Metabolic dysfunction-associated steatotic liver disease (MASLD) happens when excess fat builds up in your liver. It used to be known as nonalcoholic fatty liver disease. MASLD may not cause any symptoms at first, but when it’s left untreated, your liver can start to fail. But MASLD can be reversed. There’s no magic pill. It’s up to you to make changes to your lifestyle.
Can Fatty Liver Be Reversed?
“Lifestyle changes are the first line of treatment for MASLD because weight loss, healthy eating, and regular exercise directly address the underlying drivers — obesity, insulin resistance, and metabolic dysfunction,” says Swapnil Patel, MD, MHCM, FACP, vice chairman of the Department of Medicine at Hackensack Meridian Health's Jersey Shore University Medical Center in Neptune, New Jersey. “These steps can lower liver fat, reduce inflammation, and even reverse disease progression without the risks of medication.”
Understand Your Baseline
Different tests help your doctor diagnose MASLD and understand if your condition is mild or severe. You might have:
- Blood tests, including ones that check your liver function
- Imaging tests such as ultrasound, CT scan, or MRI to get visual details of your liver
- Liver elastography (such as FibroScan®), which uses special technology to measure fat buildup, scarring, and stiffness in your liver
- Biopsy, in which a tiny sample of your liver tissue is removed and analyzed in a lab
Your test results give your doctor a baseline of your current liver health. They can repeat these tests after you’ve made lifestyle changes that are good for your liver. That will help you and your doctor know how much your new habits are helping.
Making Your Plan
Even when you’re excited to get healthier, changing habits can be a challenge. These tips can help you stay on track:
Tackle one change at a time. That will keep you from feeling overwhelmed and going back to your old ways of doing things.
Be specific about your goals. For instance, instead of saying, “I’m going to eat better,” you might say, “I’m going to try to have vegetables at every meal.”
Go for small wins. Instead of trying to run a mile right away, walk for 10 minutes. Then, try walking a bit longer the next time. Achieving small goals will keep you motivated — and add up over time.
Track your progress. Whether you use a fitness device, check in every day with a friend, or mark progress on a chart, celebrate the goals you achieve.
Line up support. You don’t need to do this alone. Let friends and family know so they can help you.
Find your “why.” Getting in shape or changing your diet may feel easier when you can link it to a heartfelt purpose. For instance, “I want to be in good health for my kids.”
Exercise Strategically
Losing weight is the most important thing you can do for your liver health. It can lower liver fat, heal inflammation, and improve scarring.
Regular exercise is a key part of getting to a healthy weight. Working out “also produces independent effects from weight loss, all of which lead to a reduction of liver fat buildup or a reversal,” says Elizabeth Joy, MD, MPH, FACSM, leader of the American College of Sports Medicine’s Exercise is Medicine program.
How to know your healthy weight goal
Your doctor will help you understand your healthy weight goal. Studies show that if you are overweight or have obesity:
- Losing 3%-5% of your weight can lower liver fat
- Losing 7% can also ease liver inflammation
If you’re overweight or have obesity, your doctor may suggest that you try to lose 7%-10% of your body weight over the course of a year. Trying to lose it faster isn’t better. It could worsen your MASLD.
To get moving more:
Check with your doctor if you’re new to exercise or have other health conditions.
Start slow. If you do too much, too fast, too soon, “[you] may find that to be just so unpleasant that [you] don't stick with it,” Joy says.
Aim for moderate aerobic activity. Aim for three to five times a week for 30 minutes. Brisk walking is a good start. It’s OK if you can only do 10 minutes — or less — at first.
Increase non-exercise activity thermogenesis (NEAT). This includes all the little things you do during the day, such as cleaning your house or working in your yard. It all helps burn calories. See what else you can do to sit less and move more — try parking farther away or use a standing desk for part of your workday.
Start strength training. Once you’re comfortable with aerobic activity, add two days of resistance training. This could be body weight exercises, lifting free weights, or using resistance bands.
Progressive exercise is key. Once an exercise or activity feels easy, go a little longer or make it slightly harder.
If you’ve had trouble losing weight in the past, talk to your doctor about medical weight loss options. This could include prescribed medication, such as a glucagon-like peptide-1 (GLP-1) agonist like Ozempic or Wegovy, or bariatric surgery, which shrinks the size of your stomach.
Change Your Diet
MASH is linked to health issues such as diabetes, high blood pressure, and high cholesterol, which can all be harmful to your heart. Eating healthier foods won’t just benefit your liver, but your overall health.
Try to:
Follow a Mediterranean-style eating plan. It focuses on:
- Whole grains
- Fruits
- Vegetables
- Plant-based proteins such as nuts, beans, and legumes
- Healthy fats, such as extra virgin olive oil and avocado
- Fish, like salmon, that’s high in omega-3 fatty acids
Focus on complex carbs. Not all carbs are “bad.” Choose complex carbs, like brown rice or 100% whole wheat bread, over simple carbs like doughnuts. “Complex carbohydrates, which are a big component of a Mediterranean diet...are protective for the liver,” Joy says.
Limit sugar. For women, keep added sugars to no more than 24 grams a day (six teaspoons). Men should have no more than 36 grams a day (nine teaspoons).
Read nutrition labels. Many packaged foods contain added sugar. “It's in everything from juices to ketchup to spaghetti sauce,” says Joy.
