How do you support your liver?
I know… The liver is not exactly a sexy organ to which most of us give much thought. Maybe you think of a damaged liver (e.g., cirrhosis) as a final bad outcome of alcoholism. Or maybe—since an estimated 2.2 million Americans live with it–you’ve known someone with hepatitis C, a viral infection that causes inflammation of the liver (1).
However, the liver, arguably the most important organ in our body, deserves our attention and care.
The stunning prevalence of metabolic syndrome has resulted in a dramatic uptick of chronic diseases. Unfortunately, this includes non-alcoholic fatty liver disease (NAFLD), which now affects 30% to 40% of the U.S. adult population: that’s 1 in 3 people (2, 3)!!
*Given its association with metabolic risk factors, NAFLD is now being called “Metabolic Dysfunction-Associated Steatotic Liver Disease” (MASLD).
Children have also been adversely affected. The prevalence of non-alcoholic fatty liver disease is (conservatively) between 5 and 10 percent among American children aged 2 to 19 years–that’s roughly 1 in 10 children (4, 5).
Non-alcoholic fatty liver disease (NAFLD)–a build-up of fat in the liver NOT caused by alcohol–was virtually unheard of prior to 1980.
So…what has changed over the last 45 years?
The US food system (e.g., introduction of genetically engineered foods into our food supply; a dramatic increase in pesticide usage on crops); an onslaught of toxic chemical exposures in every aspect of our daily lives; our food choices; and a convenience-based, technocentric, sedentary lifestyle (6).
What exactly does the liver do?
First, it is important to understand why our liver plays an essential role in our overall health.
The second largest organ in the body (the first is our skin) and weighing apx. 3 pounds (in adults), the liver is located under our right ribcage.
In her book Good Energy, Dr. Casey Means writes (7):
“The liver is a master orchestrator of metabolism, hormone processing, detoxification, digestion, and cellular energy production across the whole body.”
A multi-tasking organ that performs over 500 functions, the liver, among other things (8, 9):
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- Cleanses the blood.
- Produces substances to help the blood clot.
- Processes nutrients from the foods we eat.
- Creates proteins and cholesterol to form hormones.
- Converts our thyroid hormone from an inactive storage form (T4) to the active form (T3), which regulates our metabolism.
- Metabolizes fats, carbohydrates and proteins so that your body can use them.
- Stores glycogen, releasing glucose, as needed.
- Produces bile, which is essential for healthy digestion and for absorbing the fats that we consume.
- **Plays a vitalrole in DETOXIFICATION. The liver absorbs and filters everything that we put into and onto our bodies, as well as what we breathe.
That said… it is a misconception that the liver “stores” toxins. It does NOT! The liver serves as a filter that, first neutralizes, then clears out, harmful toxins and waste, while retaining the nutrients the body needs.
What is Non-Alcoholic Fatty Liver Disease (NAFLD)…and why should we care?
Unfortunately, our liver can get fat.
Non-alcoholic fatty liver disease refers to a build-up of fat in the liver that is NOT caused by alcohol.
It is normal for the liver to contain some fat. However, when the liver becomes overburdened and damaged, it will store fat inside its cells, creating fatty liver disease (10). NAFLD occurs when 5% to 10% of your liver’s weight consists of fat. Roughly 100 million people are estimated to have NAFLD (11).
The 4 stages of NAFLD include (12):
Stage 1: Simple fatty liver, a mostly harmless build-up of fat in the liver cells.
Stage 2: Non-alcoholic steatohepatitis (NASH). At this stage, in addition to fatty build-up, the liver has become inflamed.
Stage 3: Fibrosis. Persistent inflammation causes scar tissue around the liver and blood vessels, but the liver is still able to function normally.
Stage 4: Cirrhosis. After years of inflammation, the liver shrinks and becomes scarred and lumpy. At this stage, the damage to the liver is irreversible and can lead to liver failure and liver cancer.
