It produces cholesterol, takes up cholesterol-containing particles from the blood, converts some cholesterol into bile acids, and packages lipids into particles that can travel through the circulation.

Two familiar terms in this conversation are LDL and HDL.

LDL, or low-density lipoprotein, carries cholesterol from the liver and other sources through the bloodstream to tissues. Excessive levels of LDL cholesterol are associated with an increased risk of atherosclerotic cardiovascular disease.

HDL, or high-density lipoprotein, participates in the movement of cholesterol from tissues toward the liver and other pathways involved in cholesterol handling. HDL is often called “good cholesterol,” but the relationship between HDL measurements and cardiovascular health is more complex than simply having as much HDL as possible.

LDL and HDL are lipoproteins—particles that transport fats and cholesterol through the blood. They are not the same thing as cholesterol itself.

The liver produces and regulates several lipoproteins, while LDL particles can arise through the transformation of other particles in circulation. It is therefore inaccurate to imagine the liver simply producing a fixed amount of LDL and HDL according to one dietary ingredient.

The body regulates cholesterol through a combination of production, absorption, transport, conversion, and elimination.

Diet can influence this system. A dietary pattern high in saturated fat may increase LDL cholesterol in many people, while replacing saturated fats with unsaturated fats can improve the overall lipid profile.

Excess added sugar and energy intake can also contribute to elevated triglycerides and metabolic dysfunction, particularly in susceptible individuals.

However, the relationship between dietary sugar, LDL cholesterol, and cardiovascular disease is not a single-step process in which sugar automatically creates oxidized LDL and clogged arteries.

Atherosclerosis develops through complex interactions involving lipoproteins, blood vessel walls, inflammation, genetics, and other risk factors.

Fatty liver disease is associated with higher cardiovascular risk, partly because the conditions that contribute to liver fat—such as insulin resistance, elevated triglycerides, hypertension, and type 2 diabetes—also affect cardiovascular health.

For many people with MASLD, cardiovascular disease is an especially important aspect of long-term risk management.

The practical lesson is not to eliminate cholesterol from the body. It is to support healthy lipid regulation through an appropriate diet, physical activity, management of blood glucose and blood pressure, and medical care when necessary.

6. Why Excess Sugar and Ultra-Processed Foods Deserve Attention

Sugar is not inherently a toxin. The body uses glucose as an energy source, and carbohydrates can be part of a healthy diet.

The problem is that certain eating patterns can make it easier to consume more energy and added sugar than the body needs, especially when sugary drinks and highly processed foods are frequent choices.

Sugar-sweetened beverages are particularly relevant because they can deliver substantial amounts of sugar without creating the same sense of fullness as many solid foods.

When these drinks are consumed frequently, they can contribute to excess energy intake and metabolic changes associated with fatty liver disease.

The liver processes fructose, one component of common added sugars. High intakes of added sugars, particularly when combined with excess energy intake, can increase the production of fat in the liver in some circumstances.

Over time, this may contribute to liver fat accumulation, particularly in people who already have insulin resistance or other metabolic risk factors.

Ultra-processed foods can also make energy balance more difficult for some people. Many are designed to be convenient, highly palatable, and easy to consume quickly. They may contain combinations of refined starches, added sugars, saturated fats, and salt while providing relatively little fiber.

However, it is important not to label every packaged food as harmful. Frozen vegetables, canned beans, plain yogurt, and many other convenient foods can fit into a healthy dietary pattern.

The overall composition of the diet matters more than whether a food comes in a package.

Replacing some sugary drinks with water or unsweetened beverages is a practical step. Choosing whole grains more often, including legumes and vegetables in meals, and reducing frequent reliance on foods high in added sugar and saturated fat can also help.

These changes do not need to be extreme.

A person does not have to eliminate every dessert or carbohydrate to support liver health. A sustainable pattern that reduces excess added sugar and improves overall nutrient quality is generally more useful than a highly restrictive plan that is difficult to maintain.

For people with diagnosed fatty liver disease, dietary recommendations should be individualized according to their metabolic health, other medical conditions, and nutritional needs.

The aim is to reduce the factors that promote excessive fat accumulation while ensuring the body still receives enough energy, protein, fiber, vitamins, and minerals.

7. Eight Everyday Foods That Can Help Support Liver Health

No individual food can cure fatty liver disease. Nevertheless, certain foods can contribute to a dietary pattern associated with better metabolic health.

The eight options below provide different combinations of fiber, unsaturated fats, protein, antioxidants, and other nutrients. They are intended as practical foods to include regularly—not as a detox program or a replacement for medical care.

<text size="sm" color="secondary">The foods are presented as part of an overall eating pattern. Evidence is stronger for healthy dietary patterns and management of metabolic risk factors than for any single food acting as a treatment for liver disease.</text>

Food 1: Leafy Green Vegetables

<text size="sm" color="secondary">Examples: spinach, kale, bok choy, lettuce, and other leafy greens.</text>

Leafy green vegetables are valuable additions to a liver-supportive eating pattern because they provide fiber, vitamins, minerals, and a range of plant compounds while generally contributing relatively little energy per serving.

Spinach, kale, bok choy, and similar vegetables contain nutrients such as folate, vitamin K, and carotenoids. Different varieties provide different nutrient combinations, so eating a range of vegetables can be more beneficial than relying on just one.

Their fiber contributes to digestive health and can help meals feel more satisfying. A diet rich in vegetables can also make it easier to replace some energy-dense foods with options that provide more nutrients.

These changes may support healthier overall energy intake and metabolic regulation, both of which are relevant to fatty liver disease.

Leafy greens also contain plant compounds with antioxidant activity. Antioxidants participate in processes that help cells manage reactive molecules produced during normal metabolism and other physiological activities.

However, the presence of antioxidants does not mean that eating a bowl of spinach directly removes fat from the liver or reverses scarring. The effects of whole foods arise from their overall nutritional composition and their place within a person's broader diet.

Research has examined the relationships between vegetable intake, dietary patterns, and metabolic health. Findings generally support including a variety of vegetables, but the evidence does not establish one leafy green as a stand-alone treatment for MASLD.

How to include them: Add spinach to eggs, mix leafy greens into soups, include bok choy in stir-fries, or serve a green salad alongside a meal. Fresh, frozen, and many canned vegetables can all be useful options.