WHY YOU SHOULD READ THIS NOW
→ I recently diagnosed a 19 year-old with fatty liver disease. This is not a disease of the old anymore.
→ Nearly 1 in 3 U.S. adults have fatty liver, and 80% of them don’t drink heavily.
→ Fatty liver disease can quietly progress to cirrhosis, liver failure, and even liver cancer.
→ It’s one of the most reversible chronic diseases.. if you catch it early.
Dr. Tabibian and Dr. Storage here. Here’s something we’re glad is trending right now: more talk about fatty liver disease.
Fatty liver disease happens when excess fat builds up inside your liver. This eventually triggers inflammation, scarring, and potentially liver failure, among other sequelae.
Now you might be saying to yourself, “I’m not a heavy drinker, so I'm good.”
Not so fast. Most people with fatty liver don’t drink much, or at all.
Read on for common symptoms, and our take on what you can do to prevent this very preventable disease.
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?”
TikTok Trend We’d (Not Quite) Ban
#Fibermaxxing
Fiber is having a moment on TikTok, and honestly, we're not mad about it.
Especially because higher fiber intake is associated with lower risk of fatty liver disease.
#FiberMaxxing involves dramatically increasing your fiber intake using powders like psyllium husk, acacia fiber, or inulin, often blending them into dense sludge drinks with the goal of “clearing out” your digestive system or achieving overnight weight loss.
TikTok’s right. Eat more fiber folks!
Most Americans don’t get nearly enough fiber. The USDA recommends 25–38 grams per day, but over 90% of U.S. adults don’t get enough. Yes, we’re talking to you.
Fiber is vital for digestive health, blood sugar control, and even lowering cholesterol.
Here’s the (slight) potential problem:
Going from 10g to 40g overnight can backfire. People doing #fibermaxxing without ramping up slowly, or without drinking enough water, are reporting bloating, cramps, gas, and even constipation. We've seen some folks end up in clinic thinking something was seriously wrong.
What to do instead:
→ Increase fiber gradually: 5g per week is a safe ramp-up
→ Prioritize whole foods first: fruits, vegetables, oats, beans, chia seeds
→ Use fiber powders as a supplement, not a replacement
→ Always pair added fiber with more fluids
Verdict: NOT BANNED.
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As gastroenterologists, we definitely have a lot to talk about when it comes to your gut health and well-being. But we can’t always get to everything (you know… like coffee enemas)! So reply directly to this email or DM us on TikTok below and maybe YOUR topic will be featured soon!
