Fatty liver disease is a serious problem. Here's who should be worried about it.

It’s often, “silent” – meaning it rarely presents with symptoms. 

Until it is severe. 

It is projected to be the number one cause of liver transplantation in the United States by the year 2030. And it’s rising in children. 

Dr. Blanca Lizaola-Mayo, MD, a transplant hepatologist and the Medical Director of the Liver Transplant Center at the Mayo Clinic in Arizona, is sounding the alarm on NASH or nonalcoholic steatohepatitis. 

NASH occurs when a “fatty liver” or nonalcoholic fatty liver disease (NAFLD) leads to inflammation and liver cell damage called fibrosis. In its most severe form, it can be fatal. 

But Lizaola-Mayo wants you to know it is treatable and reversible when it is caught early. She walks us through everything you need to know about NASH. 

What are the signs of a fatty liver?

Most of the time, a “fatty liver” does not cause any symptoms in its early stages. Occasionally, one may have pain in the right upper side of the abdomen. 

“Patients do not know they have it and it does not hurt. So they are presenting for care when they have decompensated liver failure or even liver cancer,” explains Lizaola-Mayo. 

While there may not be signs, there are well-defined risk factors that may help determine if you need to be screened for NAFLD or NASH. 

Lizaola-Mayo emphasizes that the number one risk factor for fatty liver disease is Type 2 diabetes. This can have major implications because around 30.6 million Americans live with Type 2 diabetes. 

While obesity and Type 2 diabetes are risk factors for developing NAFLD, Lizaola-Mayo says the combinations of conditions within the umbrella term “metabolic syndrome” encapsulates most of the risks for the development of fatty liver disease. “Metabolic syndrome is a combination of different diseases including Type 2 diabetes, insulin resistance, hypertension, high cholesterol, high triglycerides and sleep apnea,” explains Lizaola-Mayo. She adds, “I see it as 'fatty liver' is the liver manifestation of metabolic syndrome.” 

If you are among the one in three Americans who have metabolic syndrome, you should start thinking about the possibility of fatty liver disease. 

Who should be screened for fatty liver disease?

Lizaola-Mayo says that she often gets questions from primary care and endocrinology providers about who should get screened for NAFLD and NASH. She recommends patients who have the following should undergo screening:

• Two or more metabolic risk factors 
• Any patient that has elevated liver enzymes for more than 6 months
• Any patient that has hepatic fat seen on ultrasound or CT scan 

Patients with a low risk (determined by something called an FIB-4 score) can be observed by their PCP or endocrinologist, and those with increased risk should be referred to a hepatologist or GI physician. Intermediate and severe-risk patients may undergo a test called a FibroScan, which can help determine the elasticity of the liver and help your doctor determine how much fibrosis or damage is present.

Lizaola-Mayo also encourages people to be their own advocates. “We need to encourage people to ask providers if they have identified themselves as having risk factors (being overweight, having diabetes, having a family history, etc.) and asking their providers to get tested.” 

How can fatty liver be treated? 

Lizaola-Mayo says she gets asked a lot about what kinds of supplements can be used to help the liver. Her answer: none. “The only thing that cleanses the liver is the liver itself,” she explains. “No supplements have been shown to be beneficial for the liver and we have actually seen patients who have made it to the hospital with acute liver failure because of the supplements,” she cautions. 

There is, however, one caveat: black, caffeinated coffee. “A least 3 cups of coffee a day will keep the hepatologist away,” Lizaola-Mayo jokes. 

Does fatty liver go away?

There are other treatment options, and Lizaola-Mayo emphasizes that fatty liver disease is reversible. “We can remove the fat that’s on the liver. We can decrease inflammation and reverse the scar tissue.

“The most important thing (for treatment) is lifestyle modifications like diet and exercise,” says Lizaola-Mayo. 

What is the best way to diet? Lizaola-Mayo says, “I tell my patients that one of the toughest things they will ever do is diet and exercise because it is so difficult. We go on a diet, we lose weight, and then we stop the diet and we gain weight back. So there has been a lot of research into what the best diet is and it’s the Mediterranean diet, especially when it comes to cardiovascular health,” she explains.“ She adds, “However, the best diet is the diet that you are best going to be able to comply with,” she says with a smile. 

More about fatty liver:Fatty liver disease affects millions of unaware Americans. Here's what you need to know.

Coffee study:Drinking 3 to 4 cups of coffee a day reduces risk of liver cancer

Silent killer:They were young. They thought they had time. Then they nearly died of liver disease.