Jennifer Lai, MD, on Counseling Patients About Liver-Healthy Nutrition

As the global burden of fatty liver disease continues to rise, clinicians are increasingly turning to nutrition-based interventions as frontline management. In this final installment of our liver health series in partnership with the Global Liver Institute (GLI), Jennifer Lai, MD, transplant hepatologist and Physician Nutrition Specialist at the University of California, San Francisco (UCSF), shares evidence-based strategies clinicians can use to counsel patients on the role of diet and lifestyle in liver disease prevention and management.

Why Nutrition Is Foundational in Liver Care

“The liver is the body’s metabolic hub,” says Lai. “While the intestine is the first organ to encounter food, the liver is where all of that food gets processed, detoxified, and converted into essential proteins.”

Lai emphasizes that clinicians should frame dietary counseling in simple, relatable language. “I often tell my patients: If you eat junk, your liver has to process junk. But if you eat well, you’re bathing your liver in nutrients that help it stay strong and functional.”

Hidden Dietary Risks Beyond Alcohol: The Role of Fructose

While the hepatotoxic effects of alcohol are well known, Lai highlights that excessive fructose — particularly from high-fructose corn syrup and ultra-processed foods — poses a significant but underrecognized threat to liver health.

“Many patients unknowingly consume large amounts of fructose through sugary beverages, snacks, and packaged foods,” she explains. “Like alcohol, the liver can handle some fructose, but chronic high intake contributes to steatosis and inflammation.”

For clinicians, counseling patients on reading food labels and identifying hidden sugars is a critical step in reducing liver disease risk.

Practical Nutrition Counseling: Focus on Polyphenols and Fiber

Lai advises physicians to focus on achievable dietary targets:

• Polyphenol-Rich Foods: Coffee, green tea, fruits, vegetables, and whole grains are all associated with hepatoprotective effects. “Coffee remains the most studied, but fruits and vegetables offer similar benefits,” she notes.
• Fiber Intake: Recommending 25 to 30 grams of fiber per day supports gut health and reduces the liver’s inflammatory burden. “Fiber feeds the gut microbiome, helping neutralize toxins before they reach the liver.”

Lai encourages gradual increases in fiber intake to minimize gastrointestinal side effects.

Label Literacy: Teaching Patients to Read Nutrition Facts

When counseling time is limited, Lai suggests focusing on two key points from food labels:

• Added Sugars: Advise patients to check the “added sugars” line on the Nutrition Facts panel. A sustainable long-term goal is <50 grams/day, but incremental monthly reductions of 10% are often more achievable for patients starting from higher baselines.
• Fiber Content: Encourage choices with higher fiber, aiming toward the 25–30 grams/day target.

“When in doubt, remind patients: The best foods often don’t have labels at all — fruits, vegetables, legumes, and whole grains,” says Lai.

Addressing Asymptomatic Disease and Public Awareness

Lai stresses that most patients with early fatty liver disease are asymptomatic, making patient education even more critical.

“Until recently, we had no FDA-approved medications for fatty liver disease,” she says. “Lifestyle intervention remains the most evidence-based ‘treatment’ we can offer.”

For clinicians, this means reinforcing that weight loss, dietary improvements, and increased physical activity remain the cornerstone of fatty liver management, especially for metabolic dysfunction-associated steatotic liver disease (MASLD).

Integrating Movement with Nutrition Counseling

Lai advocates for pairing nutrition advice with achievable physical activity goals.

“If patients walk within 30 minutes after eating, they can blunt postprandial glucose spikes,” she explains. “For those starting exercise routines, I tell them: Add 10 extra minutes of walking each day. Small steps build momentum.”

The key message for providers: Encourage sustainable, incremental lifestyle changes. Tracking tools, step counters, and motivational interviewing techniques can help patients stay engaged.

Clinical Takeaways for Practice

• Screen for ultra-processed food and added sugar consumption in at-risk patients.
• Provide targeted label-reading education during nutrition counseling.
• Advocate for fiber-rich, polyphenol-containing foods that support liver and gut health.
• Encourage gradual increases in both physical activity and dietary improvements to enhance adherence.

With new therapeutics for MASH on the horizon, Lai’s guidance serves as a timely reminder that lifestyle remains a first-line, low-cost intervention that every clinician can support.