What Is Fatty Liver Disease?
Drinking a lot of alcohol can make you more likely to get one type of fatty liver disease. Over time, too much alcohol leads to a buildup of fat inside your liver cells. This makes it harder for your liver to work.
The good news is you can prevent or stop FLD with lifestyle changes.
Fatty Liver Disease Types
There are two main types of fatty liver disease:
1. Nonalcoholic fatty liver disease (NAFLD)
This type is very common in the U.S., affecting 1 in 3 adults. Researchers aren't exactly sure what causes it, but obesity and diabetes will increase your risk of getting it. Unlike the other main type, you don't get it from drinking alcohol. There are two forms of NAFLD:
Simple fatty liver: This means you have fat in your liver, but you may not have any inflammation in your liver or damage to your liver cells. It usually doesn’t get worse or cause problems with your liver. Most people with NAFLD have simple fatty liver.
Nonalcoholic steatohepatitis (NASH): This is much more serious than simple fatty liver. NASH means you have inflammation in your liver. The inflammation and liver cell damage that happen with NASH can cause serious problems such as fibrosis and cirrhosis, which are types of liver scarring, and liver cancer. These problems can lead to liver failure and require a liver transplant. About 20% of people with NAFLD have NASH.
2. Alcohol-related fatty liver disease (ALD)
This type is less common, affecting about 5% of people living in the U.S., and is caused by drinking alcohol. For this reason, it usually gets better when you stop drinking alcohol. If you keep drinking, ALD can cause serious problems. These include:
- Enlarged liver. It doesn’t always cause symptoms, but you may have pain or discomfort on the upper right side of your belly.
- Alcoholic hepatitis. This is swelling in the liver that can cause fever, nausea, vomiting, belly pain, and jaundice (yellowish skin and eyes).
- Alcoholic cirrhosis. This is a buildup of scar tissue in your liver. It can cause the same symptoms as alcoholic hepatitis, plus:
Alcohol-related fatty liver disease usually comes first. It can then get worse and become alcoholic hepatitis. Over time, it may turn into alcoholic cirrhosis.
If you drink heavily, talk with your doctor. It’s confidential, and they can help you get your drinking under control to save your health.
Fatty Liver Disease Symptoms
With ALD and NAFLD, there are usually no symptoms. Some people may have signs such as tiredness or pain in the upper right side of the belly where your liver is.
If you have NASH or get cirrhosis, you may have symptoms such as:
- Swollen belly
- Enlarged blood vessels underneath your skin
- Larger-than-normal breasts in men
- Red palms
- Skin and eyes that appear yellowish, due to a condition called jaundice
- Nausea, weight loss, or loss of appetite
- Tiredness or mental confusion
Fatty Liver Disease Risk Factors
For ALD, the cause is too much alcohol. You may be even more likely to get it if you drink a lot and
The reason why some people with NAFLD have simple fatty liver and others get NASH isn’t known. Genes may be a reason. NAFLD or NASH is more likely if:
- You have obesity or are overweight
- Your body doesn’t respond to insulin as it should (called insulin resistance) or if you have type 2 diabetes
- You have high levels of triglycerides or “bad” (LDL) cholesterol, or low levels of “good” (HDL) cholesterol
- You’re older
- You have polycystic ovary syndrome
- You have sleep apnea
- You have an underactive thyroid (the doctor will call this hypothyroidism)
- You have an underactive pituitary gland (you’ll hear this called hypopituitarism)
- You’re malnourished
- You’ve lost weight rapidly
- You’ve been exposed to certain toxins and chemicals
- You're Hispanic or Asian
- You have metabolic syndrome. This is a mix of conditions that make you more likely to get type 2 diabetes and heart disease. With metabolic syndrome, you may have any three of these conditions:
There are also some less common reasons why you may get NAFLD or NASH. They include:
- Medical conditions that affect how your body uses or stores fat
- Hepatitis C or other infections
- Fast weight loss
- Taking certain medicines such as glucocorticoids, methotrexate (Rheumatrex, Trexall), synthetic estrogen, tamoxifen (Nolvadex, Soltamox), and others
- Gallbladder removal. Some people who have surgery to remove their gallbladder are more likely to have NAFLD.
