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Fatty Liver Disease

Fatty liver is the accumulation of fat in liver cells, impairing its normal function. It can be divided into alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD). If left untreated, it can progress to cirrhosis and liver cancer.

Symptoms of fatty liver disease

Initially, fatty liver disease may not cause any symptoms. However, as it progresses, symptoms may appear:

  • Fatigue
  • Weight loss
  • Abdominal pain
  • Jaundice
  • Swelling in legs and abdomen

Causes of fatty liver disease

Causes are multifactorial, often involving an interplay of genetics, diet, and lifestyle.

AFLD is caused by excessive alcohol consumption.

NAFLD is linked to high fructose or refined sugar consumption, overweight and obesity, insulin resistance, high blood sugar (Type 2 diabetes), and high levels of fats in the blood.


Diagnostic tests include blood tests, imaging studies (ultrasound, CT, MRI), and liver biopsy. Often a high ALT or GGT on a routine blood test will be the first indication of a fatty liver development. Keep in mind that from a Functional Medicine perspective the reference ranges given by most lab for ALT and GGT are far too high. Even an ALT or GGT of 25 should be considered pathologic and early intervention should be started. There really is no reason to delay treatment and wait for more extensive damage before treatment is initiated.


  • Hepatitis
  • Cirrhosis
  • Liver failure
  • Liver cancer


Traditional approaches primarily involve lifestyle changes, including diet and exercise.

If caught and treated early, pharmaceutical intervention is usually not required.

Every individual is unique in terms of genetics, lifestyle, and health status. Thus, a one-size-fits-all diet plan is not recommended. Treatment should be tailored to YOUR situation. We will work closely with you to develop a personalized treatment plan which may involve:

  • Weight loss if overweight or obese. Excessive weight is an important risk factor for fatty liver.
  • Improve insulin sensitivity for better blood sugar levels which reduces insulin levels. Insulin resistance is important for the development of NAFLD.
  • Increase intake of nutrient-dense foods that support liver function, such as fruits, vegetables, lean proteins, and whole grains. The liver greatly depends on macro- and micronutrients to carry out its functions.
  • Limit intake of sugars, carbs and unhealthy fats, which increases insulin and worsens fatty liver.
  • Hydration aids in the detoxification processes.

Your lifestyle plays a crucial role in managing and reversing fatty liver disease. Our team provides guidance on:

  • Aerobic and resistance exercise improve insulin resistance, reduces inflammation and liver fat. and promote weight loss.
  • Stress management reduces cortisol and blood sugar levels, improves insulin resistance and fatty liver disease. Mindfulness, prayer, yoga, and counseling are often useful to reduce stress
  • Better sleep hygiene has many positive effects, including weight loss, better metabolic health and less fatty liver.

Nutritional Supplementation can improve liver health and overall metabolic function.

  • Milk thistle, an herb with potent antioxidant and anti-inflammatory properties.
  • Omega-3 fatty acids, which can help reduce liver fat and inflammation.
  • Vitamin E, an antioxidant that may be beneficial in non-diabetic patients with NAFLD.
  • Specific nutrients required for detoxification, which may include selenium, vitamin C, vitamin D, zinc and various B vitamins
  • Probiotics to improve gut health. Gut health is closely associated with liver health. Many intestinal issues spill over and burdens the liver.
  • It’s important to note that these supplements are used as part of a comprehensive approach and are not a substitute for a healthy diet and lifestyle.

The liver plays a vital role in detoxification. To support this function, we offer techniques such as:

  • Sauna therapy to promote detoxification through sweating. This can lessen the detoxification that the liver needs to do.
  • Hydration and dietary fiber to facilitate the elimination of toxins.
  • Specific dietary protocols designed to reduce toxin exposure and enhance the body’s detoxification processes.

Gut Health Optimization: The gut and liver are closely linked, and an unhealthy gut can contribute to liver disease. Our team may:

  • Use probiotics and prebiotics to support a healthy gut microbiome.
  • Address any underlying gut issues such as leaky gut syndrome, which can contribute to inflammation and liver disease.
  • Suggest dietary changes to promote a healthy gut, such as increasing fiber intake and reducing processed foods.

Address NAFLD with DMH Functional Medicine

At DMH Functional Medicine, we will work closely with you, monitoring your progress and making necessary adjustments to the treatment plan to ensure optimal results. We believe in empowering patients to take charge of their health and are committed to providing comprehensive, personalized care.


Fatty liver disease is a significant health concern, but with the right approach, it can be effectively managed.

DMH Functional Medicine is committed to providing individualized, comprehensive care that addresses the root causes of fatty liver disease.


  • Younossi, Z., et al. (2016). Global epidemiology of nonalcoholic fatty liver disease—Meta‐analytic assessment of prevalence, incidence, and outcomes. Hepatology.
  • Vernon, G., et al. (2011). Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Alimentary Pharmacology & Therapeutics.
  • Boursier, J., et al. (2016). The severity of nonalcoholic fatty liver disease is associated with gut dysbiosis and shift in the metabolic function of the gut microbiota. Hepatology.
  • Lassailly, G., et al. (2015). Bariatric surgery reduces features of nonalcoholic steatohepatitis in morbidly obese patients. Gastroenterology.
  • Chalasani, N., et al. (2018). The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology, 67(1), 328-357.
  • Zelber-Sagi, S., et al. (2017). The Mediterranean dietary pattern as the diet of choice for non-alcoholic fatty liver disease: Evidence and plausible mechanisms. Liver International.
  • Hashida, R., et al. (2017). Aerobic vs. resistance exercise in non-alcoholic fatty liver disease: A systematic review. Journal of Hepatology.
  • Leung, C., et al. (2019). Sleep in patients with non-alcoholic fatty liver disease: A systematic review.

