to such benefits is to drink coffee daily. For your overall health, it’s best to avoid adding sugars and artificial creamers. Instead, try swapping in non-dairy alternatives like unsweetened soy milk, almond milk, and  cinnamon, or cocoa powder. Because coffee usually contains caffeine, the Food and Drug Administration (FDA) recommends a maximum of four to five 8-ounce cups per day, though the safe amount can differ from person to person. (This seems like A LOT. Yay attention to how much you can handle.)

Olive oil has been found to improve heart health. A large 2020 study suggests that eating more than half a tablespoon of olive oil every day could lower your risk of cardiovascular disease by 14 percent.

A number of small studies suggest that olive oil can help reduce liver enzymes and liver fat that contribute to disease. Olive oil may also increase the amount of HDL cholesterol in the blood.

Nuts, when consumed in small amounts, are nutrient-dense snacks that are also high in healthy fats. Aside from boosting cardiovascular health, nuts may also help reduce the incidence of liver disease. Of all types of nuts, walnuts are among the most beneficial for reducing fatty liver disease. This is thanks to their higher antioxidant and fatty acid content. Walnuts have the most omega-6 and omega-3 fatty acids, as well as polyphenol antioxidants.

In a 2021 study, participants were provided 28 grams of walnuts every day as part of a Mediterranean diet. People who ate walnuts at least 5 or 6 times a week had significantly greater liver (intrahepatic) fat loss than those who ate walnuts less often. This fat loss was associated with overall anti-inflammatory and metabolic health benefits.

Complex carbohydrates are better than simple carbs because they’re metabolized slower and prevent wide fluctuations in blood sugar. This is why it’s best for people with NAFLD to choose complex carbs over simple carbs, as the National Institute of Diabetes and Digestive and Kidney Diseases  advises.

Nonrefined carbs also have essential nutrients like zinc, B vitamins, and higher fiber levels, which are all important for a healthy liver and metabolism. The key is selecting whole grain carbs, such as: wild and brown rice, millet, corn, buckwheat, amaranth, quinoa, teff and sorghum.

There are liver conditions may require a more specialized diet. In some cases, people with advanced liver disease may not be able to absorb the fats they eat and may have to limit oils. Some people might have to avoid iron or salt.

Contact your doctor if you lose a lot of weight in a short amount of time despite eating liver-friendly foods. This could mean that your liver isn’t processing nutrients effectively.

Lucuma Powder

Lucuma powder is a dried, milled version of lucuma fruit. Cultivated in the Andean region of South America, the fresh fruit is a nutritional powerhouse and commonly used in the foods of Chile, Ecuador, and Peru. The light brown powder is an alternative sweetener. Touted as a “superfood” and can be added as-is to beverages, smoothies, desserts, and soups.

It has a hard, green outer shell and soft, yellow flesh with a dry texture and sweet flavor that’s often likened to a mix of sweet potato and butterscotch.  The fruit is about three inches long with an oval, curved shape similar to an egg, which also gave it its English name, eggfruit. The flesh is yellow to orange depending on the variety, and as it matures, the flesh becomes softer. The pulp of lucuma is orange with a distinctive, sweet aroma reminiscent of maple syrup. Only the flesh is eaten, the skin and large seeds are discarded.

Nicknamed the “gold of the Incas,” lucuma has been used as a traditional remedy in South America for centuries. It is often paired with fruits such as bananas, lemon, pineapple, strawberries, and blueberries, as well as chocolate, caramel, dulce de leche, cinnamon, vanilla, as well as almonds, cashews, macadamia nuts, and peanuts.

The stevia herb is one of the best-known alternative sweeteners, available in liquid and powder forms. Unlike lucuma powder, stevia has no glycemic impact and is free from calories and carbohydrates. Stevia’s taste can be off-putting to some because, while it is sweet, some stevia leaves a bitter or metallic aftertaste. Lucuma powder generally doesn’t have that bitterness.

Lucuma can be eaten raw but is most commonly found in a dried, powdered supplement form that’s often used as a natural sweetener.

One tablespoon of lucuma powder provides:

  • Calories: 30
  • Protein: 0 grams
  • Fat: 0 grams
  • Carbs: 6 grams
  • Sugars: 1.5 grams
  • Fiber: 2 grams

Lucuma contains less sugar but more nutrients than table sugar. More specifically, it has about half the carbs and 75% less sugar than the same amount of table sugar. One tablespoon of lucuma powder also provides some calcium, iron, potassium, niacin, and vitamin C  – though these amounts generally cover less than 1% of the Daily Value (DV). Still, it’s more nutritious than other popular sweeteners.

