The best treatment for you depends on the underlying cause of your nonalcoholic fatty liver disease. Preferred treatments include:
Weight loss and exercise. If your body mass index is above 25, a diet and exercise program may reduce the amount of accumulated fat in your liver. The most effective diet is rich in fiber and low in calories and saturated fat, with total fat accounting for no more than 30 percent of total calories. But go slowly. Aim to lose 10 percent of your body weight over six months, because rapid weight loss may lead to a worsening of liver disease. Even if you aren't overweight or obese, a healthy diet and daily physical activity may reduce inflammation, lower elevated levels of liver enzymes and decrease insulin resistance.
Diabetes control. Strict management of diabetes with diet, medications or insulin lowers blood sugar, which may prevent further liver damage. It may also reduce the amount of accumulated fat in your liver.
Cholesterol control. Controlling elevated levels of cholesterol and triglycerides with diet, exercise and cholesterol-lowering medications may help stabilize or reverse nonalcoholic fatty liver disease.
Avoidance of toxic substances. If you have nonalcoholic fatty liver disease — especially nonalcoholic steatohepatitis (NASH) — don't drink alcohol. Also avoid medications and other substances that can cause liver damage. Talk to your doctor about which drugs to avoid.
There's no standard medical treatment specifically for nonalcoholic fatty liver disease. Several possible treatments are under investigation, but so far none has proved effective. These approaches include:
Vitamins E and C. Since both vitamins are antioxidants, it's thought that they may reduce liver damage caused by oxidants, unstable oxygen molecules that damage cell membranes.
Ursodiol (Actigall). Most commonly used to treat gallstones, this drug decreases production of bile acids, which may in theory help lower elevated levels of liver enzymes in people with liver disease.
Other medications. Researchers are studying the effects of several medications on insulin resistance and nonalcoholic fatty liver disease in people with and without diabetes. These include metformin (Glucophage, Glucophage XR), pioglitazone (Actos), rosiglitazone (Avandia) and betaine (Cystadane). Another drug being investigated is orlistat (Xenical), a medication that blocks the absorption of some of the fat from your food. Early results indicate that orlistat may reduce the amount of fat in the liver.
Bariatric surgery. While abdominal weight-loss surgery coupled with rapid weight loss has been implicated as contributing to the development of NASH, some research suggests that bariatric surgery combined with modest weight loss may reduce the inflammation and scarring associated with NASH.