Are We Turning Into Foie Gras? Fatty Liver and How to Reverse It

Foie gras is made by force-feeding ducks and geese a carbohydrate-rich mash until their livers swell with fat. We find the practice troubling enough that some places have banned it. Yet a version of the same thing is happening to us, quietly and by choice. Non-alcoholic fatty liver disease, the buildup of fat in a liver that sees little or no alcohol, has become one of the most common chronic conditions on earth. The good news is that the liver is remarkably willing to reverse it.

How common it has become

This isn't a niche problem. In a 2022 systematic review and meta-analysis, Riazi and colleagues estimated that non-alcoholic fatty liver disease now affects roughly 30% of adults worldwide, and the number keeps climbing [1]. A condition that was a medical footnote a few decades ago now sits in nearly one in three livers, which tells you something in how we eat has changed.

How the liver fills with fat

The liver fills with fat much the way the duck's does: a flood of carbohydrate, especially sugar and refined starch, beyond what your body can burn or store as muscle glycogen. The liver turns the excess into fat through a process called de novo lipogenesis, literally making new fat. Fructose is a particular problem, because the liver handles almost all of it and readily turns it into fat. In a controlled study, Schwarz and colleagues took fructose out of children's diets without changing their calories and watched liver fat fall and new fat production drop [2]. The fat in the liver tracks the sugar going in, not the fat on your plate.

How to empty it

Here's the encouraging part, and the core of what we recommend. If carbohydrate fills the liver, restricting carbohydrate empties it, often fast. Browning and colleagues compared diets and found that cutting carbohydrate reduced liver fat more than cutting calories alone, a metabolic advantage that showed up within days [3]. Pair a lower-carbohydrate, protein-forward diet with intermittent fasting, which gives the liver long stretches to burn through its stores, and you give the organ exactly the conditions it needs to clear the fat.

Weight loss seals the result. In a study of people with the more advanced, inflamed form of the disease, Vilar-Gomez and colleagues found that losing weight through lifestyle change markedly improved the liver on biopsy, and the more weight people lost, the more the liver healed [4].

A practical sequence

The approach we use follows the biology. First, take out the fuel that fills the liver: sugar, sugary drinks, and refined grains. Build meals around protein and whole foods, and use a daily eating window so the liver spends real time in the fat-burning state. Most people see liver enzymes and triglycerides improve within weeks. Then, once weight and metabolic markers come back into a healthy range, many people can bring back whole, non-grain carbohydrates like fruit and tubers in reasonable amounts, because a metabolically healthy liver handles them well. The restriction is a tool to empty the liver, not necessarily a life sentence.

An honest word

A couple of caveats belong here. Fatty liver usually causes no symptoms until it's advanced, so it's worth checking; simple blood tests (liver enzymes and triglycerides, among the markers in our metabolic panel) and sometimes imaging tell the story. If you have advanced liver disease or take medications, make these changes with your physician, not on your own. For the common, early fatty liver that affects so many of us, though, the liver's willingness to recover is genuinely good news. We did this to ourselves, which means we can largely undo it.

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References

1. Riazi K, Azhari H, Charette JH, et al. The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2022. PMID: 35798021
2. Schwarz JM, Noworolski SM, Erkin-Cakmak A, et al. Effects of dietary fructose restriction on liver fat, de novo lipogenesis, and insulin kinetics in children with obesity. Gastroenterology. 2017. PMID: 28579536
3. Browning JD, Baker JA, Rogers T, et al. Short-term weight loss and hepatic triglyceride reduction: evidence of a metabolic advantage with dietary carbohydrate restriction. Am J Clin Nutr. 2011. PMID: 21367948
4. Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015. PMID: 25865049