Non-alcoholic fatty liver disease (NAFLD) - causes and natural counter-strategies

Non-alcoholic fatty liver disease(NAFLD) is the most common liver disease in Western countries today. It is estimated that around one in four adults suffers from fatty liver disease - often without realizing it【2】. Unlike alcoholic fatty liver disease, this is not caused by excessive alcohol consumption. Instead, the causes are closely linked to our modern lifestyle: Overeating, a sedentary routine and a high-sugar diet are major contributors to fat deposition in the liver【2】. In this article, you will find out how NAFLD develops, what risks it entails and - most importantly - what natural measures you can take to help your liver. From the right diet and proven medicinal herbs to tips suitable for everyday use - we show you well-founded counter-strategies to treat fatty liver naturally.

Important note: A fatty liver develops gradually and often goes unnoticed for a long time. Nevertheless, it is not harmless. If left untreated, NAFLD can develop into an inflammatory form (NASH) and, in the worst case, lead to liver cirrhosis or liver cancer【2】. The good news: with targeted lifestyle changes and natural support measures, a fatty liver can usually be effectively reduced or at least stopped. We show you how - scientifically proven and practical.

Causes and risk factors of non-alcoholic fatty liver disease

In NAFLD, excess fat is stored in the liver cells. But how does this happen in the first place? The main risk factor is overeating in combination with a lack of exercise. If we eat more calories than we consume, the body converts the excess into fat and stores it - including in the liver. A diet high in carbohydrates and sugar in particular promotes fatty liver. Studies show that a high consumption of fructose (e.g. in soft drinks) promotes the development of a fatty liver, as fructose is very easily converted into fat in the liver. At the same time, too much sugar and refined carbohydrates lead to insulin resistance - a core cause of metabolic syndrome, which is often associated with NAFLD【11】.

Overweight and abdominal obesity are also directly linked to NAFLD. In global analyses, over 50% of NAFLD patients were obese and around 70% had elevated blood lipid levels【2】. Excess visceral fat on the abdomen releases pro-inflammatory messenger substances that put a strain on the liver. In addition, a fatty liver often goes hand in hand with type 2 diabetes, high blood pressure and lipometabolic disorders - this is known as metabolic syndrome【2】. Genetic factors also play a role: certain gene variants (such as PNPLA3) increase susceptibility to NAFLD. Overall, fatty liver is therefore usually a sign that metabolism and lifestyle are out of balance.

There is also evidence that certain medications, environmental toxins and a disturbed intestinal flora can contribute to fatty liver. Some common medications (e.g. cortisone or methotrexate) can promote fatty deposits in the liver as a side effect. Environmental toxins such as certain pesticides are also suspected of affecting liver health. In recent years, the gut-liver connection has also come into focus: an imbalance of gut bacteria (e.g. due to antibiotics or an unfavorable diet) can promote inflammation and thus put a strain on the liver. Probiotics are therefore being discussed as a supportive therapy - more on this later.

Symptoms and consequences: How can you recognize a fatty liver?

NAFLD often remains asymptomatic for a long time. At most, many sufferers feel a little more tired than usual or notice a slight feeling of pressure in the right upper abdomen. Only at an advanced stage - when inflammation (NASH) or fibrosis has already developed - do more obvious symptoms appear. These can include tiredness, concentration problems, a feeling of fullness, loss of appetite and, in severe cases, yellowing of the skin and eyes (jaundice). As the liver itself has no pain receptors, it only causes pain when it is greatly enlarged or the capsule around the liver is stretched.

The greatest danger of fatty liver is its possible consequences. In an estimated 20 % of those affected, simple fatty liver develops into non-alcoholic steatohepatitis (NASH), i.e. inflammation of the fatty liver. This in turn can leave behind scar tissue - this is known as fibrosis, which can lead to liver cirrhosis【2】. NAFLD is now one of the most common causes of liver cirrhosis and liver transplants. A fatty liver also increases the risk of liver cancer (hepatocellular carcinoma) and is associated with a higher overall mortality rate【2】. NAFLD also has negative effects beyond the liver: It is closely linked to cardiovascular disease - heart attacks and strokes are the most common cause of death in fatty liver patients. In addition, the risk of developing type 2 diabetes increases.

