Liver Health: Understanding Fatty Liver Disease
When it comes to our health, so much of what is happening inside our bodies goes unnoticed - until it doesn't. Fatty liver disease is a perfect example of this, most patients have no idea they have it until a blood test or scan picks it up incidentally. The good news? It is also one of the most responsive conditions to the right diet and lifestyle changes.
In this article I will walk you through what fatty liver actually is, why it matters beyond just your liver health, how it is typically found and, most importantly, what the evidence tells us you can do about it.
What is Fatty Liver Disease?
Your liver is one of your body's most hardworking organs. It filters your blood, supports digestion, stores energy, and processes everything you eat and drink. When too much fat builds up within liver cells, it begins to struggle with these functions and this is what we call Non-Alcoholic Fatty Liver Disease, or NAFLD. Recently, NAFLD has be re-named in the science literature as MASLD (Metabolic dysfunction-Associated Steatotic Liver Disease), a name that better reflects what is actually driving this condition. The shift in terminology is significant as it places metabolic health front and centre, making clear that this is not simply a liver problem, but a whole-body metabolic issue rooted in how we eat, move, and live.
Despite the name, this condition has nothing to do with alcohol. It is driven by diet, excess weight, and how well your body manages blood sugar and fat metabolism. It is now the most common liver condition in Australia, affecting roughly 1 in 3 adults. Many whom have no symptoms at all.
There are two important stages:
Simple Fatty Liver, when fat accumulates in liver cells but there is little to no inflammation or damage. With the right changes, this stage is often fully reversible.
NASH (Non-Alcoholic Steatohepatitis), when the liver is not only fatty but inflamed, with active cell damage occurring. Left untreated, this can progress to scarring and cirrhosis. This is the stage we most want to prevent.
How is it diagnosed
In my experience, most people discover they have fatty liver by accident. It shows up on a routine blood test or an ultrasound ordered for something else entirely. Because fatty liver rarely causes symptoms in its early stages, it often goes undetected for years. Below describes the common tools and findings that reveal poor liver health;
Blood tests: Liver enzymes - particularly ALT and AST - are often mildly elevated when the liver is under stress. I also look closely at fasting blood sugar, HbA1c, triglycerides, HDL cholesterol and ferritin, as these give a broader picture of metabolic health and liver inflammation.
Liver ultrasound: Usually the first imaging test ordered. It uses sound waves to create a picture of the liver. A fatty liver appears noticeably brighter than a healthy one on the screen. It is widely available, painless, and a reliable first step, though it cannot quantify fat levels or detect early scarring.
FibroScan: A specialised clinic scan that takes around 10 minutes and is completely painless. It measures how much fat is present in the liver and how stiff the liver tissue is - stiffness being a marker for scarring.
Liver biopsy: Reserved for cases where the above tests leave real diagnostic uncertainty, or where significant scarring needs to be confirmed. A small tissue sample is taken with a fine needle under local anaesthetic. It remains the gold standard for assessing liver damage - but the vast majority of patients do not require one.
NOTE: Liver enzymes are sensitive to high intensity exercise. If you have concerns about your liver markers the first step is to re-test after 48 hours of rest. This helps avoid confusion.
Why Does it Matter?
Understanding the 'why' is what motivates real and lasting change. Fatty liver, if left unaddressed, can progress through a spectrum of increasing severity:
Stage 1 - Fatty Liver: Fat accumulates in liver cells. No symptoms. Fully reversible with diet and lifestyle changes.
Stage 2 - NASH: Inflammation and liver cell damage. May cause fatigue or mild discomfort. Needs active management.
Stage 3–4 - Scarring & Cirrhosis: Permanent scarring of liver tissue. Can progress to liver failure or liver cancer.
Fatty liver is one of the few liver conditions that can genuinely be reversed. Studies consistently show that losing just 7–10% of body weight significantly reduces liver fat and in many cases reverses early damage entirely.
What Causes It?
Fatty liver is almost always the result of several factors working together over time. At its core, it develops when the liver is overwhelmed with more fat and sugar than it can efficiently process. The most common drivers are carrying excess weight (particularly around the abdomen), eating a diet high in sugar, refined carbohydrates and processed foods, and insulin resistance, where the body's inability to regulate blood sugar properly leads to excess sugar being converted into liver fat. A sedentary lifestyle, type 2 diabetes, elevated triglycerides and low HDL ('good') cholesterol all compound the problem. I rarely see a patient where just one factor is responsible. It is typically the cumulative effect of diet, inactivity and metabolic dysfunction over time.
