Non-Alcoholic Fatty Liver Disease: Why It Happens and How to Reverse It

If you’re living with Type-2 Diabetes, pre-diabetes, insulin resistance or another form of metabolic syndrome, you may already know that these conditions don’t often appear alone.

A diagnosis of Type-2 Diabetes or metabolic syndrome further increases your chances of also having:

  • High blood pressure,
  • Obesity,
  • Atherosclerosis,
  • High blood cholesterol and triglycerides,
  • Arthritis,
  • Dental problems,
  • Cataracts,
  • Haemochromatosis (i.e., high iron levels),
  • A high infection rate,
  • Pancreatitis, and
  • Non-Alcoholic Fatty Liver Disease (NAFLD).

Yes.  That’s a long list!  And those conditions have their own risk factors.

While most people are familiar with the first ten conditions, Non-Alcoholic Fatty Liver Disease is a bit more mysterious because we’re still learning a lot about it. 

In this article, we’ll address fatty liver, what it is, how it occurs, and how we can optimise our nutrition to reverse fatty liver.  

What Is Fatty Liver?

Non-Alcoholic Fatty Liver Disease, often referred to as fatty liver disease, fatty liver, or NAFLD, is an umbrella term for several conditions. 

NAFLD occurs when liver cells begin storing too much fat, resulting in excess fat accumulation around the liver.

NAFLD is common in people who are obese and overweight, and it’s the most common form of liver disease in the United States, affecting a whopping 1 in 4 people! 

Unsurprisingly, non-alcoholic fatty liver is predominantly present in western nations where it’s easy to get energy (calories).

NAFLD is one of several conditions that tend to accompany or precede other conditions related to metabolic health, like Type-2 Diabetes, metabolic syndrome and cardiovascular disease.

As the name suggests, NAFLD is not the same as Alcoholic-Fatty Liver Disease.  Someone who does not drink alcohol can still get Non-Alcoholic Fatty Liver Disease.  However, both conditions can still result in long-term liver impairment.

What Are the Signs of a Fatty Liver?

The three most prominent signs and symptoms of NAFLD include:

  • abdominal swelling (ascites),
  • fatigue, and
  • pain or discomfort in the upper right abdomen.

However, other indications of the condition that are often overlooked are:

  • enlarged blood vessels just beneath the skin’s surface;
  • yellowing of the skin and eyes (jaundice);
  • red palms; and
  • an enlarged spleen.

While they are not outright symptoms of NAFLD, you may want to get examined by your doctor if you have any of the above indications along with:

  • High cholesterol, triglycerides, or blood sugars;
  • Metabolic syndrome;
  • Cardiovascular disease (CVD);
  • Obesity, especially when fat concentrates around the abdomen;
  • Polycystic ovarian syndrome (PCOS);
  • Sleep apnoea;
  • Type-2 Diabetes;
  • High body mass index (BMI);
  • Hypothyroidism; or
  • Hypopituitarism.

How Serious Is a Fatty Liver?

Non-alcoholic Fatty Liver Disease is relatively harmless; instead, it indicates increasing metabolic dysfunction.  That said, if NAFLD is left unaddressed for a prolonged period, the condition can morph into a more serious one, known as non-alcoholic steatohepatitis.

Non-alcoholic steatohepatitis, or NASH for short, is an aggressive form of fatty liver disease.  It’s characterised by a high degree of liver inflammation which eventually results in the scarring of liver tissue, a condition known as cirrhosis.  If cirrhosis progresses, it often results in liver failure and sometimes cancer.

Once NAFLD has turned into cirrhosis, this condition can lead to fluid build-up in the abdomen, and oesophageal varices, which occur when veins of the oesophagus can rupture and bleed.  Additionally, it can result in hepatic encephalopathy, which is a condition that results in confusion, drowsiness, and slurred speech.  Lastly, if NAFLD gets as far as end-stage liver failure, your liver—an essential organ—ceases to function.

What Causes a Fatty Liver in a Non-Drinker?

While the exact cause of NAFLD is listed as ‘unknown’, it’s seemingly linked to a poor diet, high body weight, and sedentary lifestyles.  The combination of these three factors ultimately leads to energy toxicity or excess energy stored on your bum, butt and belly, in your blood, and on your liver. 

