Why some plant-based eaters might still be at risk for liver disease

Plant-based diets have surged in recent years due to their perceived health benefits and environmental sustainability [12]

These diets primarily consist of fruits, vegetables, grains, nuts and seeds, with little or no animal products.

While plant-based diets are generally associated with improved health, a recent study published in BMC Medicine suggests that particular plant-based eaters may still be at risk for liver disease. 

Let’s explore the findings of this study and shed light on why some plant-based dieters might face this unexpected health concern.

The study in question examined data from a large group of individuals following various diets, including omnivores (those who consume both plant and animal foods), vegetarians (those who exclude meat but may consume dairy and eggs) and vegans (those who exclude all animal products) [3]. 

Surprisingly, the researchers discovered that some plant-based eaters, particularly vegans, exhibited higher levels of non-alcoholic fatty liver disease (NAFLD) than their omnivorous counterparts.

Non-alcoholic fatty liver disease is characterized by the accumulation of fat in the liver, which can lead to inflammation and liver damage over time [4].

NAFLD is typically associated with high-calorie diets, excessive sugar consumption and sedentary lifestyles. However, the study findings suggest that NAFLD can also affect individuals who follow plant-based diets.

Per the study, these factors contribute to NAFLD in plant-based dieters [3].

Factors contributing to non-alcoholic fatty liver disease in plant-based diet

High caloric intake

Some plant-based foods, like nuts, seeds and avocados, are calorie-dense. While these foods offer numerous health benefits, excessive consumption can lead to an overabundance of calories, contributing to the development of NAFLD.

Insulin resistance

Insulin resistance, often associated with obesity and high sugar intake, can contribute to the development of NAFLD. Plant-based dieters should be cautious of sugar intake, even from natural sources like fruits.

Lack of omega-3 fatty acids

Omega-3 fatty acids, primarily found in fish, have anti-inflammatory properties and benefit liver health [5]. Plant-based eaters may need to be mindful of obtaining sufficient omega-3s from sources like flaxseeds, chia seeds and walnuts.

Nutrient deficiencies

Vegans, in particular, are at risk of certain nutrient deficiencies, such as vitamin B12 and iron, which can impact liver health [6]. These deficiencies may impair the body’s ability to metabolize fats effectively, leading to the development of NAFLD.

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Processed foods

Plant-based diets can sometimes include highly processed foods rich in added sugars and unhealthy fats. Consuming these foods in excess can raise the risk of NAFLD.

While the study highlights potential risks, it must be noted that plant-based diets can still be a healthy choice when approached thoughtfully. Here are some strategies to reduce the risk of NAFLD while following a plant-based diet [3]:

How to reduce NAFLD while on a plant-based diet

Balanced nutrition

Ensure a well-rounded diet with various plant-based foods to minimize nutrient deficiencies.

Limit processed foods

Minimize the consumption of processed plant-based foods high in added sugars and unhealthy fats.


Incorporate omega-3-rich foods like flaxseeds, chia seeds and walnuts into your diet.

Physical activity

Engage in regular physical activity to support overall health and liver function.

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Sugar awareness

Monitor your sugar intake, even from natural sources like fruits, to prevent excessive sugar consumption.

Watch portion sizes

Be mindful of calorie-dense foods and practice portion control, especially with nuts, seeds, and avocados.

Plant-based diets are celebrated for their health benefits, but this study reminds us that they are not a one-size-fits-all solution.

While plant-based eaters generally experience improved health outcomes, some individuals, particularly vegans, may be at risk for non-alcoholic fatty liver disease due to nutrient deficiencies, high-calorie intake and poor food choices.

By adopting a balanced and mindful approach to plant-based eating, individuals can reduce the risk of liver disease while enjoying the many benefits of this dietary choice. Always consult a healthcare professional or registered dietitian for personalized guidance on your nutritional needs and health goals.

[1] https://www.linkedin.com/pulse/green-revolution-unveiling-phenomenon-plant-based
[2] https://apps.who.int/iris/bitstream/handle/10665/349086/WHO-EURO-2021-4007-43766-61591-eng.pdf?sequence=1&isAllowed=y
[3] https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-023-03028-w
[4] https://www.nhs.uk/conditions/non-alcoholic-fatty-liver-disease/
[5] https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10027313/

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