The latest on fatty liver disease—America’s most lethal epidemic-in-the-making

The 21st century has been plagued by what’s commonly referred to as the “twin epidemics”: diabetes and obesity. We’ve even combined the two into a single, deadly phenomenon known as “diabesity.”

But now, there’s a third epidemic on the rise. One that joins these two as part of an increasingly lethal trifecta. And this one’s on track to becoming a public health crisis that’s every bit as devastating to Americans of all ages.

I’m talking about fatty liver disease.

It’s not the first time I’ve addressed the topic in these pages. And unfortunately, given the flood of ugly statistics out there, it probably won’t be the last.

Recent figures estimate that about one third of adults in Western countries—and a staggering 10 percent of children, even as young two years old—now suffer from fatty liver. And to say this news is bad would be the understatement of the century.

Before this gets too “doom and gloom,” there IS good news. In fact, when it comes to fatty liver disease, your fate is almost entirely in your own hands. And changing it for the better can be easier than you’d expect. I’ll tell you how in just a moment.

But first, let’s take a closer look at what makes this new epidemic-in-the-making the most terrifying one yet.

Don’t stop the tests at fasting glucose

Non-alcoholic fatty liver disease (NAFLD) carries all the obvious risks you might expect. Most notably, there’s the risk of irreversible scarring—also known as liver cirrhosis. This, in turn, can lead to liver cancer and liver failure. And it goes without saying that all these potential developments can carry fatal outcomes.

But some recent studies are shedding light on just how far the danger of fatty liver reaches. And their findings might surprise you.

Take the results of one recent population study. Japanese researchers recruited nearly 1,500 men and 3,000 women, separating them into six groups according to fasting glucose levels and fatty liver index, or FLI. (This is an algorithm that uses waist size, BMI, triglyceride levels, and gamma-glutamyl-transferase—a measure of liver health—to predict the likelihood of fatty liver.)

These patients fell into one of six categories: low FLI, moderate FLI, or high FLI, either with or without high fasting blood sugar. And as it turns out, these distinctions uncovered a striking trend.

After three years of follow-up, 176 men and 320 women went on to develop diabetes. But here’s the thing: Analysis showed that subjects with a high FLI were significantly more likely to wind up with diabetes. Even if they didn’t have high fasting blood sugar.1

In other words, fatty liver is an independent risk factor for diabetes. And it could send you careening down the path toward metabolic disease, even if your fasting blood sugar levels are well within the normal range.

This isn’t the first study to link fatty liver to diabetes. In fact, previous research suggests NAFLD can result in a six-fold increase in diabetes risk. But these latest results make pretty quick work of showing just how destructive fatty liver disease really is.

And they’re not the only ones, either.

The silent culprit behind a shrinking brain

Liver fat is also an independent risk factor behind brain aging. In fact, it literally shrinks your brain. And not by a small amount, either.

As part of another recent study, researchers used MRI to measure the brain volume of more than 750 men and women, which they then compared to CT scans of their livers.

Just shy of 20 percent had non-alcoholic fatty liver disease. And these patients also had significantly smaller brains—a degree of shrinkage equivalent to an extra 4.2 years of aging among subjects in their 60s, in fact. And a whopping 7.3 extra years of aging among people younger than 60.2

Even in subjects over age 75, fatty liver still contributed to an additional 1.5 years’ worth of brain aging. And that’s even after accounting for traditional brain risk factors—like heart disease, diabetes, smoking, heavy drinking, excess weight, sedentary lifestyle, or menopause.

These results appeared in JAMA Neurology earlier this year. And if they haven’t convinced you to take steps to save your liver, I can’t imagine what will.

Which brings me to the good news I mentioned earlier. Like diabetes and obesity, fatty liver is completely reversible. All you have to do is follow the same tried-and-true diet strategies I’ve been recommending to my patients—and to you—for years.

