Non-alcoholic fatty liver disease (NAFLD) is a build-up of fat within liver cells that is not primarily caused by alcohol. It is now also called metabolic dysfunction-associated steatotic liver disease (MASLD), a name that better reflects its close relationship with metabolic health.
The condition is common and often causes no symptoms. It may be discovered through blood tests or imaging arranged for another reason. Some people experience tiredness, a general sense of being unwell or discomfort beneath the right ribs.
Most people have simple steatosis, in which fat has accumulated without significant damage. A smaller proportion develops inflammation, formerly called non-alcoholic steatohepatitis (NASH), followed by fibrosis and potentially cirrhosis. Later-stage liver disease increases the risk of liver failure and liver cancer. Cardiovascular disease, type 2 diabetes, kidney disease and high blood pressure are also important associated risks.
Diagnosis and monitoring
Assessment may include liver blood tests, ultrasound or other scans and calculations that estimate fibrosis risk. Other causes of liver disease, including viral hepatitis, medicines and alcohol, need to be considered. Normal liver enzymes do not always exclude significant disease.
Recognising serious symptoms
People with fibrosis or cirrhosis require specialist follow-up. Yellowing of the eyes or skin, increasing abdominal swelling, vomiting blood, black stools, confusion or marked drowsiness needs urgent medical care.
Food, movement and weight
Lifestyle change is the principal treatment for early NAFLD. If someone is above their healthiest weight, gradual and sustained weight loss can reduce liver fat and may improve inflammation and fibrosis. Crash diets are unnecessary and can be counterproductive.
A Mediterranean-style pattern is a useful template: plenty of vegetables, legumes, whole grains, nuts and seeds; fish and other suitable proteins; olive oil and other unsaturated fats; and fewer sugary drinks, refined carbohydrates, highly processed foods and excessive saturated fat. Whole fruit is nutritionally different from fruit juice and does not need to be eaten only between meals.
Regular activity helps even when weight changes slowly. The NHS suggests aiming for at least 150 minutes weekly, adapted to fitness and medical circumstances. Alcohol should remain within medical advice and UK low-risk limits, although a liver specialist may recommend avoiding it completely. Smoking cessation and management of diabetes, blood pressure and cholesterol are equally important.
Useful supplements
Supplements should be selected for the individual rather than used automatically. Product directions and advice from an appropriately qualified professional should take precedence over general information.
| Supplement | Effects |
|---|---|
| Lecithin powder or granules, with a broad-spectrum probiotic considered separately | Lecithin supplies choline used in phospholipid and fat transport; probiotics support intestinal microbial balance. Evidence for treating fatty liver with either remains limited. |
| Whole-leaf aloe vera juice | Has prebiotic and proposed anti-inflammatory effects, although clinical evidence in NAFLD is insufficient and some preparations can cause diarrhoea. |
| Coenzyme Q10, preferably ubiquinol | Supports cellular energy production and antioxidant protection. Some studies report altered CoQ10 status in metabolic disease, but benefit in NAFLD is uncertain. |
| Spirulina | Provides antioxidant pigments and nutrients and may influence metabolic markers; it is not an established treatment for liver fibrosis. |
| Broad-spectrum plant digestive enzymes | Assist food breakdown but have not been shown to remove liver fat in people without pancreatic or digestive enzyme insufficiency. |
| Fat-soluble antioxidants such as vitamins A and E and carotenoids | Support antioxidant systems. Vitamin E is used by specialists for selected patients, while unsupervised high doses and preformed vitamin A can cause harm. |
| Krill oil | Provides omega-3 fats with anti-inflammatory and antioxidant activity. Evidence that it prevents liver-fat accumulation in humans is not conclusive. |
| Vitamin C | Supports antioxidant defences and enzyme function. High-dose supplementation has not been shown to “detoxify” the liver. |
| Magnesium citrate | Contributes to normal energy metabolism and many enzyme reactions. It may be appropriate when intake is low, but excess can cause diarrhoea. |
The liver processes concentrated herbal extracts and supplements; some products marketed for “detox” or weight loss can themselves cause liver injury. Check every product with a clinician or pharmacist, especially where fibrosis, cirrhosis, diabetes or prescription medicines are present.
Looking for personalised nutrition and lifestyle support? An FNTP member may be able to help you explore an approach suited to your individual needs. Find an FNTP practitioner.
This article is for general education and does not replace individual medical advice, diagnosis or treatment.
