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4 Ways to Reverse Nonalcoholic Fatty Liver Disease

About 1 in 4 U.S. adults have the often symptomless condition

spinner image Fatty liver disease and hepatic steatosis rendering
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Nonalcoholic fatty liver disease (NAFLD) might just be the most common disease you’ve never heard of.

The condition — which occurs when excess fat accumulates in the liver of people who aren’t heavy drinkers — is the most common form of chronic liver disease, affecting roughly 1 in 4 U.S. adults. Still, it isn’t on most people’s radar.  

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“The biggest problem is low awareness among primary care doctors,” says Mary Rinella, M.D., a professor of medicine and director of the Metabolic and Fatty Liver Disease Clinic at University of Chicago Medicine.

Indeed, research suggests primary care doctors aren’t always certain which patients to screen for NAFLD. (Why test your teetotaling patients for a liver disease?)

Further complicating matters: Those who have the condition typically experience few, if any, symptoms. (How can you talk to your doctor about a condition you don’t even suspect you have?)

“It’s a common myth that only alcohol can damage the liver or cause scarring — also known as cirrhosis — but the truth is that fat buildup is a major cause of liver damage and can lead to liver failure and its most feared complication, liver cancer,” says Ani Kardashian, M.D., assistant professor of medicine in the Division of Gastroenterology and Liver Diseases at the Keck School of Medicine at the University of Southern California. “In fact, fatty liver is the second most common reason for liver transplants in the U.S.”

It’s normal for the liver to have some fat, but if more than 5 to 10 percent of your liver’s weight is fat, you have what’s known as a fatty liver. With NAFLD, this happens in people who aren’t heavy drinkers. And the risk is higher for people over age 50, particularly women.

“As adults age, they are more likely to develop high blood pressure, diabetes, high cholesterol or obesity, which are the principal risk factors for fatty liver,” Kardashian says. “In women, menopause is an additional hit. Estrogen is protective against fatty liver and liver scarring ... and after women hit menopause, as estrogen levels drop, they lose that protective effect.”

While there is no cure for NAFLD, it can be reversed. The longer it goes undiagnosed, however, the greater the chances of progressing to nonalcoholic steatohepatitis (NASH), a more severe form of NAFLD, which can be more difficult to reverse.

NAFLD exists on a spectrum “ranging from fat with no scarring — which is 100 percent reversible — to cirrhosis, which is way at the other end of the spectrum and not reversible,” Rinella says. “Where you are on the spectrum of disease determines how much reversibility you’re able to get.”

Here are four things you can do to reverse NAFLD:

1. Maintain a healthy weight

Not only do excess pounds raise your risk for NAFLD — research shows that the overwhelming majority of people with the condition are overweight or have obesity — but losing weight and maintaining the loss is a must in terms of reversing the condition.


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The good news is, you don’t have to reach your ideal weight to reap the rewards.

“If you lose 5 percent of your body weight you can have improvement,” Rinella says. “If you lose 7 percent, you can eliminate some of the damage to the liver cells, and if you lose 10 percent, you can see improvement in scar tissue.”

Keep in mind: How you lose the weight makes a difference. According to the American Liver Foundation, rapid weight loss and poor eating habits may also lead to NAFLD. Rinella recommends that her patients try the Mediterranean diet — think fresh fruits and veggies, whole grains, nuts, beans, fish and olive oil.

She also recommends coffee.

“Coffee is associated with reduced progression of scarring in the liver in both alcohol- and nonalcohol-related liver disease,” she says, citing a study published in Frontiers in Pharmacology. “Caffeinated coffee is probably better, but there’s evidence that decaf is also beneficial, even if you add milk and sugar. I tell patients to use low-fat milk rather than cream or milk, and minimal sugar or sugar substitute, because you want to be mindful of the calories.”

2. Skip fast food

In terms of reversing NAFLD, what you do and don’t consume are equally important. In a study published in Clinical Gastroenterology and Hepatology, researchers found that people with obesity and people with diabetes who consume at least 20 percent of their daily calories from fast food have dramatically elevated levels of fat in their liver compared to those who consume less fast food, or none at all. 

“The types of foods that we eat can lead to all of the same negative side effects on the liver that we typically think of with heavy drinkers,” Kardashian says.

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3. Break a sweat

Exercise plays a role in any weight loss plan — of course — but research suggests it plays a specific role in reversing NAFLD that has nothing to do with losing weight. A review of studies published in 2021 in Frontiers in Nutrition found that regular exercise improved NAFLD, even in patients who didn’t lose weight. It also helped prevent early-stage NAFLD from progressing to NASH.

Studies show a combination of strength training and cardio is most effective. Aim for two to three strength-training sessions a week and 150 to 300 minutes per week of moderate-to-vigorous aerobic activity like brisk walking, running or swimming.

“Cardio is more effective in terms of reducing fat in the liver,” says Rinella, citing other research showing that patients with NAFLD who followed a regular aerobic exercise regimen — meaning moderate-intensity cardio for at least 30 minutes five days a week, or vigorous cardio for at least 20 minutes three days a week — experienced a reduction in liver fat of 10 to 43 percent.

4. Avoid alcohol

All those guidelines about moderate drinking you’ve had drilled into your head, you can pretty much dismiss them if you have a fatty liver.

Research suggests there is no such thing as an OK amount of alcohol for people trying to reverse NAFLD — not even the standard drink per day for women or two drinks per day for men. A study published in Gastroenterology found that alcohol significantly impacts disease progression in other forms of liver disease, including NASH.

“We’re starting to move toward the recommendation that there is no safe amount of alcohol,” says Rinella, a coauthor of the study.

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