Yet many of them are unaware. That’s in part because the disease usually has no symptoms, and many primary-care physicians don’t routinely screen for it, so it goes undiagnosed, says William Sanchez, a liver transplant expert at the Mayo Clinic in Rochester, Minn.

But its consequences can be severe. In a 2019 study published in BMJ Gastroenterology, researchers analyzed data on more than 3,000 older adults and found that those ages 60 to 74 with NAFLD had a 60 percent higher risk of early death from any cause over five years and a 22 percent increased risk over 10 years. In addition, in some cases the disease progresses to a more severe stage called nonalcoholic steatohepatitis (NASH), which may require a liver transplant or lead to liver cancer.

But the liver is a unique organ in that it can regenerate and repair itself. So there’s much you can do to prevent and possibly reverse NAFLD.

The causes of fatty liver

This organ performs over 500 key functions, which is why a damaged liver can contribute to so many far-reaching health problems. It’s responsible for filtering toxins from the blood, producing bile to process food for digestion, making proteins to regulate nutrition, balancing fluid content, helping to clot the blood, and metabolizing sugars, fats and vitamins. This vital organ also is a key part of the body’s immune system.

When your body stores too much fat in the liver, the organ becomes overwhelmed. This can lead to an inflammatory response that damages liver cells and eventually interferes with liver function. Researchers don’t know why some people develop NAFLD, but those who are obese or have high blood pressure, high cholesterol, or a family history of diabetes or liver disease are at greatest risk, Sanchez says.

“Carrying a lot of weight in the belly is especially dangerous,” he says, because this type of fat is thought to produce compounds that promote inflammation.

Lifestyle steps are powerful

There are no drugs on the market yet to treat or cure NAFLD or NASH. But lifestyle changes can be highly effective. Anyone who has been diagnosed with either of these conditions should take the steps that follow. They’re also helpful in preventing liver damage and good for overall health as well.

1. Get a liver checkup. The symptoms of NAFLD, when present, are fatigue, pain on the right side of the abdomen, swelling and jaundice. But even without symptoms, some people should be regularly monitored for liver disease.

“People over 50 who are overweight and have Type 2 diabetes should ask their physician to include liver screening in their annual medical checkup,” says Scott Friedman, chief of the Division of Liver Diseases at the Icahn School of Medicine at Mount Sinai in New York. This includes a blood test to determine whether liver enzymes, such as ALT, AST and bilirubin, are elevated. “If so, there is liver inflammation, and they should get an ultrasound of the abdomen to check the liver for fat deposits.”

2. Lose weight. “Weight loss in many cases can eliminate the problem,” Friedman says. “In fact, no experimental therapy that’s been developed so far is more effective.”

A study published in 2015 in the journal Gastroenterology was one of the first to show the impact of losing weight. People with NASH, the more severe form of fatty liver disease, who were able to drop 7 to 10 percent or more of their body weight over a year showed improvements in liver function and health.

3. Go Mediterranean. Following a plant-based Mediterranean-style diet reduced fat levels in the liver by 29 percent in a study published in 2018 in Circulation. Another study published in 2021 in the journal Gut found that including walnuts in this diet, along with exercising, led to liver fat loss and that adding green tea and an aquatic plant called Mankai cut the risk of fatty liver in half.

This diet, which focuses on high-fiber foods such as fruits, vegetables, beans and whole grains, has several healthy aspects. Fiber promotes weight loss and regulates glucose levels, according to a review published in 2020 in the journal Nutrients. And these foods are rich in antioxidants, which help control inflammation.

The diet is also low in saturated fat, which is good for the liver and rich in unsaturated fats. That’s in part because it limits red meat. While you can have meat occasionally, “focus on monounsaturated fats like olive oil, avocados and nuts, since they reduce inflammation and help promote the loss of liver fat,” says Debra A. Silverman, a clinical dietitian at the Mayo Clinic in Jacksonville, Fla. The omega-3 fats in fish also offer these benefits.

Although wine is often considered part of the Mediterranean diet, don’t drink alcohol if you have any form of liver disease. And avoid sugary beverages and processed foods, Silverman says. In large amounts, added sugars can prompt the liver to create fat. Instead, drink lots of water to help your liver function better. Coffee and green tea are good choices, too. They have antioxidant and anti-inflammatory properties.

4. Move your body. It’s helpful for weight loss, and exercise has a direct impact on liver function. “Increasing your heart rate through exercise is like a mini massage for the liver,” says Wayne Eskridge, CEO of the Fatty Liver Foundation, a nonprofit organization. “It improves blood flow, reduces hypertension and slows liver damage.”

A combination of strength and cardio exercise is best. “Ideally, 30 minutes of exercise five times a week is recommended to reverse NAFLD if it is not too progressed,” Sanchez says. Start slowly and work your way to that goal over time.

Are liver supplements safe?

Many supplements come with the promise that they optimize liver function, detox the liver or otherwise promote liver health. They typically contain several ingredients. Research on common substances in these products is limited, and the evidence that does exist has been mixed.

Milk thistle, for example, contains a chemical called silymarin that may reduce liver inflammation. A study of 72 people with NAFLD, published in 2013 in the World Journal of Hepatology, found that it had a small positive effect. But the study subjects were also taking vitamins B12 and E, and were following a healthy diet.

Other studies have suggested that 800 international units of vitamin E daily may help people with NASH who don’t have diabetes. Omega-3s in fish oil are also good for liver health, but many experts say it’s better to get these unsaturated fats from fish than from supplements. Some fish oil pills may contain contaminants, such as PCBs and mercury.

No one — especially if they suspect or know they have liver disease — should turn to supplements unless they’re approved by their doctor. “These products are not tested by the Food and Drug Administration, so the purity and amount of ingredients in them is unpredictable,” says Pieter Cohen, an associate professor at Harvard Medical School in Boston. “And some may have compounds that may irritate the liver and do more damage.” Healthy eating and exercise are more proven ways to keep your liver in good working order.