Ditch carbs and double down on MUFAs

Yes, it really is that simple. Swedish researchers recently looked at the effects of carb restriction—with an increase in protein, but no reduction in calories—on a small group of 10 obese subjects with fatty liver.

And the results, according to study authors, were both “rapid and dramatic.”

For one thing, liver fat levels took a nosedive—alongside a host of other cardiometabolic risk factors. And the rate at which subjects’ livers accumulated new fat decreased markedly in response to these dietary changes.3

The most impressive part? It only took two weeks of high-protein, low-carb eating to see drastic changes.

Then there’s this: Yet another recent study looked at dietary habits and liver fat scans of more than 1,500 participants in the Framingham Heart Study. And results showed that subjects following a strict Mediterranean diet—rich in fish, lean protein, veggies, nuts, and monounsaturated fats—were more than a quarter less likely to wind up with NAFLD.4

Low adherence, on the other hand, was linked with greater liver fat accumulation—especially among subjects at high genetic risk. But, the study found that, even among this high-risk group, Mediterranean-style eating was enough to keep liver fat in check.

In other words, just as with obesity, “fat genes” aren’t a life sentence for your liver. Ultimately, beating NAFLD boils down to diet. (And more specifically, to my A-List Diet—which is both low-carb and Mediterranean-style.)

But there are a few supplements that can give you some extra help along the way.

Six supplements for powerful liver support

I went over this protocol in detail back in the November 2016 issue—but given the gravity of the fatty liver statistics, it bears repeating. (You can revisit the full article by logging into my newsletter archives on Because while diet is and will always be your best defense against fatty liver, supplements can really make a difference.

Here are six of my favorites:

• Glucevia – Glucevia™ is a standardized extract of Fraxinus excelsior—the European ash tree. This is by far one of the newest and most exciting supplements for liver support out there. It can help your body eliminate stored fat in the liver (which in turn helps with toxin removal). I’ve written about this supplement a lot, but it really is a crucial part of this fight. A good dose is 1,000 mg per day.

• Lactobacillus fermentum ME-3 – This is another hot-off-the-shelves nutritional supplement. It’s a probiotic I refer to simply as ME-3, and it’s the only supplement proven to promote the production of glutathione. This is critical, as glutathione is the main detoxifying agent in your liver, and one of the body’s most important antioxidants. Your body loses the ability to make this necessary antioxidant with age—and supplementation is the only way to jumpstart the process reliably. That’s why I recommend 60 mg per day.

• Milk thistle – This is an “oldie but goodie” in the liver-support category. And to this day, it still remains a favorite. I recommend taking 500 mg of silymarin (that’s the active component of milk thistle) twice per day.

• N-acetyl cysteine – This amino acid is a precursor to glutathione, which I mentioned above. Your body needs N-acetyl cysteine as a building block in order to form that all-important antioxidant. I recommend 1,200 mg per day.

• Benfotiamine – This is a special form of the B vitamin thiamine. It’s essential to buffer your body from the damaging effects and toxic reactions resulting from excess sugar in your body. I recommend 150 mg per day.

• Mulberry – This powerful antioxidant does double duty for blood sugar support. It doesn’t act directly on the liver like some of the nutrients on this list. But keep in mind that liver damage in the U.S. is being largely fueled by sugar. So you need both antioxidants and blood sugar balancers in your arsenal in order to effectively fight this battle. I recommend 200 mg per day.

You need to look after your liver. This organ takes a beating more than ever in today’s toxic world. It’s up to you to do your best to avoid being a statistic in America’s next major health epidemic.

To a healthier you,

Fred Pescatore, M.D.


  1. Hirata A, et al. Hepatol Res. 2018 Jan 17.
  2. Weinstein G, et al. JAMA Neurol. 2018 Jan 1;75(1):97-104.
  3. Mardinoglu A, et al. Cell Metab. 2018 Mar 6;27(3):559-571.e5.
  4. Ma J, et al. Gastroenterology. 2018 Mar 28.