Lucuma powder also offers a good amount of both soluble and insoluble fiber. Insoluble fiber adds bulk to your stool and prevents constipation by helping food move smoothly through your gut . Soluble fiber feeds your beneficial gut bacteria, which, in turn, produce short-chain fatty acids (SCFAs) like acetate, propionate, and butyrate. These are then used as food by cells in your gut, keeping them healthy. These short-chain fats also protect against inflammation and improve symptoms of gut disorders, including irritable bowel syndrome (IBS), Crohn’s disease, and ulcerative colitis.

Lucuma contains a variety of antioxidants, which are powerful compounds that help protect your cells from damage caused by highly reactive molecules called free radicals. Research shows that lucuma is particularly rich in polyphenols and carotenoids, two groups of antioxidants known for their anti-inflammatory, cancer-fighting, and heart-health-promoting properties. It’s especially high in xanthophylls, a group of carotenoids responsible for lucuma’s yellow color that’s thought to promote eye health and good vision.

Despite being rich in carbs, lucuma may offer some protection against type 2 diabetes. In part, this may be because most of its carbs are complex. Carbs can be split into three categories:

  • Sugars. These are short-chain types of carbs found in many foods. Examples include glucose, fructose, and lactose. They’re quickly digested and can lead to
    spikes in your blood sugar levels.
  • Starches. These are longer chains of sugars that get broken down into sugars in your gut. They take longer to digest and are less likely to spike blood sugar
    levels drastically.
  • Fiber. This is a type of nondigestible carb that’s broken down and used as food by beneficial gut bacteria. It helps maintain stable blood sugar levels.

Sugars are considered simple carbs, while starches and fiber are thought of as complex. Complex carbs, such as the starches and fiber making up most of the carbs in lucuma, have been shown to promote healthy blood sugar levels.

The soluble fiber in lucuma may protect against diabetes by improving insulin sensitivity and preventing blood sugar spikes after a meal or snack. Test-tube research shows that the blood-sugar-lowering mechanisms of lucuma may be comparable to those of certain anti-diabetic drugs. It prevents the action of the alpha-glucosidase enzyme, which is responsible for breaking down complex carbs into simple sugars that tend to spike blood sugar levels.

Lucuma has a low glycemic index (GI), which means that it would raise blood sugar levels to a much lower extent than other sweeteners like pure sugar.

How to Buy

Lucuma can be found in fresh, frozen, or in pulp form in Latin grocery stores. The peak season of lucuma is in the summer but it is available year-round. If you can’t find frozen lucuma pulp, you might find lucuma powder at your local grocery store.

The powder is readily available online, and many natural and health food stores carry it. Generally sold in 1/2-pound or 1-pound bags. The powder is made by dehydrating the fruit, then milling it into a fine powder, a process designed to retain the fruit’s high nutritional value. It can be used right out of the package and stirred into food and drinks.

How to Store

Lucuma powder does not require refrigeration. After opening, keep unused product sealed in a zip-top storage bag or airtight container in a cool, dry, dark place. Many brands include an expiration date on the package. Most lucuma powder has a shelf-life of two to three years when stored at or below room temperature.

How to Cook

Lucuma powder can be used as a substitute for sugar in pies, cakes, and other desserts or baked goods. Lucuma’s texture is comparable to granulated sugar, but its taste is more similar to that of brown sugar.

You can use a 1:2 ratio by volume to substitute brown sugar for lucuma. For instance, use 1 cup of lucuma for each 1/2 cup of brown sugar.

Many people use lucuma powder as a sweetener in beverages, and it’s a common sweetener in commercial nut milks. It’s also used to sweeten smoothies – add two tablespoons to green or fruit smoothie recipes. It also works well in hot drinks, such as coffee, tea, and hot chocolate. Use it to top yogurt or cereal, or add to overnight oatmeal or chia pudding.

Lucuma powder doesn’t hold water like sugar. For some recipes, add more of a liquid ingredient (1 tablespoon at a time) if the batter seems dry until it reaches the desired consistency.

Cinnamon and Date Chia Pudding

Stephanie Kirkos/ Photo credit: The Spruce / Diana Chistruga

2 Servings

Ingredients

  • 1/4 cup chia seeds
  • 1 1/2 cups almond milk
  • 1 1/2 – 2 tablespoons lucuma powder
  • 1 teaspoon vanilla bean paste, or 1 teaspoon pure vanilla extract
  • 1/2 teaspoon ground cinnamon
  • 6 Medjool dates, pitted and quartered
  • Berries, optional garnish
  • Chopped walnuts, for optional garnish

Instructions

  • Place all ingredients except dates in a mixing bowl. Whisk together until well combined.
  • Stir the quartered dates into the chia seed mixture until just combined.
  • Cover and chill overnight, or at least 4 hours. Stir once or twice to loosen any seeds that may have clumped together.
  • Divide chia pudding into two bowls. Top with sliced strawberries, blueberries, and a handful of nuts.

Resources

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