Focus on liver health: effective prevention and alleviation of non-alcoholic fatty liver disease (NAFLD)

⏱ 11 min read

Non-alcoholic fatty liver disease, also known by the abbreviation NAFLD, is mainly caused by poor eating habits and an unhealthy lifestyle. It is one of the most common liver diseases in industrialized countries and has therefore increasingly become the focus of health experts in recent years. The disease is widespread nowadays, but often goes unrecognized for too long.

➤ Around 30% of the world's population have NAFLD, and the share is rising. This makes it one of the most widespread liver diseases. Those affected have an increased risk of later developing more serious liver diseases such as cirrhosis or liver cancer.

What is a non-alcoholic fatty liver?

As the name suggests, NAFLD is a liver disease that is not associated with alcohol consumption. It occurs when fat accumulates in the liver cells, which then impairs liver function.

The extent of NAFLD, or non-alcoholic fatty liver disease, can vary greatly, ranging from mild fat accumulation to severe inflammation.

Roughly one in three people worldwide is affected: an analysis of 92 studies with more than 9 million people put the global figure at 30%, and at 38% in the most recent years (Younossi et al., 2023).

New name: NAFLD is now called MASLD

In 2023, the major liver societies agreed on new terms, partly because "non-alcoholic" only says what the cause is not (Rinella et al., 2023). NAFLD became MASLD (metabolic dysfunction-associated steatotic liver disease), and NASH became MASH. Doctors use the term MASLD when the liver is fatty, at least one metabolic risk factor such as excess weight, raised blood sugar, high blood pressure or unfavourable blood lipids is present, and there is no harmful alcohol intake (EASL, EASD & EASO, 2024). Medical reports may therefore use either name.

In this context, two variants can be distinguished:

1. Non-alcoholic fatty liver (NAFL): This is a pure accumulation of fat without accompanying inflammation or scarring.
2. Non-alcoholic steatohepatitis (NASH, now called MASH): Non-alcoholic steatohepatitis (NASH) also causes fat to accumulate in the liver cells. However, NASH is also associated with liver inflammation and possible scarring. Under certain circumstances, this can lead to more serious complications such as liver cirrhosis or liver cancer.

Anyone who wants to support their liver with plant extracts alongside diet and exercise will find our artichoke and milk thistle capsules in a pack together with S-acetyl glutathione and organic spirulina, each as a standalone product. Silymarin from milk thistle has been studied in fatty liver in a number of trials (more on this below).

View the pack with artichoke & milk thistle  ➜

✓ Artichoke & milk thistle + S-acetyl glutathione + organic spirulina

Find out more about the causes and possible triggers of non-alcoholic fatty liver disease

The development of NAFLD can be attributed to various factors. These include, among others:

• Being overweight: Excessive body weight plays a central role in the development of NAFLD, especially if the excess pounds are stored in the form of abdominal fat.
• Insulin resistance: Impaired insulin sensitivity, which is often associated with type 2 diabetes, can also contribute to the development of NAFLD.
• Genetics: Recent research findings also suggest that genetic predisposition could also play an important role.
• Diet: Another particularly high risk factor is an unhealthy diet with a high proportion of saturated fats, trans fats and sugar, such as those found in fast food, industrially processed products and sugary drinks.
• Lack of exercise: A lifestyle that lacks physical activity can also contribute to the development or worsening of NAFLD.

The symptoms of non-alcoholic fatty liver disease at a glance - How NAFLD affects the body

Non-alcoholic fatty liver disease often progresses gradually and is often asymptomatic in the early stages - meaning that it can develop without any recognizable symptoms or complaints. Early detection therefore becomes a real challenge. However, as the disease progresses, there are a number of symptoms that can serve as warning signs. These include:

• Tiredness: Persistent tiredness and weakness that cannot be explained by usual causes such as lack of sleep or stress.
• Upper abdominal pain: A dull or stabbing pain in the right upper abdomen, directly under the ribs.
• Weight loss: Sudden and unexplained weight loss that is not caused by a change in diet or heavy physical activity.
• Yellow coloration: The conspicuous yellowing of the skin and eyes, also known as jaundice, occurs especially in the advanced stage.
• Liver enlargement: A palpable or visible enlargement of the liver is noticed during the medical examination.
• Oedema: Water retention in the body, which leads to swollen legs or fluid in the belly (ascites), is often seen in more advanced stages.