Fatty liver disease and children
About 10% of children in the U.S. have NAFLD – and numbers are growing as the number of obese kids grows. NAFLD is also more common in:
- Older children rather than younger children
- Hispanic and Asian American children rather than White and African American children (least common)
- Boys rather than girls (though it's equally common among children with NASH)
But most children with NAFLD don't get liver problems – and NAFLD can be controlled or reversed if your child changes their lifestyle and eating habits.
Fatty Liver Disease Diagnosis
Because most people don’t have symptoms, these conditions aren’t easy to diagnose.
Your doctor may use different methods to find out if you have fatty liver disease. Some of the things your doctor may use to diagnose fatty liver disease are:
Health history and physical exam
Your doctor will ask about your alcohol use. This information can help your doctor tell if you have ALD or NAFLD, so be truthful. They’ll also ask about medications you take, how you eat, and other health conditions you might have. Your doctor will also:
- Check your body for signs of liver problems such as an enlarged liver or jaundice
- Check your height and weight to calculate your body mass index (BMI). Your BMI determines how much you should weigh based on your height.
Your doctor may order the following blood tests:
- Liver function and liver tests to detect and monitor liver disease and damage. The cells in your liver have proteins called enzymes. When these cells are damaged, the enzymes leak into your bloodstream, where they can be measured. If your liver is damaged, the level of these enzymes will be higher than normal.
- Fibrosis assessment tests to estimate your level of liver scarring (fibrosis). These blood tests result in a score that estimates your level of liver scarring or fibrosis.
- Lipid profile to measure blood fats, such as cholesterol and triglycerides
- Other blood tests to rule out other causes of FLD, like tests for hepatitis C and Wilson disease (a rare genetic condition)
- Hemoglobin A1c, which shows how stable your blood sugar is
You may get an ultrasound, computerized tomography (CT) scans, or magnetic resonance imaging (MRI). These tests can show if there’s any fat in your liver. But they can’t tell whether you have simple fatty liver or NASH. There are some tests that can show whether you have fibrosis by measuring the stiffness of your liver. When liver cells die, they're replaced by scar tissue, which is stiff. The stiffer your liver is, the more scarring it has.
- Transient elastography measures liver stiffness using a special ultrasound machine.
- Magnetic resonance elastography (MRE) combines ultrasound and MRI to create a visual map of stiffness throughout your liver.
Not everyone with NAFLD needs to have a liver biopsy. Your doctor may recommend it if you’re at risk for NASH or if other tests show that you may have NASH complications such as cirrhosis. A doctor removes a sample of tissue from your liver and sends it to a lab to see if you have liver inflammation or damage. You’ll get this done at a hospital or outpatient surgery center. Before the procedure, you’ll get medicine to help you relax or control pain. For the biopsy, your doctor numbs the area and uses a special needle to take a small piece of tissue from your liver. A liver biopsy is the only way for doctors to diagnose NASH.
Fatty Liver Disease Treatment
There are no medications approved for NAFLD, though some are in clinical trials.
Usually the first line of treatment is to lose weight. It helps reduce fat, inflammation, and scarring in your liver. Losing just 3% to 5% of your body weight can cut down on how much fat is in your liver. Weight loss surgery is also an option if you have a lot to lose.
You’ll also need to quit drinking. It’s the only way you can keep liver damage from getting worse. You may even be able to undo some of the liver damage that’s already happened. Talk to your doctor about how you can get help. You may need a medically supervised detox program to safely quit drinking and manage withdrawal symptoms.
If you have complications due to NASH, such as cirrhosis or liver failure, you may need to have a liver transplant. In general, people with NASH who get a liver transplant do very well.
Fatty liver disease alternative treatments
Vitamin E. Studies have shown that vitamin E could improve liver health by reducing inflammation, but the results varied depending on the dosage, patient's age, and how overweight they were. Also, some studies showed that high does of vitamin E could be dangerous for people with other medical conditions as well as FLD.
Coffee. Caffeinated coffee has long been thought to be good for the liver and linked to slowing down liver scarring in various liver diseases. It's not clear how coffee prevents liver damage. One theory is that coffee activates enzymes that detoxify the liver. Another is that coffee has compounds that lower inflammation.
