When people come to see me after being told they have metabolic dysfunction-associated steatotic liver disease (fatty liver) alongside type 2 diabetes, they are often overwhelmed. It can feel like you are suddenly expected to look after two organs at once while sorting through confusing advice about carbohydrates, fats and weight. What many people find reassuring is that the two conditions share a common thread, insulin resistance, and the food choices that support one tend to overlap with the other.
The Insulin Resistance Link
Insulin acts like a key, helping your cells take up glucose from the blood. In insulin resistance, the body needs to make more insulin to do the same job, and high insulin levels may encourage the liver to store more energy as fat. Over time, that fat can build up in liver cells. This is a simplified picture, but it explains why the same eating patterns are often recommended for both conditions.
I work alongside your doctor, who looks after your medication and liver and blood monitoring, so changes to your medication stay with them while I help with the everyday food choices that sit around it.
Carbohydrates: Quality Over Cutting Out
Many people assume they need to eliminate carbohydrates entirely. That is rarely necessary or sustainable. Instead, focus on the quality of your carbohydrates. Refined options like white bread, sugary snacks and sweetened drinks digest very quickly. Swapping some for higher-fibre carbohydrates, such as wholegrains, pulses and legumes, is a sensible step. Research suggests that eating more fibre is associated with better metabolic health.
In my 1-to-1 work, I often guide clients through simple tweaks like these. If you would like some context on how food and type 2 diabetes interact, my article on type 2 diabetes and remission may be helpful.
Fats: Quality Matters
It is a common myth that eating fat directly causes fatty liver. In reality, the type of fat matters. Diets high in saturated fat, found in processed meats, butter and fried foods, are associated with higher liver fat. Unsaturated fats, such as olive oil, avocado, walnuts, chia seeds and oily fish, are part of a Mediterranean-style pattern that is widely recommended for heart and metabolic health.
If you are also thinking about cholesterol, you can read my guide on diet priorities for diabetes and cholesterol for ideas on structuring fats.
Practical Food Changes
Small, consistent changes tend to last longer than big, restrictive ones:
- Fill much of your plate with non-starchy vegetables such as leafy greens, broccoli, peppers and cauliflower.
- Include a protein source at meals, such as lentils, beans, tofu, poultry or fish, which help you feel satisfied.
- Swap refined grains for wholegrains such as oats, quinoa, brown rice or lower-GI flours. See my guide on low-GI rice swaps for diabetes.
- Replace sugary drinks and fruit juices with water, herbal teas or sparkling water with lemon.
- Have fewer processed foods high in added sugar and hidden saturated fat, choosing more whole, minimally processed ingredients.
Alcohol and Your Liver
Alcohol is processed by the liver, so it is worth being honest about how much you drink when you are looking after a fatty liver. The UK Chief Medical Officers' low-risk drinking guideline is to keep to no more than 14 units a week, spread over three or more days, with some alcohol-free days. A unit is smaller than most people expect: a standard glass of wine is around two to three units. A drink diary for a couple of weeks can show you where you really are, without judgement.
A Day of Meals Using UK Supermarket Foods
Here is how these ideas can look using foods you can find in any UK supermarket. Treat it as a template, not a prescription.
- Breakfast: porridge oats made with semi-skimmed milk or unsweetened soya drink, with frozen berries and a few walnuts.
- Lunch: a bowl of lentil or bean soup (tinned pulses are a good shortcut) with a slice of seeded wholemeal bread and a side salad.
- Dinner: grilled mackerel or salmon with new potatoes in their skins and a large portion of green vegetables, or a chickpea and spinach curry with a small portion of brown basmati rice.
- Snacks: a piece of fruit, unsalted nuts or plain yoghurt.
The NHS advises eating at least two portions of fish a week, including one of oily fish such as mackerel, sardines or salmon, which fits well with this pattern. For a longer shopping list, see my type 2 diabetes food list, and for everyday habits around blood sugar, my guide to steadier energy.
Reading UK Labels for Sugar and Saturated Fat
The red, amber and green labels on the front of many UK packs are a quick way to compare similar foods. Per 100g, green means 5g or less of sugars and 1.5g or less of saturated fat, while red means more than 22.5g of sugars or more than 5g of saturated fat. Aim for more green and amber foods in your regular shop and keep red ones occasional. For fibre, look at the nutrition table on the back: 3g or more per 100g can be called a source of fibre and 6g or more high fibre. These are not strict rules, but they make shopping decisions quicker.
Gradual, Steady Habits
Carrying extra weight around the abdomen is associated with liver fat, and for some people a gradual, steady change in weight is part of the picture. Rapid crash diets and extreme cleanses are best avoided, as they are hard to sustain and can leave you feeling worse. A steady approach based on balanced, nourishing whole foods is usually kinder and easier to keep up. You can read more about this in my guide to weight loss.
Eating Well for Your Liver and Blood Sugar
In my online consultation service, I work with clients across the UK to turn these ideas into food plans that fit their daily lives without extreme sacrifices. If you would like help finding what suits you, as a diabetes nutritionist I can look at your usual meals with you. Explore my online consultation and nutrition services, or reach out through my contact page to book.
