Herbs & Spice for Fatty Liver Disease Diet: Evidence, Safety, and Culinary Use
Herbs and Culinary Spices in NAFLD/MASLD
1. Introduction
One of the most common things that we know doctors say when diagnosing any chronic cardiovascular or chronic liver disease is the recommendation to eat better, limit fast food or ultraprocessed food and limit salt. basically they want you to limit the hyperpalatable food and replace it with “cleaner” food.
There is a myth out there that clean foods should be bland, tasteless and eating them should feel like a punishment for some sins that we have committed. The fitness influencers and gym bros seem to eat zero spiced brown rice and chicken and we feel that somehow eating clean means we do that.
In this chapter we are trying to broaden your palate and tell you that eating spices, herbs will not only make you use less salt (which is good!) but make healthy food more palatable which will increase your compliance to your healthy diet and will lead to less cheat days.
Some people are concerned that eating herbs and spices (at culinary doses) might be harmful for you. Well, that is far from true, if anything, they might have some health benefits of their own.
The kitchen cabinet offers a large variety of bioactive compounds with potential hepatoprotective properties.
Culinary herbs, spices, and vegetables have been used therapeutically for millennia across various cultures, and modern scientific research is beginning to validate many traditional applications.
This chapter explores the evidence for potential health benefits from common culinary herbs and spices. While most clinical studies use supplements or extracts, the focus here is on achievable dietary incorporation. The goal is not to replicate pharmacologic effects, but to highlight how habitual use of small quantities may contribute to overall liver and metabolic health as part of a whole-food diet.
After reading this chapter, our hope is that you will not be afraid to try out recipes you see online that uses lots of herbs and spices!
2. Culinary Doses vs. Supplements
Most clinical trials use concentrated extracts or supplements to test effects at measurable doses for a short duration (few months to a year). Culinary use delivers much lower concentrations for a long time (especially if used in everyday cooking), and therefore, results cannot be directly extrapolated. However, traditional dietary patterns rich in herbs and spices (e.g., Indian and Mediterranean dietary studies) show long-term safety and potential additive benefits through repeated, low-dose exposure.
A critical distinction must be made between culinary use of herbs and spices—the amounts typically used in cooking and meal preparation and concentrated supplements or extracts. Culinary doses generally range from 0.5 to 5 grams per day for most spices, delivered through food as part of a meal. Supplements, by contrast, may provide 500-2,000 mg or more of isolated active compounds in a single capsule.
This distinction matters for several reasons:
- Bioavailability: Spices consumed with food often have enhanced absorption due to fats and other food components
- Safety: Culinary doses have centuries of safe use, while concentrated supplements carry potential toxicity risks
- Synergy: Whole spices contain multiple bioactive compounds that may work synergistically
- Practical sustainability: Cooking with spices is more sustainable and enjoyable than taking pills
Throughout this chapter, unless otherwise specified, the evidence and recommendations focus on culinary doses that can reasonably be achieved through normal cooking practices.
3 Turmeric (Curcumin): The Most-Studied Spice for Liver Health
3.1 Active Compounds and Mechanisms
Turmeric (Curcuma longa),a golden-yellow spice derived from the root of a plant in the ginger family, contains curcuminoids as its primary bioactive compounds, with curcumin being the most abundant and well-studied. Turmeric has been used in Traditional Chinese and Indian (Ayurvedic) medicine for thousands of years as a detoxification herb with apparent liver-protective properties and as a potent anti-inflammatory agent (Ajanaku et al (2022).
3.2 Turmeric & NAFLD/MASLD
The evidence base for turmeric/curcumin in NAFLD is extensive:
Liver Enzymes: An umbrella meta-analysis of 11 systematic reviews comprising 99 randomized controlled trials and 5,546 participants found that curcumin supplementation significantly reduced AST (effect size -1.072) and ALT (effect size -0.625) in NAFLD patients (Molani-Gol et al., 2024).
A 2025 meta-analysis of 15 randomized controlled trials (905 participants) found that curcumin supplementation significantly reduced ALT (weighted mean difference -4.10 IU/L) and AST (weighted mean difference -3.27 IU/L) compared to placebo.
Liver Steatosis: A meta-analysis of 16 RCTs with 1,028 participants (Ngu et al., 2022) demonstrated that curcumin improved NAFLD severity (RR 3.52) and increased liver steatosis resolution (RR 3.96) based on ultrasound findings.
