Non-alcoholic fatty liver disease (NAFLD) affects approximately a quarter to a third of UK adults, making dietary management a crucial component of treatment. The type of grains you choose can significantly impact liver health, as whole grains help improve glycaemic control, reduce hepatic fat accumulation, and support weight management—all key goals in NAFLD treatment. Refined grains, conversely, may worsen insulin resistance and promote fat storage in the liver. This article examines which grains are most beneficial for fatty liver disease, which to limit, and how to incorporate liver-friendly grains into your daily diet in line with NHS and NICE guidance.

Understanding Fatty Liver Disease and Dietary Management

Non-alcoholic fatty liver disease (NAFLD) affects approximately a quarter to a third of adults in the UK and occurs when excess fat accumulates in liver cells in people who drink little to no alcohol. The condition exists on a spectrum, ranging from simple steatosis (fat accumulation) to non-alcoholic steatohepatitis (NASH), which involves inflammation and potential progression to fibrosis or cirrhosis. Risk factors include obesity, type 2 diabetes, insulin resistance, dyslipidaemia, and metabolic syndrome.

Note on terminology: Some international guidelines now use the term metabolic dysfunction-associated steatotic liver disease (MASLD), though NICE guidance currently continues to use NAFLD.

Dietary modification represents a cornerstone of NAFLD management, as recommended by NICE guideline NG49. Weight loss of 7–10% of body weight has been shown to improve liver histology and reduce hepatic fat content significantly. The quality of carbohydrate intake plays a particularly important role, as refined carbohydrates and added sugars contribute to hepatic lipogenesis (fat production in the liver) and worsen insulin resistance.

Key dietary principles for fatty liver management include:

• Reducing overall calorie intake to achieve gradual, sustainable weight loss

• Limiting refined carbohydrates and avoiding sugar-sweetened drinks

• Increasing fibre intake through whole grains, vegetables, fruit, and pulses (aiming for 30 g per day)

• Following a healthy, balanced dietary pattern such as the NHS Eatwell Guide

• Staying within UK alcohol guidance (no more than 14 units per week, spread over at least three days; many clinicians advise further limitation or abstinence in NAFLD)

• Incorporating regular physical activity and behaviour change support

UK care pathway: If you have been diagnosed with NAFLD, your GP may calculate a FIB-4 score (using age, liver enzymes, and platelet count) to assess the likelihood of advanced liver fibrosis. Depending on the result and your age, you may be offered an Enhanced Liver Fibrosis (ELF) blood test or referred to a liver specialist. Seek urgent medical advice if you develop jaundice (yellowing of skin or eyes), abdominal swelling, vomiting blood, black tarry stools, confusion, unintended weight loss, or severe upper-right abdominal pain.

The choice of grain products significantly impacts glycaemic control, insulin sensitivity, and hepatic metabolism. Whole grains contain the entire grain kernel—bran, germ, and endosperm—providing fibre, B vitamins, minerals, and phytochemicals that support metabolic health. In contrast, refined grains have been stripped of these beneficial components, leading to rapid glucose absorption and metabolic consequences that may exacerbate fatty liver disease. Understanding which grains to prioritise can help you make informed dietary choices that support liver health and overall metabolic function.

Why Whole Grains Matter for Liver Health

Whole grains exert multiple beneficial effects on hepatic metabolism and overall metabolic health through several interconnected mechanisms. The high fibre content of whole grains slows carbohydrate digestion and glucose absorption, resulting in lower postprandial (after-meal) glucose and insulin responses. This improved glycaemic control helps reduce hepatic lipogenesis and decreases the metabolic stress on liver cells that contributes to fat accumulation.

The soluble fibre found in grains such as oats and barley has particular relevance for liver health. Beta-glucan, a type of soluble fibre, has been shown to improve postprandial glycaemic response and, when consumed at adequate levels (3 g per day from oats or barley), to lower LDL-cholesterol. Additionally, soluble fibre binds to bile acids in the intestine, promoting their excretion and requiring the liver to synthesise new bile acids from cholesterol. This process helps lower circulating cholesterol levels, which is beneficial given that dyslipidaemia commonly accompanies NAFLD.

