‘I'm a Hepatologist-This Is the One Thing I Tell Every Patient With Fatty Liver Disease To Do Before Anything Else'

"Fatty liver" is a commonly used term, but it's no longer a formal diagnosis. That's not because liver disease no longer exists. But a group of multinational liver societies, including in the United States and Europe, banded together in June of 2023 and agreed to rename non-alcoholic fatty liver disease (NAFLD) metabolic dysfunction-associated steatotic liver disease (MASLD).

One hepatologist says the name change isn't just semantics. "This distinction is important because while previously fatty liver was thought of as a disease of obesity, it is now better understood as a disease of metabolic syndrome," explains Dr. Rucha Shah, MD, a gastroenterologist and hepatologist for HonorHealth. "Metabolic syndrome is a collection of diseases associated with insulin resistance, such as diabetes, pre-diabetes, high blood pressure, high cholesterol and weight around the belly."

She adds that scientists are even looking into whether polycystic ovary syndrome (PCOS), a hormonal disorder that can contribute to fertility issues, belongs under the umbrella of a MASLD diagnosis. If you have MASLD, it's crucial to be on top of it with your provider, including taking lifestyle-related steps to manage the condition.

"Management and diagnosis of fatty liver has to look at the causes and manage those to prevent long-term damage," Dr. Shah tells Parade. "It is now the number one cause of liver disease in the United States, and left untreated, it can lead to cirrhosis."

For the unfamiliar, cirrhosis is liver scarring from long-term damage, and it's generally irreversible. The earlier you make changes, the greater your chance of reducing the impact your MASLD has on your life. That's why, as a hepatologist, Dr. Shah counsels her patients with "fatty liver disease" to do this one thing first.

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The One Thing a Hepatologist Tells Patients With Fatty Liver Disease To Do First

"Cutting back on sugars can help stimulate a...breakdown of fat, and actually allow the liver to start to heal," Dr. Shah tells Parade.

A 2018 review in the Journal of Hepatology notes that early clinical studies suggest that reducing sugary drink intake and total fructose (particularly from added sugar) may reduce liver fat accumulation.

A more recent 2023 review in Hepatology Communications found that scientists were still working through the role of added sugar consumption in liver disease. But the authors shared that most people were consuming too much added sugar and said cutting back could help lower risks for health conditions, including liver disease.

"Consuming too much sugar can lead to direct damage to the gut, microbiome and the liver," Dr. Shah says. "It causes droplets of fat to accumulate in the liver, triggering inflammation, which eventually leads to scarring."

Additionally, consuming too much sugar increases your risk of insulin resistance. Dr. Shah explains that insulin resistance makes it harder for your cells to break down sugars, so your pancreas has to go into overdrive, which can cause type 2 diabetes, among other health issues. "Insulin resistance...leads to more localized inflammation, sometimes pain, elevation of liver enzymes and ultimately scarring, which is cirrhosis-even without drinking alcohol," she warns.

Related: Is Fatty Liver Disease Reversible? Experts Share the Truth

How Much Sugar Can You Eat per Day With Fatty Liver Disease?

Dr. Shah points to the World Health Organization's guidance to consume no more than 10% of your daily calories from added sugars. "That is around 50 grams or no more than 200 calories if you were on a 2000-calorie-per-day diet," she clarifies.

She understands it can be hard to cut back on added sugar if you have a sweet tooth or it's a regular part of your diet (or both). She suggests prioritizing foods rich in protein and fiber, explaining, "Foods that are high in protein and high in fiber slow down digestion, leading to more fullness."

Greek yogurt and broccoli not nixing your sweet cravings? "[I encourage] adding high-quality honey, maple syrup and dates instead of a spoonful of sugar or artificial sugar," Dr. Shah says. "Flavors associated with sweetness like vanilla or cinnamon can help trick the mind into feeling like you're having a tasty snack that, in fact, is low on sugar."

While cutting back on sugar can be helpful, remember that real change takes time. "I usually give my patients at least three to six months before we even consider evaluation to see the results," Dr. Shah explains. "Typically, within a year, patients are restructuring their livers with healthier lifestyles."

Related: The #1 Sweetener To Avoid if You Have Fatty Liver Disease, According to Gastroenterologists

Other Ways To Support Your Liver Health

Besides cutting back on added sugar, Dr. Shah says she has other recommendations for patients dealing with fatty liver disease (or people at higher risk for it).

For starters, avoid alcohol, and don't fall for the "liver cleanses" you see on TikTok. And look at your diet.

"Following the Mediterranean Diet has been shown to boost liver health," she explains. "Regular exercise, such as cardiovascular activity and weightlifting, can also help the liver utilize some of the fat and protect it from damage."

Indeed, studies, including one in Diabetes Spectrum, linked a Mediterranean-style diet and regular physical activity as the most evidence-based treatments for liver disease. The Mediterranean Diet is rich in plant-based and lean proteins (like beans and chicken), produce (fruits and veggies) and healthy fats (omega-3s, found in olive oil, avocados and fatty fish like salmon).

As for physical activity, the American Heart Association's guidance to log at least 150 minutes of moderate-intensity (heart rate up, conversational pace) activity per week is a great place to start.

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Related: Here's Exactly What To Eat at McDonald's if You Have Fatty Liver Disease

Sources:

• Dr. Rucha Shah, MD, a gastroenterologist and hepatologist for HonorHealth
• Cirrhosis of the Liver. Cleveland Clinic.
• Metabolic Dysfunction-Associated Steatotic Liver Disease and Polycystic Ovary Syndrome: A Complex Interplay. Journal of Clinical Medicine.
• No More NAFLD: The Term Is Now MASLD. Endocrinology and Metabolism.
• Fructose and Sugar: A Major Mediator of Nonalcoholic Fatty Liver Disease. Journal of Hepatology.
• The Impact and Burden of Dietary Sugars on the Liver. Hepatology Communications.
• Reducing free sugars intake in adults to reduce the risk of noncommunicable diseases. World Health Organization.
• Practical Lifestyle Management of Nonalcoholic Fatty Liver Disease for Busy Clinicians. Diabetes Spectrum.
• American Heart Association Recommendations for Physical Activity in Adults and Kids. American Heart Association.

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This story was originally published May 13, 2026 at 5:50 PM.