Bone broth has gained popularity as a health food, with some proponents suggesting benefits for various conditions, including fatty liver disease. However, it is important to understand that no clinical evidence demonstrates bone broth specifically treats or reverses hepatic steatosis. Fatty liver disease, affecting approximately 25–30% of the UK population, requires evidence-based management centred on weight loss, dietary modification, and lifestyle changes as recommended by NICE guidance. Whilst bone broth may form part of a balanced diet, patients should prioritise proven interventions rather than relying on unsubstantiated claims about individual foods or supplements.

Understanding Fatty Liver Disease and Dietary Management

Fatty liver disease, medically termed hepatic steatosis, occurs when excess fat accumulates in liver cells, comprising more than 5% of the liver's weight. The condition exists in two primary forms: non-alcoholic fatty liver disease (NAFLD), affecting individuals who consume little to no alcohol, and alcohol-related fatty liver disease (AFLD), directly related to excessive alcohol intake. (International guidance now uses the term metabolic dysfunction-associated steatotic liver disease [MASLD] for NAFLD, though NAFLD remains widely used in UK clinical practice.) NAFLD affects approximately 25–30% of the general population in the UK, with rates rising alongside obesity and type 2 diabetes.

The pathophysiology involves complex metabolic disturbances, including insulin resistance, oxidative stress, and inflammatory processes. When the liver receives more fatty acids than it can process through oxidation or export, triglycerides accumulate within hepatocytes. Left unmanaged, simple steatosis may progress to non-alcoholic steatohepatitis (NASH), characterised by inflammation and hepatocyte damage, potentially advancing to fibrosis, cirrhosis, or hepatocellular carcinoma.

Dietary management and lifestyle modification represent the cornerstone of treatment for fatty liver disease, as recommended by NICE guidance (NG49). Weight reduction of 7–10% in overweight or obese patients can significantly reduce hepatic fat content and improve liver enzyme levels; weight loss of 10% or more is often needed to improve inflammation and fibrosis in NASH. The therapeutic approach focuses on achieving a sustainable calorie deficit (typically around 600 kcal per day), limiting refined carbohydrates and added sugars (to less than 5% of total energy intake), reducing saturated fats, increasing dietary fibre, and adopting Mediterranean-style eating patterns rich in vegetables, wholegrains, and healthy fats. Alcohol should be limited to no more than 14 units per week (spread over at least 3 days) in line with UK Chief Medical Officers' guidance; in alcohol-related liver disease, abstinence is essential.

Assessment and monitoring are important. In primary care, adults with suspected NAFLD should have advanced liver fibrosis assessed using the FIB-4 score. If the FIB-4 score is raised or indeterminate, an Enhanced Liver Fibrosis (ELF) blood test should be arranged. Adults with an ELF score of 10.51 or above, or other concerning features (such as persistently abnormal liver blood tests, signs of cirrhosis, or significant comorbidities), should be referred to a hepatologist. NICE recommends considering repeat assessment for advanced fibrosis every 3 years in adults with NAFLD. Regular monitoring through blood tests (liver function tests, lipid profiles, glucose levels) and imaging studies helps assess disease progression and treatment efficacy.

Patients diagnosed with fatty liver disease should work collaboratively with healthcare professionals, including GPs, hepatologists, and dietitians, to develop personalised nutrition plans. Importantly, no single 'superfood' or supplement can reverse fatty liver disease; sustainable lifestyle modifications remain the evidence-based foundation for management.

What Is Bone Broth and Its Nutritional Profile

Bone broth is a liquid preparation made by simmering animal bones (typically beef, chicken, or fish) with connective tissues in water for extended periods, often 12–48 hours. This prolonged cooking process extracts various compounds from the bones and cartilage, including collagen, gelatin, amino acids (particularly glycine, proline, and glutamine), and minerals such as calcium, magnesium, and phosphorus. The resulting liquid has been consumed across cultures for centuries, both as a culinary ingredient and traditional remedy.

The nutritional composition of bone broth varies considerably depending on several factors: the type and quality of bones used, cooking duration, addition of vegetables or herbs, and the ratio of bones to water. Commercial bone broths differ substantially from homemade versions, with some products containing added salt, flavourings, or preservatives. Nutritional content per 100 ml typically provides modest amounts of protein (around 2–5 g), minimal carbohydrates, variable fat content (0–2 g depending on preparation), and small quantities of minerals. It is important to check product labels, as salt content can be high in some commercial varieties. In the UK, foods with more than 1.5 g salt per 100 g (or 0.6 g sodium per 100 g) are considered high in salt; those with 0.3 g salt or less per 100 g (or 0.1 g sodium per 100 g) are low in salt.

Proponents claim bone broth offers numerous health benefits, including supporting gut health, reducing inflammation, promoting joint health, and improving skin elasticity due to its collagen content. However, it is important to note that scientific evidence supporting many of these claims remains limited. Collagen consumed orally undergoes digestion into constituent amino acids, which the body then redistributes according to physiological needs rather than directly incorporating into specific tissues. Trace amounts of compounds such as glucosamine and chondroitin may be present but are unlikely to be physiologically significant in typical servings.

The mineral content, whilst present, typically provides only a small percentage of daily requirements. For individuals seeking bone broth for health purposes, understanding realistic expectations based on current evidence is essential. The broth should be viewed as a potentially nutritious addition to a balanced diet rather than a therapeutic intervention for specific medical conditions.

