Fatty Liver Disease - All you need to know

Fatty Liver Disease Guide


The world over, fatty liver disease is widely misconstrued as an outcome only caused as a result of heavy drinking. Although the fatty liver can also be caused as a consequence of excessive consumption of alcohol – also termed as Alcoholic liver disease (ALD) – there's another condition – termed as non-alcoholic fatty liver disease (NAFLD) – which occurs as a result of excessive fat deposits in the liver, or steatosis. Needless to say, both these conditions are responsible for the cause of chronic liver disease as well as other liver disorders in most patients.

What causes fatty liver?

A common liver complaint – especially in western countries– fatty liver disease or steatosis can be described as the build-up of excess fat in the liver cells. Affecting nearly one in every 10 individuals, fatty liver disease has increasingly and rapidly escalated into a global health issue. As a matter of fact, as per various studies, its been reported that nearly 20-40 percent of the US population is now affected by Non-alcoholic fatty liver disease (NAFLD) – a truly alarming statistic. While it's considered to be normal for the liver to contain some amounts of fat, if the fat deposits in the liver exceed 10 percent of the weight of the liver, it's diagnosed to be a case of fatty liver. While inflammation caused by a fatty liver is linked to alcohol abuse called as alcoholic steatohepatitis, NAFLD can be further categorized into two groups: 

  • Simple steatosis: Simple steatosis can be better described as fat accumulation in the liver without causing severe damage or inflammation. However, it needs to be mentioned that this condition can progress to non-alcoholic steatohepatitis or liver inflammation (NASH)
  • Non-alcoholic steatohepatitis (NASH): NASH can be described as a condition where the presence of excess fat in the liver can result in inflammation. Furthermore, as a consequence of this inflammation, the cells in the liver can get damaged, thus developing into cirrhosis or irreversible scarring and dysfunction of the liver. People affected with cirrhosis may go on to develop liver failure and may in need of a liver transplant.

While its difficult to pinpoint the exact cause of NAFLD, its been linked due to the occurrence of certain health conditions such as obesity – especially having too much belly fat, type 2 diabetes, metabolic syndrome, high cholesterol or LDL cholesterol, high blood pressure, insulin resistance, and high blood fat levels in the form of high triglycerides. Other conditions which may increase the risk include polycystic ovary syndrome (PCOS), sleep apnea, and underactive thyroid (hypothyroidism). Hence, NAFLD is sometimes termed as silent liver disease. However, in the case of certain individuals, they may go on to develop a fatty liver even if they have none of these conditions.

 It also needs to be reiterated that NAFLD or NASH is not caused as a result of excessive alcohol consumption. In that regard, patients suffering from any type of liver disease should avoid consuming alcohol or consume alcohol only in small amounts. While this condition is most common in middle-aged people, even children, as well as young adults, can get affected by this disease. 

What are the symptoms of Fatty Liver Disease?

The liver plays a vital role is in flushing out toxins from the body. If it’s functioning is affected, several symptoms can arise as a result. While in most individuals, non-alcoholic fatty liver disease (NAFLD) doesn’t result in any symptoms and go about their lives without the risk of liver damage. However, in case there are symptoms, there’s indeed a cause of worry. 

In certain cases, NAFLD can further progress into non-alcoholic steatohepatitis (NASH), but it could take years for the symptoms to show up. Besides the risk of cirrhosis, NASH can also lead to liver cancer, hardening of the liver along with several potentially fatal developments. Some of the common symptoms associated with this disease are as below: 

  • A build-up of fluid in the abdomen (fluid retention)
  • Severe tiredness or fatigue
  • Loss of appetite
  • Stomach discomfort characterized by pain in the right upper belly (abdomen)
  • Formation of spider-like blood vessels on the skin
  • Excessive Weight loss
  • Weakness
  • Presence of blood in vomit and stools
  • Easy bleeding and bruising
  • Incessant itching of the skin
  • Jaundice or Yellowing of the skin or eyes
  • Internal bleeding
  • Muscle wasting
  • Confusion
  • Slurred speech

These symptoms may resemble other health problems which is why it makes sense to visit your nearest healthcare professional for a diagnosis.