In this context, it is important to point out that the occurrence of one or more of these symptoms does not necessarily indicate the presence of NAFLD. However, it is always advisable to seek medical advice if you suspect this.

Warning signs that need a doctor straight away: yellow skin or yellow eyes, a belly that keeps getting bigger because of fluid, vomiting blood, black stools, and new confusion or strong drowsiness. These signs point to advanced liver disease and are not something to treat on your own.

Can a fatty liver heal, and how long does it take?

The liver is able to recover, especially while the disease is still at the stage of simple fat build-up or inflammation without much scarring. The clearest data come from a study of 293 people with biopsy-confirmed NASH who changed their lifestyle to lose weight and had a second liver biopsy after 52 weeks. After that one year, the inflammation had cleared in 25% of them, the overall disease activity score had improved in 47%, and scarring (fibrosis) had receded in 19%. The more weight people lost, the better their liver tissue looked (Vilar-Gomez et al., 2015).

Weight is not the only lever. A meta-analysis of 12 controlled trials found that regular exercise lowered liver fat even when people lost little or no weight, and at training levels below those usually recommended for weight loss (Keating et al., 2012). The benefits of reversing a fatty liver go beyond the liver itself: the European guideline links MASLD with type 2 diabetes, obesity and heart and blood vessel risk, which is why it also calls for good management of these conditions (EASL, EASD & EASO, 2024). How fast things improve differs from person to person, so follow-up checks with blood tests and, if needed, an ultrasound or elastography scan show whether the changes are working.

Natural ways to prevent and treat non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) requires a targeted approach that takes into account both general health recommendations and specific natural support. According to the European guideline, weight loss, a change in diet, exercise and avoiding alcohol come first, together with good treatment of related conditions such as type 2 diabetes (EASL, EASD & EASO, 2024).

1. Healthy diet

A balanced diet with whole grain products, fresh fruit, vegetables and lean protein can help to reduce the accumulation of fat in the liver. It is particularly important to avoid saturated fats, trans fats and sugar at the same time.

In this context, studies often recommend a calorie-reduced diet, whereby the focus here should be on reducing carbohydrates and fats in the diet. Particular attention is currently being paid to low-carbohydrate and Mediterranean diets. Coffee may also play a part: in a meta-analysis of observational studies, people with NAFLD who drank the most coffee had 35% lower odds of significant liver scarring (Ebadi et al., 2021).

2. Regular physical activity

Even moderate physical activity, such as a daily walk, can reduce the risk of developing fatty liver disease and even slow down the progression of existing disease.

Studies have shown that regular exercise in people with NAFLD helps to reduce the fat content of the liver, even if it results in little or no weight loss. The effect appeared at training levels below those usually recommended for losing weight (Keating et al., 2012). The benefits of physical activity lie primarily in the reduction of inflammation and the change in the liver's fat metabolism.

3. Weight control

As overweight and obesity are among the most significant contributing factors to the development of NAFLD, gradual and sustained weight loss can be effective in both preventing and treating symptoms.

In this context, studies have shown that lifestyle changes involving both diet and physical activity can be effective in helping to improve liver health in patients with NAFLD. Weight loss has been shown to be particularly effective. In a study of 293 people with NASH who changed their lifestyle for one year, the more weight they lost, the more their liver improved. Among those who lost at least 5%, the liver inflammation cleared in 58%. With a loss of 10% or more, it cleared in 90%, and scarring receded in 45%. However, only 30% of participants managed to lose at least 5% (Vilar-Gomez et al., 2015). Small, lasting steps are therefore more realistic than a strict diet.

4. Avoid alcohol

Even though alcohol is not the cause of this type of fatty liver, it puts an extra burden on a liver that is already fatty. The European guideline therefore advises people with MASLD to avoid alcohol as far as possible (EASL, EASD & EASO, 2024).

5. Check medication

Certain medications can put additional strain on the liver. It is therefore essential to discuss the use of medication with a doctor and to have regular follow-up examinations.

6. Regular medical examinations

It is particularly important for people at increased risk to have regular medical check-ups and blood tests to monitor the condition of their liver.