Let’s break this down a bit more!

It’s a big misnomer that insulin toxicity is the cause of the obesity epidemic.  Your body is super efficient and doesn’t produce more of any substance, including insulin, than it absolutely NEEDS to unless you have something like an insulinoma (tumour on your pancreas).

Your body produces insulin to compensate for something. 

Most people know insulin as an anabolic hormone we release when we eat to manage our food.  However, it can be more useful to view insulin as an anti-catabolic hormone that our bodies produce to halt the flow of stored energy (i.e., liver glycogen and body fat) so we can use up the fuel we just put in our mouths.

For more on this, check out What Does Insulin Do in Your Body?

Now, as you consume more energy than you use from low-satiety processed foods day in and day out, you become over-fuelled, and this excess energy piles up in your body.  Eventually, you exceed your body’s capacity to store all that energy comfortably.  That is, you exceed your Personal Fat Threshold.  Subsequently, you end up with high blood sugars and fats (i.e., triglycerides and cholesterol) in your blood. 

Because you have exceeded your body’s capacity to store fat, the energy backs up in your system, eventually into your bloodstream.  But the root cause is the excessive storage of fat in your body. 

While unsightly for vanity reasons, the fat in your adipose tissue is relatively safe.  It’s when your adipose tissue becomes full, like an overfull sponge, and overflows into your blood and vital organs, like your liver, that it becomes dangerous.  

Eventually, the body has nowhere safe to store the extra energy floating around your bloodstream, so it finds its way around the liver.  As a result, liver cells fill with fat, which can impede function and lead to inflammation and damage over time.

Can Fatty Liver Affect Blood Sugar?

Fatty liver does not seem to cause high blood sugar; instead, NAFLD and high blood glucose are two conditions that stem from the same root cause: energy toxicity.

In both situations, you’ve consumed more energy than your body can efficiently use and store, which has resulted in too much excess fuel in your body.  Thus, some of this energy registers as high blood sugar, triglycerides, and cholesterol.  Others may see the fat build up around their liver, and some may even see both.

To learn more about the effects of extra energy in your bloodstream, see

Does the Liver Metabolize Macronutrients?

So, at this point, you might be wondering, ‘well, it’s just a liver.  It can’t be that important!’

Unfortunately, you’d be wrong.

Our liver is a remarkable organ with many critical roles.  It’s perhaps most well-known for its ability to filter the blood and metabolise various wastes in the body so they can be safely excreted in your stool. 

The substances your liver filters include alcohol, drugs, toxins your body produces from metabolism, and environmental chemicals you come into contact with daily.  Thus, you would die without your liver!

Once your liver metabolises these wastes, it has to do something with them.  So, liver cells take toxins and package them into a substance known as bile, which is released during digestion.  Bile is not only a transport vessel to get wastes out of your system via your poop, but it also helps you emulsify dietary fat.

Speaking of nutrient metabolism, the liver is one of the main drivers of the metabolisation of carbs, fats, and proteins.  Additionally, it helps regulate blood glucose levels, as it is the main site of glycogen storage (the storage form of glucose).  The liver stores glucose (as glycogen) for later.  In contrast, it releases glycogen if blood glucose is low and you’re not eating.

The fat-soluble vitamins A, D, E, and K are stored in the stellate cells of the liver.  It also is a reserve for many other nutrients, like B12, iron, and copper.  Because it is the primary site of vitamin K storage, the liver is critical for blood clotting.

Your liver is also the leading site for converting the thyroid hormone T4 into its more active version, T3.  Lastly, the liver is critical for regulating blood levels of amino acids like albumin, a transport protein necessary for moving a lot of essential substances throughout the body.

So, to reiterate: the liver is important!  Hence, when NAFLD persists, liver function takes a hit and can eventually become so damaged that it ceases to function. 

Does Sugar Cause Non-Alcoholic Fatty Liver Disease?

No.  Sugar doesn’t cause NAFLD itself; it’s the overconsumption of energy that does. 

However, certain sugars—like sucrose, the formal name for table sugar—have been linked to NAFLD because of how it’s metabolised.

Chemically speaking, regular sugar is known as sucrose.  It is made up of two monosaccharides: glucose and fructose.  

