5 things you need to know about fatty liver disease (and how to reverse it)


by Robert Rahimi, MD

Dec 28, 2021

Fatty liver is the most prevalent form of liver disease in the US, and it is unfortunately on the rise. As many as 1 in 4 people have fatty liver disease. Many of these people will experience declining health as a result.

Let’s discuss what fatty liver disease is, how it develops and a few things you can do to stop it.

1. What is fatty liver disease?

Nonalcoholic fatty liver disease (NAFLD) is a condition in which fat builds up in the liver. As the fat replaces healthy liver tissue, the liver stops working well.

The more severe form of NAFLD is nonalcoholic steatohepatitis (NASH), which causes the liver to swell and become damaged, leading to fibrosis or cirrhosis and liver cancer. It is also becoming the number one reason for liver transplantation in the US, but there’s good news—NASH is preventable.

Heavy alcohol use also causes fat to build up in the liver. Alcoholic fatty liver disease is on the rise and is also preventable.

2. What causes fatty liver disease?

Nonalcoholic steatohepatitis tends to develop in people who have the following risk factors:

Keep in mind, due to genetics, it is possible to develop NASH even if you don’t have these risk factors.

3. What are the symptoms of fatty liver disease?

Although fatty liver is the leading form of liver disease in adults, it is not on everyone’s radar. Why? Because people don’t usually develop symptoms for many years. There are no routine screening guidelines for fatty liver, making it unlikely to be detected. 

That’s why a yearly physical exam with bloodwork by a healthcare provider is so important. Early diagnosis and intervention are key to treating and managing fatty liver disease.

4. How is fatty liver disease diagnosed?

The best way to diagnose nonalcoholic fatty liver disease is with routine bloodwork (liver tests) on a yearly basis by your family doctor or primary care physician. If liver tests reveal elevated enzymes, or if you are overweight or obese, your doctor may order a liver ultrasound. The imaging results will show liver damage if any exists.

Depending on the severity or the results, you may be referred to a hepatologist (liver specialist) to see if further testing or imaging is warranted to determine the severity of your liver disease. Finding the cause and extent of liver damage is key to guiding your treatment.

5. Is fatty liver disease reversible?

Here’s the good news. Fatty liver disease is treated with a combination of diet and exercise. With this regimen, the liver can heal itself and actually reverse the damage that has occurred over the years.

  • Eat smaller portion sizes: The first step is to reduce portion sizes during meals.
  • Reduce alcohol: Alcohol causes inflammation and damage to liver cells.
  • Reduce overall calories: By cutting back about 150 calories a day, you can expect about 1 pound of weight loss per month, but keep in mind every person is different. Talk to your doctor about what dietary guidelines are right for you.
  • Exercise: Exercise will enhance additional weight loss. Ideally, the goal should be to lose about 10% of body weight but improvement may be achieved even if you lose 3-5% of your starting weight.

New medications are showing promise in reducing liver inflammation in study patients with nonalcohol fatty liver disease. But so far, no drug treatment has been approved by the Food and Drug Administration.

At present, diet and exercise are the best ways to reverse and prevent further damage to your liver. Worried about your risk for fatty liver disease? Find a doctor or hepatologist near you.

About the Author

Robert Rahimi, MD, is a transplant hepatologist on the medical staff at Baylor University Medical Center. Get to know Dr. Rahimi today.

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