Few health conditions are more amenable to natural methods to support structure and function than fatty liver.
Clinical studies have found that you can sometimes reverse fatty liver with supplements alone, and sometimes can be cured with diet alone, but it is a combination of diet and supplements that works best.
It is not just diet, and it is not even just diet and silymarin, that helps the liver heal itself. Diet, plus the milk thistle derivative called silymarin, plus probiotics, plus vitamin D, vitamin E, copper, and DHA work together to provide optimal nutritional support.
What Is Fatty Liver?
Non-alcoholic fatty liver disease is the most common complication of obesity worldwide. Up to 30 percent of the populations of some Asian and African countries could be diagnosed with fatty liver disease.
Additionally, up to 46 percent of the populations of some Middle Eastern countries and the United States are in some stage of the condition. [1] Fatty liver disease is a spectrum of diseases that includes non-alcoholic steatohepatitis, fibrosis, cirrhosis, and liver cancer. The complications of fatty liver disease usually appear in that order, although there is increased risk of liver cancer even without going through the intermediate steps of fibrosis and cirrhosis.[2]
If you struggle with your weight, or if there is liver disease in your family, it is important to treat fatty liver disease before it causes serious or even life-threatening complications.
Ideally, you want to focus on prevention so that you don’t have to reverse fatty liver disease after it is already a problem in your life.
Symptoms of Fatty Liver Disease
How can you know whether you have fatty liver disease? Severe fatty infiltration of the liver can result in anorexia, nausea, and abdominal discomfort.
In addition, it can cause a vague feeling of fatigue. Jaundice (yellowing of the skin and eyes) is present in about 15 percent of patients admitted to the hospital.
Most people who have fatty liver disease, however, won’t have yellowing of the eyes or skin. Liver enzymes such as ALT and AST are elevated in fatty liver disease, but they are also elevated in many other conditions.
There are diseases not affecting the liver at all that cause high ALT and AST. That is the reason that the definitive test for fatty liver is a liver biopsy.
A doctor uses a scarily long needle to draw out a tiny sample of your liver tissue. Then a pathologist examines it under a microscope to determine whether you have fat in your liver and if they are causing inflammation and scarring of your liver.
However, some people just aren’t good candidates for a liver biopsy. If you take blood thinners, your gastroenterologist probably will not do a needle biopsy.
Furthermore, if you are extremely underweight or extremely overweight a needle biopsy may be out of the question.
Noninvasive Studies are Imperfect
Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) can help your doctor determine whether the problem is fatty liver or gallbladder disease.
However, they cannot distinguish between a benign form of fatty liver disease and the more serious complication called steatohepatitis. Therefore, if you happen to be in the 1 to 2 percent of the population who has some form of iron overload disease, an MRI is not as useful because iron deposits look a lot like fat deposits in some patients.
Busy radiologists may take a quick look at your history and interpret “iffy” images as fatty liver disease. (Of course, if you have hereditary iron overload disease that you have not had treated, it is entirely possible that you will have both iron and fat deposits in your liver.)
Unfortunately, the diagnosis of fatty liver disease is usually not definitive. Your doctor makes an educated guess based on the fact that many, many people are found to have fatty liver once they are given liver biopsies, and if you have diabetes, or pre-diabetes, or if you are obese, then there is a very good chance that you have some form of fatty liver disease.
Even if you are not certain, it is a good idea to educate yourself here on the tactics to reverse fatty liver disease. It doesn’t hurt to improve your diet and nutritional status even if turns out you don’t have the condition. By the time you have obvious symptoms, treatment becomes complicated.
Therefore, it is best to make positive changes in your lifestyle as soon as possible. Anything you do to change your lifestyle to support liver health will be helpful even if you don’t actually have liver disease.
Causes of Fatty Liver Disease
What causes fatty liver disease? And how do I reverse fatty liver disease? These are the two most common questions we get.
If you have non-alcoholic fatty liver disease and you are overweight, then your liver problem may be a complication of being too fat.
However, that does not mean it is entirely your fault. It’s not just a matter of what you eat and how much you eat. It also has to do with the microbes that live in your digestive tract.
Both friendly and unfriendly bacteria influence the progress of the disease. Researchers often describe fatty liver disease as a “two-hit” condition. The mere presence of excess fat in liver cells invites oxidation, and the byproducts of oxidation cause inflammation that ultimately damages liver tissue.