Conclusion: Fatty liver should be taken seriously, even if it does not initially cause severe symptoms. However, the good news is that you can do a lot yourself to prevent or treat an existing fatty liver. In the next section, you will find out which natural countermeasures really help.

Diet and lifestyle - the cornerstones of fatty liver therapy

As the causes of NAFLD are primarily to be found in diet and lifestyle, these are the most effective levers for treatment. In fact, there is currently no approved medication specifically for NAFLD - the first therapy recommendation worldwide is weight reduction, a healthy diet and exercise. Studies show that even moderate weight loss can have an enormous impact on liver health【1】. Let's look at the most important steps in detail:

Weight loss: reduce liver fat by losing weight

Losing weight is considered the most effective way to combat fatty liver. Excess weight - especially belly fat - promotes fat storage in the liver. Conversely, a calorie deficit causes the body to mobilize and break down stored fat reserves - including in the liver tissue. A highly regarded clinical study with NAFLD patients showed that a weight loss of just 5% significantly improved the fatty liver in over half of the test subjects; with a weight loss of ≥10%, the inflammatory NASH【1】 even regressed in 90% of cases. It was also shown that a loss of ≥7-10% of body weight often led to a reduction in existing liver fibrosis (scarring)【1】. This data makes it clear: Every kilogram lost relieves the liver measurably.

Sustainable weight loss success is important. Crash diets are neither necessary nor advisable - they often lead to the yo-yo effect and stress the body. A permanent change to a slight reduction in calories (e.g. 500 kcal per day less than required), combined with a healthy diet and exercise, is better. This typically results in a loss of 0.5-1 kg per week, which is considered a healthy pace. Noticeable improvements in liver values can be seen after just a few months.

A special concept for rapid degreasing of the liver is liver fasting according to Dr. Worm®. This 14-day program is based on a highly calorie-reduced diet using special protein shakes and vegetables, supplemented with vital substances. Studies by the developers claim that liver fat can be drastically reduced in two weeks. In fact, participants often show impressive results with liver fasting - mainly due to the significant calorie deficit and the avoidance of sugar and white flour. It should be noted that such cure programs can only be the first step. It is crucial to switch to a healthier lifestyle afterwards in order to maintain success. In any case, extreme fasting cures should be clarified by a doctor, especially in the case of previous illnesses.

The right diet for fatty liver

A healthy liver diet aims to keep blood sugar levels stable, avoid excess calories and provide the liver with protective nutrients. Specific recommendations are

• Drastically reduce sugar: Fruit sugar (fructose) and table sugar in particular promote fatty degeneration of the liver. Avoid sweet drinks, sweets and ready-made products with high added sugar. Fruit juices should also only be drunk in moderation, as they contain a lot of fructose.
• Complex carbohydrates instead of white flour: opt for wholegrain products, oatmeal, quinoa and the like instead of white bread, pasta made from flour or light-colored baked goods. Whole grains are more filling, avoid insulin spikes and contain more fiber - which also supports the intestines.
• High-quality protein and healthy fats: Incorporate lean protein (e.g. fish, poultry, pulses) into your diet. Protein helps you lose weight as it is filling and prevents muscle loss. When it comes to fats, unsaturated fatty acids (e.g. from avocado, nuts, olive oil) are particularly recommended. Avoid trans fats and reduce saturated fats (fatty meat, butter), as high levels of these are associated with NAFLD.
• Vegetables and bitters: Eat plenty of vegetables, especially green and bitter vegetables (artichokes, arugula, chicory, dandelion). These provide few calories, many micronutrients and bitter substances that promote digestion and bile flow. Bitter substances are traditionally regarded as a liver tonic (the links between bitter substances and liver health have not yet been confirmed by the EFSA; further studies are required).
• Moderate coffee consumption: Coffee contains antioxidant polyphenols that appear to benefit the liver. Observational studies show that regular coffee drinkers have a lower risk of liver fibrosis and liver cancer【8】. 3-4 cups a day were associated with ~35% less advanced fibrosis (the links between coffee consumption and liver health have not yet been confirmed by EFSA; further studies required). Important: Drink black or with a little milk, without sugar!
• Strictly avoid alcohol: Although NAFLD is by definition not caused by alcohol, alcohol will damage any liver. If you have a fatty liver, you should abstain as much as possible, as even small amounts can increase the liver's susceptibility to inflammation.

