Fatty liver disease is becoming increasingly common in many parts of the world, affecting about 25% of people globally. It is linked to obesity, type 2 diabetes and other disorders characterised by insulin resistance.
What’s more, if fatty liver is not addressed, it may progress to more serious liver disease and other health problems.
What Is Fatty Liver?
Fatty liver occurs when too much fat builds up in liver cells. Although it is normal to have a tiny amount of fat in these cells, the liver is considered fatty if more than 5% of it is fat. While drinking too much alcohol can lead to fatty liver, in many cases it does not play a role.
A number of fatty liver conditions fall under the broad category of non-alcoholic liver disease (NAFLD), which is the most common liver disease in adults and children in Western countries. Non-alcoholic fatty liver (NAFL) is the initial, reversible stage of liver disease. Unfortunately, it often goes undiagnosed. Over time, NAFL may lead to a more serious liver condition known as non-alcoholic steatohepatitis, or NASH. NASH involves greater fat accumulation and inflammation that damages the liver cells. This can lead to fibrosis, or scar tissue, as liver cells are repeatedly injured and die off. Unfortunately, it is difficult to predict whether fatty liver will progress to NASH, which greatly increases the risk of cirrhosis (severe scarring that impairs liver function) and liver cancer.
NAFLD is also linked to an increased risk of other diseases, including heart disease, diabetes and kidney disease.
In many cases of NAFLD, there are no noticeable symptoms. When symptoms are present, they usually include:
- Pain in the upper right side of the abdomen
- Enlarged liver or spleen (usually observed by a doctor during an exam)
- Ascites, or swelling in the belly
- Jaundice, or yellowing of the skin and eyes
If NAFLD progresses to cirrhosis, symptoms may include:
- Mental confusion
- Internal bleeding
- Fluid retention
- Loss of healthy liver function
What Causes Fatty Liver?
There are several factors that may cause or contribute to developing fatty liver:
Obesity involves low-grade inflammation that may promote liver fat storage. It’s estimated that 30–90% of obese adults have NAFLD, and it’s increasing in children due to the childhood obesity epidemic
Excess belly fat
Normal-weight people may develop fatty liver if they are “viscerally obese,” meaning they carry too much fat around the waist
Insulin resistance and high insulin levels have been shown to increase liver fat storage in people with type 2 diabetes and metabolic syndrome
High intake of refined carbs
Frequent intake of refined carbs promotes liver fat storage, especially when high amounts are consumed by overweight or insulin-resistant individuals
Sugary beverage consumption
Sugar-sweetened beverages like soda and energy drinks are high in fructose, which has been shown to drive liver fat accumulation in children and adults
Impaired gut health
Recent research suggests that having an imbalance in gut bacteria, problems with gut barrier function (“leaky gut”) or other gut health issues may contribute to NAFLD development
Dietary Strategies for Getting Rid of Fatty Liver
There are several things you can do to get rid of fatty liver, including losing weight and cutting back on carbs. What’s more, certain foods can help you loose liver fat.
Lose Weight and Avoid Overeating If Overweight or Obese
Weight loss is one of the best ways to reverse fatty liver if you are overweight or obese. In fact, weight loss has been shown to promote loss of liver fat in adults with NAFLD, regardless of whether the weight loss was achieved by making dietary changes alone or in combination with weight loss surgery or exercise. In a three-month study of overweight adults, reducing calorie intake by 500 calories per day led to an 8% loss of body weight, on average, and a significant decrease in fatty liver score. What’s more, it appears that the improvements in liver fat and insulin sensitivity may persist even if some of the weight is regained
Cut Back on Carbs, Especially Refined Carbs
t may seem as though the most logical way to address fatty liver would be to cut back on dietary fat. However, researchers report only about 16% of liver fat in people with NAFLD comes from dietary fat. Rather, most liver fat comes from fatty acids in their blood, and about 26% of liver fat is formed in a process called de novo lipogenesis (DNL). In one study, obese adults who consumed a diet high in calories and refined carbs for three weeks experienced a 27% increase in liver fat, on average, even though their weight only increased by 2%. Studies have shown that consuming diets low in refined carbs may help reverse NAFLD. These include low-carb, Mediterranean and low-glycemic index diets
Include Foods That Promote Loss of Liver Fat
In addition to cutting back on carbs and avoiding excess calorie intake, there are certain foods and beverages that may be beneficial for fatty liver: +Monounsaturated fats: Research suggests that eating foods high in monounsaturated fatty acids like olive oil, avocados and nuts may promote liver fat loss +Whey protein: Whey protein has been shown to reduce liver fat by up to 20% in obese women. In addition, it may help lower liver enzyme levels and provide other benefits in people with more advanced liver disease +Green tea: One study found that antioxidants in green tea called catechins helped decrease liver fat and inflammation in people with NAFLD. +Soluble fibre: Some research suggests that consuming 10–14 grams of soluble fibre daily may help reduce liver fat, decrease liver enzyme levels and increase insulin sensitivity
Bottom Line: Losing weight, avoiding overeating, including certain foods in your diet and cutting back on sugar and carbs may help reduce liver fat.
