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32% Of People Have Nonalcoholic Fatty Liver Disease — But It Can Be Reversed

Author:

Molly Knudsen, M.S., RDN

March 12, 2024

Registered Dietitian Nutritionist

By Molly Knudsen, M.S., RDN

Registered Dietitian Nutritionist

Molly Knudsen, M.S., RDN is a Registered Dietician Nutritionist with a bachelor’s degree in nutrition from Texas Christian University and a master’s in nutrition interventions, communication, and behavior change from Tufts University. She lives in Newport Beach, California, and enjoys connecting people to the food they eat and how it influences health and wellbeing.

Image by ZOA Photo

March 12, 2024

At mindbodygreen, we do a lot of reporting on all things metabolic health, from the dangers of high blood sugar and insulin resistance to the habits you can implement to improve your health. It's no secret that conditions like Type 2 diabetes and excess weight are on the rise. But there's a related condition on the rise that's generating far less buzz (and that many may not even connect to metabolic health). That's nonalcoholic fatty liver disease (NAFLD).

NAFLD is now estimated to affect 32% of adults globally 1—for reference, Type 2 diabetes is at about 10.5%, and 16%2 of people are living with obesity. And it's something we need to talk about. Here's what you need to know about NAFLD and what you can do to improve your liver function (and cardiometabolic health).

What is NAFLD?

NAFLD occurs when too much fat accumulates in the liver 3—but the reason for that fat buildup is not related to alcohol consumption. Instead, it's tied to things like high-calorie intake, excess body fat, and insulin resistance—metabolic concerns—as the liver plays a major role in energy balance.

Poor metabolic health hurts the liver, as there's an increase in the amount of fat (aka triglycerides), and hormonal changes tell the body to store that fat in the liver over burning that fat for energy.

This fat accumulation doesn't necessarily progress into long-term, nonreversible damage), but it does strain the liver and makes its job (including detoxification) more challenging. It also puts people at a higher risk of other health conditions like diabetes and heart disease—and people with those conditions are also at high risk for NAFLD.

However, it can snowball if unfavorable lifestyle habits are maintained. In severe cases, inflammation and damage can occur in conjunction with fat buildup (called nonalcoholic steatosis), which can lead to cirrhosis and even liver cancer.

What are the signs of it?

The tricky thing is, there are very few signs of this silent disease, and most people experience no symptoms—especially in the early stages.

Health care providers may look at your triglycerides and blood sugar levels for a blood test to evaluate your risk of the condition. A blood test can also measure liver enzymes 4 like alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT). These biomarkers aren't often included in standard blood work, so they may only be measured as part of a liver function test if your health care provider thinks it's warranted.

That's what makes this disease so sneaky—if you don't go to the doctor until you start to feel symptomatic in some way (like fatigued or a dull pain over the lower right side of the ribs), the disease has progressed substantially. And it's at the point of cirrhosis—severe scarring of the liver—the damage is not reversible.

Can you prevent or reverse fatty liver?

The good news is that you can prevent fatty liver and reverse some 3—if not all—of the current fat accumulation. And all the current treatment includes lifestyle habits: There's no medication to lean on.

Aim for healthy weight loss: This is really the primary treatment for NAFLD, as the disease progression is so closely correlated with overweight and obesity 5. Even a modest, gradual reduction of body fat can significantly decrease liver fat. Research shows that just a 5% reduction in BMI (yes we know it's an imperfect and dated measure of health) leads to a 25% reduction of liver fat 5. While diet and exercise set the foundation for a healthy, fat-loss-promoting lifestyle, a science-backed metabolism-boosting supplement can also provide a beneficial nudge.
Bump up your protein intake: Eating a high-protein diet helps promote fat loss. Protein revs up your metabolism (it takes more energy to digest protein than it does fat), helps keep you full, and helps you shed fat while maintaining your muscle mass, which is vital for sustained weight loss. Most people need at least 100 grams of protein a day, but we break down how to calculate your specific needs here.
Follow a Mediterranean diet: Many studies show that following the principles of a Mediterranean 6 diet (like reducing intake of sugars and refined carbs) and increasing intake of monounsaturated fats (like olive oil) as well as omega-3s can reduce liver fat.
Eat lots of fiber: Research shows that eating a diet rich in fiber is linked to a lower risk of developing 7NAFLD. Fiber promotes a healthy weight and balanced energy levels, whereas excess energy (or calories) is the main driver of fat buildup in liver cells.
Get regular physical activity: An inactive lifestyle (on its own and paired with a poor diet) is a contributing factor to fatty liver. Multiple clinical trials show that both aerobic and resistance exercise reduces liver fat and improves insulin resistance 8.
Include liver-friendly antioxidants & vitamins: So these nutrients won't directly manage NAFLD or prevent it, but they can help the liver do its job more effectively. Vitamin B12, vitamin C, vitamin D, NAC, selenium, glutathione, milk thistle, and turmeric all help the liver keep up with its detoxification responsibilities and can be obtained either through the diet or through a targeted liver supplement.

The takeaway

If your metabolic health is poor, your liver will suffer. And many people may not be aware of that connection. The silent progression of NAFLD makes this disease hard to identify, especially if you aren't getting at least yearly health checkups.

Lifestyle changes are currently the only research-backed treatment options to lessen the burden of NAFLD, reverse it, or prevent it altogether. Maintaining a healthy weight, eating a protein- and fiber-rich diet with lots of veggies, and getting plenty of physical activity are the best ways to improve your metabolic health and in turn, your liver health.