Liver Detoxification

Liver detoxification, a crucial function in maintaining overall health, consists of two phases: Phase 1 (Biotransformation) and Phase 2 (Conjugation). Both phases require specific micronutrients, lifestyle changes, and may require additional supplementation to restore optimal function.

However, there is no point in working on supporting the livers detoxification process if we do not stop overloading the liver with more toxic load. So, reduced toxic load is important and the measures mentioned above are all a very important part of the detoxification support.

Phase 1: Biotransformation

During Phase 1, the liver uses the cytochrome P450 enzyme family to convert toxins into less harmful intermediates. This process may generate free radicals, necessitating antioxidants to neutralize potential damage.

To support Phase 1 of the detoxification we may recommend a number of micronutrients with appropriate dosages:

  • B Vitamins: Essential cofactors for enzymes in Phase 1.
  • Vitamin A, E & C: Potent antioxidants to neutralize free radicals created during the detoxification
  • Glutathione or N-Acetyl Cysteine (NAC): NAC is a precursor to glutathione, the body’s ‘master’ antioxidant.
    • Some patients may have a reduced capacity to convert NAC to glutathione and direct supplementation with glutathione may then be recommended.
  • Magnesium: Essential co-factor enzymes in Phase 1
  • Milk Thistle: Known for its antioxidant and anti-inflammatory properties.

Phase 2: Conjugation

Phase 2, the conjugation phase, involves several pathways, including methylation and sulfation. These pathways further convert the intermediates from Phase 1 into water-soluble molecules for excretion.

We may recommend nutrients for phase 2 methylation with appropriate dosages:

  • Cobalamin (B12) and Folate (B9)
  • Methionine: An essential amino acid involved in methylation.
  • Choline/Betaine (Trimethylglycine): Involved in methylation as a methyl group donor.
  • Magnesium: A cofactor for enzymes in methylation.

We may recommend nutrients for phase 2 sulfation with appropriate dosages:

  • Sulfur-containing Amino Acids: Cysteine and methionine are needed for sulfation
  • Alpha-Lipoic Acid (ALA): An important antioxidant that supports sulfation.
  • Magnesium: A cofactor for enzymes involved in sulfation.

Additional Supplements for Liver Health:

  • Turmeric (Curcumin): Has potent anti-inflammatory and antioxidant effects.
  • Dandelion Root: Traditionally used to support liver health
  • Probiotics: Support gut health, indirectly aiding in detoxification.
  • It’s crucial to always consult a healthcare provider before beginning any new supplement regimen, as dosages and combinations need to be personalized and monitored.
  • A balanced diet, regular exercise, adequate sleep, and stress management are also key components in supporting optimal liver detoxification.
  • Although, these supplements can support your body’s natural detoxification processes, they’re not a substitute for a healthy lifestyle.
  • Minimize your exposure to toxins, maintain a healthy weight, stay hydrated, and eat a diet rich in fruits, vegetables, lean proteins, and healthy fats to further support your liver health.


  • Hodges, R. E., & Minich, D. M. (2015). Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application. Journal of Nutrition and Metabolism, 2015.
  • Krajka-Kuźniak, V., Paluszczak, J., & Baer-Dubowska, W. (2017). The Nrf2-ARE signaling pathway: An update on its regulation and possible role in cancer prevention and treatment. Pharmacological Reports, 69(3), 393-402.
  • Liska, D. J. (1998). The Detoxification Enzyme Systems. Alternative Medicine Review, 3(3), 187-198.
  • Finkelstein, J. D. (1990). Methionine metabolism in mammals. Journal of Nutritional Biochemistry, 1(5), 228-237.
  • Ueland, P. M. (2011). Choline and betaine in health and disease. Journal of Inherited Metabolic Disease, 34(1), 3-15.
  • Selhub, J. (2002). Folate, vitamin B12 and vitamin B6 and one carbon metabolism. Journal of Nutrition Health and Aging, 6(1), 39-42.
  • Loguercio, C., & Festi, D. (2011). Silybin and the liver: From basic research to clinical practice. World Journal of Gastroenterology, 17(18), 2288–2301.
  • Packer, L., Witt, E. H., & Tritschler, H. J. (1995). Alpha-Lipoic acid as a biological antioxidant. Free Radical Biology and Medicine, 19(2), 227-250.
  • Hewlings, S. J., & Kalman, D. S. (2017). Curcumin: A Review of Its’ Effects on Human Health. Foods, 6(10), 92.
  • Schütz, K., Carle, R., & Schieber, A. (2006). Taraxacum—A review on its phytochemical and pharmacological profile. Journal of Ethnopharmacology, 107(3), 313-323.