Exercise That Can Help Reduce Liver Fat
Physical activity can be an effective way to decrease liver fat. Studies have shown that engaging in endurance exercise or resistance training several times a week can significantly reduce the amount of fat stored in liver cells, regardless of whether weight loss occurs.
In a four-week study, 18 obese adults with NAFLD who exercised for 30–60 minutes five days per week experienced a 10% decrease in liver fat, even though their body weight remained stable.
High-intensity interval training (HIIT) has also been shown to be beneficial for decreasing liver fat. In a study of 28 people with type 2 diabetes, performing HIIT for 12 weeks led to an impressive 39% reduction in liver fat.
However, even lower-intensity exercise can be effective at targeting liver fat. According to a large Italian study, it appears that how much you exercise is most important. In that study, 22 diabetics who worked out twice per week for 12 months had similar reductions in liver fat and abdominal fat, regardless of whether their exercise intensity was considered low-to-moderate or moderate-to-high.
Since working out regularly is important for reducing liver fat, choosing something you like doing and can stick with is your best strategy.
Bottom Line: Endurance exercise, strength training or high- or low-intensity interval training can help reduce liver fat. Working out consistently is key.
Supplements That May Improve Fatty Liver
Results from several studies suggest that certain vitamins, herbs and other supplements may help reduce liver fat and decrease the risk of liver disease progression. However, in most cases, experts say that further research is required to confirm this.
In addition, it’s important to speak with your doctor or healthcare practitioner before taking any supplements, especially if you are taking medication.
Milk thistle, or silymarin, is an herb known for its liver-protecting effects. Some studies have found that milk thistle, alone or in combination with vitamin E, may help reduce insulin resistance, inflammation and liver damage in people with NAFLD. In a 90-day study of people with fatty liver, the group who took a silymarin-vitamin E supplement and followed a low-calorie diet experienced twice the reduction in liver size as the group who followed the diet without taking the supplement. The dosages of milk thistle extract used in these studies were 250–376 mg per day.
However, although experts believe that milk thistle shows promise for use in NAFLD, they feel that more studies are needed to confirm its effectiveness for both short- and long-term use
Berberine is a plant compound that has been shown to significantly reduce blood sugar, insulin and cholesterol levels, along with other health markers. Several studies also suggest that it may benefit people with fatty liver. In a 16-week study, 184 people with NAFLD reduced their calorie intake and exercised for at least 150 minutes per week. One group took berberine, one took an insulin-sensitising drug and the other group took no supplement or medication. Those taking 500 mg of berberine, three times per day at meals, experienced a 52% reduction in liver fat and greater improvements in insulin sensitivity and other health markers than the other groups.
Researchers say that despite these encouraging results, further studies are needed to confirm berberine’s effectiveness for NAFLD
Omega 3 Fatty Acids
Several studies have shown that taking omega-3s may improve liver health in adults and children with fatty liver. In a controlled study of 51 overweight children with NAFLD, the group who took DHA had a 53% reduction in liver fat, compared to 22% in the placebo group. The DHA group also lost more belly fat and fat around the heart. Furthermore, in a study of 40 adults with fatty liver, 50% of those who took fish oil in addition to making dietary changes had reductions in liver fat, while 33% experienced a complete resolution of fatty liver . The dosages of omega-3 fatty acids used in these studies were 500–1,000 mg per day in children and 2–4 grams per day in adults. Although all the studies above used fish oil, you can get the same benefits by consuming fish high in omega-3 fats several times a week.
Importantly, these studies show that certain supplements appear to enhance the effects of lifestyle changes. Taking them without following a healthy diet and exercising regularly will likely have little effect on liver fat.
Conclusion: Supplements that may help reverse NAFLD include milk thistle, berberine and omega-3 fatty acids. They are most effective when combined with lifestyle changes.
Take Home Summary
Fatty liver can lead to a number of health problems. Fortunately, it can be reversed if addressed at an early stage.
Following a healthy diet, increasing physical activity and perhaps taking supplements can reduce excess liver fat and decrease the risk of its progression to more serious liver disease.
It is important to see your doctor or health care practitioner regularly for standard exams and blood tests that can diagnose fatty liver at the early, reversible stage.