7. Food supplements

In addition to the general measures mentioned above, it also makes sense to consider natural support through specific dietary supplements and natural remedies that have been studied in NAFLD:

• Omega-3 fatty acids: These valuable polyunsaturated fatty acids are primarily known for their anti-inflammatory and heart-protective properties. In the presence of NAFLD, omega-3 fatty acids can help to reduce fat deposits in the liver. In a meta-analysis of 18 trials with 1,424 people, they lowered liver fat, the liver enzymes ALT, AST and GGT, and blood triglycerides (Yan et al., 2018). A second meta-analysis of 22 trials with 1,366 participants found that omega-3 reduced liver fat more often than a placebo and also improved total cholesterol and HDL cholesterol (Lee et al., 2020).

➤ Buy Omega 3

• Vitamin E: As one of the most powerful natural antioxidants, vitamin E can help to reduce oxidative stress, which can lead to liver damage in the long term. In a large trial in adults with NASH without diabetes, 800 IU of vitamin E a day for 96 weeks improved liver tissue in 43% of participants, compared with 19% on placebo (Sanyal et al., 2010).
  
  ➤ Buy vitamin E complex
  
  
• Milk thistle and artichoke: Both milk thistle and artichoke are known for their liver-strengthening properties. Milk thistle contains the powerful substance silymarin, a compound known for its antioxidant and anti-inflammatory effects. A meta-analysis of 26 trials with 2,375 people with NAFLD found lower liver enzymes (ALT and AST), better blood lipids and less fat in the liver tissue with silymarin (Li et al., 2024). More on the plant in our guide to milk thistle. The extract from the artichoke, on the other hand, contains cynarin, an ingredient that can promote the flow of bile and also has antioxidant properties.
  
  
  
  
• Turmeric: Curcumin, the active ingredient in turmeric, has anti-inflammatory and antioxidant effects. In a meta-analysis of 16 trials with 1,028 people with NAFLD, fatty liver on ultrasound resolved more often with curcumin, and the liver enzymes ALT and AST went down (Ngu et al., 2022).
  
  
  
  

Our artichoke and milk thistle capsules are also available in a pack with S-acetyl glutathione and organic spirulina, each as a standalone product.

View the pack with artichoke & milk thistle  ➜

✓ Artichoke & milk thistle + S-acetyl glutathione + organic spirulina

What to keep in mind with supplements and a fatty liver

People with liver disease are best advised to check supplements with their doctor first, especially if they also take medication. For products with turmeric and with ashwagandha, rare individual cases of liver irritation have been described, usually a few weeks to a few months after starting them and often with yellowing of the skin (Halegoua-DeMarzio et al., 2023; Björnsson et al., 2020). If yellow skin or eyes, dark urine or strong itching appear, stop the product and have it checked by a doctor.

Frequently asked questions

How long does it take to heal a non-alcoholic fatty liver?

There is no fixed timeline. In a study of people with NASH, one year of lifestyle change cleared the liver inflammation in 25% of all participants and in 90% of those who lost at least 10% of their body weight. Regular checks with the doctor show how well the changes are working.

Do weight loss benefits start at 5 to 10 percent for fatty liver?

Yes, the data fit this range. People with NASH who lost at least 5% of their weight saw the inflammation clear in 58% of cases, from 10% onwards it cleared in 90%, and scarring receded in 45%. Exercise helps even before the scales move, because it lowers liver fat with little or no weight loss.

Does coffee have benefits for fatty liver?

Observational studies point in that direction: people with NAFLD who drank the most coffee had 35% lower odds of significant liver scarring. An ideal daily amount has not yet been set.

Do omega-3 supplements benefit fatty liver?

In meta-analyses of controlled trials, omega-3 lowered liver fat, the liver enzymes ALT, AST and GGT, and blood triglycerides, and no serious side effects were found. Omega-3 works best as an addition to a change in diet and more exercise.

Does vitamin E benefit non alcoholic fatty liver disease?

In a large trial in adults with NASH without diabetes, 800 IU of vitamin E a day for 96 weeks improved liver tissue in 43% of participants, compared with 19% on placebo. Anyone with a diagnosed liver condition is best advised to agree the dose with their doctor.

