If you've been told you have fatty liver or non-alcoholic fatty liver disease, the good news is it's fully reversible. In this article, I'll go over the exact steps you need to take to not only reverse it, but to do it quickly and start seeing changes within weeks. I'll also cover actionable advice on the foods you need to eat and avoid to help your liver heal, along with other steps you can take to improve your liver health and the best supplements that can help your liver recover and return to normal.
Hi, I'm Dr. Leonid Kim, and I share the most up-to-date, evidence-based information on weight loss, metabolic health, and longevity. Let's get into it.
What Causes Fatty Liver
To better understand how to reverse fatty liver, we first have to identify what causes it in the first place, and it's pretty simple: fatty liver is caused, for the most part, by overconsumption of sugars, specifically fructose and sucrose, with sucrose being just table sugar that breaks down into fructose and glucose.
The consumption of both fructose and sugar sets off a cascade of changes in our bodies that leads not only to fatty liver, but also to other conditions like diabetes, heart disease, dementia, and even many cancers.
What makes fructose unique is that it doesn't stimulate leptin, a hormone released in our bodies after a meal that signals satiety, or fullness, to our brains. So consuming fructose doesn't trigger the normal response that signals we're full, which makes it very easy to overeat. If that wasn't bad enough, continued consumption of fructose drives the development of leptin resistance, which results in persistent hunger and impaired satiety, even with other foods, not just fructose.
A study published in the American Journal of Clinical Nutrition found that just seven days of a high-fructose diet increased lipid deposition in the liver and decreased liver insulin sensitivity.
How to Avoid Excess Fructose
So how do we avoid fructose? Fructose is a simple sugar commonly found in honey, fruits, and root vegetables, and humans have consumed it for hundreds of thousands of years. It did not pose a health risk until we started consuming large quantities of manufactured fructose and sugar.
Most fruits and vegetables contain fructose. However, our intestines can inactivate about four to five grams of fructose, which is roughly the amount we get from vegetables. We get a little more fructose from fruits, but fruits, like vegetables, are also consumed with a lot of fiber, which slows down the absorption of the excess fructose. In addition, many fruits are rich in vitamin C, which blocks some of the effects of fructose and largely negates any adverse effects of the fructose we get from fruit.
Food Group to Avoid #1: Sugary Drinks
That brings us to the first food group we need to avoid to reverse fatty liver: sugary drinks. We all know about the dangers of sodas and soft drinks, but the sneaky drinks loaded with sugar are juices, which are often promoted as healthy and frequently given to kids.
If you drink orange juice, apple juice, tomato juice, cranberry juice, or any juice, check the ingredient label to see how many grams of sugar you get from just one serving. Don't be fooled by statements like "contains natural sugars" or "zero grams of added sugars." It may be natural, but it's still highly concentrated and consumed without the fiber you'd normally get from eating a whole fruit. It's also a lot easier to overconsume sugar when it's in liquid form as opposed to eating a fruit itself.
Other drinks notorious for being high in sugar include sports and energy drinks. The American Heart Association recommends eating less than 24 to 36 grams of sugar per day, but if you suffer from fatty liver disease, I would abstain from all drinks that contain sugar.
Along the same lines, I would also avoid eating dried fruit like dates, raisins, or prunes. Yes, they're natural and don't contain added sugars. Still, those natural sugars are very concentrated and lack the volume of the original fruit, making it much easier to overwhelm your GI tract, and later your liver, with fructose and sugar.
To support that, a study published in JAMA in 2019 noted that just eight weeks of restricting sugar intake in adolescent boys to less than 3% of daily calories led to significant improvement in hepatic steatosis.
Eat More Protein, Especially at Breakfast
Another way to fix your fatty liver is to eat more protein, and it's especially important to eat more protein for breakfast, or whatever your first meal of the day happens to be.
A recent study published in Obesity examined over 9,000 Australians and found that getting enough protein, especially at the first meal of the day, had profound effects on what people ate later in the day. Eating higher levels of protein for breakfast translated to consuming less food over the rest of the day, while people who had a low-protein breakfast were found to eat more energy-dense, processed foods and foods high in sugar.