How Diet and Lifestyle Can Turn It Around
Fatty liver responds remarkably well to lifestyle intervention. Unlike many chronic conditions, the damage can often be halted or reversed, and the tools to do so are accessible to everyone.
Losing a modest amount of weight makes a significant difference
You do not need to reach an ideal weight to see results. Clinical trials consistently show that losing just 5-10% of body weight substantially reduces liver fat, lowers inflammation, and can reverse early scarring. That is entirely achievable with gradual, consistent changes with a plan that is individualised to you.
The Mediterranean diet is the gold standard
Across multiple clinical trials, a Mediterranean-style diet has outperformed every other eating pattern for reducing liver fat and improving metabolic markers. It is built around vegetables, legumes, wholegrains, fish and quality olive oil, with far less processed food and added sugar. In my experience, patients find it genuinely enjoyable and sustainable in a way that restrictive approaches simply are not.
Cutting sugar has a fast, direct impact
Fructose, the sugar in fizzy drinks, fruit juice and the vast majority of packaged foods, is processed almost exclusively by the liver, where it is converted directly into fat. Removing sugary drinks alone has been shown in research to measurably reduce liver fat within just a few weeks. This is one of the highest leverage changes you can make.
Exercise reduces liver fat independently of weight loss
Both cardiovascular exercise and resistance training reduce liver fat even in people who do not lose weight. The liver is one of the fastest organs to respond to increased physical activity.
Coffee is a genuine, research-backed liver protector
Multiple large studies show that drinking coffee daily is associated with lower liver fat, reduced inflammation, and a significantly lower risk of fibrosis (scarring) progression. For coffee drinkers, this is one habit worth keeping however, I would always suggest avoiding coffee after 12 noon so that it doesn’t impact your sleep.
Foods & Drinks to Avoid
These directly increase liver fat or hinder the liver's ability to recover:
🚫 Fizzy & Sweet Drinks: Loaded with fructose - goes straight to your liver as fat.
Fizzy drinks, energy drinks
Fruit juice - even fresh-squeezed
Sports drinks (Gatorade,Powerade)
Flavoured milk, milkshakes
Cordials and sweet iced teas
🚫 Takeaway & Packaged Foods: High in salt, poor-quality fats and hidden sugars.
Burgers, fried chicken, hot chips
Pizza from takeaway shops
Packaged chips, crackers and dips
Instant noodles and frozen ready meals
Salami, frankfurts and processed meats
🚫 Sugary, White Starchy Foods: Spike blood sugar - the excess is stored as liver fat.
Cakes, biscuits, lollies and chocolate
Sugary breakfast cereals (e.g. Coco Pops)
White bread, white rice and white pasta
Pastries, donuts and muffins
Dried fruit and tinned fruit in syrup
Foods to Eat Instead
These are the foods I consistently recommend and all well-supported by current evidence:
✅ Good Fats: Reduce liver inflammation - include daily.
Olive oil
Avocado - on toast or in salads
A small handful of walnuts or almonds
Salmon, sardines or mackerel (2–3x/week)
Chia seeds or flaxseeds on porridge
✅ Vegetables & Fruit: Fill at least half your plate with these.
Broccoli, spinach, kale, capsicum
Carrots, zucchini, cucumber, tomato
Garlic and onion- actively liver-protective
Berries - blueberries, strawberries
Whole fruit (not juice) - apple, orange, kiwi
✅ Everyday Proteins & Carbs: Sustaining, liver-friendly and easy to prepare.
Chicken or turkey (without the skin)
Eggs - boiled, poached or scrambled
Lentils, chickpeas and kidney beans
Plain Greek yoghurt (no added sugar)
Rolled oats, brown rice or quinoa
I hope this helps you understand not just what fatty liver disease is, but why the choices you make every day are so directly connected to your liver's ability to heal. The evidence for diet and lifestyle intervention in this space is genuinely exciting and the results patients achieve when they commit to these changes are consistently rewarding to witness.
If you would like to explore this further - including a comprehensive metabolic blood panel, dietary review, or a personalised lifestyle plan - please reach out via the contact page.
If you would like to discuss this with me further, please reach out via the contact page.