The origins of fatty liver are diverse: some are directly related to genetics (e.g., cystic fibrosis, Wilson's disease), while others are a result of medications or toxins (e.g., alcohol, contraceptives). Add an unhealthy lifestyle (excessive high-calorie foods, obesity, diabetes, along with pancreas and intestinal issues) and we have a recipe for these problems.

Who is most at risk?

The main culprits are obesity, alcoholism, and type 2 diabetes. Not long ago, fatty liver was considered a harmless change, but today we know it can even lead to cirrhosis – a serious, far from benign condition. The numbers speak volumes:

• In Europe, approximately 27% of adults have NAFLD (non-alcoholic fatty liver disease) (32.8% of men and 19.6% of women). Among children and adolescents with excess weight, it is as high as 31.6%.
  
  
• Globally, it affects about 30% of the population.
  
  
• In developed countries, this figure reaches up to 35%, with 3 to 12% of adults already having a more severe form known as NASH.
  
  
• One of the reasons NAFLD is such a significant health problem is its strong link to metabolic syndrome – a combination of high cholesterol, sugar, blood pressure, and excess body weight. These factors only exacerbate the issue.

Diet as a Treatment Tool

In contrast to many diseases where doctors resort to pharmaceuticals, vibrant foods and a balanced lifestyle can be of great help here. And why is that?

• They often replace energy-dense foods, juice boxes, and saturated fats with fruits, vegetables, fiber, and good fats like omega-3. Research shows that patients with steatosis consume these empty calories more frequently than healthy individuals.
  
  
• The Mediterranean diet – a combination of olive oil, nuts, fish, fruits, and vegetables – significantly reduces liver fat. One of the most well-known studies, PREDIMED, involving over 7,400 individuals, showed a 30% reduction in cardiovascular events with these diets, and visible health effects within just 5 years. Although PREDIMED is not specifically about fatty liver, the logic is clear: the same guideline is excellent for the liver.
  
  
• Fructose (fruit sugar) and other simple carbohydrates should make up a maximum of 10% of total calories – a proven recommendation.

How much do these steps actually help?

If you lose around 7% of your body weight through careful eating and exercise, after a year, the liver histology of people with NASH also improves – meaning a reduction in inflammation and fat inside the liver cells (parenchyma). This is not just theory – it has been proven.

What about dietary supplements?

Rumors suggest that vitamins will save your liver. But the facts are as follows:

• Vitamin E is a potent antioxidant – and antioxidants act as a firefighting unit for the inflammations that cause insulin resistance. This means they reduce oxidative stress in the liver… yet further research on safety and dosages is needed.
  
  
• Vitamin D plays a role in regulating inflammation and fibrosis – studies indicate a beneficial effect on insulin sensitivity, but we are still awaiting strong randomized trials.
  
  
• Probiotics – the good bacteria that help regulate the gut, indirectly reducing the inflammations triggered in the intestines (a crucial element of the leaky gut theory).
  
  
• Omega-3 fatty acids – such as EPA and DHA, have consistently been shown to lower liver enzymes (ALT by 2–8 IU/L, AST by 1–2 IU/L), triglycerides by about 45 mg/dL, and improve cholesterol. A famous meta-analysis from August 2024, covering studies up to June 2023, revealed a statistically significant reduction in ALT and triglycerides. Additionally, the plant-based form of omega-3 (e.g., from flaxseeds) also improves the body mass index (BMI), waist circumference, and significantly decreases ALT levels.

Why are liver enzymes (ALT, AST) so important? These are indicators – in liver damage, their levels increase. If they decrease, it indicates liver recovery – the mistake is being corrected.

What does the big picture of epidemiology say?

• In Europe, NAFLD is present in nearly 27% of adults; more in men, and as high as 75% in people with metabolic syndrome.
  
  
• A cross-European study showed: NAFLD affects around 42% of individuals with HIV (of which 35% have NASH, 13% fibrosis) – emphasizing how widespread this disease is in various populations.
  
  
• The prevalence of NAFLD in Europe and the USA is expected to rise to 33.5% by 2030 – affecting over a billion people worldwide.

What can you do?

Reversing fatty liver back to a healthy state is largely in your hands. How? Moderate weight loss (7-10%), a Mediterranean diet, reducing sugars, adding omega-3s and vitamins – this combination shows real changes in the liver, reflected in biopsies. And what's even better: the effects aren't just on the liver but also on the heart, blood sugar, and overall well-being.

The People's Perspective

Many cultures around the world rely on nature (olive oil, nuts, herbs, and fish...) and modern medicine actually upholds this principle in practice. I always emphasize that we are more than just components in a laboratory, so a holistic approach involving traditional wisdom and modern evidence is the best.

We suggest the following step: everyone should make a liver-friendly plan and incorporate two Mediterranean meals a day, swap fats (e.g., butter) for good oils, add omega-3 (e.g., 2-4g per day), and monitor progress through blood tests (ALT/AST, ultrasound). In just a few months, you'll see a difference.

In conclusion...

• NAFLD affects around 30% of the global population, up to 40% in developed countries, more in men than women, and up to 75% in metabolic syndrome.
  
  
• Fatty liver is not a benign problem but rather a gateway to more serious diseases – cirrhosis, fibrosis, cancer.
  
  
• The solution lies in simple diet, weight loss, and supplements: Mediterranean diet, sugar restriction, losing at least 7% of body weight, omega-3, vitamins E and D, probiotics.
  
  
• Clinical data shows a decrease in liver enzymes, improvement in lipids, and reduction in inflammations.