Metabolic Parameters: The same umbrella meta-analysis found that curcumin supplementation reduced HOMA-IR (insulin resistance index), BMI, waist circumference, and triglyceride levels in NAFLD patients.
Dose Considerations: Curcumin averages around 3.14% by weight of turmeric powder which is used for culinary usage.
Studies showing benefit typically used doses of 50 mg/day upto 1,000 mg/day or higher (Ngu et al., 2022), with some studies showing a dose-response relationship. This translates to approximately over 15 grams of turmeric powder daily if relying solely on culinary use, which exceeds typical culinary doses (1-3 grams daily).
This highlights an important limitation: while culinary use of turmeric is safe and may provide benefits, the doses used in most clinical trials are difficult to achieve through cooking alone.
3.3 Practical Culinary Use For Turmeric
Typical culinary doses of turmeric range from 1-3 grams per day (approximately ½ to 1 teaspoon). While this may provide lower concentrations of curcumin than studied in clinical trials, regular consumption over time may still offer benefits:
- Add to curries, soups, and stews
- Use in “golden milk” (turmeric latte with milk and black pepper)
- Include in scrambled eggs or tofu
- Mix into rice, quinoa, or other grains while cooking
- Add to smoothies
Bioavailability Enhancement: Black pepper (containing piperine) can significantly enhance curcumin absorption, a principle used in traditional Indian cooking where turmeric and black pepper are often combined Shoba et al (1998).
3.4 Turmeric Safety Note
While turmeric at culinary doses has an excellent safety profile spanning millennia of use, concentrated curcumin supplements have been associated with hepatotoxicity in rare cases, particularly at very high doses (LiverTox, 2012). The key message: food-based turmeric consumption is safe; high-dose supplements should be approached cautiously.
4. Ginger: Anti-Inflammatory Root with Metabolic Benefits
4.1 Evidence of Ginger for Liver Health
A randomized, double-blind, placebo-controlled trial of 44 NAFLD patients found that 2 grams per day of ginger supplementation for 12 weeks resulted in significant reductions in ALT, GGT, inflammatory cytokines (hs-CRP, TNF-α), insulin resistance index, and hepatic steatosis grade (Rahimlou et al 2016).
A later randomized controlled trial (Rafie et al., 2020) with 46 participants also showed similar benefits of ginger supplementation in reducing ALT, insulin resistance and lowering some inflammatory markers, however, it found no statistical difference in gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), fatty liver index (FLI), fatty liver grade.
A scoping review of culinary doses of herbs and spices found that ginger showed promise for controlling blood glucose and insulin, reducing blood lipid levels, and decreasing systemic inflammation (Mackonochie et. al., 2023).
4.2 Culinary Applications for Ginger
Typical culinary doses range from 1-4 grams of fresh ginger daily: - Grate fresh ginger into stir-fries - Steep in hot water for ginger tea - Add to smoothies or fresh juices - Include in salad dressings and marinades - Use in soups (particularly Asian-style broths)
5. Garlic: Allium with Metabolic Effects
Garlic (Allium sativum) has demonstrated anti-diabetic action and improvements in various metabolic parameters in preliminary research. While specific studies in NAFLD patients are limited, garlic’s effects on insulin sensitivity, lipid profiles, and inflammation suggest potential benefits.
5.1 Practical Use
- Use fresh crushed or minced garlic (crushing activates allicin, the primary bioactive compound)
- Allow crushed garlic to sit for 10 minutes before cooking to maximize allicin formation
- Add to sauces, dressings, and marinades
- Roast whole garlic cloves for milder flavor
Caution: Garlic and ginger should be avoided 4-7 days before scheduled surgery due to their anti platelet effects, increasing bleeding risk (Cheng et al, 2002).
6. Cinnamon: Sweet Spice for Glycemic Control
6.1 Evidence for Cinnamon and Metabolic Effects
A scoping review (Mackonochie et. al., 2023) found that cinnamon, along with fenugreek and ginger, showed the most promise in controlling blood glucose and insulin among culinary spices studied.
Multiple studies have examined cinnamon’s effects on glucose metabolism, though results have been mixed, with some showing benefits in poorly controlled diabetes but minimal effects in well-controlled conditions or prediabetes.
6.2 Cinnamon Safely Considerations
Cassia cinnamon, the most common variety in US grocery stores, contains coumarin, which can be hepatotoxic at very high doses. Ceylon cinnamon (true cinnamon) contains much less coumarin and may be preferable for regular use.
