Preventing and reversing fatty liver disease

It’s possible to have a serious liver disease and not know it.

Fatty liver disease is sometimes called a “silent disease.” It doesn’t cause many, if any, symptoms until the disease reaches an advanced stage. At that point, you’re more likely to notice it. Your skin and eyes might turn yellow, your legs and abdomen could swell, and you may have pain in your belly and feel nauseous and tired.

Fat doesn’t typically grow in the liver. But if you drink too much on a regular basis or are obese or have diabetes, fat can accumulate in your liver. That, in turn, can trigger chronic inflammation in your body, putting you at risk of your liver tissue scarring. Over time, that can lead to advanced liver disease called cirrhosis, when parts of the liver are permanently scarred and damaged.

What is fatty liver disease?

There are two main types of fatty liver disease:

• Alcoholic fatty liver disease, which is caused by too much alcohol
• Nonalcoholic fatty liver disease, which is also called metabolic dysfunction-associated steatotic liver disease or MASLD, which is commonly seen in people with obesity and type 2 diabetes. MASLD is one of the most common chronic liver diseases affecting one out of every three people worldwide. It’s the second leading cause of cirrhosis in the United States.

Can fatty liver disease be reversed?

If you can improve the underlying causes of your fatty liver disease, you can improve the condition.

When people quit drinking, lose weight and get their type 2 diabetes under control, fatty liver disease improves.

If you lose:

• 7% or more of your weight, you can see the level of fat in your liver go down, and sometimes the inflammation as well.
• 10% or more of your weight, the scarred liver may begin to turn healthy again.

Losing weight can be difficult. We understand that. Even if you don’t lose weight, you can experience many benefits from just eating a healthy diet and exercising.

As long as you’re able to improve the condition of your liver, even by a little bit, that’s a success.

Are there medications that can improve fatty liver disease?

Many clinical trials are being done at The Ohio State University Wexner Medical Center to test new treatments for non-alcoholic fatty liver disease.

One medication that’s already been approved by the U.S. Food and Drug Administration is resmetirom, which is sold under the brand name Rezdiffra. It treats non-alcoholic fatty liver disease.

Studies show that, on average, one-quarter to one-third of patients who took Rezdiffra experienced a reduction in liver scarring by at least one stage. That's a major step forward in treating fatty liver disease.

Why fat can get stored in the liver

The liver is the key organ that breaks down the nutrients we eat, including fat and sugar.

Normally, the liver doesn’t store fat. Most fat is stored outside the liver, around your waist and your internal organs.

If you regularly take in too many calories well beyond what your body consumes, your liver can have difficulty breaking down the fat, so it gets stored in the liver, keeping it from working properly.

Drinking too much alcohol can also lead to fatty liver disease. Alcohol is toxic to your liver. Your liver can handle a certain amount of toxins without a problem. But when you drink excessively on a regular basis, that changes how your liver functions, and your liver starts to accumulate fat and get injured.

How much drinking will cause fatty liver disease?

Fatty liver disease caused by alcohol doesn’t have to be years in the making. Sometimes just high amounts of alcohol over several weeks can cause significant liver disfunction and fat to begin growing in the liver.

Genes account for why some people can drink a lot and not have damage to their liver, while others who drink in lower quantities damage their liver.

Risk factors for fatty liver disease

• Type 2 diabetes (almost half of patients with type 2 diabetes have fat in their liver)
• Obesity
• High blood pressure
• High cholesterol

If you have any of these conditions, it’s good idea to be screened for fatty liver disease.

It’s possible to have fat in your liver — maybe even a lot — without it causing inflammation or scar tissue. Conversely, you might have only a little bit of fat in your liver and it causes inflammation and scar tissue. Genes play a role. So far, researchers haven’t identified all the genes associated with fatty liver disease, though.

Is there a test for fatty liver disease?

One of the most common tests, elastography, is noninvasive and determines how stiff the liver is and how much fat is growing within it. The test takes 10 to 15 minutes.

If we see mild scarring and fat, we usually recommend lifestyle changes and then repeat the test in a couple of years to look for changes.

Fatty liver disease is a relatively slow-progressing condition. From one stage of liver scarring to the next more advanced stage usually takes five to seven years.

A lot of people may not know they have the disease until they’re in a later stage, which is why it’s important to be screened for fatty liver disease if you have a condition that puts you at risk for the disease.

By living a healthy lifestyle, you can do a lot to ensure your liver is not damaged, or if it is, that damage can be reversed.