Sources (in English):

Cotter, T. G., & Rinella, M. (2020). Nonalcoholic Fatty Liver Disease 2020: The State of the Disease. Gastroenterology, 158(7), 1851–1864. doi: 10.1053/j.gastro.2020.01.052

Polyzos, S. A., Kountouras, J., & Mantzoros, C. S. (2019). Obesity and nonalcoholic fatty liver disease: From pathophysiology to therapeutics. Metabolism: clinical and experimental, 92, 82–97. doi: 10.1016/j.metabol.2018.11.014

Rinella M. E. (2015). Nonalcoholic fatty liver disease: a systematic review. JAMA, 313(22), 2263–2273. https://doi.org/10.1001/jama.2015.5370

Tokushige, K., Ikejima, K., Ono, M., Eguchi, Y., Kamada, Y., Itoh, Y., Akuta, N., Yoneda, M., Iwasa, M., Yoneda, M., Otsuka, M., Tamaki, N., Kogiso, T., Miwa, H., Chayama, K., Enomoto, N., Shimosegawa, T., Takehara, T., & Koike, K. (2021). Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis 2020. Journal of gastroenterology, 56(11), 951–963. https://doi.org/10.1007/s00535-021-01796-x

Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F et al. (2023). A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology, 78(6):1966-1986. doi: 10.1097/HEP.0000000000000520

European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO) (2024). EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). Journal of Hepatology, 81(3):492-542. doi: 10.1016/j.jhep.2024.04.031

Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L (2023). The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology, 77(4):1335-1347. doi: 10.1097/HEP.0000000000000004

Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, Torres-Gonzalez A, Gra-Oramas B, Gonzalez-Fabian L et al. (2015). Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis. Gastroenterology, 149(2):367-378.e5. doi: 10.1053/j.gastro.2015.04.005

Keating SE, Hackett DA, George J, Johnson NA (2012). Exercise and non-alcoholic fatty liver disease: a systematic review and meta-analysis. Journal of Hepatology, 57(1):157-166. doi: 10.1016/j.jhep.2012.02.023

Ebadi M, Ip S, Bhanji RA, Montano-Loza AJ (2021). Effect of Coffee Consumption on Non-Alcoholic Fatty Liver Disease Incidence, Prevalence and Risk of Significant Liver Fibrosis: Systematic Review with Meta-Analysis of Observational Studies. Nutrients, 13(9):3042. doi: 10.3390/nu13093042

Yan JH, Guan BJ, Gao HY, Peng XE (2018). Omega-3 polyunsaturated fatty acid supplementation and non-alcoholic fatty liver disease: A meta-analysis of randomized controlled trials. Medicine (Baltimore), 97(37):e12271. doi: 10.1097/MD.0000000000012271

Lee CH, Fu Y, Yang SJ, Chi CC (2020). Effects of Omega-3 Polyunsaturated Fatty Acid Supplementation on Non-Alcoholic Fatty Liver: A Systematic Review and Meta-Analysis. Nutrients, 12(9):2769. doi: 10.3390/nu12092769

Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM et al. (2010). Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. New England Journal of Medicine, 362(18):1675-1685. doi: 10.1056/NEJMoa0907929

Li S, Duan F, Li S, Lu B (2024). Administration of silymarin in NAFLD/NASH: A systematic review and meta-analysis. Annals of Hepatology, 29(2):101174. doi: 10.1016/j.aohep.2023.101174

Ngu MH, Norhayati MN, Rosnani Z, Zulkifli MM (2022). Curcumin as adjuvant treatment in patients with non-alcoholic fatty liver (NAFLD) disease: A systematic review and meta-analysis. Complementary Therapies in Medicine, 68:102843. doi: 10.1016/j.ctim.2022.102843

Halegoua-DeMarzio D, Navarro V, Ahmad J, Avula B, Barnhart H, Barritt AS et al. (2023). Liver Injury Associated with Turmeric – A Growing Problem: Ten Cases from the Drug-Induced Liver Injury Network [DILIN]. American Journal of Medicine, 136(2):200-206. doi: 10.1016/j.amjmed.2022.09.026

Björnsson HK, Björnsson ES, Avula B, Khan IA, Jonasson JG, Ghabril M, Hayashi PH, Navarro V (2020). Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network. Liver International, 40(4):825-829. doi: 10.1111/liv.14393