Fatty liver is not just related to the excessive consumption of alcohol. The food we eat has a major role to play in increasing the build-up of fats in the livers. This can be further highlighted by the fact that today, fatty liver cases related to diabetes and obesity far outnumber those linked with alcoholic fatty liver diseases as used to be the case up until a few decades back. The risk of contracting Non-alcoholic fatty liver disease is higher in men having a waist circumference of more than 102 centimetres and in women with 88 centimetres or higher waist circumference. In addition to the weight and circumference size, an individual having deep abdominal fat is also more susceptible to getting diagnosed with a fatty liver.

How is fatty liver diagnosed?

As mentioned before, NAFLD doesn’t cause any symptoms unless it progresses into NASH. It’s usually detected by accident while doing an imaging study for unrelated reasons. Abnormal liver blood tests can also help ascertain the risk of fatty liver. In case you have a suspicion of a fatty liver or if you want to diagnose whether you have it or not, your healthcare professional may order these tests to help make an accurate diagnosis:

  • Imaging tests such as abdominal ultrasounds, CT scan, or MRI/MR-EFF (elastography fat fraction), may be able to detect any fatty infiltration in your liver. 
  • Certain blood tests which are ordered specifically by the doctor can help in analyzing how diseased your liver is. 
  • While a liver biopsy is not required, sometimes this may be ordered to determine the severity of liver damage. A biopsy is usually performed by inserting a long needle through the skin into the liver to remove a small piece of tissue. This tissue is then observed closely under a microscope which helps in determining the exact nature and extent of liver damage.

What are the Complications of Fatty Liver Disease?

NASH is typically characterized by liver inflammation, which may progress to scarring and irreversible damage caused to the liver. This damage can replicate the damage caused by excessive consumption of alcohol and in severe cases, can even further lead to liver cirrhosis, liver damage, and liver failure. Up to 25 percent of adults with NASH may have cirrhosis. 

Liver cirrhosis can be described as a life-threatening condition which occurs when the liver has been inflamed for a long period of time thus causing permanent scarring along with loss of function. While the damage caused to the liver by cirrhosis is irreversible, a patient can still prevent further damage and survive longer by reducing or completely abstaining from alcohol consumption. 

As reported by various studies and research, a liver may start functioning improperly or inefficiently when 70-80 percent of its cells are either lost or damaged. This can eventually lead to liver failure which might require the need for liver transplantation surgery. Like any other transplant procedure, a liver transplant is a technically challenging and highly complicated procedure which is not only tedious but very expensive as well. It’s usually undertaken for replacing a diseased or a failed liver and substituting it with a healthy and functional liver. 

A liver transplant should be looked at as a last resort option. Prevention is better than cure which is why one should look to take up healthier initiatives like quitting alcohol, incorporating a healthier diet, and making lifestyle modifications early on as its proven to be the best and most effective way for an individual to increase their chances of reversing or slowing down the disease before it can prove to be deadly and fatal. 

What is the treatment for Fatty Liver Disease?

To keep a track on the condition of the liver, its advisable to check the status of the liver by visiting your healthcare professional or doing routine medical check-ups on an annual basis. However, in the case of patients who have already been diagnosed with NASH, it's advisable that patients undergo a medical check-up at least once every six months. While it's deemed possible to cure fatty liver disease with the aid of weight loss and by maintaining healthy body weight, the truth of the matter is that only 20 percent of patients have managed to lose weight and ward off the disease. 

In our modern, fast-paced lives we often tend to forget about our basic requirements; keeping our bodies healthy. If you have been diagnosed with fatty liver disease or simple to make sure your liver remains in optimal condition and keeps functioning at top efficiency all times, you need to ensure that your liver is hale and hearty and avoid anything that can damage your liver. In that regard, here are some tips in the right direction. 