Nutritionists often recommend the Mediterranean diet as ideal for fatty liver. This is characterized by lots of vegetables, fruit, fish, olive oil, nuts and whole grains - red meat and sugar are hardly ever included. In fact, a study showed that a green Mediterranean diet (rich in plant polyphenols from green tea and a special vegetable) reduced fatty liver on average by 39% within 18 months, significantly more than a standard diet【4】. More important than the diet label, however, is that you find a balanced, natural eating style that tastes good and fills you up. This will help you avoid cravings and stick to it in the long term.

Regular exercise - a booster for your metabolism

Alongside diet, physical activity is the second mainstay of treating a fatty liver. Exercise helps in many ways: It supports weight loss, improves insulin action, stimulates blood flow to the liver and can already increase fat burning in the liver independently of weight loss. Exercise acts like a metabolic turbo - and this directly benefits the liver.

We recommend at least 150 minutes of moderate exercise per week (e.g. brisk walking, cycling) or 75 minutes of intensive exercise (jogging, swimming, etc.). A mixture of endurance training and strength training is ideal. Endurance training burns calories and directly reduces liver fat. Strength training builds muscle mass, which increases the basal metabolic rate and removes excess glucose from the blood. Just 2-3 training sessions per week can make a difference. In studies, regular exercise (without dieting) led to a reduction in the relative liver fat content by ~30-40 %【12】 within 3-6 months - in some cases even without major weight loss. In combination with a diet, the effects are even stronger.

The important thing is to find something you enjoy: be it cycling, dancing, walking, swimming or working out in the gym. Everyday exercise also counts: Climbing stairs, going for a walk during your lunch break, taking the dog for a walk in the evening. Try to break up long periods of sitting in the office with exercise breaks every 30-60 minutes - this will also improve your blood sugar levels. If you have been very inactive so far, slowly increase your workload. Every little bit of exercise helps. Remember: your liver "likes" it when you work up a sweat, because then your metabolism works at full speed and breaks down fat.

Intermittent fasting combined with exercise is an interesting option. Initial studies suggest that intermittent fasting (e.g. 16:8 method - 16 hours of fasting, 8 hours of eating) in combination with regular exercise is particularly effective at removing fat from the liver【13】. In an experiment, the liver fat content in overweight NAFLD patients who alternated between fasting for one day and eating normally on the following day, plus doing endurance training three times a week, fell significantly more than in a control group. However, the advantage over fasting or exercise alone was not very great - in other words: both help, the combination possibly a little more. Intermittent fasting is not suitable for everyone, but many find it easier than traditional diets. It is important that the food in the eating window remains balanced and moderate. If you are interested, talk to your doctor beforehand, especially if you have diabetes.

Detox cures and detox - what do you think?

There are countless "liver detox cures" circulating on the internet that promise quick miracles - from juice fasts lasting several days to Epsom salt drinks and questionable liver cleansing protocols. The fact is: a fatty liver cannot be magically removed with a short cure. The best way for the body to detoxify the liver is to support it in the long term. Radical detox cures, on the other hand, can in the worst case do more harm than good - for example through a lack of nutrients during juice fasting or dangerous fluctuations in the fluid and electrolyte balance. A healthy diet and moderate exercise may have a less spectacular effect, but they are sustainable and safe.

Nevertheless, short periods of detoxification can be useful: for example, giving up alcohol, sugar and convenience foods for a week and instead consuming lots of bitter substances, vegetables, herbal tea and water. A gentle detox week like this can be a good starting point for making the transition to a better lifestyle. However, the EFSA (European Food Safety Authority) has not yet recognized any "detox drink" or similar as a cure for the liver. There are no miracle cures that can repair a diseased liver in just a few days (and they should not be advertised with such health claims). Our recommendation: concentrate instead on the scientifically supported measures - weight management, diet, exercise - and use certain medicinal herbs as a supplement. You can now find out what these are and what the research says about them.