Evidence-Based Dietary Approaches for Fatty Liver

NICE guidance (NG49) and international hepatology societies consistently recommend lifestyle modification and weight loss as the primary treatment for fatty liver disease, based on robust clinical evidence. A calorie-reduced, Mediterranean-style eating pattern is supported by evidence from European and international guidelines (EASL, AASLD), characterised by high consumption of vegetables, fruits, wholegrains, legumes, nuts, and olive oil, moderate fish and poultry intake, and limited red meat and processed foods. Multiple studies have shown this pattern reduces hepatic steatosis, likely through anti-inflammatory and antioxidant mechanisms.

Caloric restriction remains fundamental, with NICE obesity guidance supporting a deficit of around 600 kcal per day for gradual, sustainable weight loss of approximately 0.5–1 kg per week. Very rapid weight reduction or crash diets should be avoided, as they may worsen liver inflammation. Macronutrient composition matters: reducing refined carbohydrates and added sugars (particularly fructose from sweetened beverages) significantly improves liver fat content. The Scientific Advisory Committee on Nutrition (SACN) recommends limiting free sugars to less than 5% of total energy intake.

Specific dietary components warrant attention. Omega-3 fatty acids from oily fish (salmon, mackerel, sardines) may reduce liver fat and inflammation; the NHS recommends eating at least 2 portions of fish per week, including 1 portion of oily fish. Coffee consumption (2–3 cups daily) has been associated with reduced fibrosis progression in observational studies, though this should not be considered prescriptive. Adequate protein intake helps preserve lean muscle mass during weight loss; higher intakes may be considered under specialist guidance in patients with cirrhosis and sarcopenia. Dietary fibre from wholegrains, vegetables, and legumes improves insulin sensitivity and promotes beneficial gut microbiota.

Foods to limit or avoid include: saturated fats found in processed meats, baked goods, and fried foods; refined carbohydrates such as white bread, pastries, and sugary snacks; and alcohol. In NAFLD/MASLD, alcohol should be limited to no more than 14 units per week (spread over at least 3 days) in line with UK Chief Medical Officers' guidance; in alcohol-related liver disease, abstinence is essential. Industrial trans fats (partially hydrogenated oils) are now uncommon in the UK food supply but should be avoided where present.

Physical activity is equally important. UK Chief Medical Officers recommend at least 150 minutes of moderate-intensity aerobic activity per week, plus muscle-strengthening activities on 2 or more days per week. Patients should be referred to registered dietitians for individualised meal planning, particularly those with comorbidities such as diabetes or cardiovascular disease. Regular follow-up appointments allow monitoring of adherence, nutritional adequacy, and clinical outcomes, with adjustments made as needed to optimise liver health whilst maintaining overall nutritional status.

Safe Use of Bone Broth: Considerations and Precautions

There is no clinical evidence demonstrating that bone broth specifically treats, prevents, or reverses fatty liver disease. Whilst bone broth may form part of a balanced, whole-food diet, patients should not rely upon it as a therapeutic intervention for hepatic steatosis. The amino acids and minerals present in bone broth can be obtained from various dietary sources, and no unique properties of bone broth have been proven to target liver fat accumulation or inflammation.

For individuals considering incorporating bone broth into their diet, several practical considerations apply. Homemade preparations allow better control over ingredients, particularly salt content, which can be high in some commercial varieties. Check product labels and choose low-salt options where possible. Salt content should be expressed both as sodium (in mg) and salt (in g); remember that 1 g salt contains approximately 400 mg sodium. Patients with hypertension, chronic kidney disease, or fluid retention should exercise caution. Those with advanced liver disease and ascites require strict salt restriction (typically around 2 g sodium per day, equivalent to approximately 5 g salt per day) under specialist guidance (NICE NG50); such patients should consult their hepatologist before adding bone broth regularly.

Quality and food safety matter. Proper food hygiene during preparation is essential. The Food Standards Agency (FSA) advises cooling broth within 2 hours, storing it at 5°C or below, and consuming it within 2–3 days or freezing for longer storage. Reheat broth thoroughly until steaming hot throughout before consumption. Concerns have occasionally been raised about potential heavy-metal contamination in bone broth; however, evidence is limited and the risk in typical diets is considered low. If you have specific concerns, consult your GP or dietitian.

Patients with fatty liver disease should prioritise evidence-based interventions: achieving a healthy weight through calorie reduction (around 600 kcal per day deficit), adopting a Mediterranean-style eating pattern, increasing physical activity (at least 150 minutes per week of moderate-intensity exercise plus muscle-strengthening activities on 2 or more days), managing comorbidities such as diabetes and dyslipidaemia, and limiting or avoiding alcohol in line with UK Chief Medical Officers' guidance (no more than 14 units per week in NAFLD/MASLD; abstinence in alcohol-related liver disease). Do not stop any prescribed medicines without consulting your GP or hepatologist. Be cautious with unregulated herbal remedies and supplements, as some may cause liver toxicity.

If considering significant dietary changes, including regular bone broth consumption, discuss this with your GP or dietitian to ensure it aligns with your overall management plan. Seek urgent medical advice if you experience worsening symptoms such as persistent or severe abdominal pain, jaundice (yellowing of skin or eyes), unexplained fatigue, confusion, vomiting blood, black or tarry stools, or rapidly increasing abdominal swelling, as these may indicate complications requiring prompt assessment.

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