  • Maintaining a healthy weight

One of the primary yardsticks that define the overall health of a person is by maintaining a healthy height-weight ratio. In that regard, being too obese or being underweight are both are signs of a neglected and unhealthy body. Various studies coupled with research have revealed some shocking statistics – As per a survey that was conducted on obese/overweight people, it was revealed that out of the 60 percent people who were reported to be obese, an alarming 30 percent of them suffered from fatty liver disease. Thus, being overweight not only puts them at risk for an unhealthy lifestyle but also increases the risks of cirrhosis, scarring and liver cancer. 

That said, even a 5 percent reduction in overall body weight has proven to be sufficient enough to not only improve abnormal liver tests but also in helping reduce liver fat. Further, a weight loss in the region of 7-10 percent has proven effective in reducing the chances of liver inflammation as well as preventing further injury to the liver cells. That said, any weight loss should be done gradually as severe weight loss can prove to be counter-productive and may result in swelling, fibrosis or even worse. What this means that care should be taken to ensure that no more than half to one kilogram (one to two pounds) of weight should ideally be lost in a week 

  • Consuming Alcohol in Moderation

Alcohol is responsible for causing a myriad of health issues/disorders and considering the liver is responsible for processing alcohol, it’s crucial that you keep a tab on the amount of alcohol you consume. Excessive consumption of alcohol not only puts an increased amount of stress on the liver but can also prove to be toxic if taken regularly in large amounts. Make sure you drink in moderation or better still, avoid drinking alcohol completely even if you have been diagnosed with nonalcoholic fatty liver disease. 

  • Limiting your fat intake

Try to replace saturated and trans fats and instead, always opt for unsaturated (monounsaturated and polyunsaturated) fats but in balanced amounts. Avoid consuming processed foods as they tend to be loaded with unhealthy fats and preservatives while high-GI foods, such as white bread and white rice should also be avoided. The truth is, consuming a high-fat or diet can increase the risk of contracting fatty liver diseases. 

  • Quitting smoking

Smoking does no good for your body and your liver is no different. It has been observed that smoking has a harmful and detrimental effect on the effective and efficient functioning of your liver owing to the number of hazardous toxins that it contains. In fact, unhealthy lifestyle habits such as smoking have been considered to be a significant risk factor associated with NAFLD. 

  • Opting for regular health check-ups 

Make sure you schedule regular health check-ups blood tests as it does not only act as a preventive measure but will also ensure that you’re always aware of the overall health of your body and its organs. In addition, blood tests help in keeping a tab on the levels of your glucose, cholesterol and fat all of which are associated with liver diseases. 

  • Shunning the use of illegal/ illicit drugs 

Illicit/Illegal drugs contain a variety of chemicals which are toxic in nature and if consumed can result in a bunch of health disorders and diseases. That said, one should stay away from drugs and intravenous drugs exchange as it leads to contracting of Hepatitis B and Hepatitis C amongst a host of other diseases. 

  • Avoid Medication Risks 

Doctors specifically advise to avoid mixing different type of medications, herbs, and supplements and there’s a good reason behind the word of caution. Certain types of medication are toxic to the liver as they put undue stress on your liver to metabolise it properly. This, in turn, can lead to extra pressure being exerted on the liver thus also increasing the risks of damaging it in the long run. Before getting prescribed with a new medicine or treatment, you should find out how it will help you. You should also try finding out what the side effects of those medications are. However, one should look to get vaccinated in order to protect against liver viruses such as hepatitis A and B. 

  • Make Exercise a Priority 

Exercising and staying active in general is a sure shot way to increase the amount of muscle you have, which in turn will speed up your metabolism. Cardio and aerobic exercises like cycling or running also lead to decreased fat in the liver. Having said that, most of us need more muscle building activities, and strength training is a brilliant way of acquiring this and vigorous exercises can also possibly lead to decreased inflammation independent of weight loss.

What should be the Diet during Fatty Liver Disease?

While lifestyle improvements and weight loss can prove to be an effective treatment in improving or avoiding the development of NAFLD and NASH, incorporating and avoiding specific types of food in your diet have also proven to be a successful measure. 