Natural food supplements and medicinal herbs for the liver

In addition to basic lifestyle measures, certain vital substances and medicinal plants can help to support liver function. Many of these originate from traditional herbal medicine and are gaining renewed interest thanks to recent studies. Important: No dietary supplement is a miracle cure - they serve as a supplement, not a substitute for a healthy lifestyle. In addition, in the EU we are only allowed to make verified health claims. Where official health claims are missing, we provide a corresponding reference. Let's take a look at the best-known natural remedies for fatty liver and what science has to say about them.

Milk thistle (Silybum marianum)

Milk thistle is probably the best-known liver herb. Its seeds contain the active ingredient silymarin, a complex of antioxidant flavonolignans. Milk thistle extract has been used for centuries to support the treatment of liver disorders. Modern studies are primarily investigating whether silymarin can reduce elevated liver values (ALT, AST) in fatty liver patients. A meta-analysis of 8 clinical studies with a total of 587 patients actually found that silymarin lowered liver enzymes significantly more than a placebo【6】. Specifically, milk thistle reduced ALT by about 9 U/L more and AST by ~6 U/L more than in the control group. The authors concluded that milk thistle may be a promising phytotherapy for NAFLD【6】 (The links between milk thistle extract and liver health have not yet been confirmed by EFSA; further studies are needed).

However, not all study results are consistent. A recent large RCT (randomized controlled trial) over 48 weeks found no significant improvement in liver histology with high-dose silymarin. The dose and duration may play a role - in the meta-analysis, the strongest effects occurred at moderate doses <420 mg/day, and especially in younger patients under 50 years of age. Milk thistle is considered to be well tolerated. Nevertheless, it should be noted that it can influence the effectiveness of some medications (by inhibiting liver enzymes). Anyone who regularly takes medication should therefore consult a doctor before taking milk thistle preparations.

In Germany, milk thistle is available as a herbal medicine (e.g. Legalon®) or as a dietary supplement. When buying, look for a standardized extract with a known silymarin content in order to achieve a reliable effect. The typical dosage is 140 mg silymarin three times a day (as a medicine) or as a supplement. Overall, milk thistle can be a useful support to normalize elevated liver values and protect the liver cells from oxidative stress. However, it is not a substitute for lifestyle changes, but works best as an adjunct.

Artichoke extract (Cynara scolymus)

The artichoke is not only a vegetable, but also an ancient medicinal plant. Its leaves contain bitter substances (such as cynarin) and antioxidant flavonoids, which are said to have liver-protective effects. In herbal medicine, artichoke leaf extract is mainly used for digestive complaints and to lower cholesterol - also relevant for NAFLD patients, who often suffer from dyslipidemia. A small placebo-controlled pilot study on 100 NAFLD patients showed that 600 mg of artichoke extract daily for 2 months improved some liver values and sonography findings【5】. Taking artichoke significantly reduced ALT and AST, liver size decreased and blood flow through the hepatic veins improved. Total cholesterol and LDL levels also decreased moderately. The authors concluded that artichoke extract could be a useful complementary therapy for fatty liver【5】 (The associations between artichoke extract and liver health have not yet been confirmed by EFSA; further studies required).

The data on artichoke is still limited, but promising. It is certain that artichoke extract promotes bile production and thus supports fat digestion - which can indirectly help the liver. In addition, studies in cell cultures and animal models show that artichoke has an anti-inflammatory effect and could stimulate the regeneration of liver cells. In practical terms, this means that artichoke extract (in capsule form, usually 300-600 mg) may be worth a try, especially if you also have high cholesterol levels. However, you should have realistic expectations - it is a supportive measure and not a substitute for weight control. People with gallstone disease need to be careful as the increased bile flow can cause cramps. Overall, however, artichokes are well tolerated and are also a tasty vegetable that can be included in the diet more often (e.g. steamed artichoke bottoms as a side dish).

Omega-3 fatty acids (fish oil)

Omega-3 fatty acids, especially the long-chain EPA and DHA from fish oil, have many health benefits. In NAFLD, omega-3s are known to lower elevated triglyceride levels and have anti-inflammatory effects. Since many fatty liver patients have elevated blood lipids, the use of fish oil capsules makes sense. A meta-analysis of 15 studies with NAFLD patients found that omega-3 supplements significantly lowered the liver enzymes ALT and AST【7】. Although the absolute changes were moderate (on average approx. 2-3 U/L difference to placebo), there was a clear trend towards improvement. In addition, the blood lipid values improved significantly: triglycerides, LDL cholesterol and total cholesterol fell when omega-3 was administered【7】. It remains unclear whether omega-3 directly reduces the extent of fatty degeneration in the liver - some studies suggest that it does, especially at higher doses of 3-4 grams per day (the links between omega-3 fatty acids and a reduction in fatty degeneration of the liver have not yet been confirmed by the EFSA; further studies are required).