Fructose can increase de novo lipogenesis, or fatty acid synthesis in the liver, especially if consumed excessively.  If someone is consistently overconsuming calories, this can increase this effect. 

Does Fructose Cause Liver Dysfunction?

Simply eating one piece of fruit won’t damage your liver.

However, consuming large amounts of fructose from juice, soda, and fruit can increase blood sugar and insulin, creating an inflammatory environment and putting pressure on the liver to handle all that excess energy. 

Interestingly, when your blood glucose is high, your body can convert glucose to fructose via the polyol pathway.  Dr Richard Johnson has recently been drawing attention to the role of fructose in downregulating our metabolism and increasing hunger which can further lead to eating and storing more than we need to. 

Additionally, studies have shown that too much fructose—especially from high-fructose corn syrup—can change the composition of your gut bacteria (i.e., your microbiome), which can cause inflammatory changes.

Thus, the overconsumption of fructose and sugar can cause liver inflammation. 

Does High-Fructose Corn Syrup Cause Non-Alcoholic Fatty Liver Disease?

High-fructose corn syrup (HFCS) does not directly cause NAFLD, and you will not end up with the condition if you drink one soda pop containing it.  Instead, it’s the consistent, longer-term consumption of lots of HFCS-containing products alongside a processed, high-calorie diet.

Most of the studies looking at NAFLD and HFCS have been epidemiological or based on association.  In other words, they are looking at whether or not populations with NAFLD consume a lot of high-fructose corn syrup.  So, while these populations consume a lot of HFCS, the question becomes whether or not the cause is HFCS itself or the overconsumption of a lot of processed foods that contain it.

Nonetheless, we know that HFCS is chemically similar to sucrose (i.e., table sugar), a molecule of fructose and glucose joined together.  However, in HFCS, fructose and glucose are unbound (free), unlike in table sugar, where they’re bound. 

HFCS is around 42 or 55% fructose (average 48.5%, sucrose is 50% fructose), with the rest being glucose.  Because we know that fructose is more likely to result in fatty acid synthesis in the liver, we might infer that overconsuming HFCS can contribute to a greater likelihood of someone developing NAFLD, especially with consistent, long-term use.

Does Eating Fruit Cause Fatty Liver

Nothing good comes from extremes, whether it be from fat, carb, protein, fibre, salt, cholesterol, saturated fat, or *insert any nutrient here*.  Fructose and sugar are no different!

When it comes to sugar and fructose, it is not the consumption of either that is to blame for NAFLD; instead, the excessive intake of these food components can land you in trouble.   As with anything, moderate your intake! 

If you’re already carrying a lot of excess body fat and have elevated blood glucose, it might be wise to prioritise more nutrient-dense foods that will provide greater satiety rather than going all out on fruit.

Why Do Diabetics Develop Fatty Liver?

If you can remember above, where we mentioned that the root cause of metabolic syndrome is energy toxicity and not insulin toxicity, this is critical for understanding why and how someone with Type-2 Diabetes develops fatty liver.

When the body has too much energy that it doesn’t know what to do with, it has to store it somewhere.  Thus, it backs up in the liver.

Can You Repair a Non-Alcoholic Fatty Liver?

If you Google whether or not you can reverse NAFLD, you’ll end up with a bunch of results telling you that there is no drug that’s currently FDA-approved that can remove the fat around your liver.

But because NAFLD often results from people exceeding their Personal Fat Threshold, we know that exercise, not overconsuming calories, eating a healthy diet, and not smoking or drinking can help someone reverse the condition.  A considerable amount of research has shown that anything that leads to weight loss will reverse fatty liver.

Ultimately, once you begin to use up the excess energy your body has stored within your body—including your liver—the condition should resolve over time.

What Foods Should I Avoid with Non-Alcoholic Fatty Liver Disease?

If you have NAFLD—or don’t, and want to prevent yourself from ever having to worry about it—there are a few foods you might consider avoiding, like:

  • Processed foods (i.e., ‘junk’ foods);
  • High-calorie, energy-dense foods;
  • Foods that are poorly satiating and prompt you to overeat;
  • Too many calories overall;
  • Too much sugar;
  • Too much fructose (i.e., juice, honey, candy, soda pop, fruit);
  • Alcohol; and
  • Tobacco.

For more info on some of these foods, visit Ultra-Processed Foods: What’s the Problem and How to Avoid Them.

