Treating non-alcoholic fatty liver disease (NAFLD) involves identifying and treating any underlying conditions (e.g. type 2 diabetes), improving insulin resistance with lifestyle changes and medication, and using antioxidants to protect the liver from cirrhosis. Treatment will, however, depend on the stage of the disease.
If you have NAFLD, the first step is to gradually lose about 7-10% of your body weight. Weight loss remains the most effective way to remove fat from the liver.
Apart from limiting your kilojoule intake and exercising most days of the week (doing both aerobic and weight-bearing exercises), it’s important to limit your intake of saturated fats (found in meat and other animal products), refined sugar (especially sugar-sweetened beverages and juices), processed foods, and alcohol. Your doctor and/or dietician may recommend that you follow a Mediterranean-style diet high in fibre and mono-unsaturated fats from fish, nuts, seeds, olive oil and avocado.
Doctors sometimes also use bariatric surgery to induce weight loss, improve insulin resistance and improve glucose metabolism in individuals with non-alcoholic steatohepatitis (NASH), a more severe form of NAFLD. But these procedures, during which changes are made to the digestive system, should only be reserved for people in whom drastic weight loss is required.
No medicines have been approved to treat NAFLD specifically. However, if you have insulin resistance or overt diabetes, your doctor may prescribe insulin-sensitising drugs such as the thiazolidinediones or metformin. Medication to treat high levels of cholesterol and other types of fat in the blood (dyslipidaemia) and high blood pressure (hypertension) may also be prescribed.
Your doctor may furthermore recommend that you get vaccinated against viral hepatitis to protect your liver from further damage. He or she will also check if you’re not taking any medication that could be worsening your condition, and stop or change that medicine.
If you’ve been diagnosed with NASH, and don’t have diabetes or cirrhosis, your doctor may also recommend taking antioxidants in the form of vitamin E.
Pioglitazone, a diabetes drug, may also be prescribed.
Probiotics and essential phospholipids
Probiotics and essential phospholipids (EPLs) are of growing interest in the management of NAFLD.
Research shows that a strain of bacteria called Lactobacillus rhamnosus GG may protect against the development of fructose-induced NAFLD. However, no firm recommendations can be made as yet and more research is needed to confirm the benefits of probiotics in the treatment of NAFLD.
Some research studies also show promising results with essential phospholipids. Taken as supplements, the phospholipids seem to have anti-inflammatory, antioxidant and lipid-regulating effects in the liver, while helping to regenerate the liver cell membranes.
However, dealing with the major issues of overweight and lack of exercise remains key.
Reviewed by Dr Mark Sonderup, B Pharm, MB ChB, FCP (SA). Senior Specialist, Division of Hepatology, Department of Medicine, University of Cape Town and Groote Schuur Hospital. July 2018.