How Can I Reverse Fatty Liver Disease?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Fatty liver disease is now the most common cause of abnormal liver blood tests in the United States. Non-alcoholic fatty liver disease, or NAFLD, is often discovered during a visit to your doctor, with the news that your “liver function blood tests” are abnormal. After being told your AST and ALT blood tests are abnormal you may have a liver ultrasound to confirm fatty liver changes.

NAFLD can lead to cirrhosis—chronic liver damage, that can lead to liver failure—so here are 10 ways to reverse fatty liver. Just do it.

  1. Weight loss is the therapy with the best evidence, along with changes to your lifestyle. For those who fail to lose weight with diet and exercise, bariatric surgery may be an option. Weight loss medications can also be added to diet and exercise. One to two pounds a week is a nice goal.
  2. Exercise. Increased physical activity has been shown to improve liver enzymes and quality of life in patients with fatty liver disease. Period.
  3. Treatment of underlying high cholesterol (hyperlipidemia). Statin therapy like atorvastatin (Lipitor), (rosuvastatin) Crestor or simvastatin (Zocor), have been shown to be safe in patients with NAFLD. This is important—even if your liver function tests are abnormal from fatty liver changes, you can take statins, and the medications can often improve fatty liver.
  4. Control your sugars. In diabetics with NAFLD, optimizing blood sugar control is crucial.
  5. No alcohol. It is suggested that patients with NAFLD avoid all alcohol consumption. Why? Well, alcohol use is associated with disease progression. Yes, fatty liver changes can lead to cirrhosis and heavy alcohol use may accelerate this.
  6. Vitamin E, for some. Vitamin E has been shown to improve the liver blood test (the ALT). But wait, there’s a catch. Some studies have shown higher mortality in patients taking larger doses of Vitamin E (800 IU per day), so only taking 400 IU is recommended in those with fatty liver disease and fibrosis, and without diabetes or heart disease.
  7. Victoza (liraglutide). Victoza may be an option for treating patients with fatty liver disease, but additional studies are needed. Victoza improves blood sugars, promotes weight loss and appears to improve fatty liver disease.
  8. Orlistat (Xenical, and over the counter as Alli) is a weight loss medication that has been shown, when given to obese patients, to improve fatty liver. Diarrhea is a common side effect that limits use of this medication though.
  9. Ursodiol (ursodeoxycholic acid) is a prescription medication (a bile acid) that may benefit folks with fatty liver, especially when used in combination with Vitamin E.
  10. Omega-3 fatty acids. Studies have shown a small benefit of omega-3 fatty acids in people with NAFLD. In studies that have shown benefit, the median dose taken was per day—so four tablets daily.

Dr O.

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