Fatty Liver...how to reverse it

A practical guide...and no, you don't need a prescription to start!

Are you worried you might have fatty liver?

Did an ultrasound scan show signs of it?

Maybe your doctor told you to “eat better and exercise”; but you're feeling overwhelmed and unsure where to start? Fear not! This simple guide will help you begin healing and even reversing the effects of fatty liver disease with a clear, actionable plan.

What is fatty liver?

Fatty liver, now formally known as Metabolic dysfunction-associated steatotic liver disease (MASLD), is very common. Recent studies estimate that 1 in 3 adults have it. Recognising and treating it early is important to prevent progression to liver fibrosis or even cirrhosis.

What does it feel like?

Often, fatty liver causes no symptoms at all. But early signs can include:

• A dull ache or feeling of fullness in the upper right abdomen

• Unexplained weight gain

• Fatigue

What tests should you have?

If you've been told you have fatty liver, your doctor may recommend:

• Blood tests: Liver function, bone profile, inflammatory markers, HbA1c (for diabetes), cholesterol, lipid profile, and triglycerides.

• Blood pressure and Body Mass Index (BMI) assessment

• A FibroScan (if scarring is suspected): This painless scan checks for liver fibrosis or cirrhosis

Please put down the sugar!

A major culprit is excess sugar, especially sucrose and fructose. Over time, this can lead to type 2 diabetes, cardiovascular disease, some cancers and, yes, fatty liver.

One interesting fact: Fructose does not stimulate leptin, the hormone that signals fullness. Therefore, we can consume a lot without feeling satisfied. A study showed that just seven days on a high-fructose diet increased fat in the liver and worsened insulin sensitivity.

“Wait!! should I stop eating fruit?”

No! Although fruit contains fructose, it also has fibre, vitamins, antioxidants, and water; all protective for your liver and gut. For example, fibre and vitamin C counteract the effects of fructose.

The real enemy? Manufactured or synthetic fructose, found in processed foods and drinks.

What should you cut back on?

Sugary drinks
Sodas, fizzy drinks, even juices. Watch for labels like “no added sugar” or “natural sugar”, they're still problematic, especially without the fibre found in whole fruit. Avoid drinks with processed sugars. If I could pass one take home message from this article, completely cutting out sugary drinks would be it. A randomised clinical trial in 2019 reported an 8 week diet low in dietary sugar led to a significant improvement in fatty liver.

Processed foods
Sweets, biscuits, crisps, ready meals…they're low in fibre, packed with preservatives and artificial sweeteners, and often hyper-palatable, making them easy to overeat. This leads to weight gain and visceral fat.

Alcohol
A major liver toxin. There are plenty of studies linking excess alcohol misuse to liver disease. Alcohol also disrupts the gut microbiome, reducing beneficial bacteria like Lactobacillus and Bifidobacterium, while promoting inflammatory ones like Enterobacteriaceae and Proteobacteria. This gut imbalance can harm the liver.

Saturated fats
Found in processed meats, fried foods, and ice cream. Instead, choose healthy fats like those in nuts, avocados, and olive oil.

What should you eat more of?

Protein
Go for fish, poultry, legumes, and tofu. A protein-rich breakfast helps with satiety. One study of 9,000 people found those who ate more protein in the morning consumed fewer calories overall. Aim for 25–35g of protein per meal, even small amounts of weight loss (just 5%) can significantly improve fatty liver.

A mediterranean style diet
Low in refined carbohydrates and sugars. High in fibre, healthy fats (olive oil) and anti-oxidants. Rich in anti-inflammatory foods like oily fish, nuts and vegetables. What’s not to love? These foods will reduce oxidative stress, insulin resistance and chronic inflammation, all linked with fatty liver. Plus there are multiple studies showing the benefit of a mediterranean style diet in improving liver function and fatty liver.

What about exercise?

I’ve got a whole article on this coming up…but for now, here’s the TL;DR:

• Aim for 150 minutes of Zone 2 aerobic exercise per week (heart rate at 60–70% of your max)

• Add resistance training 2–4 times a week

• Stay consistent with the above!

Don’t forget sleep

Poor sleep harms insulin sensitivity and promotes weight gain, both of which worsen fatty liver. Improve your sleep hygiene by sticking to a consistent bedtime and wake-up time.

The takeaway?

A balanced diet, regular movement, good sleep, and reducing harmful substances like alcohol and sugar can go a long way in healing your liver.

Making these changes won’t just help your liver…it’ll boost your overall health, energy levels, and long-term well-being.

References

1. Kanerva N, Sandboge S, Kaartinen NE, Männistö S, Eriksson JG. Higher fructose intake is inversely associated with risk of nonalcoholic fatty liver disease in older Finnish adults. Am J Clin Nutr. 2014 Oct;100(4):1133-8.

2. Schwimmer JB, Ugalde-Nicalo P, Welsh JA, et al. Effect of a Low Free Sugar Diet vs Usual Diet on Nonalcoholic Fatty Liver Disease in Adolescent Boys: A Randomized Clinical Trial. JAMA. 2019;321(3):256–265.

3. Nania C, Perla FM, Olivero F, Pacifico L, Chiesa C. Mediterranean diet and nonalcoholic fatty liver disease. World J Gastroenterol. 2018 May 21;24(19):2083-2094. doi: 10.3748/wjg.v24.i19.2083.

4. Yang J, Zhang K, Xi Z, Ma Y, Shao C, Wang W, Tang YD. Short sleep duration and the risk of nonalcoholic fatty liver disease/metabolic associated fatty liver disease: a systematic review and meta-analysis. Sleep Breath. 2023 Oct;27(5)