That inflammation is not enough to damage your liver. There has to be a second hit, such as alcohol abuse or drug abuse or an imbalance in the microbes in your gut.
More often than not, the second hit causes changes to the bacteria in your colon, not alcohol or drug abuse.
Bacteria Often Determine the Course of Fatty Liver Disease
The presence or absence of probiotic bacteria makes a tremendous difference in whether you reverse fatty liver disease, you live with fatty liver disease but your liver functions normally, or you suffer complications of fatty liver disease like those mentioned above. There are over 10,000,000,000,000 microorganisms, both friendly and unfriendly, in your digestive tract.[3]
Many of these microbes are harmful. However, even more of these microbes are helpful probiotic bacteria. Probiotic bacteria are a wonderful influence for good health.
They can slow down the development of obesity,[4] cardiovascular disease,[5] both type 1 and type 2 diabetes,[6] and various forms of liver disease.[7]
Microbes and Your Liver
The liver diseases influenced by the microbes in your digestive tract are all related to fatty liver. They can be described along a spectrum ranging from simple fatty liver disease to non-alcoholic steatohepatosis (NASH) to fibrosis, cirrhosis, and liver cancer (hepatocarcinoma).[8]
In addition to the “two hits”[9] that your doctor is likely to explain to you, various microbes in your digestive tract influence inflammation and insulin resistance, both of which can make you fatter, the use of bile salts (that carry away excess fats) and the liver’s use of choline (which is used to make protective cell membranes).[10]
Therefore, having the right probiotic bacteria is crucial. It can make a huge difference in whether your fatty liver disease becomes a much more serious problem, stays benign, or even whether you are able to reverse fatty liver disease.
How You Can Use Probiotics to Prevent or Reverse Fatty Liver Disease
There are eight probiotic bacteria that have been found to make a major difference in liver health. They are three kinds of Bifidobacteria (B. breve, B. longum, B. infantis), one kind of beneficial Streptococcus (S. thermophilus), and four kinds of Lactobatillus ( L. plantarum, L. acidophilus, L. paracasei and L. delbrueckii subsp. Bulgaricus).
Of these, the Bifidobacteria are the most important for stopping new fat deposits in the liver.[11] However, it is the combination of all eight that has been shown in clinical trials to prevent fibrosis, the next step in liver disease after fatty liver.[12]en tested in clinical trials involving children and adults with proven fatty liver disease. The combination improves insulin sensitivity and inflammation.[13] In addition, it amplifies the effects of statin drugs and metformin.[14]
A clinical trial In Iran even found that taking probiotics with the prebiotics that feed them (mostly plant fiber) increased production of the body’s satiety hormone, leptin, reducing hunger.[15]
And although probiotics alone won’t reverse fatty liver disease—diet is required to accomplish that—they can make dieting easier, as we will discuss below.
What About Other Supplements?
Which natural supplements can help you prevent or reverse fatty liver disease? Some researchers believe that a vitamin D level below 75 nmol/L, which is to say, just about everyone’s vitamin D levels in the United States, encourages the progression of fatty liver disease to NASH, fibrosis, and cirrhosis.[16]
An exact dosage of supplemental vitamin D that may prevent problems from fatty liver disease has not been established, but 1,000 IU a day is a reasonable start.
Clinical trials have found that taking vitamin E is helpful in correcting some of the advanced complications of fatty liver disease.
Children and teens who are given vitamin E are less likely to develop “ballooning” of liver tissue.[17] Adults who take vitamin E are less likely to have new fat deposits, inflammation, or cirrhosis, although vitamin E will not correct existing fibrosis of the liver.[18]
Additionally, a combination of copper deficiency and sugar consumption accelerates the accumulation of fat in the liver. Copper deficiency exacerbates liver damage, and fructose interferes with the absorption of copper from food.[19]
There are also some very preliminary indications that curcumin, the antioxidant found in turmeric, can reduce the inflammation that causes fatty liver disease to progress to fibrosis and cirrhosis.[20]
Sometimes DHA supplements alone are enough to reverse fatty liver disease in children. Because their bodies are still growing, the anti-inflammatory effects of DHA plus the calorie needs of growing bodies deplete excess fat.[21]
DHA may lessen insulin resistance in adults, but it won’t correct the underlying problem, fatty liver.[22] Most adults who have fatty liver disease absolutely, positively must change their diets.
