Question:

I have nonalcoholic fatty liver disease. What dietary steps do I need to take to get rid of this problem?

Answered by gastroenterologist Shane Manatsathit, MD

Nonalcoholic fatty liver disease, or NAFLD, and nonalcoholic steatohepatitis, or NASH, are the accumulation of liver fat in people who drink little to no alcohol. Because it generally does not have symptoms, it is often diagnosed through abnormal lab results or as an incidental finding when a patient has any abdominal imaging.

Weight loss is the most important treatment for NAFLD/NASH. We recommend patients try to lose 7% to 10% of their body weight through a healthy diet and exercise.

As for the diet itself, there are data on the Mediterranean diet and NAFLD/NASH. But, because weight loss is the key to reversing the condition, any diet resulting in weight loss is a good option. A health care provider or registered dietitian can help you with a weight loss plan.

You may be wondering how serious NAFLD/NASH is. Although NAFLD/NASH is a problem with the liver, the most common causes of death are heart attack and cancer. For this reason, in our clinic, we often focus on cholesterol and preventing a heart attack, along with age-appropriate cancer screening.

Although most people with NAFLD/NASH will not go on to develop further liver damage, approximately one-third of those with NAFLD/NASH will develop cirrhosis or scarring of the liver. Therefore, determining the degree of scarring in the liver is crucially important.

While we once had to depend on liver biopsy to check for scarring, we now have a noninvasive diagnostic tool called Fibroscan, a type of ultrasound technology. Using this tool, we can identify scarring, which helps us know your risk for becoming more ill and how closely you will need to be followed. If you are interested in Fibroscan, we recommend contacting your primary care physician for a referral.

If you have NAFLD/NASH with cirrhosis, you may consider enrolling in a clinical trial since there is no current FDA-approved medication for the condition. We are enrolling patients with cirrhosis from NASH in a 12-week trial, during which they will receive a weekly infusion. If you want to join the trial, please email our team.