Non-alcoholic fatty liver disease is fat accumulation in liver cells in someone who drinks little or no alcohol. It is usually silent and found incidentally on a scan. It responds well to dietary change, particularly to removing fructose from drinks, and it progresses if ignored.
How it happens without alcohol
The liver makes fat when it is given more sugar than it can otherwise use. Fructose in particular is metabolised almost entirely by the liver, and unlike glucose it bypasses the main regulatory step — so a large fructose load is converted to fat directly.
Insulin resistance compounds it, because high insulin instructs the liver to make more fat and store it. This is why fatty liver, type 2 diabetes and raised triglycerides appear together so reliably.
Is this what is happening to you?The two-minute check further down asks four questions and shows the result immediately. No email, no call.
Take the 2-minute checkWhy it is missed
Early fatty liver produces no symptoms at all. Most diagnoses are incidental — an ultrasound done for something else, or a mildly raised ALT on a routine panel.
Because the finding arrives with no symptoms attached, it is frequently dismissed as unimportant. That is the wrong conclusion. Simple fatty liver can progress to inflammation, then fibrosis, then cirrhosis, and the early stages are where it is most responsive.
- A mildly raised ALT, often with AST normal
- “Fatty liver, grade 1” noted on an abdominal ultrasound
- Raised triglycerides with low HDL
- Increased waist circumference, sometimes at a normal BMI
2-minute check
What is your risk of type 2 diabetes?
Four questions. No email required for the result.
Does a parent or sibling have diabetes?
Where do you carry weight?
How active is an ordinary day?
Any thirst, frequent urination or afternoon crashes?
A lower risk profile
Risk still rises with age, so an HbA1c every couple of years is sensible.
A moderate risk profile
This is the stage where change makes the most difference, because the process can still be slowed.
A higher risk profile
Not a diagnosis. An HbA1c and fasting glucose test is inexpensive and worth doing soon.
This check is an indication, not a diagnosis. It does not replace medical advice.
What the evidence supports
This is one of the areas where dietary change has clear and consistent support.
- Remove sweetened drinks and fruit juice. Usually the single largest change available, and often the fastest to show on liver enzymes.
- Reduce refined carbohydrate. White rice, maida, biscuits, sweets.
- Modest weight reduction, where there is weight to lose. The relationship between weight reduction and liver fat is well established.
- Coffee. Consistently associated with lower progression in studies. An unexpected but genuine finding.
- Resistance training, which reduces liver fat even where weight does not change.
What to ask your doctor
Whether a FibroScan or a fibrosis score is warranted, to distinguish simple fat from established fibrosis. Whether hepatitis B and C have been excluded. Whether thyroid function has been checked, since hypothyroidism contributes.
And whether any of your current medicines affect the liver — a question for the prescriber, never for us.
In short
Questions we are asked
Is fatty liver serious if I have no symptoms?
The absence of symptoms says nothing about the stage. Simple fat is very responsive; established fibrosis is a different matter. That distinction needs assessment, which is why a finding on a scan deserves follow-up rather than dismissal.
Can it be reversed?
Liver fat responds to dietary change, and early-stage disease improves in many people. How completely depends on the stage at which it is caught and what else is going on, which is why we will not put a figure on it.
Reading about it is the easy part.The assessment turns this into your own numbers — free, with a free first consultation, and no figure quoted that we cannot substantiate.
Start my free assessmentConditions this relates to
Recipes that put this into practice
Methi thepla with curd
The same thepla, with a flour blend and a partner that flatten the glucose rise.
See the recipe →Moong dal chilla
Thirteen grams of protein at breakfast, and the difference shows up at four in the afternoon.
See the recipe →Cinnamon and fenugreek water
Two minutes, modest real evidence, and an honest account of its limits.
See the recipe →Related reading
Why weight will not move when your thyroid is underactive
When effort stops producing a result, the problem is often not the effort.
Read →Insulin resistance, explained without the jargon
One mechanism sits underneath PCOS, fatty liver, acne and stubborn weight.
Read →Eight numbers worth understanding on your blood report
Most reports get read for what is flagged. The useful information is often elsewhere.
Read →References
- Indian National Association for Study of the Liver — consensus on non-alcoholic fatty liver disease.
- World Gastroenterology Organisation — global guidelines on NAFLD.
- [Further references to be completed by the medical review panel.]
This article is general health information, written by a clinical nutritionist and reviewed by a doctor. It is not a diagnosis and it does not replace advice from your own clinician. Never change prescribed medication on the basis of what you read here.