6.3 Culinary Applications for Cinnamon
- Add to oatmeal, yogurt, or smoothies
- Use in baking (approximately ½-1 teaspoon per recipe)
- Sprinkle on coffee or cappuccinos
- Include in savory dishes like Moroccan tagines or Indian curries
7. Mediterranean Herbs (Oregano, Basil, Rosemary, Thyme, and Parsley)
These herbs contain hepatoprotective phytochemicals including rosmarinic acid, carnosol, and eugenol, which provide antioxidant benefits. While specific clinical trials in NAFLD are lacking, their potent antioxidant properties and anti-inflammatory compounds support metabolic and hepatic health (Elbouny et al., 2025).
7.1 Potential Health Benefits
These herbs contain: - Polyphenols: Powerful antioxidants that reduce oxidative stress - Rosmarinic acid (rosemary, basil): anti-inflammatory and neuroprotective - Carnosol (rosemary): antioxidant and anti-inflammatory. - Eugenol (basil): Anti-inflammatory properties
7.2 Culinary Integration for Mediterranean Herbs
These herbs are easily incorporated into daily meals: - Fresh herbs in salads and as garnishes - Dried herbs in soups, stews, and sauces - Infused in olive oil for cooking and dressings - As part of spice blends (Italian seasoning, herbes de Provence)
8. Capsaicin: The Heat That May Help
Chili peppers containing capsaicin may improve fat oxidation and positively influence gut microbiota. Except studies using animal model (Shin, et al 2020), direct human evidence in NAFLD is limited, but capsaicin’s metabolic effects and its ability to enhance thermogenesis suggest potential benefits.
8.1 Practical Application
- Add fresh or dried chili peppers to taste in dishes
- Use hot sauce (watch sodium content)
- Include cayenne pepper in spice blends
- Remember: capsaicin tolerance varies greatly among individuals
9. Cumin, Fennel, Fenugreek, and Other Spices
A scoping review (Mackonochie et al 2023) found evidence supporting metabolic benefits for multiple spices including cumin, fennel, fenugreek, cardamom, cloves, coriander, and nigella seed, particularly for blood glucose control, lipid profiles, and inflammation markers.
9.1 General Principles for Culinary Integration
For all these spices: - Use variety to maximize different bioactive compounds - Incorporate into daily cooking rather than relying on sporadic use - Combine multiple spices for synergistic effects - Purchase fresh, whole spices when possible and grind as needed for maximum potency
10. Herbs That May Harm the Liver at High Doses
10.1 The Supplement vs. Culinary Distinction
It is crucial to understand that herb-induced liver injury (HILI) occurs almost exclusively with concentrated herbal supplements, not with culinary use of common cooking herbs and spices.
10.2 Herb/Spices Based Supplements Associated with Hepatotoxicity
The Drug Induced Liver Injury Network found that herbal and dietary supplements accounted for approximately 20% of drug-induced liver injury cases, with this proportion increasing over time (Navarro et al 2017, Teschke et al 2015, Lin et al 2023).
Specific supplements implicated include: - Green tea extract: Contains high concentrations of Epigallocatechin gallate (EGCG) which can cause hepatotoxicity at doses of 140-1,000 mg/day in susceptible individuals - Turmeric/curcumin supplements: High-dose curcumin supplements have been associated with liver injury in rare cases - Ashwagandha: Recent case reports of hepatotoxicity - Black cohosh: Associated with rare cases of liver injury - Garcinia cambogia: Weight loss supplement linked to hepatotoxicity - Red yeast rice: Contains statin-like compounds
10.3 Key Message for Patients
Taking a “food-first approach” by adding active ingredients like turmeric or green tea in culinary form is much safer than using concentrated supplements. Common cooking herbs and spices used in typical culinary amounts have not been associated with liver toxicity.
