Weight loss is best for fatty liver

Dear Dr. Roach: I have been suffering from fatty liver for the past 10 years. Is there any medication to reverse it? — A.A.

Fatty liver is a very common finding that refers to the accumulation of excess fat in the liver cells. The most common cause, in people who do not drink excess alcohol, is being overweight, which eventually leads to insulin resistance and many other metabolic abnormalities. This includes changes in the cholesterol levels and elevations in blood pressure.

Although you asked about medication treatment, the primary treatment for people who are overweight with fatty liver is losing weight. Ideally, this is accomplished through healthy dietary changes and increased exercise; however, bariatric surgery is worth considering in people who continue to have fatty liver despite their best efforts on diet and exercise.

Fatty liver should not be taken lightly. It may progress to inflammation of the liver (steatohepatitis, from “steat-”, meaning “fat” in Greek), fibrosis and eventually cirrhosis of the liver.

Drug therapy is more often used to help the underlying and accompanying conditions than it is for treatment of the fatty liver itself. Treatment of diabetes (if present), high blood pressure and high cholesterol are often of benefit in reducing not only liver disease risk, but also risk of heart attack and stroke. Weight-loss medications are prescribed by some weight management experts.

For people who have fatty liver without diabetes, the use of vitamin E appears to be of modest benefit, although there are conflicting data. Vitamin E should not be used in people with diabetes for the treatment of fatty liver. Most experts will not use vitamin E in men with a personal history or strong family history of prostate cancer, since a large trial showed vitamin E increased the risk of prostate cancer about 17%.