If you have 2 friends one of you has a fatty liver - does it matter? Should you care?

Fatty liver has a long history of being largely ignored except in alcoholics.  It has long been believed that fat in the liver was mostly benign and would not cause most patients a problem so it was perhaps noted in passing but not viewed with concern. As our modern society has fattened it has become clear that obesity is the handmaiden of disease and liver disease is a central player in a host of medical problems.  Are you or someone you love overweight? You need to pay attention. Consider the rate of change of the death rate for the major medical problems.  The scary one is liver. This is British data because they have a national data base, but in fact our situation is probably worse.


As a patient you need to be aware that most primary care physicians and many gastroenterologists fail to identify liver disease before it becomes a serious health problem. Many patients are shocked to learn that they have cirrhosis and their lives are at risk because they have never had a symptom or any warning from their physicians. Liver disease is often silent which makes the huge number of people at risk a very serious concern. Your best defense is to become educated and work to protect your own health.

  • 100 million American have a fatty liver.
  • 20 million of you will develop liver fibrosis disease as a result.
  • 5 million of you will progress to cirrhosis and possible end stage liver failure.  
  • Some of you will be lucky enough to be listed for transplant, which is the only cure, but 30% of those who do will die waiting.
  • Death by liver failure is often long and a very difficult way for your life to end.  
  • Our mission is to help you avoid that kind of death by helping you understand how you are killing yourself slowly and what you can do about it.  If you are already ill we will do our best to help you with that process.

Fatty liver is the accumulation of triglycerides and other fats in the liver cells. The amount of fatty acid in the liver depends on the balance between the processes of delivery and removal. In some patients, fatty liver will be accompanied by hepatic inflammation and liver cell death (steatohepatitis). Potential pathophysiologic mechanisms for fatty liver include the following:

  • Decreased mitochondrial fatty acid beta-oxidation
  • Increased endogenous fatty acid synthesis or enhanced delivery of fatty acids to the liver
  • Deficient incorporation or export of triglycerides as very low-density lipoprotein (VLDL)

No single pathway of cause and effect has been found. However, societal changes in diet and adoption of a a sedentary lifestyle have combined to give us an epidemic of obesity and liver disease is one of the results of those changes.

Despite rising prevalence and clinical significance, NAFLD remains a disease that is not well understood, mainly due to its long and typically asymptomatic course.  It is generally not recognized that it often begins in adolescence or even childhood. In the absence of non-invasive biomarkers that correlate with disease stage, early screening and longitudinal follow-up of patients is not done. Moreover, NAFLD course is not linear with both deterioration and improvement between all categories and severity of disease and lack of the full knowledge of factors that are predictive of disease regression or progression confounds diagnosis.

HOWEVER, you are not helpless and it is clear that obesity is on the critical path for most cases of NAFLD, NASH and cirrhosis. You can have a positive influence on your disease by adopting a mostly plant based diet, the so called Mediterranean Diet, and getting some exercise.

This is a link to the science behind our approach to managing this liver disease.


This is a link to a discussion of diet.


If you want to learn more about the actual physiology this is a link to short videos which explain liver disease.







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