NAFLD is a metabolic liver disease that is strongly associated with (13, 14, 15):
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- Obesity.
- Type 2 diabetes.
- Metabolic syndrome.
- Increased risk of chronic kidney disease.
- Increased risk of liver-related disease, including liver cancer.
- Increased risk of all-cause mortality.
- Increased risk of atherosclerosis, cardiovascular disease and cardiac complications.
The consequence?
Research suggests that unaddressed NAFLD can lead to a potentially shorter lifespan–and a lower quality of life (16).
What are the risk factors for NAFLD?
You are at increased risk for NAFLD if you (17, 18, 19, 20):
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- Are overweight or obese, characterized by a large waist size (Men: >40 inches and >35 inches for women) / excess abdominal fat.
- Have high blood sugar or Type 2 diabetes.
- Have insulin resistance or a condition that affects how your body uses insulin, like Polycystic Ovarian Syndrome (PCOS).
- Have an underactive thyroid, also known as hypothyroidism.
- Havelow HDL “good” cholesterol.
- Have high triglycerides.
- Are age 50 or older.
- Smoke now OR have a history of smoking.
- Have a history of long-term prescription drug use. *Medications commonly implicated in causing fatty liver include corticosteroids, antidepressant and antipsychotic medications, and Tamoxifen, a selective estrogen receptor modulator used to treat and prevent breast cancer. Amiodarone, used to treat abnormal heart rhythms, and methotrexate, used to treat cancer and autoimmune conditions, are also capable of causing fatty liver disease.
A study published in the Annals of Hepatology suggests that the best predictors of a fatty liver are your BMI (Body Mass Index) and waist circumference (21).
According to researchers, among people who have NAFLD, the disease is mainly associated with metabolic risk factors such as obesity (75-95%), Type 2 diabetes and/or insulin resistance (70%), and abnormal cholesterol levels (50%).
Up to two-thirds (66%) of people with obesity and Type 2 diabetes present with fatty liver disease (22).
What you can do
The good news? Your food choices and lifestyle habits can make a significant difference in reversing fatty liver, especially in the early stages of NAFLD. Consider the following:
1. Test. Don’t automatically assume you’re “fine”! Most conventional medical doctors will run routine lab work that includes the liver function markers discussed above. You can also order your own blood work via direct access labs—no doctor’s visit required—and the results will be emailed directly to you within 7 to 10 days. The Essential Labs Panel provides excellent insight into your overall metabolic health, and it includes liver function tests (ALP, ALT and AST). Learn more here.
2. Do a whole foods cleanse that supports the liver. Learn more here.
3. Limit or eliminate pro-inflammatory foods, including: all forms of sugars, refined carbohydrates, excess starches, processed foods, GMO foods and alcohol.
4. Eat whole foods, ideally, organic.
5. Cook more at homevs. ordering online or eating out most nights.
6. Move your body every day.
7. Hydrate well.Ideally, drink filtered water.
8. Try a 12-hour fast.For example: Finish dinner by 7PM; eat breakfast at 7AM the next morning. No foodin the 12 hours between 7PM and 7AM.
9. Sleep,ideally 7-9 hours.
Sources
1 Karon C Lewis, Laurie K Barker, Ruth B Jiles, Neil Gupta, Estimated Prevalence and Awareness of Hepatitis C Virus Infection Among US Adults: National Health and Nutrition Examination Survey, January 2017–March 2020, Clinical Infectious Diseases, Volume 77, Issue 10, 15 November 2023, Pages 1413–1415.
2 Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023 Apr 1;77(4):1335-1347.
3 Appleby RN, Moghul I, Khan S, Yee M, Manousou P, Neal TD, Walters JRF. Non-alcoholic fatty liver disease is associated with dysregulated bile acid synthesis and diarrhea: A prospective observational study. PLoS One. 2019 Jan 25;14(1):e0211348.
