The Mediterranean Diet Modification That Might Help Support Liver Health, According To New Research

It's no secret that the Mediterranean diet is popular: 2021 marked its fourth year topping the U.S. News & World Report ranking of the best diets overall, and it's been the catalyst for inspiring cookbooks and countless recipes. All that clout is thanks to an impressive list of well-studied benefits, and now, research is digging into the efficacy of modified versions (like a pesco-Mediterranean diet) of this whole-foods-focused eating style.

A new study, published in Gut, proposes what they call a "green-Mediterranean diet" to help minimize intrahepatic (liver) fat and fight against nonalcoholic fatty liver disease (NAFLD). Between 25 and 30% of people in the United States and Europe are affected by NAFLD, and the only strategy for managing and treating it is dietary intervention.

The original Mediterranean diet is based on a study that took place in the 1950s and 1960s where researchers looked into the diets of seven countries and found that those in Italy and Greece had the lowest risk of heart disease. It hinges on a concentration on whole foods, with limited dairy and red meat.

The key components of the green-Mediterranean diet are the same, with a few tweaks. Its name comes from an increased focus on green foods: veggies, fruits, and even green tea (three or four cups a day, to be exact). The other key green food on the menu is 100 grams per day of mankai, a freshwater plant that's a member of the duckweed family. Similar to sea veggies, it's a super-source of nutrients and also sustainable to cultivate. Mankai is a complete source of the nine essential amino acids (plus a few more), and it's also rich in polyphenols, fiber, minerals, and vitamins.

In the trial, the 294 participants were split into three groups: One followed a healthy dietary regimen; the next, a standard Mediterranean diet; and the third, a green modified Mediterranean diet. They were also all given access to a gym, for their exercise regimen.

The researchers found that while all the diets led to a decrease in liver fat, the most effective was the green-Mediterranean diet. This specific modification resulted in a 39% decrease in hepatic fat, while the classic version of the diet led to only a 20% decrease. Even when the results were adjusted to include the simple impact of weight loss, the benefits of the diet were still found to be significant.

At baseline, 62% of participants had NAFLD, but the green-Mediterranean diet group dropped that percent to 31.5% (the classic Mediterranean diet group only dropped to a 47.9% prevalence). The researchers also further investigated the impacts of specific foods assigned to the modified Mediterranean diet, concluding that greater amounts of mankai and walnuts, with fewer red meats, was associated with liver fat loss.

"Addressing this common liver disease by targeted lifestyle intervention might promote a more effective nutritional strategy," says Anat Yaskolka-Meir, Ph.D., first author of the study "This clinical trial demonstrates an effective nutritional tool for NAFLD beyond weight loss."

The study suggests that while a diet like the Mediterranean diet is already a great place to start for promoting health, focusing on specific ingredients that provide particular nutrients can be a powerful tool for health intervention—but let's not forget that nutrition should be a priority in helping prevent illness, too.