The guidelines recommend that NAFLD patients with high triglycerides take omega-3 to improve the blood profile - this also indirectly benefits the liver. Typical dosages are 2 grams of EPA+DHA per day. Alternatively, you can eat 2-3 portions of oily sea fish per week (salmon, herring, mackerel), which has roughly the same effect. According to the EFSA, omega-3 fatty acids officially contribute to normal heart function (at 250 mg/day EPA+DHA) and help to maintain normal triglyceride levels (at 2 g/day). There is no approved health claim specifically for the liver, but the anti-inflammatory properties and improvement in fat levels make omega-3 a useful complementary therapy. Important: High doses (>3 g) only in consultation with a doctor, as they can affect blood clotting.

Vitamin E (alpha-tocopherol)

Vitamin E is a fat-soluble antioxidant that protects cell membranes from oxidative damage. Vitamin E has received much attention in NAFLD research because oxidative stress plays a key role in the development of NASH (inflamed fatty liver). A large placebo-controlled study (PIVENS trial) investigated vitamin E (800 I.U. daily) in NASH patients without diabetes over 96 weeks. The result: liver inflammation and fatty liver improved significantly in 43% of the vitamin E group, compared to only 19% with placebo; the histology of the liver (fatty degeneration, inflammatory activity, cell decay) showed significant improvements with vitamin E【3】. Based on these data, some professional societies recommend vitamin E as a treatment option for non-diabetic NASH patients.

Nevertheless, there are reservations: Vitamin E in high doses over a long period of time is suspected of minimally increasing the risk of mortality in some patients (this link is controversial). In the PIVENS trial, vitamin E was also not recommended for people with diabetes or advanced fibrosis. The European guidelines advise caution - vitamin E can be considered, but should be weighed up on an individual basis. EFSA status: Vitamin E contributes to the protection of cells from oxidative stress - a general claim that is also relevant for the liver. A healing effect on fatty liver has not been officially confirmed. The following therefore applies: Vitamin E should only be used in consultation with a doctor, especially in high doses (the correlation between vitamin E and an improvement in fatty liver has not yet been confirmed by the EFSA; further studies are required). If prescribed, then usually 800 I.U. (approx. 536 mg RRR-α-tocopherol) per day for at least 1-2 years. However, natural sources of vitamin E (nuts, seeds, vegetable oils) should be included in the diet in abundance - they also go very well with the Mediterranean diet.

Turmeric (curcumin)

Curcumin is the bright yellow active ingredient in turmeric root. As a powerful antioxidant and anti-inflammatory, curcumin is being tested in studies for a variety of health effects - including NAFLD. In a high-quality Iranian study, 50 fatty liver patients were given either 1500 mg curcumin or a placebo for eight weeks. The curcumin group showed a significantly greater decrease in liver fat values (measured by ultrasound), an improvement in ALT and AST and a reduction in BMI and waist circumference. Another RCT with 1000 mg curcumin daily also found positive effects on liver fat and enzymes【10】. Inflammation markers such as CRP also decreased with curcumin. However, these studies were relatively short (8-12 weeks). A meta-analysis from 2021 concludes that curcumin tends to improve liver values and blood lipids, but the overall effect on NAFLD parameters is still low (the links between curcumin and liver health have not yet been confirmed by the EFSA; further studies are required).

The challenge with curcumin is its low bioavailability - the body absorbs it poorly. Therefore, curcumin preparations with piperine (black pepper extract) or as a phytosome (special encapsulation) are often used to increase absorption. Doses of 500-1500 mg curcumin extract per day are typically tested for fatty liver. Using turmeric as a spice in cooking (e.g. in curry or as "golden milk") is certainly also beneficial, but does not replace concentrated extracts. Curcumin is considered safe, but can cause gastrointestinal complaints in high doses. Anyone with bile duct problems should be careful, as turmeric stimulates the flow of bile. Overall, curcumin is an interesting natural remedy with anti-inflammatory effects - possibly a good building block in the anti-fatty liver package.

