Can You Reverse Nonalcoholic Fatty Liver Disease?

Finding out you have nonalcoholic fatty liver disease (NAFLD) can come as a shock. Though NAFLD is common, many people aren’t even aware they have it until it’s discovered by chance. 

But here’s the good news: NAFLD is often reversible, especially if you catch it early before you have liver damage. Read on for more information about NAFLD and how you may be able to reverse it with weight loss, a healthy diet, and exercise. 

What is nonalcoholic fatty liver disease?

NAFLD is extra fat buildup in your liver. Unlike many other forms of liver disease, the cause is not from drinking alcohol. 

There are two types of NAFLD:

1. Simple fatty liver (steatosis) is when you have a fatty liver, but your liver is not swollen or inflamed yet. It’s a less severe type of NAFLD. Simple fatty liver can be harmless at first, but over time it can become more serious. 

2. Nonalcoholic steatohepatitis (NASH) is a more severe form of NAFLD, where you have a fatty liver and liver inflammation. NASH can lead to other liver problems, like fibrosis (scarring), cirrhosis, and liver cancer. 

NAFLD affects about 1 in 4 adults in the U.S. People usually get a diagnosis in their 40s or 50s, but NAFLD can happen to people of any age — including children. It’s more common in people who have certain risk factors, like a high BMI or Type 2 diabetes. 

Most people with NAFLD don’t have any symptoms. It’s often discovered on routine lab tests or because your healthcare provider notices a lot of fat in your liver during a medical procedure. If your provider thinks you might have NAFLD, they may suggest you have a liver ultrasound or biopsy to learn more. 

What causes nonalcoholic fatty liver disease?

We don’t know exactly what causes NAFLD, but it may be related to how the body processes sugars and fats. It’s common in people who have a group of health conditions called “metabolic syndrome.” 

You’re also more likely to get NAFLD if you’re older than age 50, smoke, or take certain medications (like corticosteroids). There’s also a higher chance of getting NAFLD if you have:

• A lot of stomach fat

• A BMI over 25

• Insulin resistance 

• Prediabetes or Type 2 diabetes

• High cholesterol

• Thyroid problems

• High blood pressure

• Certain infections, like hepatitis C

But here’s the reality: Anyone can get NAFLD, even if you don’t have any risk factors. 

How can you reverse fatty liver disease?

You can stop NAFLD in its early stages if there’s no liver inflammation or scarring. 

By making the following changes, you can help reverse or prevent fatty liver disease:

• Losing weight 

• Eating nutritious foods

• Exercising regularly

• Cutting back on alcohol

• Managing your other health conditions, like diabetes

Weight loss

If you have a heavier weight, losing some weight is the number one thing you can do to reverse NAFLD. 

In research studies, people with NAFLD had a healthier liver after losing weight. Weight loss also helps your liver by improving your blood glucose (sugar) levels, cholesterol levels, and blood pressure. 

So how much weight should you lose? If you’re carrying excess weight, you’ll know that shedding pounds is not easy. Your goal should be to lose 1 to 2 pounds per week, until you’ve lost at least 3% to 7% of your total starting body weight. If you have NASH, you may need to lose up to 10% of your body weight to see an improvement in your liver health. 

But keep in mind: Slow, gradual weight loss is best. Rapid weight-loss diets (crash diets) can actually worsen your liver disease — and your health. 

You may be able to lose weight by changing your eating habits and exercising. But if you’re having a hard time meeting your goals, your provider might recommend weight loss surgery or medications — especially if you already have liver inflammation and scarring. 

Best diet for fatty liver disease

The best diet for reversing fatty liver disease is one that includes a wide variety of nutritious foods and limits sugar, “junk food,” saturated fats, and alcohol.

Here’s what this means: 

• Eating nutritious foods, like fruits, vegetables, proteins, dairy, and whole grains

• Choosing healthier fats

• Limiting refined carbohydrates, like white bread, chips, and crackers 

• Limiting sugars and sweetened junk foods

What you drink matters, too:

• Avoid alcohol if you have NAFLD. An occasional drink may be OK, but moderate or heavy drinking can make your liver disease worse. 

• Enjoy coffee if you like it. There’s evidence that drinking 1 to 2 cups of unsweetened coffee per day can be good for people with NAFLD. 

Need more guidance on what to eat? Though there’s no “official” diet for NAFLD, the DASH diet or Mediterranean diet are great places to start. Both of these eating plans have lots of health benefits, and they may be good for your liver, too. 

Physical exercise

Exercise can also help your NAFLD get better. Experts recommend doing at least 50 minutes of aerobic exercise 3 times per week to reverse or slow down NAFLD. And just like weight loss and healthy eating, regular exercise has many benefits beyond boosting your liver health. 

Management of health conditions

If you have other health conditions, it’s important to get them under control. Your liver is affected by your blood sugar, cholesterol, thyroid hormones, and more. So taking care of your other health problems can also help reduce fat in your liver. 

The good news is that eating nutritious foods, exercising, and losing weight can also treat other health conditions — not just your fatty liver. In some cases, your healthcare provider might also recommend medication to help out, like a statin for high cholesterol.

Can choline and other supplements help reverse fatty liver disease?

It’s not clear. At this point, there’s no strong evidence that choline can help to reverse fatty liver — but it can help to prevent it.  

Choline is a nutrient that keeps your brain, nerves, and muscles functioning properly. Choline also helps to carry fat away from your liver. Many foods have choline, including: 

• Meat

• Poultry

• Eggs

• Red meat

• Cruciferous vegetables

• Beans

Your body can make some choline on its own, but it’s not enough to keep up with your body’s needs. And if you don’t have enough choline in your body, fat can build up in your liver. Making sure to get enough choline in your diet can prevent NAFLD and keep your muscles and brain healthy. 

There’s also some evidence that other supplements — like omega-3s and vitamin E — may be helpful in reversing fatty liver disease. But more research is needed to say for sure. 

How long does it take to reverse fatty liver disease?

It’s hard to say. Many people will see an improvement in their liver health after losing 3% to 5% of body weight. But if you have NASH you may need to lose more weight before you see results. Your recovery also depends on how advanced your liver disease is and if you have other health problems. 

When to see a doctor

You should talk to a healthcare provider if you have any of the following symptoms:

• Yellow skin or eyes

• Fatigue or feeling unusually tired

• Belly swelling or pain

• Leg or ankle swelling

• Upset stomach 

• Vomiting

• Confusion

Even if you don’t have symptoms, it’s a good idea to check in with your healthcare provider every 3 to 6 months. Your provider may recommend regular lab tests or other procedures to see if your liver is getting better or worse. 

Why trust our experts?

Written by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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