How Do Get Rid of a Non-Alcoholic Fatty Liver?

Instead of focusing on the things you should avoid, let’s include some of the best things you can focus on to reverse or prevent the onset of NAFLD.  We’ve all got to eat something!

To counter or prevent non-alcoholic fatty liver disease, you should:

  • Make nutrient-dense foods and meals the majority of your diet;
  • Avoid processed, low-protein, fat-and-carb combo foods;
  • Avoid eating more calories than you’re burning so you can unload extra energy and get below your Personal Fat Threshold;
  • foods and meals that contain protein and fibre;
  • Moderate and minimise sugar and fructose, especially from added sugar sources (i.e., high-fructose corn syrup);
  • Exercise; and
  • Avoid alcohol and tobacco.

Once you get things to a better state, don’t discontinue the behaviour.  Your NAFLD can come back if you slip back into your old bad habits!

To learn more about nutrient-dense foods and meals, check out

What Should I Eat to Fix My Fatty Liver?

Nutrient-dense whole foods allow you to stay satiated so you can eat fewer calories, feel satiated doing so, maintain an energy deficit, and eventually lose weight, which leads to decreasing energy toxicity and reversing fatty liver.

Over the last few years, we’ve spent a lot of time taking what we learned about satiety and nutrient density to create over 600 NutriBooster recipes and 29 different recipe books tailored towards various goals and preferences.  Because we experience satiety if and only if we get adequate nutrients, each food or meal was designed to optimise the number of nutrients per calorie so you can feel fuller while eating less.

Additionally, you can also check out our Macros Masterclass.  In four weeks, we walk our Optimisers through dialling up their protein and fibre while dialling back their carbs and fat so they can increase their nutrient intake and feel fuller for fewer calories.

Will Fasting Fix Fatty Liver?

Fasting, or abstaining from food for a given period, is a great way to give your body a rest.  It’s also a good way for your body to use up the extra energy you’ve stored on board.

Recent studies have supported this and shown positive links between intermittent fasting, alternate-day fasting, and NAFLD.  In addition, several studies revealed that all sorts of fasting had the same results: weight reduction, decreased hepatic (liver) inflammation, and less fat accumulated in the liver.

However, extended fasting can come with detriments, too.  At first, fasting might be easy if you have a lot of extra energy stored.  However, as you continue to push through your hunger cues day in and day out for extended periods, you’re more likely to burn through your metabolically active lean muscle mass, which drives your metabolism.  As a result, you might be more prone to weight gain.

How equipped you are to fast depends on how you were eating in the meals and days before your next meal.  In other words, you might not have enough energy stored to make it 24, 20, 18, 16, or even 14 hours.  Your body is constantly changing!

Hence, too much fasting with a static window (i.e., a fixed fasting widow) can affect blood sugar and prompt binge eating when someone goes to refeed.  This might cause you to consume more calories than if you had just eaten regularly!  Being that hungry also tends to lower your inhibitions regarding the food you choose.

If you like the sound of fasting but you’d like to find a fasting regimen that’s a bit more adaptable to your dynamic, ever-changing body, you might check out our Data-Driven Fasting Challenges

In four weeks, we walk our Optimisers through using their blood sugar as a fuel gauge to give them insight on what they should eat and when they should eat again.  Over time, this will slowly allow someone’s body to use up the extra fuel they’ve stored on board, lowering body weight, insulin, blood sugar, triglycerides, and the amount of fat around your liver (if done correctly!).

Data-Driven Fasting uses your blood glucose to guide when and what you eat to ensure you progressively deplete the glucose in your bloodstream and liver without the rebound binging that often comes from more extended forms of fasting.  As you drain the excess glucose in your system, your body turns to the stored fat on your body, including the fat in your liver.   

If you already have a blood glucose meter, you can click here to get started with our Data Driven Fasting app for free today

Summary

  • Non-alcoholic fatty liver is part of the constellation of issues that relate to obesity and metabolic syndrome. 
  • As we continue to consume low-satiety, nutrient-poor foods, we continue to store fat in our bodies.  When our adipose tissue becomes full, the excess energy is stored in our vital organs, including our liver. 
  • Reversing fatty liver requires us to change when and what we eat to achieve long-term fat loss. 

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