So if you find yourself constantly craving sugary or processed foods, foods that will make your fatty liver worse, try increasing your protein intake, especially at breakfast, and aim to get at least 25 to 35 grams of protein per meal if you're eating three meals a day. Getting enough protein will help you eat less sugar and lose weight, and weight loss is one of the most effective ways to improve fatty liver.
In fact, just 5% of total body weight loss can decrease hepatic steatosis, and losing 7% of total body weight can lead to complete resolution of non-alcoholic steatohepatitis (NASH), a more severe form of fatty liver disease.
Watch Your Fat Sources
As you increase your protein intake, you have to be careful about what kind of fats you're getting in the process. Animal meats and dairy products are wonderful sources of protein; however, you do have to watch your intake of saturated fats, which are usually found in red meat, processed meats, butter, ice cream, and many fried foods.
Eating red meat is a controversial topic, and I happen to follow the view that it's okay to consume red meat in moderation, but that's a whole other conversation for another day.
A study published in Diabetes & Metabolism showed that while overfeeding with either saturated fats or fructose increases liver fat, the group overfed with saturated fats increases liver fat to a much greater degree than the group overfed with fructose.
There are at least four human intervention studies confirming the harmful effects of saturated fat on hepatic steatosis. Still, the one I want to highlight is a double-masked, randomized controlled trial in which lean individuals were overfed muffins high in either saturated fatty acids (palm oil) or polyunsaturated fatty acids (sunflower oil).
They found that just seven weeks of overfeeding resulted in a marked increase in liver fat in the saturated-fat group. In contrast, the polyunsaturated-fat group saw a nearly threefold increase in lean, fat-free mass, with no effect on the liver.
So it's important not to overeat saturated fats. I emphasize "overeat" because it's okay to eat saturated fats in moderation. Eating more than about 5% of your calories from saturated fats is when you start getting into trouble. In practice, that means eating less processed meat, fewer store-bought or restaurant fried foods and pastries, and being careful with ice cream and cheese.
At the same time, aim to eat more of the good fats, the poly- and monounsaturated fats that come from fish, nuts, and avocados. When it comes to cooking oils, olive oil is preferred over saturated fats like coconut or palm oil.
A Note on Low-Carb and Ketogenic Diets
The type of fat you eat is especially important for those on very low-carbohydrate or ketogenic diets, where much of the energy must come from fat. Keto can be a very effective way to lose weight and improve metabolic health. It's very safe as long as the majority of the fat comes from polyunsaturated or monounsaturated fats rather than saturated fats. Many people have been successful using ketogenic diets to reverse fatty liver.
However, for just as many people, that degree of severe carbohydrate restriction isn't sustainable long term. The good news is that cutting out carbs entirely isn't a requirement for fatty liver reversal. It's really the quality and type of carbohydrates you consume that play a larger role in treating fatty liver.
Eating carbs with a low glycemic index, meaning they don't cause wild swings in your blood sugar, is much better for liver health than eating high-glycemic-index carbs.
So while lowering your overall carbohydrate intake is generally a good idea for most people, I wouldn't worry as much about consuming lower-glycemic-index carbohydrates from legumes, dairy, vegetables, or fruits. I would, however, stay away from high-glycemic-index carbohydrates like white bread, white rice, most breakfast cereals, and processed potatoes like French fries or chips.
Lifestyle Factors That Help
To wrap this up, other things that are highly beneficial for reversing fatty liver disease include abstaining from alcohol, getting at least 150 minutes of moderate-intensity activity per week, and including resistance training or muscle-building exercise at least two days a week to help restore your liver to good health.
If you do all of the things mentioned here, you will see changes in your liver biomarkers within weeks, as seen in the studies discussed earlier, and you will eventually fully reverse your fatty liver. It's important to take these steps as soon as possible, before your liver progresses into a more severe form of fatty liver disease, like NASH or steatohepatitis, and eventually to fibrosis and even cirrhosis, at which point a liver transplant becomes the only option.