11. Practical Implementation: A Spice-Rich, Liver-Healthy Diet
11.1 Daily Integration Strategies
Morning:
- Add turmeric and black pepper to scrambled eggs
- Include ginger in morning smoothie
- Sprinkle cinnamon on oatmeal or yogurt
Lunch/Dinner:
- Use garlic and fresh herbs generously in cooking
- Build meals around vegetable-forward Mediterranean patterns
- Include variety of colorful vegetables (including nightshades)
Snacks:
- Fresh vegetables with herb-infused hummus
- Herbal teas (ginger, turmeric)
11.2 Sample Daily Spice Intake
A health-promoting daily intake might include: - 1-2 g turmeric (½-1 tsp) - 2-4 g fresh ginger (½-1 inch piece) - 2-3 cloves fresh garlic - ½-1 tsp cinnamon - Liberal use of fresh or dried Mediterranean herbs - Variety of colorful vegetables including tomatoes and peppers
11.3 Practical Tips
- Prep ahead: Mince garlic and ginger in batches; store in olive oil
- Build a spice collection: Invest in quality spices and replace annually
- Start small: If unfamiliar with spices, begin with smaller amounts and gradually increase
- Combine wisely: Many traditional spice combinations (e.g., turmeric + black pepper, ginger + garlic) enhance both flavor and bioavailability
- Make it easy: Keep commonly used spices near the stove
12. Conclusion
Culinary herbs, spices, and vegetables offer a flavorful approach to supporting liver health and metabolic function in NAFLD/MASLD. The evidence is strongest for turmeric (curcumin), with multiple high-quality studies demonstrating improvements in liver enzymes, steatosis, and metabolic parameters. Ginger, garlic, cinnamon, and Mediterranean herbs show promise based on their anti-inflammatory, antioxidant, and insulin-sensitizing properties.
Critically, the hepatoprotective effects discussed apply to culinary doses of whole herbs and spices consumed as part of food, not to concentrated supplements. While supplementation may have a role under medical supervision, the safest and most sustainable approach is incorporating these ingredients into daily cooking. This strategy provides not only bioactive compounds but also enhances the palatability of the whole-food, plant-forward diet that forms the cornerstone of NAFLD management.
By thoughtfully stocking the spice cabinet and using herbs and spices liberally in meal preparation, patients can transform their diet into a daily source of hepatoprotective compounds—one delicious meal at a time.
13. References
Ebrahimzadeh A, Ebrahimzadeh A, Fooladshekan S, Mohseni S, Mohtashamian A, Babajafari S, Sohrabi Z. Therapeutic effects of curcumin supplementation on liver enzymes of nonalcoholic fatty liver disease patients: A systematic review and meta-analysis of randomized clinical trials. Food Sci Nutr. 2024 Dec 1;13(1):e4144. doi: 10.1002/fsn3.4144. PMID: 39803230; PMCID: PMC11716989. https://pubmed.ncbi.nlm.nih.gov/39803230/. Meta-analysis of 14 studies showing curcumin supplementation significantly reduces ALT and AST in NAFLD patients, with effects influenced by dose and duration.
Molani-Gol, R., Dehghani, A., & Rafraf, M. (2024). Effects of curcumin/turmeric supplementation on the liver enzymes, lipid profiles, glycemic index, and anthropometric indices in non-alcoholic fatty liver patients: An umbrella meta-analysis. Phytotherapy Research, 38(2), 539-555. https://pubmed.ncbi.nlm.nih.gov/37918958/ Comprehensive umbrella meta-analysis of 11 meta-analyses examining curcumin’s effects across multiple metabolic parameters in NAFLD patients.
Ngu MH, Norhayati MN, Rosnani Z, Zulkifli MM. Curcumin as adjuvant treatment in patients with non-alcoholic fatty liver (NAFLD) disease: A systematic review and meta-analysis. Complement Ther Med. 2022 Sep;68:102843. doi: 10.1016/j.ctim.2022.102843. Epub 2022 Jun 2. PMID: 35661765. https://pubmed.ncbi.nlm.nih.gov/35661765/. Meta-analysis of 16 RCTs demonstrating curcumin improved NAFLD severity and increased liver steatosis resolution on ultrasound.
Shoba G, Joy D, Joseph T, Majeed M, Rajendran R, Srinivas PS. Influence of piperine on the pharmacokinetics of curcumin in animals and human volunteers. Planta Med. 1998 May;64(4):353-6. doi: 10.1055/s-2006-957450. PMID: 9619120. https://pubmed.ncbi.nlm.nih.gov/9619120/. Classic study showing that piperine increases curcumin bioavailability by 2000% in humans.
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Turmeric. [Updated 2025 Jun 16]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548561/
Mackonochie M, Rodriguez-Mateos A, Mills S, Rolfe V. A Scoping Review of the Clinical Evidence for the Health Benefits of Culinary Doses of Herbs and Spices for the Prevention and Treatment of Metabolic Syndrome. Nutrients. 2023 Nov 22;15(23):4867. doi: 10.3390/nu15234867. PMID: 38068725; PMCID: PMC10708057. https://pubmed.ncbi.nlm.nih.gov/38068725/. Comprehensive scoping review of 142 studies examining culinary doses of 15 different herbs and spices, finding strongest evidence for cinnamon, fenugreek, ginger, and turmeric in metabolic health.