  • Reduce Your Sugar and Starch Consumption 

Foods rich in sugar and starch tend to secrete insulin the most, which plays the role of a major fat storage hormone inside your body. If you have low insulin levels, then it will be easier for fat to get out of your fat storage, thereby allowing your body to burn more fats instead of helpful carbs. 

Furthermore, low insulin can also assist your kidneys in getting rid of excess water and sodium from your body, resulting in the removal of bloating and excess water weight. Shunning starches and sugar can also increase your appetite which results in your meals being evenly stretched out throughout the day which also aids in the weight-loss process. 

  • Flax Seeds 

One of the world's healthiest foods, flax seeds contain vitamins, minerals and a tonne of other healthy nutrients which help give your metabolism a boost, lower bad cholesterol levels, and burn out the excess fat your body is carrying. 

  • Fish 

Researchers have discovered that oily fish/fish is one of the best sources of anti-inflammatory omega-3 fats. Omega-3 fats are one of the naturally occurring magic foods and have been linked to lowering rates of heart disease, dementia, cognitive disorders, depression and many other diseases. Moreover, consuming omega-3 fatty acid rich fish like mackerel, sardines, salmon, trout and herring at least twice a week has proven to be effective in reducing liver fat (steatosis) along with lowering aspartate aminotransferase levels (described as a liver function test that reveals any liver damage). Additionally, adding fish to the diet has also helped in reducing incidences of heart attacks, blood pressure, atherosclerosis, high blood fats etc.  Including these fishes in your dietary plan can help raise good cholesterol while also supporting a healthy weight and better brain function. 

  • Avocados 

Avocados are rich in glutathione, an antioxidant to neutralise free radicals and also a potent source of heart-healthy monounsaturated fatty acid (good fat) which are great for lowering LDL levels. Besides, Avocados also contain high levels of antioxidants and soluble fibres while boasting of lipid-lowering, anti-inflammatory, and weight maintenance properties thus helping improve LDL levels in overweight and obese people. Try including avocados in your diet by adding them to your sandwiches, smoothies, salads or you could even make some guacamole and try it out with other heart-healthy foods on this list. However, it’s prudent to remember not to go overboard with avocado consumption and keep it limited to half an avocado a day as it’s high-fat content makes it a high-calorie food. 

  • Olive Oil 

Olive oil is full of heart-healthy, lipid-lowering monounsaturated fatty acids while also containing a bucket load of antioxidants and Vitamin E which will help raise HDL levels while simultaneously decreasing LDL levels. Moreover, olive oil is also an anti-inflammatory ingredient while being a source of phenolics, which makes blood harder to clot. Further, olive oil helps in reducing oxidative stress and liver fat and hence proven beneficial for people suffering from NAFLD. 

  • Legumes/Beans 

The whole legume family is a cholesterol-free treat and includes dry or canned beans, lentils, peas, kidney beans, soybeans etc. Packed full of soluble fibre, they are also incredibly rich in protective nutrients, including minerals, Vitamin-B and phytonutrients. This, in turn, contributes to lowering LDL cholesterol levels while supporting healthy circulation. While boasting of a low Glycemic Index, beans are also naturally low in fat and devoid of any cholesterol. 

  • Green Tea 

Besides being a soothing drink, green tea contains an antioxidant ECGS which helps convert fat into energy while also lowering cholesterol levels. Sipping a few cups of green tea can halt the development and progression of NAFLD, boost your metabolism levels while helping reduce body fats and improving insulin sensitivity. 

Final Thoughts

While bringing about a rapid change in lifestyles and losing weight can prove to be a challenging task, if you have been diagnosed with a fatty liver then the risk-reward ratio makes it worth the efforts. Fatty liver disease is expected to become the biggest contributor to liver failure in the western world in the next decade so exercising a bit of caution will go a long way in ensuring that you remain in the pink of health. Besides liver failure, a person diagnosed with fatty liver also has to contend with heart diseases and disorders which is why you should act now before it’s too late.