Watch your portions. Fill half your plate at every meal with non-starchy veggies. One-fourth can be whole grains or another carbohydrate, and another fourth can be a lean protein such as tofu, fish, beans, or lean meat like chicken.
Choose healthy fats. Instead of butter and cream, choose extra virgin olive oil, avocado, nuts, and seeds.
Cut back on fast food. Research shows that even eating one fast food meal a day could increase your liver fat.
Avoid both processed and red meat. They worsen inflammation throughout your body.
Watch What You Drink
MASLD isn’t caused by excess alcohol, but drinking does strain your liver.
Your liver’s job is to process toxins, such as alcohol. Feeling tipsy or drunk is actually a sign that alcohol is in your bloodstream because your liver’s having a hard time keeping up. Over time, alcohol use harms your liver function.
You’ll need to cut out alcohol to detox your liver.
“Even people who are moderate drinkers need to abstain from alcohol because that can kind of tip the scales,” Joy says.
Ask your doctor for help, especially if you’ve tried and failed to stop drinking in the past.
Optimize Sleep
Poor sleep raises your risk of MASLD, as well as other serious health issues such as stroke, heart attack, and diabetes.
To rest better:
Practice good sleep hygiene. Wake up and go to bed at the same time every night. Keep your bedroom “cave-like” — cool, quiet, and dark.
Turn off screens at least one hour before bed. Their light signals your brain to wake up, not wind down.
Find a relaxing routine. For instance, maybe you read, listen to calming music, or meditate before bed. Avoid high-energy activities, such as a hard workout.
Find new ways to manage your stress. A stressful day can lead to a sleepless night. Get support from loved ones, spend time outside in nature, and consult a mental health expert.
Are the Latest Liver Health Trends Worth Trying?
A lot of liver health products or lifestyle tricks claim to help your liver. Here’s a look at what’s useful and what isn’t.
Intermittent fasting (IF)
This is when you switch between periods of eating and fasting. For instance, you might eat during eight hours of the day, then go 16 hours without food.
“Intermittent fasting is a strategy to help with modest weight loss. It’s been shown to improve insulin sensitivity. And that helps to reduce liver fat,” Joy says.
Still, check with your doctor before you try it, especially if you take medications.
Liver cleanses
Many of these products overlap with weight loss cleanses. They aren’t regulated by the FDA, so what you get in one box or bottle could be different from another one on the shelf, even if they’re the same brand.
“Not only is there no evidence in the scientific literature that these liver cleanses or detoxification work, but they’re actually considered dangerous, particularly for people who are using some medicinal plants as liver detoxification,” Joy says.
Coffee
Two to three daily cups of black coffee (no cream or sugar) could benefit your liver health and also slow down fibrosis (scarring). But that’s not true for all caffeinated supplements or pills.
It's not just caffeine that appears to help your liver. “It's all the various compounds that we know are in coffee,” Joy says.
Supplements
Your liver can flush out toxins on its own, so skip supplements that promise to help it detox. Not only is there no strong evidence that dietary supplements can reverse MASLD, but “they are definitely not a substitute for making changes in diet, achieving modest weight loss and engaging in regular exercise,” Joy says.
Some, like milk thistle, haven’t been confirmed to work well. Others contain ingredients that can damage your liver when taken at high doses. Those include:
- Green tea extract
- Tumeric
- VItamin A
- Glutamine
- Ashwagandha
- Ma Huang (ephedra)
- Kava
- Skullcap
- Red yeast rice
- Garcinia cambogia
As a rule, don’t start any vitamins or supplements before talking to your doctor. And remember: If something sounds too good to be true, it probably is.
How to Know if Your Changes Are Helping
After being diagnosed with MASLD, you’ll probably follow up with your doctor:
- Every one to two years if you have MASLD with fibrosis (a lot of scar tissue in your liver)
- Every two to five years if you have MASLD without fibrosis
At your checkups, your doctor will check your weight. They’ll also ask questions about your eating and exercise.
You’ll also likely repeat your initial blood tests or imaging tests. Then, your doctor can compare the results and see how much your lifestyle changes are helping.
How long will it take to reverse fatty liver?
Everyone is different, but reversing your liver fat won’t happen overnight. This is a question best answered by your doctor.
When Lifestyle Changes Aren’t Enough
Sometimes, no matter how hard you try, your liver health doesn’t improve. About 20% of people with MASLD go on to have a more severe form of liver disease called metabolic dysfunction-associated steatohepatitis (MASH).
About 20% of people with MASH develop cirrhosis or end-stage liver disease. In some cases, your liver could stop working.
If your liver gets worse, your doctor will talk to you about medical treatments that could help.
That could include:
- Bariatric surgery
- Resmetirom (Rezdiffra), the only FDA-approved medication for MASH that can help treat liver damage
- Clinical trials, which let you try new MASLD treatments that are being developed
- A liver transplant
When to contact your doctor
Let your doctor know if:
You start having new symptoms. Be especially aware of pain that you feel in your upper right belly or if you are feeling tired for no reason. These can be signs that your liver is getting worse.
You feel alone or overwhelmed. Your doctor can help connect you to mental health support. You might choose to have a one-on-one talk with a counselor or join a support group. That way, you can talk to others who are also dealing with MASLD.
Changing your habits can be a challenge. You don’t need to “power through” on your own. Support from others can help you stick to your long-term goals and improve your health.
