By Bubu Banini, MD, PhD, as told to Denise Mann
As a liver specialist, I spend a good deal of my time counseling people with fatty liver disease on what they can do more of (or less of) to improve their health. This is a big part of my role as the Translational Research Director of the Metabolic Health and Weight Management Program, the Associate Director of the Clinical and Translational Core of the Yale Liver Center in New Haven, Connecticut, and as a volunteer with the American Liver Foundation.
Recently, as the co-chair of the Fatty Liver Disease Working Group, I offered this type of advice for the entire state of Connecticut, which should give you a good idea of how many people live with the condition.
About 100 million people in the U.S. have fatty liver disease, and these numbers are on the rise. Why? Because liver disease travels with obesity, type 2 diabetes (the form of the disease most closely linked to obesity), and high blood cholesterol levels. And all of those are also becoming more common in the U.S.
Fatty liver disease happens when excess fat builds up in your liver, leading to inflammation and damage to your liver cells. You may not give your liver that much thought, but this essential organ helps you digest food, store energy, and remove poisons.
There are two main types of fatty liver disease:
- Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD)
- Alcoholic fatty liver disease (alcoholic steatohepatitis)
I was drawn to this area of medicine because so many people with these conditions fall through the cracks. Fatty liver disease is often silent, resulting in no or few symptoms until the disease has already worsened.
After years of practice, my main takeaway is always that eating a healthy diet, exercising regularly, and making other lifestyle changes are among the best ways to prevent liver damage or even reverse fatty liver disease.
Here’s what I tell all of my patients with fatty liver disease.
Lose Weight, if Necessary
If you are overweight or have obesity, even a modest amount of weight loss — just 7%-10% of your body weight — can improve how well your liver works. Losing weight lowers your risk of liver scarring (fibrosis), which can worsen to a severe and irreversible scarring called cirrhosis.
In addition to eating a healthier diet and getting regular exercise, certain medications may help you lose excess weight. Ask your doctor about liver-friendly weight loss aids. Injectable weight loss drugs such as semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro, Zepbound), and other drugs in this class are being examined for their ability to help people with fatty liver disease.
Go Greek
Eating foods from the Mediterranean diet can improve fatty liver disease. This style of eating calls for getting plenty of vegetables, fruits, whole grains, legumes, fish, lean proteins, and healthy fats, such as olive oil. It improves many of the conditions linked to fatty liver disease:
- Heart disease
- Metabolic syndrome
- Obesity
- Type 2 diabetes
Avoid foods that can worsen fatty liver disease, including added sugars and refined carbs such as soda, white bread, pastries, and other sweets. These foods are converted into blood sugar very quickly and stored as fat in the liver. Cutting these culprits out or limiting how often you eat them can help lower fat buildup in your liver and lower your risk for type 2 diabetes, too.
Diets loaded with saturated and trans fats from processed meats and fried foods can also lead to fat buildup in your liver and inflammation. I tell my patients to replace these with healthier fats from nuts, seeds, and olive oil, which are good for the liver and the heart.
Following this advice will improve your body’s ability to use the hormone insulin, lower inflammation, and halt or — in some cases — reverse fatty liver disease.
Curb Your Alcohol Intake
The best thing you can do for your liver is stop drinking alcohol entirely. This gives you the best chance to improve your liver’s health. Alcohol is a liver poison. If you can’t stop drinking immediately or completely, try to gradually cut down on how much alcohol you drink, with the goal of stopping entirely. Traditional Mediterranean diets do include wine, but I tell people with fatty liver disease to skip that part. Even small amounts of alcohol can worsen your condition and interfere with your liver's ability to heal itself.
Get Moving
Engage in moderate-intensity aerobic activities, such as brisk walking, cycling, or swimming, for about 30 minutes a day, five times weekly. The goal is a total of at least 150 minutes each week. This can lower the amount of fat in your liver. Strength training at least two to three times weekly is also a good idea, as loss of muscle leads to worse outcomes in people with liver disease. Start where you’re most comfortable in terms of time and intensity and gradually build up to these recommended levels.
Mind Your Vitamins, Supplements, and Medications
Many of my patients ask about vitamins and “liver supplements." I tell them there is no magic pill that can cure liver disease or even prevent damage.
There is some evidence that certain vitamins and supplements may benefit the liver:
- Vitamin E may help improve the health and function of your liver. Do not take vitamin E without first talking to your doctor.
Low levels of vitamin D have also been linked to fatty liver disease. A simple blood test can tell you where you stand and whether you need more vitamin D.
Some over-the-counter medications and supplements can harm your liver:
Acetaminophen (Tylenol). I tell my patients that the painkiller acetaminophen is safe at standard doses of ≤2 grams a day, but that any more than that can be dangerous.
It’s better to be safe than sorry, so ask your doctor before starting any new vitamin, supplement, or medication.
