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
characterized by insulin resistance.
What’s more, if fatty liver isn’t addressed, it may progress to
more serious liver disease and other health problems.
What Is Fatty Liver?
While drinking too much alcohol
can lead to fatty liver, in many cases it does not play a role.
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 (4, 5).
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Bottom Line: Fatty liver occurs when too
much fat builds up in the liver. Fatty liver is reversible at
an early stage, but it sometimes progresses to advanced liver
What Causes Fatty Liver?
There are several factors that may cause or contribute to
developing fatty liver:
Obesity: 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
(2, 3, 9, 10).
Excess belly fat: Normal-weight people may
develop fatty liver if they are “viscerally obese,” meaning
they carry too much fat around the waist (11).
Insulin resistance: 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 (14, 15).
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 (16, 17).
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 (18, 19).
Bottom Line: Causes of NAFLD include
obesity, insulin resistance, excessive intake of refined
carbs and sugar, as well as impaired gut health.
Symptoms of Fatty Liver
There are several signs and symptoms of fatty liver, although
not all of these may be present. In fact, you may not even
realize you have fatty liver.
- Fatigue and weakness
- Slight pain or fullness in the right or center abdominal
- Elevated levels of liver enzymes, including AST and ALT
- Elevated insulin levels
- Elevated triglyceride levels
If fatty liver progresses to NASH, the following symptoms may
- Loss of appetite
- Nausea and vomiting
- Moderate to severe abdominal pain
- Yellowing of eyes and skin
It’s important to see your doctor regularly for standard exams
and blood tests that can diagnose fatty liver at the early,
Bottom Line: Fatty liver may cause subtle
symptoms and is often detected by blood tests. NASH usually
involves more pronounced symptoms, such as abdominal pain and
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 lose 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 (20, 21, 22, 23, 24).
What’s more, it appears that the improvements in liver fat and
insulin sensitivity may persist even if some of the weight is
Cut Back on Carbs, Especially Refined Carbs
It 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
During DNL, excess carbs are converted into fat. The rate at
which DNL occurs increases with high intakes of fructose-rich
foods and beverages (27).
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% (15).
In one study, liver fat and insulin resistance decreased
significantly more when people consumed a Mediterranean diet
than when they consumed a low-fat, high-carb diet, even though
weight loss was similar on both diets (33).
In this study, 14 obese men with NAFLD followed a Mediterranean
diet. After 12 weeks, 13 of the men experienced reductions
in liver fat, including three who achieved complete resolution
of fatty liver (31).
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 (35, 36).
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 (37, 38).
Green tea: One study found that antioxidants
green tea called catechins helped decrease liver fat and
inflammation in people with NAFLD (39).
Soluble fiber: Some research suggests that
consuming 10–14 grams of soluble fiber daily may help reduce
liver fat, decrease liver enzyme levels and increase insulin
sensitivity (40, 41).
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
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 (42, 43, 44).
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
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 before
taking any supplements, especially if you are taking
Milk thistle, or silymarin, is an herb known for its
liver-protecting effects (48).
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
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 (53).
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-sensitizing drug and
the other group took no supplement or medication (57).
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
Omega-3 Fatty Acids
Omega-3 fatty acids have been credited with many
health benefits. The long-chain omega-3s EPA and DHA are
found in fatty fish, such as salmon, sardines, herring and
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 (60).
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
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
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.
Bottom Line: Supplements that may help
reverse NAFLD include milk thistle, berberine and omega-3
fatty acids. They are most effective when combined with
Take Home Message
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