What is a fatty liver?

Fatty liver occurs when you have excess fat in your liver cells. Yes! There’s nothing wrong with having a small amount of fat in your liver cells. However, if more than 5% of your liver is fat, you will be diagnosed with fatty liver (2).

Drinking alcohol in excess can lead to fatty liver. However, in many cases, it doesn’t play a role.

Several fatty liver conditions are classified as non-alcoholic liver disease (NAFLD). NAFLD is the commonest liver disease that affects children and adults in Western countries (2, 3).

Non-alcoholic fatty liver is the first stage of liver disease. It is interesting to note that it is also reversible. In many cases, though, NAFL usually goes undiagnosed. Over time, it may lead to non-alcoholic steatohepatitis, a more serious condition.

Non-alcoholic steatohepatitis is a condition characterized by inflammation and greater accumulation of fat. Both inflammation and fat accumulation can cause damage to the liver cells. This, in turn, leads to scar tissue (fibrosis) due to repeated injuring of the liver cells.

The problem with fatty liver is that it is usually difficult to predict whether it will progress to non-alcoholic steatohepatitis (NASH) or not. If it progresses to NASH, then the risk of liver cancer and cirrhosis will increase tremendously (4, 5).

Non-alcoholic fatty liver disease also increases the risk of other conditions, like diabetes, heart disease, and kidney disease (6, 7, 8).

What causes fatty liver?

Many factors may contribute to a fatty liver. These include:

• Obesity: Obesity is characterized by low-grade inflammation, which promotes the storage of fat in the liver. Studies have shown that between 30–90% of obese adults have non-alcoholic fatty liver disease (2, 3, 9, 10).
• Belly fat: It is important to note that non-obese people may develop NAFLD if they carry plenty of fat around the waist. This condition is known as “visceral obesity” (11).
• Insulin resistance: Studies have shown that high insulin and insulin resistance increase liver fat storage in individuals with metabolic syndrome and type 2 diabetes (12, 13).
• Excessive consumption of refined carbs: High consumption of refined carbs promotes fat storage in the liver. This is especially common in overweight individuals and insulin-resistant individuals (14, 15).
• Excessive consumption of sugary beverages: Sugary beverages like energy drinks and soda contain a lot of fructose. Studies have shown that fructose promotes fat accumulation in the liver in both adults and children (16, 17).
• Poor gut health: Recent studies have shown that having an imbalance in gut flora, leaky gut, or other gut conditions may contribute to the onset of NAFLD (18, 19).

How do you know that you have a fatty liver?

Many symptoms characterize fatty liver. However, not all of these may show up. In most cases, people with fatty liver do not even realize that they have it.

Common symptoms include:

• Weakness and fatigue
• Elevated insulin levels
• High liver enzymes, such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT).
• Increased triglyceride levels
• Fullness or slight pain in the center or right side of the abdomen.

If your condition progresses to non-alcoholic steatohepatitis, then you may develop the following symptoms:

• Nausea and vomiting
• Loss of appetite
• Moderate to severe abdominal pain
• Yellowing of skin and eyes

You must consult your doctor regularly for checkups (blood tests and standard exams). This helps to diagnose fatty liver at the early stage — when it can be reversed.

Different strategies for reversing fatty liver

There are a couple of things that you can do to reverse fatty liver. These include losing weight, reducing your carb intake, switching to the ketogenic diet or kombucha, and even taking apple cider vinegar.

1. Weight loss

Weight loss is one of the most effective ways to reverse fatty liver, especially for people who are obese or overweight. Studies have shown that weight loss promotes liver fat loss in NAFLD adults, regardless of how the weight loss was achieved (20, 21, 22, 23, 24).

In a 3-month study involving overweight adults, researchers found that reducing daily calorie intake by up to 500 calories caused an 8% body weight loss. It also caused the fatty liver score to reduce drastically (21).

2. The ketogenic and low-carb diet

Studies have shown that eating low-carb diets may reverse NAFLD. Diets low in refined carbs include Mediterranean, ketogenic, and low-glycemic-index diets (22, 23, 24, 25, 26, 27, 28).

14 obese men with non-alcoholic fatty liver disease followed the ketogenic diet for 12 weeks in a particular study. The results showed that 13 participants experienced drastic reductions in liver fat, and three had their fatty liver completely resolved (29).

Low-carb diets rid the body of excess water, lowers insulin levels, and lead to rapid weight loss within the first two weeks of adopting the diet (30).

3. Kombucha

Kombucha is rich in antioxidants. Antioxidants are substances that fight off free radicals. Free radicals are reactive molecules with a damaging effect on your cells (31, 32).

Many researchers believe that dietary antioxidants and beverages improve health much more than antioxidant supplements (33).

Kombucha, when prepared with green tea, seems to have antioxidant effects on your liver. In addition, rodent studies have shown that regular intake of kombucha reduces liver toxicity caused by toxins. In some cases, the toxicity goes down by over 70% (34, 35, 36, 37).

4. Milk thistle

Milk thistle is also known as silymarin. This herb is well-known for its liver-protecting functions (38).

Several studies have found that milk thistle, either taken alone or combined with vitamin E, reduces inflammation, insulin resistance, and liver damage in people with non-alcoholic fatty liver disease (39, 40, 41, 42).

A 90-day study involving patients with fatty liver found that intake of silymarin-vitamin E supplement alongside a low-calorie diet greatly reduced the fatty content in the liver (42). Patients in this study were given 250–376 mg of milk thistle extract per day.

5. Berberine

Berberine is a compound found in plants. Research has shown that it can reduce insulin levels, blood sugar levels, and cholesterol levels (43).

Some studies suggest that berberine is beneficial for the fatty liver (44, 45, 46).

A 16-week study involving 184 people with the non-alcoholic fatty liver disease found that taking 500 mg of berberine three times daily at meals caused a 52% reduction in liver fat and improved insulin sensitivity and other health markers (46).

What’s the conclusion?

Fatty liver causes several health issues. The good news is that it can be reversed if addressed in time.

Eating healthy and leading an active lifestyle can reduce the amount of fat in your liver, and by extension, its risk of progressing into a chronic condition.