When fat collects inside the cells of your liver, you have what is known as a fatty liver, or steatosis. Fatty liver alone generally causes no symptoms and does not prevent the liver from carrying out its usual functions.
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But over time, inflammation can also develop in the liver, producing steatohepatitis. The inflammation destroys liver cells, reducing overall liver function. As inflammation continues, scar tissue — called fibrosis — appears, and when fibrosis is severe, cirrhosis and liver failure occur.
A number of strategies can help repair a fatty liver. When these strategies are applied before the fatty liver progresses to steatohepatitis, they are generally successful. If excessive alcohol consumption is the cause, stopping drinking is the most important approach. When alcohol is not the culprit, a combination of strategies may be useful, including reducing alcohol intake, losing weight and changing your diet. Ask your doctor which strategies are most appropriate for you.
Stop or Limit Your Alcohol
When fatty liver is caused by excessive alcohol — a condition called alcoholic fatty liver disease (AFLD) — it is necessary to stop all alcohol. Excessive alcohol in this case means more than 21 drinks per week in men and more than 14 drinks per week in women. According to the American College of Gastroenterology guidelines published in the January 2018 issue of “The American Journal of Gastroenterology,” fatty liver alone disappears quickly with complete abstinence from alcohol.
Fatty liver not caused by excessive alcohol is known as nonalcoholic fatty liver disease (NAFLD). In this condition, alcohol consumption should be limited. Joint guidelines from the American Gastroenterological Association, American Association for the Study of Liver Diseases and American College of Gastroenterology (AGA/AASLD/ACG) published in “Gastroenterology” in June 2012 strongly recommend that people with NAFLD avoid heavy drinking.
They define heavy as more than 14 alcohol drinks per week in men and more than 7 drinks per week in women. The guidelines make no recommendations about lighter drinking, as some studies have suggested that small amounts of alcohol may be helpful in NAFLD.
Lose Excess Weight and Get Moving
Being overweight significantly increases a person’s likelihood of developing NAFLD. The AGA/AASLD/ACG guidelines strongly recommend that overweight people with NAFLD lose weight. The guidelines indicate that losing 3 to 5 percent of the total body weight will usually improve a fatty liver, but more weight loss may be necessary if steatohepatitis has developed.
Joint guidelines from the European Association for the Study of the Liver, European Association for the Study of Diabetes and European Association for the Study of Obesity (EASL/EASD/EASO00734-5/pdf)) published in 2016 in the “Journal of Hepatology” recommend a 7 to 10 percent weight loss goal for all overweight people with NAFLD.
Even without losing weight, exercise alone can improve a fatty liver. Authors of the AGA/AASLD/ACG guidelines noted that in 3 of the 4 studies they reviewed, exercise alone produced improvement. The exercise in these studies involved 30 to 60 minute sessions 2 to 3 times per week for 6 to 12 weeks.
Clean Up Your Diet
Besides reducing the total number of calories, some dietary changes are recommended for people with a fatty liver. A healthy diet, such as a Mediterranean diet high in fresh fruits and vegetables and low in saturated fats, can improve a fatty liver even without weight loss. Eating fewer red meats and avoiding fried foods are good ways to reduce saturated fat consumption.
The EASL/EASD/EASO00734-5/pdf) guidelines also recommend limiting consumption of foods and beverages containing fructose, as research has shown that high fructose intake increases the chances of developing NAFLD. Interestingly, the guidelines state that there is no need to limit coffee consumption. People who drink more coffee are less likely to develop NAFLD, and if NAFLD occurs, it tends to be less severe, than people who consume minimal or no coffee.
Avoid Harmful Medications
Liver damage is a possible side effect of many medications. When you have any type of liver problem, your doctor will often avoid these medications if there is an effective alternative.
Your doctor may particularly try to avoid medications that are known to worsen liver function in people with a fatty liver. Corticosteroids, tetracycline, methotrexate, tamoxifen, irinotecan and some anti-HIV medications are medicines known to be potentially harmful in this situation, according to a January 2014 article00931-2/pdf) in "Mayo Clinic Proceedings."
A number of over-the-counter medications and supplements are also potentially harmful to the liver. Discuss all medicines and supplements with your doctor if you have a fatty liver. Acetaminophen is a common medication that your doctor may recommend avoiding or using a reduced dose.
In general, most medications and supplements will not improve a fatty liver. The AGA/AASLD/ACG and EASL/EASD/EASO00734-5/pdf) guidelines both indicate that vitamin E and pioglitazone (Actos) are the only 2 that appear to have a possible direct benefit in people with fatty liver disease.
However, both guidelines recommend that they only be considered for people with steatohepatitis because of their possible side effects and because fatty liver alone should improve with non-medicine strategies. High doses of vitamin E can prevent proper blood clotting and increase the likelihood of heart failure and prostate cancer. Pioglitazone may cause low blood sugar and heart failure.
The AGA/AASLD/ACG and EASL/EASD/EASO00734-5/pdf) guidelines specifically indicate that metformin — a medication for type 2 diabetes — and omega-3 fatty acids and statin medications — medications for high cholesterol and triglycerides — have no direct effect on fatty liver disease. However, they may have indirect benefits, since good control of diabetes and high cholesterol/triglycerides may improve a fatty liver.
Reviewed and revised by Mary D. Daley, M.D.
- Merck Manual Professional Version: Fatty Liver (Hepatic Steatosis)
- National Institute of Diabetes and Digestive and Kidney Diseases: Nonalcoholic Fatty Liver Disease and NASH
- Merck Manual Professional Version: Alcoholic Liver Disease
- Merck Manual Professional Version: Nonalcoholic Steatohepatitis (NASH)
- Gastroenterology: The Diagnosis and Management of Non-alcoholic Fatty Liver Disease: Practice Guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology
- Liver International: Impact of Coffee on Liver Diseases -- A Systematic Review
- Journal of Hepatology: EASL-EASD-EASO Guidelines for the Management of Non-alcoholic Fatty Liver Disease
- The American Journal of Gastroenterology: ACG Clinical Guideline: Alcoholic Liver Disease
- Mayo Clinic Proceedings: Drug-Induced Liver Injury