Whole grains support liver health through:

• Improved glycaemic control – reducing the metabolic dysfunction that drives fat accumulation

• Enhanced satiety – helping with weight management, a primary treatment goal

• Potential anti-inflammatory effects – whole grains contain antioxidants and phytochemicals; emerging evidence suggests they may help reduce systemic inflammation

• Possible benefits on gut microbiota – fibre serves as a prebiotic, supporting a healthy microbiome that may influence liver metabolism

Research evidence, whilst not yet definitive, suggests that higher whole grain intake is associated with reduced risk of NAFLD development and improved markers of liver function in observational studies. A systematic review examining dietary patterns found that diets rich in whole grains, as part of an overall healthy eating pattern, were associated with lower hepatic fat content. The mechanisms appear to involve both direct metabolic effects and indirect benefits through weight management and improved cardiometabolic risk factors.

To support liver health, follow the NHS Eatwell Guide and aim for 30 g of fibre per day from a variety of sources, choosing wholegrain or higher-fibre starchy carbohydrates where possible. It is important to note that glycaemic index (GI) values vary depending on grain variety, processing, and cooking method, so focus on choosing minimally processed whole grains and balancing portions with protein and vegetables.

Best Grains to Include in a Fatty Liver Diet

Oats represent an excellent choice for individuals with fatty liver disease. They are particularly rich in beta-glucan soluble fibre. A 40 g serving of porridge oats provides approximately 1.5–2 g of beta-glucan. An authorised UK health claim states that consuming 3 g per day of oat or barley beta-glucan can help lower blood cholesterol. Oats have a low to moderate glycaemic index (GI), helping to maintain stable blood glucose levels. They can be consumed as traditional porridge, overnight oats, or added to smoothies and baked goods. Note for coeliac disease: If you have coeliac disease, choose oats labelled as gluten-free, as standard oats may be contaminated with gluten during processing.

Barley is another grain high in beta-glucan and offers similar metabolic benefits to oats. Pearl barley, whilst slightly more processed than hulled barley, still retains significant fibre content and can be more readily available. Barley can be used in soups, stews, risotto-style dishes, or as a side dish similar to rice. Its chewy texture and nutty flavour make it a versatile addition to various meals. Barley contains gluten and should be avoided if you have coeliac disease or gluten intolerance.

Quinoa, technically a pseudocereal, provides complete protein containing all essential amino acids, alongside fibre, magnesium, and antioxidants. With an approximate GI of around 53, quinoa causes minimal blood glucose spikes. It cooks quickly and can replace rice or couscous in most recipes, making it practical for everyday meals. Quinoa is naturally gluten-free.

Brown rice retains the bran and germ layers removed in white rice processing, providing significantly more fibre, B vitamins, and minerals. Whilst its GI is moderate (approximately 68, though this varies by variety and cooking method), it remains a better choice than white rice for liver health. Varieties such as brown basmati may have a slightly lower GI than short-grain brown rice. Brown rice is naturally gluten-free.

Bulgur wheat is made from parboiled, dried, and cracked wheat kernels. It has a low GI (approximately 48) and high fibre content, making it beneficial for blood glucose control. Bulgur requires minimal cooking time and works well in salads such as tabbouleh or as a base for vegetable dishes. Bulgur contains gluten and should be avoided if you have coeliac disease or gluten intolerance.

Wholemeal pasta and bread made from 100% whole wheat flour provide more fibre and nutrients than refined versions. When selecting these products, check labels to ensure whole grain is the first ingredient. Look for products that are a 'source of fibre' (at least 3 g per 100 g) or 'high in fibre' (at least 6 g per 100 g). Use the traffic-light labelling on the front of packs to help you choose products lower in saturated fat, salt, and sugar. Wholemeal wheat products contain gluten.

Grains to Limit or Avoid with Fatty Liver

Refined grains have been processed to remove the bran and germ, stripping away fibre, vitamins, and minerals whilst leaving primarily starchy endosperm. This processing dramatically alters how these grains affect metabolism, resulting in rapid glucose absorption, insulin spikes, and increased hepatic lipogenesis—all factors that can worsen fatty liver disease.

White rice, particularly short-grain varieties, has a high GI (approximately 73–89 depending on variety and cooking method) and minimal fibre content. Some observational studies have found associations between regular consumption of large amounts of white rice and increased risk of type 2 diabetes in certain populations, though this relationship varies by dietary context. Whilst white rice need not be completely eliminated, it should be consumed in limited quantities and ideally combined with protein, healthy fats, and vegetables to moderate its glycaemic impact.

White bread, white pasta, and products made with refined wheat flour cause similar metabolic effects to white rice. These foods are rapidly digested, leading to blood glucose spikes that trigger insulin release and promote fat storage in the liver. Many commercial white breads also contain added sugars, further compounding their negative metabolic effects.