The First Rule of Diet to Heal Fatty Liver: Eliminate Unnatural Sources of Fructose
If you want to reverse fatty liver disease, then your diet is a crucial part of the equation. It’s not easy to correct fatty liver with diet alone, but dietary changes result in the greatest and longest lasting reduction of fat deposits.
There are two groups of foods that have to be avoided, and then there is the task of counting calories. Let’s talk about the dietary no-no’s first. There are two universal rules for diets that work for reversing fatty liver disease. Here’s the first one: High-fructose corn syrup has to be completely eliminated from your diet.
The only organ in your body that uses fructose as fuel is your liver. When your liver is using fructose, it does not use glucose or fatty acids, and it stores them as fat. The harder your liver works at clearing fructose from your bloodstream and using it to make energy, the more fat it accumulates.[23]
Additionally, fructose in high doses, such as you would get from a Big Gulp or a Slurpee, also floods your liver with toxins. Fructose is not just food for you. It is also food for “unfriendly” bacteria.
The more fructose you consume, the more you feed the harmful bacteria in your colon. For people who truly want to reverse fatty liver disease, pay close attention to your relationship with fructose.
Large Amounts of Fructose Make the Linings of the Intestines More Permeable.
Any toxins that “bad” bacteria have made in your gut are more readily absorbed. The first place they stop is your liver. The liver’s Kuppfer cells attempt to keep the toxins from reaching the rest of your body by becoming inflamed and enlarged.
If they are constantly inflamed, they form fibrous scar tissue, which becomes the fibrosis that can lead to cirrhosis and even liver cancer.[24]
A good way to remember the importance of avoiding fructose is “Fructose Makes You Fat.” A clinical study found that people who get 500 calories a day from fructose put on belly fat at a rate four times faster than people who get just 100 calories a day from fructose.
Additionally, they have triglyceride levels that are 45 percent higher.[25] A couple of super-sized soft drinks a day may be enough to give you 500 calories from fructose. Three to five pieces of fruit will give you 100 calories from fructose.
It’s also true that “Fructose Causes Liver Fibrosis.”
Too much fructose dooms your liver to fibrosis and later cirrhosis, even if you do not drink alcohol.
Small amounts of fructose from fruit, no more than 25 grams (about 100 calories) per day, the equivalent of two or three pieces of fruit, are OK. Your liver can use that small amount of fructose without increasing fat production, and the low load of fructose sugar does not increase the permeability of your intestine’s lining so that toxins pass through.
However, excessive fructose is not the only dietary no-no for people seeking liver health…
If you want to prevent or reverse fatty liver disease, then don’t just eliminate drinks and snacks that are made with high-fructose corn syrup. Eliminate table sugar as well because it is a chemical combination of sucrose and glucose.
A study of 1,685 sons and daughters of doctors in the United States found that drinking any sugar-sweetened beverage daily results in a 56 percent greater likelihood of developing fatty liver disease.[26]
The Second Rule of Diet to Heal Fatty Liver: Don’t Eat Bad Fats
High-fructose corn syrup is not the only food you have to eliminate from your diet. The second universal rule for diets is this: Eat good fats sparingly. Don’t eat bad fats at all.
Which fats are the bad fats? For fatty liver disease, it turns out that the bad fats also are essential fats. How can something that is essential in your diet possibly be bad for you? It’s not just a matter of which fats you eat. It is also a matter of how much.
You are probably aware of the omega essential fatty acids. There are omega-3’s, which your body must obtain from diet, and which become anti-inflammatory hormones.
There are omega-6’s, which your body must also obtain from diet, and which become pro-inflammatory hormones.
Most of us don’t get enough of the omega-3’s, such as DHA, and we get too much of the omega-6’s, which are found in cooking oils. Excess omega-6 fatty acids also accelerate damage from fatty liver disease.
Furthermore, the problematic omega-6 essential fatty acids are abundant in soybean oil, corn oil, and fish oil. Clinical studies with NASH patients confirm that a diet with too many omega-6’s and not enough omega-3’s accelerates the deposit of fats in the liver.[27]
This means that people who want to reverse fatty liver disease not only need to avoid cooking oils and the various packaged baked goods that are loaded with them.
