Hi Friends,
Dr. Tabibian here.
A few months back, I wrote about recently diagnosing a 19-year-old with fatty liver disease.
It was a sobering moment, but one that is becoming far too common in my clinic.
This is no longer a "disease of the old," and it’s certainly not just a consequence of heavy drinking.
In fact, nearly 1 in 3 U.S. adults now have fatty liver, and 80% of them don't drink heavily.
Dr. Storage and I are seeing this quiet epidemic escalate. Fatty liver happens when excess fat builds up inside the organ…
Triggering a cascade of inflammation and scarring that can progress to cirrhosis, liver failure, or even cancer.
The most alarming part? It usually happens in total silence.
But here’s the good news:
Fatty liver is one of the most reversible chronic diseases, if you catch it early.
Whether it's driven by metabolic shifts or emerging environmental factors like the microplastics we’re now finding in our digestive tracts, the time to act is before the damage becomes permanent.
Read on for the symptoms you need to watch for and our clinical take on how to prevent this disease before it starts.
Today’s Opponent:
Fatty Liver Disease
Specifically, Metabolic Dysfunction-Associated Steatotic Liver Disease, or MASLD. This form of liver disease is now the most common liver disease in the world. It has nothing to do with alcohol and everything to do with diet, insulin resistance, and metabolic health. Some researchers even call it the “liver manifestation of metabolic syndrome.”
The scary part is you can feel perfectly fine... and still be on the road to irreversible liver damage.
Noteworthy Causes of MASLD
1. Poor metabolic health
The #1 cause of fatty liver isn’t alcohol. It’s insulin resistance. When your body can’t use insulin properly, it stores more fat in the liver. This is common in people with pre-diabetes, type 2 diabetes, and obesity.
2. Too much sugar and processed carbs
Fructose (i.e. from processed drinks like sodas and some fruit juices sodas) is a direct contributor to liver fat. Refined carbs as found in white bread, crackers, and pastries are also contributors.
3. Sleep disorders
Conditions like sleep apnea and poor sleep quality are linked to MASLD and liver inflammation, partly due to increased oxidative stress and metabolic dysregulation.
4. Certain medications and toxins
Drugs like steroids, amiodarone, tamoxifen, and some antivirals can contribute to liver fat buildup in rare cases.
3 Symptoms of Fatty Liver Disease
Fatigue: The most common complaint in people with fatty liver, possibly from low-grade inflammation and disrupted sleep.
Upper right belly pressure: The liver has no pain receptors, but it does have stretch receptors, so if your liver is enlarged from fat, you can feel a dull pressure.
Nothing at all: The most dangerous symptom is no symptom. Half of all people with fatty liver have normal liver enzymes.
"Fatty liver disease rates are projected to continue rising around the world. This will lead to further increases in liver-related complications, such as cirrhosis, esophageal varices, hepatocellular carcinoma, and more.”
I don’t want you to be part of this statistic. Some things you can do right now to help prevent or reverse MASLD:
Cut sugary drinks. Fructose is a major liver stressor. Swap soda for water or unsweetened herbal teas, or other low-sugar alternatives.
Check your waistline. Visceral fat (fat around in the abdomen) is a red flag and a driver of metabolic disease. Even people with thin arms and legs can have excess visceral fat and thus fatty liver and impaired metabolic health.
Eat a Mediterranean-style diet. Rich in plants, lean protein, healthy fats (e.g. from olive oil), and low in refined sugar, it’s one of the best-proven diets for reversing MASLD as well as other diseases.
Move every day. Even just a 5-minute walk after meals can reduce insulin resistance, visceral fat, and fatty liver.
Lose 7-10% of your body weight. It doesn’t take massive weight loss to help reverse MASLD.
“Fatty liver disease used to be something we primarily saw in middle-aged adults with alcohol issues. Not anymore. I just diagnosed a 19-year-old. This isn’t a rare occurrence anymore.”
Many people hear “fatty liver” and think it's no big deal. Or assume it's only from alcohol. But MASLD is very real, very common, and highly under-diagnosed.
If your doctor says “your liver labs are a little elevated,” don’t let that slide. Ask more questions, and bring up MASLD. Because this is a disease you can reverse if you take action early.
What To Tell Your Doctor
"My labs showed elevated liver enzymes. I’m not a heavy drinker. Could this be MASLD? Should we do a FibroScan or some other imaging test to see if this could be fatty liver disease?”
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