4 Yu EL, Schwimmer JB. Epidemiology of Pediatric Nonalcoholic Fatty Liver Disease. Clin Liver Dis (Hoboken). 2021 Apr 13;17(3):196-199.
5 Cha, Ariana Eunjung. “Fatty Liver Was a Disease of the Old. Then Kids Started Getting Sick.” Washington Post. Oct. 3, 2023.
6 Center for Sustainable Systems, University of Michigan. 2024. “U.S. Food System Factsheet.”Pub. No. CSS01-06.
7, 10 Means, C with Means, C. (2024). Good Energy. Avery.
8 Cleveland Clinic. (2021, Feb. 22). Liver.
9, 23 Jockers, D. (2020). Heal Your Liver Now e-Guide. Pgs. 3, 17-20.
11, 29 American Liver Foundation. (2025, Feb. 13). Nonalcoholic Fatty Liver Disease (NAFLD).
12, 17 NHS. (2022, Jan. 13). Non-alcoholic fatty liver disease (NAFLD).
13 Mantovani, Alessandro et al. Complications, morbidity and mortality of nonalcoholic fatty liver disease. Metabolism: Clinical and Experimental, Oct. 2020. Volume 111, 154170.
14, 16 Vancells Lujan P, Viñas Esmel E, Sacanella Meseguer E. Overview of Non-Alcoholic Fatty Liver Disease (NAFLD) and the Role of Sugary Food Consumption and Other Dietary Components in Its Development. Nutrients. 2021; 13(5):1442.
15 Targher G, Byrne CD, Tilg H. NAFLD and increased risk of cardiovascular disease: clinical associations, pathophysiological mechanisms and pharmacological implications. Gut. 2020 Sep;69(9):1691-1705.
18 Vassilatou E. Nonalcoholic fatty liver disease and polycystic ovary syndrome. World J Gastroenterol. 2014 Jul 14;20(26):8351-63.
19 Bikeyeva V, Abdullah A, Radivojevic A, Abu Jad AA, Ravanavena A, Ravindra C, Igweonu-Nwakile EO, Ali S, Paul S, Yakkali S, Teresa Selvin S, Thomas S, Hamid P. Nonalcoholic Fatty Liver Disease and Hypothyroidism: What You Need to Know. Cureus. 2022 Aug 16;14(8):e28052.
20 LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Nonalcoholic Fatty Liver. [Updated 2019 May 4].
21, 22 Lopez-Velazquez JA, Silva-Vidal KV, Ponciano-Rodriuez G, Chavez-Tapia NC, Arrese M, Uribe M, Mendez-Sanchez N. The prevalence of fatty liver disease in the Americas. Annals of Hepatology. (March-April 2014). Vol. 13. Issue 2. Pgs 166-178.
24 Pezzino S, Sofia M, Faletra G, Mazzone C, Litrico G, La Greca G, Latteri S. Gut-Liver Axis and Non-Alcoholic Fatty Liver Disease: A Vicious Circle of Dysfunctions Orchestrated by the Gut Microbiome. Biology (Basel). 2022 Nov 6;11(11):1622.
25 Purssell H, Whorwell PJ, Athwal VS, Vasant DH. Non-alcoholic fatty liver disease in irritable bowel syndrome: More than a coincidence? World J Hepatol. 2021 Dec 27;13(12):1816-1827
26, 27 Appleby RN, Moghul I, Khan S, Yee M, Manousou P, Neal TD, Walters JRF. Non-alcoholic fatty liver disease is associated with dysregulated bile acid synthesis and diarrhea: A prospective observational study. PLoS One. 2019 Jan 25;14(1):e0211348.
28 Shin A, Xu H, Imperiale TF. Associations of chronic diarrhoea with non-alcoholic fatty liver disease and obesity-related disorders among US adults. BMJ Open Gastroenterol. 2019 Aug 12;6(1):e000322.
30 Cleveland Clinic. (2023, Oct. 4). Liver Disease.
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33 Center for Food Safety. GE Foods.