Don’t Just Eat Right, Eat Less
In addition to eating right, people who have fatty liver disease need to eat less. If you eat fewer calories so that your body has to burn fat for energy, it will burn fat deposits in your liver. Please note that this rule is not “if you exercise more so that your body burns more calories,” your liver will heal itself.
Vigorous exercise actually does help resolve fatty liver disease, however, the level of vigorous exercise that works is a lot more than most people are ever willing to do. Clinical trials found that this level of exercise was 5 hours per week at 80 percent of maximum heart rate, and the benefits were limited to a 50 percent reduction in the risk of developing fibrosis.
All that hard exercise did not cure fatty liver, rather it just kept it from getting worse.[28] It takes diet that results in weight loss (or diet plus silymarin, even without weight loss, as we will see a little later) to reverse fatty liver disease.
The Weight Loss that Helps Reverse Fatty Liver Disease has Come by Calorie Reduction.
Most authorities recommend eating 500 to 1,000 fewer calories per day so that you lose 1 or 2 pounds (500 to 1000 g) every week.
How do you reduce your consumption of food by 500 to 1000 calories per day?
If you eat two sandwiches for lunch, start eating one. In addition, if you supersize, start eating small (without the side order of fries or the Coke or ice cream).
Additionally, if you eat three, or four, or five eggs for breakfast, try eating two. Give up your venti for a short if you frequent Starbucks (though we wouldn’t suggest Starbucks as part of your diet).
Furthermore, if you eat out, or if you eat prepared meals, then know the calorie counts. Most importantly, write down absolutely everything you eat to keep track of calories, and be prepared for a shock when you find how much you really eat.
Dieting is Hard but the Rewards are Significant:
- If you can diet long enough to lose 9 percent of your body weight, ideally over about a year, clinical trials confirm that you will have reductions in both inflammation and fatty deposits in liver tissue.[29]
- Also, if you can diet so that you lose 8 percent of your body weight, clinical trials confirm that you will have significant loss of hepatic fat deposits.[30]
- If you can just lose 7 percent of your body weight by dieting, clinical research tells us that you will have less “ballooning” of liver tissue.[31]
- Even if you can only lose 5 percent of your body weight while you diet, you will have measurably fewer fat deposits in your liver.[32]
But what if you can’t even lose 5 percent of your body mass by dieting? Or you want to enjoy better liver health even while you are still losing weight? Then you need to supplement with silymarin.
Silymarin Can Help Heal Your Liver Even Before You Have Lost the Weight
Silymarin is a group of healing antioxidant chemicals found in the herb milk thistle. It is one of the most extensively studied of all natural products.
And it might be one of the keys for those who want to reverse fatty liver disease. If you diet and you take silymarin, a clinical study tells us that you will see improvements in your liver enzymes faster.
In one study, non-alcoholic steatohepatitis patients who took just a low dose of silymarin (210 mg a day) had improved ALT and AST in eight weeks.[33] In addition, silymarin also helps even if you don’t succeed at weight loss at all.
A team of physicians in Naples (Italy) studied the effects of silymarin in 72 fatty liver disease patients who were able to eat “right,” eliminating industrially produced fructose and unhealthy fats, but who weren’t able to eat the right amounts, losing weight on a calorie-restricted diet.
After Three Months of Taking 540 mg of Silymarin Every Day:
- Liver enzyme ALT levels fell from an average of 109 to an average of 75.
- Liver enzyme AST levels fell from an average of 72 to an average of 48.
- Ultrasound scans of the liver showed an average of 42 percent fewer fatty infiltrations.
Three months of silymarin did not completely reverse fatty liver, but it greatly improved it—even in patients who did not succeed at losing weight by dieting.[34] Silymarin will not be as helpful in patients who have advanced liver disease, and it has to be taken in a higher dose (700 mg per day) to help people in the advanced stages of fatty liver disease.
Even if these cases, however, clinical trials find that silymarin seems to cause a significant reduction in fibrosis, stopping the potentially deadly progression from fatty liver to fibrosis and more serious conditions.[35]
Therefore, if you want to reverse fatty liver disease, or if you want to prevent it, then it would be smart to take a milk thistle supplement every day that has silymarin in it.
