The good news is that fatty liver (and even NASH with early fibrosis) can be reversed in many cases. The liver is a resilient organ. If you can reduce the fat drivers – for instance, lose weight, improve diet, control diabetes – the fat content in the liver drops and inflammation can subside. Studies show that losing around 7-10% of body weight can not only reduce liver fat but also reverse inflammation and some fibrosis in a significant proportion of patients. Even in cases with fibrosis (scar tissue), if the cause is addressed, fibrosis can improve over time. However, if it has progressed all the way to cirrhosis, that severe scarring is usually not fully reversible (short of transplant), though its progression can be halted or slowed. The earlier in the disease you intervene, the more likely you can completely normalize the liver. Many patients who commit to lifestyle changes have seen their liver enzymes normalize and imaging improve, essentially “defatting” their liver. So yes, fatty liver is often reversible if you tackle the root causes.

There isn’t a single “fad” diet specifically for fatty liver, but research and expert opinion suggest the Mediterranean diet is very beneficial. This diet emphasizes fruits, vegetables, whole grains, lean proteins (like fish and poultry), legumes, and healthy fats (like olive oil and nuts), while limiting red meat, refined carbs, and sugars. It has been shown to improve fatty liver parameters and also helps with weight loss and cardiovascular health. Generally, a diet for MASLD should focus on:
– Calorie reduction if weight loss is needed.
– Low in simple sugars, especially fructose (cut out sugary drinks, limit sweets). Sugary beverages are strongly linked to fatty liver.
– Higher in fiber and complex carbs instead of refined carbs (choose whole grain bread/pasta, brown rice instead of white, etc.).
– Rich in healthy fats (olive oil, avocados, omega-3 rich fish like salmon) as opposed to saturated/trans fats.
– Adequate protein (including plant-based proteins) to help maintain muscle during weight loss.
– Limited processed foods and fried foods.
Also, if overweight, any diet that you can stick to that leads to weight loss will help the liver – be it Mediterranean, DASH, or other balanced diets. Avoid crash or extreme diets; slow, steady weight loss is safer for the liver (rapid weight loss can, paradoxically, worsen liver inflammation transiently or lead to gallstones). It may be helpful to consult a dietitian who can tailor a plan to your tastes and medical needs.

Pregnant women are at the highest risk – especially in the third trimester, hepatitis E can be devastating, with a maternal mortality rate of 20% or higher. So they are the single most vulnerable group. Apart from pregnancy, people with pre-existing chronic liver disease are at risk for more severe acute hepatitis (any acute hepatitis on top of chronic liver issues can precipitate liver failure). Also, individuals with weakened immune systems (like organ transplant patients or those on chemotherapy) might have difficulty clearing the virus, potentially leading to chronic infection, although that’s rare. In general, young healthy adults usually recover fully, but vigilance is needed in those high-risk categories.

There is no magic pill yet. Vitamin E at a dose of 800 IU daily has shown some benefit in non-diabetic patients with NASH (steatohepatitis). Some liver specialists might prescribe it if you fit that category. However, it’s not for everyone (e.g., not typically recommended if you have diabetes or cirrhosis due to mixed data on outcomes). Pioglitazone, a diabetes medicine, is sometimes used in NASH patients (including some non-diabetics) as it can improve liver histology – but it can cause weight gain, which is counterproductive, so its use is careful. Newer diabetes drugs like GLP-1 agonists (e.g., liraglutide, semaglutide) cause weight loss and have shown promise in treating NASH in trials; if you have type 2 diabetes, your doctor might choose one that could benefit your liver as well. Statins can be safely taken if you have high cholesterol – they primarily protect your heart, but there’s evidence they’re safe in fatty liver and might even reduce liver inflammation a bit. Avoid unproven “liver cleanse” supplements – many have no benefit and some could harm the liver (remember, “natural” doesn’t equal “safe”). Always talk to your doctor before taking any supplement. The mainstay remains diet and exercise; medications are considered on an individual basis, often to treat accompanying conditions (like diabetes or high lipids) with the side benefit of helping the liver.

Yes. It’s a common misconception that normal liver blood tests mean the liver is fine. Many individuals with fatty liver disease have normal ALT and AST levels or only very mildly elevated levels. Enzymes can even fluctuate – sometimes normal, sometimes a bit high. You could have significant liver fat or even fibrosis and still have near-normal blood tests. Ultrasound or FibroScan findings, or risk factors, might prompt a diagnosis despite normal enzymes. So a normal ALT/AST doesn’t completely rule out MASLD. Doctors look at the whole picture: risk factors (obesity, etc.), imaging, and so forth. If you have known risk factors and normal enzymes, it’s still worth pursuing weight loss and healthy habits, as silent fatty liver could still be present. Periodic rechecking is also advised. In short, normal liver enzymes = great, but with context. It’s possible to have “biochemical silence” while the disease is present, especially in early stages.