Supplements That May Help
If you'd like to enhance your recovery, you can also try adding supplements to the food changes discussed above. To be clear, you do not need any supplements to fix your fatty liver, as long as you eat the right things and use real, whole foods as your medicine. However, some supplements show promise and could help expedite recovery.
Vitamin E. Therapy with vitamin E at 800 international units a day was associated with a significantly higher rate of improvement in steatohepatitis compared to placebo. I would, however, discuss vitamin E supplementation with your doctor first, as high doses of vitamin E, meaning greater than 400 international units per day, have been inconsistently associated with an increase in all-cause mortality, as well as an increase in the rate of prostate cancer. For this reason, the recommendation to supplement vitamin E is usually reserved for patients with more advanced fatty liver disease.
Omega-3 fatty acids. I would also consider taking omega-3 fatty acids. A meta-analysis published in Clinical Nutrition in 2018 showed that supplementation with omega-3s, especially fish oils rich in DHA, was associated with improvements in liver markers such as ALT and AST, as well as reductions in liver fat.
Choline. Lastly, choline has been gaining popularity as a treatment for fatty liver. A recent case-control study showed that people with high intake of choline and betaine had an associated 81% reduction in hepatic steatosis. However, we still need more conclusive research on whether choline supplementation is actually beneficial for most people, and not just those who are choline-deficient, as well as what dose provides any real therapeutic benefit.
Until we get more data, I would focus on getting enough choline from food, which means eating plenty of eggs (with the yolk), lean meats, dairy, and seafood, which is also rich in omega-3 fatty acids. If you don't eat meat, focus on getting choline from yogurt, sunflower seeds, and cruciferous vegetables like broccoli, cauliflower, or cabbage.
This isn't a complete list of supplements commonly used to treat fatty liver, as that topic deserves its own dedicated discussion.
Conclusion
Fatty liver disease is largely driven by excess sugar and fructose intake, but the encouraging news is that it's a highly reversible condition. By cutting out sugary drinks and dried fruit, prioritizing protein (especially at breakfast), moderating saturated fat while favoring unsaturated fats, choosing lower-glycemic-index carbohydrates, staying active, and avoiding alcohol, most people can start seeing measurable improvements in their liver health within weeks. Targeted supplementation with vitamin E, omega-3 fatty acids, or choline may further support recovery, but real, whole foods should remain the foundation of any fatty liver reversal plan. Acting early is key, since untreated fatty liver can progress to more serious conditions like NASH, fibrosis, and cirrhosis.
FAQ
Is fatty liver disease reversible?
Yes. Fatty liver disease, including non-alcoholic fatty liver disease, is fully reversible with the right dietary and lifestyle changes, and improvements can often be seen in liver biomarkers within weeks.
What foods cause fatty liver?
Excess intake of sugars, especially fructose and sucrose, is the primary dietary driver of fatty liver disease. Sugary drinks, fruit juices, and concentrated sources of natural sugar, such as dried fruit, are particularly problematic.
Does eating fruit cause fatty liver?
Not typically. Whole fruits contain fiber and vitamin C, which slow fructose absorption and blunt its negative effects. The concern is primarily with concentrated sources of fructose, such as juices and dried fruit, rather than whole fruit itself.
How much weight loss is needed to improve fatty liver?
Losing just 5% of total body weight can decrease hepatic steatosis, and losing 7% of total body weight can lead to complete resolution of non-alcoholic steatohepatitis (NASH).
Are ketogenic diets good for fatty liver?
Ketogenic diets can be effective for reversing fatty liver, but it's important that the majority of dietary fat comes from polyunsaturated and monounsaturated sources rather than saturated fat. Carb restriction isn't strictly necessary either; focusing on low-glycemic-index carbohydrates can also be effective and more sustainable long term.
What supplements help with fatty liver?
Vitamin E, omega-3 fatty acids (especially DHA), and choline have shown promise in supporting liver health, but should complement, not replace, a whole-food-based diet. Vitamin E in particular should be discussed with a doctor due to potential risks at higher doses.