Breakfast cereals require particular scrutiny, as many products marketed as healthy contain substantial added sugars and are made from refined grains. Even some products labelled as 'wholegrain' may contain significant sugar content. Check the nutrition label and traffic-light colours on the front of the pack: choose cereals that are low in sugar (green or amber; ≤5 g per 100 g is low, 5.1–22.5 g per 100 g is medium, and >22.5 g per 100 g is high). Opt for no-added-sugar or low-sugar wholegrain options.

Pastries, biscuits, cakes, and other baked goods typically combine refined flour with added sugars and unhealthy fats (often high in saturated fat). These products provide minimal nutritional value whilst delivering concentrated calories and ingredients that promote hepatic fat accumulation and inflammation. Industrial trans fats have been largely removed from UK retail foods, but saturated fat remains a concern in many ultra-processed snacks and baked goods.

Practical guidance:

• Replace white rice with brown rice, quinoa, or bulgur wheat

• Choose wholemeal or granary bread over white bread

• Select wholemeal pasta and cook it al dente to help lower its GI

• Limit processed baked goods and consider homemade alternatives using whole grain flours and minimal added sugar

It is worth noting that complete elimination of refined grains is not necessary for most people, but they should constitute a small proportion of overall grain intake, with whole grains forming the foundation of carbohydrate consumption.

Practical Tips for Incorporating Healthy Grains

Start gradually when increasing whole grain intake, as a sudden dramatic increase in fibre consumption can cause gastrointestinal discomfort including bloating, gas, and altered bowel habits. Begin by replacing one refined grain product with a whole grain alternative each week, allowing your digestive system to adapt. Ensure adequate fluid intake (the NHS recommends 6–8 glasses or cups of fluid daily, including water, lower-fat milk, and sugar-free drinks) to help fibre move through the digestive system effectively. If you have irritable bowel syndrome (IBS), increase fibre very gradually and consider which whole grains you tolerate best; some people find certain grains easier to digest than others.

Make simple substitutions in familiar recipes and meals:

• Use brown rice or quinoa instead of white rice as a side dish

• Choose wholemeal pasta for your favourite pasta dishes

• Select wholemeal or granary bread for sandwiches and toast

• Replace breadcrumbs in recipes with rolled oats or wholemeal alternatives

• Use bulgur wheat or quinoa as a base for salads instead of couscous

Batch cooking and meal preparation can make incorporating whole grains more convenient. Many whole grains can be cooked in larger quantities and refrigerated for 3–4 days or frozen for up to three months. Cook a large batch of brown rice, quinoa, or barley at the weekend and use throughout the week in different meals. This approach saves time and makes healthy choices more accessible during busy weekdays.

Portion control remains important even with healthy whole grains. Whilst whole grains are nutritious, they still contain calories and carbohydrates that must be considered within overall energy intake. As an example, a typical serving size is approximately 150–180 g of cooked grains (roughly the size of a clenched fist), though individual needs vary. Use the NHS Eatwell Guide to help balance grain portions with adequate protein and plenty of non-starchy vegetables to create satisfying, nutritionally complete meals.

Reading food labels helps identify truly whole grain products. Look for terms such as 'whole wheat,' 'whole grain,' 'wholemeal,' or 'whole oats' as the first ingredient. Be cautious of marketing terms like 'multigrain,' 'wheat bread,' or 'made with whole grains,' which may indicate products containing primarily refined grains. Check the nutrition information per 100 g: products with at least 3 g of fibre per 100 g can be labelled as a 'source of fibre,' and those with at least 6 g per 100 g are 'high in fibre.' Use the traffic-light colours on the front of the pack to choose products lower in saturated fat, salt, and sugar.

Enhance palatability by experimenting with herbs, spices, and cooking methods. Toast grains before cooking to enhance their nutty flavour, cook them in vegetable or chicken stock instead of water, or add aromatic vegetables such as onions and garlic. These techniques can make whole grains more appealing, particularly during the transition from refined grain products.

Important safety note: If you have coeliac disease or gluten intolerance, avoid wheat, barley, and bulgur wheat, as these contain gluten. Choose naturally gluten-free whole grains such as quinoa, brown rice, buckwheat, and millet. If choosing oats, select products labelled as gluten-free to avoid cross-contamination.

You should consult your GP or ask to be referred to a registered dietitian for personalised dietary advice, particularly if you have multiple health conditions or find dietary changes challenging to implement. A dietitian can provide tailored meal plans and ongoing support to ensure dietary modifications are sustainable and nutritionally adequate.

Reporting side effects: If you experience any suspected adverse reactions to medicines, vaccines, or medical devices, report them via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk.

Frequently Asked Questions