Fatty liver is the build-up of fat in liver cells. It usually is caused by obesity but may be due to diabetes, high triglycerides and, in some cases, alcohol abuse, rapid weight loss, and malnutrition. Some cases are associated with drugs such as tamoxifen (used to prevent breast cancer recurrence), the antibiotic tetracycline, and long-term use of steroids. But most people who develop fatty liver are overweight and middle-aged. You're most likely to find out you have fatty liver following a routine blood test in the course of a physical exam. If the test shows the elevation of certain liver enzymes your doctor may order a liver biopsy, which will show fat in the cells.
The danger of fatty liver is that it can lead to localized inflammation (steatohepatitis), which can progress to liver damage. This condition is called NASH, which stands for Non-Alcoholic Steatohepatitis. (If alcohol abuse is involved, the condition is termed "alcoholic steatohepatitis"). NASH can cause scarring and hardening of the liver, leading to cirrhosis, a very serious disease that may require a liver transplant. Because of rising rates of obesity, NASH has become increasingly common. Some estimates suggest that one-third of adult Americans are affected, and this is consistent with the fact that one-third of Americans are considered obese.
There is no medical treatment for fatty liver – no drugs or surgery can cure it. However, it's a good idea to be under the care of a physician who specializes in treating liver diseases. The only ways to deal with fatty liver are to lose weight and lower your triglycerides if they're elevated. If you're diabetic, the focus should be to make sure that your diabetes, as well as your weight, is well controlled. Be sure to exercise regularly.
My colleague Qingcai Zhang, M.D., a Chinese physician and hepatitis expert, successfully treats fatty liver and NASH with milk thistle (Silybum marianum), and a combination of Chinese herbal remedies. For more information, visit Dr. Zhang's Web site.
Andrew Weil, M.D.