Rafie, R., et al. (2020). Effect of ginger powder supplementation in patients with non-alcoholic fatty liver disease: A randomized clinical trial. Clinical and Experimental Gastroenterology, 13, 35-45. https://pmc.ncbi.nlm.nih.gov/articles/PMC7007901/ RCT of 44 NAFLD patients showing 2g/day ginger for 12 weeks significantly reduced alanine aminotransferase (ALT), total cholesterol, low-density lipoprotein (LDL-C), fasting blood glucose, and insulin resistance index (HOMA) and inflammatory markers.
Rahimlou M, Yari Z, Hekmatdoost A, Alavian SM, Keshavarz SA. Ginger Supplementation in Nonalcoholic Fatty Liver Disease: A Randomized, Double-Blind, Placebo-Controlled Pilot Study. Hepat Mon. 2016 Jan 23;16(1):e34897. doi: 10.5812/hepatmon.34897. PMID: 27110262; PMCID: PMC4834197. https://pubmed.ncbi.nlm.nih.gov/27110262/ .Double-blind RCT demonstrating that 2g/day ginger supplementation for 12 weeks improved liver enzymes and metabolic parameters in NAFLD patients.
Ajanaku CO, Ademosun OT, Atohengbe PO, et al. Functional bioactive compounds in ginger, turmeric, and garlic. Front Nutr. 2022;9:1012023. Published 2022 Dec 8. doi:10.3389/fnut.2022.1012023. https://pmc.ncbi.nlm.nih.gov/articles/PMC9773837/. Review of bioactive compounds and therapeutic properties of three key culinary spices with anti-inflammatory and metabolic benefits.
Cheng B, Hung CT, Chiu W. Herbal medicine and anaesthesia. Hong Kong Med J. 2002 Apr;8(2):123-30. PMID: 11937667. https://pubmed.ncbi.nlm.nih.gov/11937667/
Elbouny, H., Amssayef, A., Benjamaa, R. et al. Thyme, oregano, and rosemary: herbs and food supplements for the management of metabolic associated fatty liver disease. Nutrire 50, 6 (2025). https://doi.org/10.1186/s41110-024-00307-1
Shin MK, Yang SM, Han IS. Capsaicin suppresses liver fat accumulation in high-fat diet-induced NAFLD mice. Anim Cells Syst (Seoul). 2020;24(4):214-219. Published 2020 Aug 26. doi:10.1080⁄19768354.2020.1810771. https://pmc.ncbi.nlm.nih.gov/articles/PMC7473188/.
Navarro VJ, Khan I, Björnsson E, Seeff LB, Serrano J, Hoofnagle JH. Liver injury from herbal and dietary supplements. Hepatology. 2017 Jan;65(1):363-373. doi: 10.1002/hep.28813. Epub 2016 Nov 17. PMID: 27677775; PMCID: PMC5502701. https://pubmed.ncbi.nlm.nih.gov/27677775/. DILIN Network study documenting the increasing proportion of DILI cases from herbal and dietary supplements.
Teschke, R., & Eickhoff, A. (2015). Herbal hepatotoxicity in traditional and modern medicine: Actual key issues and new encouraging steps. Frontiers in Pharmacology, 6, 72. https://pmc.ncbi.nlm.nih.gov/articles/PMC4407580/ Comprehensive review of herb-induced liver injury mechanisms, emphasizing that most hepatotoxicity occurs with supplements rather than culinary use.
Lin, J.K.-S.; Tujios, S.R. Hidden Dangers: Herbal and Dietary Supplement Induced Hepatotoxicity. Livers 2023, 3, 618-636. https://doi.org/10.3390/livers3040041 Comprehensive review of herbal and dietary supplement hepatotoxicity, noting that the proportion of drug-induced liver injury from supplements increased from 7% to 20% between 2004 and 2014.
Other Supporting References
Likhitsup, A., et al. (2024). Estimated exposure to 6 potentially hepatotoxic botanicals in US adults. JAMA Network Open, 7(8), e2425822. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821951 Population study finding that 5% of US adults (15.6 million) had used potentially hepatotoxic botanical supplements in the previous 30 days.