Probiotics and gut health

The importance of the gut-liver axis for NAFLD has long been underestimated. It is now known that a disturbed gut flora can promote inflammatory processes and contribute to fatty liver. Probiotics - i.e. beneficial live bacteria, taken in capsule form or as yoghurt, for example - are said to have a positive influence on the gut microbiome. Several meta-analyses have investigated whether probiotics can improve liver values and metabolic parameters in NAFLD. A large review that summarized 10 meta-analyses with over 5000 patients found clear evidence that probiotic preparations could reduce elevated liver enzymes【9】. ALT and AST were reduced on average by ~10 U/L, and GGT also decreased slightly【9】. In addition, there was often an improvement in insulin resistance and inflammatory markers (such as TNF-α) in those treated (the links between probiotics and liver health have not yet been confirmed by the EFSA; further studies are required).

Which probiotics are useful? In the studies, mixed preparations with Bifidobacterium and Lactobacillus strains were frequently used. These also occur naturally in the gut. It seems to depend less on a single "miracle bacteria" than on the general diversity and balance in the microbiome. Probiotics can help to restore a balance that has been disturbed by an unhealthy diet. At the same time, intestinal bacteria produce short-chain fatty acids and other metabolites that have a positive effect on sugar and fat metabolism.

In practice, this means that a high-quality probiotic (with several billion bacteria of different strains) taken over several months may be worth a try - as a supplement to alleviate liver inflammation. Alternatively or additionally, it is worth eating prebiotic foods, i.e. fiber that promotes good intestinal bacteria. Whole grains, vegetables, pulses, sauerkraut, yogurt & kefir - all of these are good for the gut and indirectly also for the liver. Due to the close connection between intestinal flora and liver metabolism, a healthy intestine is actually an important piece of the puzzle in fatty liver treatment.

Finally, it should be mentioned that there are numerous other substances that are being investigated in relation to fatty liver - such as resveratrol (an antioxidant from grapes), N-acetylcysteine (NAC) as a glutathione booster, berberine from barberry or various Asian herbs such as schisandra and licorice. Most of these are still in the early stages of research or show mixed results. For example, resveratrol has been shown to reduce inflammation in some studies (the links between resveratrol and liver health are not yet confirmed by EFSA; further studies are needed), but a meta-analysis found no clear benefit for liver fat or enzymes. Berberine shows promise for blood sugar and body weight, but is not officially recognized as a NAFLD treatment. In general, it does no harm to get enough vitamins (especially vitamin D), minerals (e.g. zinc, selenium) and phytochemicals - preferably through a varied, wholesome diet. This gives the liver everything it needs for its complex metabolic job.

Conclusion: A holistic strategy against fatty liver

Non-alcoholic fatty liver disease may seem intimidating at first glance, but there are many things you can do to counteract it. The key lies in a holistic approach: the liver can recover surprisingly well through weight loss, a conscious diet and regular exercise. Scientific studies show that just 7-10% less body weight can drastically reduce fat deposits in the liver and reverse inflammatory changes【1】. Focus on a Mediterranean-inspired diet with little sugar and lots of unprocessed foods, combine it with an active lifestyle - your liver will thank you.

Natural herbs and vital substances can complement these efforts. Milk thistle and artichoke, for example, have improved liver values in studies, omega-3 fatty acids and vitamin E can alleviate fatty liver inflammation, and curcumin or probiotics also show benefits - always provided they are used in addition to lifestyle changes and not as a substitute. Please note the EFSA guidelines for all these products: Claims of cure are not allowed, so understand them to be what their name implies - dietary supplements. They provide an extra boost, but do not replace a healthy lifestyle. In addition, always rely on quality (standardized extracts, tested products) and seek medical advice if you are unsure, especially if you have pre-existing conditions or are taking medication.

Remain patient and consistent: a fatty liver develops over years - so give yourself and your liver a few months to regenerate. Success often comes gradually: First, laboratory values improve (ALT, AST go down), then the liver fat decreases (ultrasound findings) and finally any thickened connective tissue in the liver normalizes again. Many sufferers report that they feel much more energetic after just 3-4 weeks on the new diet and that digestive problems subside. Let such positive changes motivate you!