Olive oil. As a healthy fat, olive oil lowers the amount of fat stored in your liver, improves how your body deals with fats and sugars after a meal, and reduces inflammation.
All of these products are still being studied, so talk to your doctor or nutritionist before deciding to drink extra coffee daily or take extra olive oil or vitamin E.
Reversing fatty liver disease
Fatty liver disease can be reversed if you stop drinking liquor and lose some weight. The liver is one of the few organs in your body that can replace damaged tissue with new cells rather than with scar tissue. But that reversal only works if you don't keep drinking alcohol or eating the wrong foods.
Fatty Liver Disease Self-Care
Lifestyle changes can help:
- Exercise more. Try to be active at least 30 minutes a day most days of the week. If you're trying to lose weight, you might find that it helps to exercise more than this. But if you don't already exercise regularly, get your doctor's OK first and start slowly.
- Be kind to your liver. Don’t do things that will make it work harder. Skip alcohol. Take medications and over-the-counter drugs only as instructed. Talk to your doctor before you try any herbal remedies. Just because a product is natural, that doesn’t mean it’s safe.
- Get your cholesterol down. Eat a healthy plant-based diet, exercise, and take your medications. This will get – and keep – your cholesterol and your triglyceride levels where they need to be
- Manage your diabetes. Check your blood sugar, and take medications as your doctor prescribes.
Fatty liver disease diet
Changing the way you eat can help to lessen or reverse NAFLD or NASH. You should try to:
- Limit foods that are high in fats (such as sausage, bacon, cake, chocolate, etc.).
- Replace saturated fats (such as butter, red meat, and cheese) with unsaturated fats (such as olive oil, salmon, and avocado).
- Eat foods with a low glycemic index, such as fruits, vegetables, and whole grains.
- Avoid foods and drinks with a lot of simple sugars (such as sweetened sodas, sports drinks, juices, and ice cream).
- Follow a Mediterranean diet.
Fatty Liver Disease Complications
The main complication for all these conditions is cirrhosis. As your liver tries to stop the inflammation that comes with these conditions, it creates areas of scars. As inflammation spreads, so do the scars, and eventually, your liver can’t do its job. That can result in:
- Fluid buildup in your belly
- Swollen veins in your esophagus that can burst and bleed
- Confusion and drowsiness
- An overactive spleen
- Liver cancer
- Liver failure
Life Expectancy With Fatty Liver Disease
If your liver has little or moderate scarring, it shouldn't affect your lifespan. But if you have cirrhosis, it could affect how long you live. If NASH cirrhosis is diagnosed early, you could live another 10 to 15 years. If it is diagnosed late or you have complications, like swelling or fluid in your belly or bleeding in the gut, your life expectancy could be 3 to 5 years unless you get a liver transplant.
Can You Prevent Fatty Liver Disease?
To prevent ALD:
- Drink in moderation. That’s one drink a day for men over 65 and women of all ages, and up to two drinks for men 65 and younger.
- Protect yourself from hepatitis C. This viral liver infection can make you more likely to get cirrhosis if you drink.
- Check before you mix meds and alcohol. Ask your doctor if it’s OK to drink alcohol with the prescription medications you’re taking. Read the warning label on over-the-counter meds. Don’t drink when you’re taking products like acetaminophen, which can damage your liver when combined with alcohol.
For NAFLD and NASH, It boils down to making better choices:
- Eat healthy food. Choose a plant-based diet with lots of fruits, vegetables, whole grains, and healthy fats.
- Stay at a healthy weight. Lose weight if you need to. If your weight is healthy, work to maintain it by choosing a healthy diet and exercising.
- Exercise. Get a workout most days of the week. Talk to your doctor first if you haven't been active in a while.
Fatty liver disease means you have a buildup of fat in your liver. One type of this condition is due to drinking alcohol. The other type, which is more common, doesn't have a specific cause, but things like obesity and diabetes can increase your risk of getting it. Fortunately, you can reduce or even reverse liver damage by making lifestyle changes, like eating better, getting exercise, and laying off the liquor.
Is fatty liver a serious problem?
Not for most people. But for 7% to 30% of the people with fatty liver disease, it will get worse if it is not treated.