To summarize: You can treat your fatty liver - naturally and under your own steam. Tackle it by eating consciously, exercising more and using the treasures of naturopathy. Your liver has an enormous ability to regenerate if you just let it. By creating a healthy internal environment, you help the liver to detoxify and heal itself. And you are not only doing something good for your liver, but for your whole body. After all, a healthy liver is the basis for a vital metabolism, more energy and long-term health. Good luck on your journey - your liver will thank you!

[Sources]

1. Vilar-Gómez, E., Martinez-Perez, Y., Calzadilla-Bertot, L., et al. (2015). Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis. Gastroenterology, 149(2), 367-378. doi: 10.1053/j.gastro.2015.04.005.
2. Younossi, Z. M., Koenig, A. B., Abdelatif, D., et al. (2016). Global epidemiology of non-alcoholic fatty liver disease - Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology, 64(1), 73-84. doi: 10.1002/hep.28431.
3. Sanyal, A. J., Chalasani, N., Kowdley, K. V., et al. (2010). Pioglitazone, Vitamin E, or Placebo for Nonalcoholic Steatohepatitis. New England Journal of Medicine, 362(18), 1675-1685. doi: 10.1056/NEJMoa0907929.
4. Yaskolka-Meir, A., Rinott, E., Tsaban, G., et al. (2021). Effect of green-Mediterranean diet on intrahepatic fat: the DIRECT PLUS randomized controlled trial. Gut, 70(11), 2085-2095. doi: 10.1136/gutjnl-2020-323106.
5. Panahi, Y., Kianpour, P., Mohtashami, R., et al. (2018). Efficacy of artichoke leaf extract in non-alcoholic fatty liver disease: A pilot double-blind randomized controlled trial. Phytotherapy Research, 32(7), 1382-1387. doi: 10.1002/ptr.6073.
6. Zhong, S., Fan, Y., Yan, Q., et al. (2017). The therapeutic effect of silymarin in the treatment of nonalcoholic fatty liver disease: a meta-analysis of randomized controlled trials. Medicine (Baltimore), 96(49), e9061. doi: 10.1097/MD.0000000000009061.
7. Aziz, T., Niraj, M. K., Kumar, S., et al. (2024). Effectiveness of omega-3 polyunsaturated fatty acids in non-alcoholic fatty liver disease: a systematic review and meta-analysis. Cureus, 16(8), e68002. doi: 10.7759/cureus.68002.
8. Ip, S., Bhanji, R. A., Montano-Loza, A. J., et al. (2021). Effect of coffee consumption on non-alcoholic fatty liver disease incidence, prevalence and risk of significant liver fibrosis: a systematic review with meta-analysis. Nutrients, 13(9), 3042. doi: 10.3390/nu13093042.
9. Musazadeh, V., Roshanravan, N., Dehghan, P., et al. (2022). Effect of probiotics on liver enzymes in patients with non-alcoholic fatty liver disease: an umbrella of systematic review and meta-analysis. Frontiers in Nutrition, 9, 844242. doi: 10.3389/fnut.2022.844242.
10. Rahmani, S., Asgary, S., Askari, G., et al. (2016). Treatment of non-alcoholic fatty liver disease with curcumin: a randomized placebo-controlled trial. Phytotherapy Research, 30(9), 1540-1548. doi: 10.1002/ptr.5659.
11. Yu, S., Li, C., Ji, G., & Zhang, L. (2021). The Contribution of Dietary Fructose to Non-alcoholic Fatty Liver Disease. Frontiers in Pharmacology, 12, 783393. doi: 10.3389/fphar.2021.783393.
12. Golabi, P., Locklear, C. T., Austin, P., et al. (2016). Effectiveness of exercise in hepatic fat mobilization in non-alcoholic fatty liver disease: a systematic review. World Journal of Gastroenterology, 22(27), 6318-6327. doi: 10.3748/wjg.v22.i27.6318.
13. Ezpeleta, M., Gabel, K., Cienfuegos, S., et al. (2023). Effect of alternate day fasting combined with aerobic exercise on non-alcoholic fatty liver disease: a randomized controlled trial. Cell Metabolism, 35(1), 56-70.e3. doi: 10.1016/j.cmet.2022.12.001.