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Liver Disease (Fatty Liver, Cirrhosis & More)

Fatty liver disease — now called MASLD — affects about 1 in 4 U.S. adults and usually causes no symptoms. The main treatments are gradual weight loss, no alcohol and careful use of medicines and supplements — plus, for some people with MASH and liver scarring, two newer FDA-approved medicines.

Call 911 or go to an emergency room for any of these:

Your liver and what can go wrong

Your liver helps digest food, stores energy and removes harmful substances. Liver disease can come from viruses, alcohol, fat build-up, medicines and poisons, inherited conditions and cancer. Often there are no symptoms; when there are, they can include a swollen belly and legs, easy bruising, changed urine or stool color, and yellow skin and eyes (jaundice) (MedlinePlus). In the U.S., chronic liver disease and cirrhosis caused 52,274 deaths in 2024, the ninth leading cause of death (CDC).

Hepatitis A, B and C have their own guide — see Hepatitis.

Fatty liver disease: MASLD and MASH

The names have changed. What used to be called nonalcoholic fatty liver disease (NAFLD) is now also called metabolic dysfunction-associated steatotic liver disease (MASLD): extra fat builds up in the liver, and it isn’t caused by heavy drinking. Its more serious form, once called NASH, is now metabolic dysfunction-associated steatohepatitis (MASH) — fat plus inflammation and liver damage, which can cause scarring (fibrosis), cirrhosis and liver cancer (NIDDK). Most people have the milder form, which usually doesn’t progress (NIDDK).

  • How common: experts estimate about 24% of U.S. adults have it and about 1.5%–6.5% have the inflamed form. Close to 10% of U.S. children aged 2–19 may have it too (NIDDK). MedlinePlus calls it the most common long-term liver disease (MedlinePlus).
  • Links to weight and diabetes: studies suggest one-third to two-thirds of people with type 2 diabetes have it, as do up to 75% of people with overweight and more than 90% of people with severe obesity (NIDDK). High triglycerides, abnormal cholesterol, high blood pressure, a large waist and metabolic syndrome raise the chance too (NIDDK). See our Diabetes and Cholesterol guides; MBHA plans a separate Weight Control guide.
  • Symptoms: usually none, even with cirrhosis; some people feel tired or have upper-right belly discomfort (NIDDK). Heart disease is the most common cause of death in people with it (NIDDK).

Alcohol-related liver disease

Alcohol-related (or alcohol-associated) liver disease is liver damage from drinking too much over a long time. It has three stages: fatty liver, which can usually recover if you stop drinking; alcohol-related hepatitis, where the liver is swollen and damaged; and cirrhosis, where the scarring usually can’t be reversed. It develops faster, and at lower drinking levels, in women (NHS), and a person can have both alcohol-related and metabolic fatty liver (NIDDK). CDC estimates that excessive drinking causes about 178,000 U.S. deaths a year, about two-thirds of them from long-term conditions that include liver disease (CDC).

Cirrhosis: symptoms and complications

Cirrhosis means the liver is scarred and permanently damaged; scar tissue replaces healthy tissue and partly blocks blood flow through the liver. About 1 in 400 U.S. adults have it, probably more, because many people don’t know (NIDDK). The most common causes are alcohol, fatty liver disease, and chronic hepatitis B or C (NIDDK).

  • Symptoms: early on, tiredness, itching, poor appetite, weight loss, nausea and muscle loss; later, easy bruising and bleeding, confusion, swollen legs and belly, dark urine and jaundice (NIDDK).
  • Complications come largely from high pressure in the vein that carries blood to the liver (portal hypertension): fluid in the belly (ascites), which can become infected; swollen veins (varices) that can burst and bleed; and confusion from toxins reaching the brain (hepatic encephalopathy). It also raises the risk of infections, liver cancer, liver failure, weak bones, falls and sensitivity to medicines (NIDDK).

Many people with cirrhosis feel well and live for many years (NHS). Nothing makes the scar tissue disappear, but treating the cause can keep it from getting worse (MedlinePlus).

Liver cancer, briefly

Most people who develop liver cancer already have cirrhosis (NIDDK). Other risks include hepatitis B or C, alcohol, obesity, fatty liver, diabetes, smoking and hemochromatosis. Early on it often has no symptoms; later it can cause a lump or discomfort on the upper right side, a swollen belly, jaundice and weight loss (CDC). See our Cancer guide for cancer care and support.

Hemochromatosis, briefly

In hemochromatosis the body absorbs and stores too much iron, which can damage the liver, heart, pancreas, joints and glands (NIDDK). About 1 in 225 people of Northern European ancestry carry two copies of the gene change that puts them at risk (NIDDK). Symptoms can include tiredness, joint pain, weakness and weight loss (MedlinePlus), and, untreated, it can lead to cirrhosis, liver cancer and diabetes. Found and treated early, it doesn’t shorten life; if a parent or sibling has it, ask about testing (NHS). Treatment is usually removing blood on a regular schedule (NIDDK). MBHA plans a separate Pancreas guide.

Liver injury from medicines and supplements

Acetaminophen (Tylenol, also called paracetamol) is in more than 600 prescription and over-the-counter medicines. Taken correctly it is safe and effective, but too much can cause severe liver damage, sometimes needing a transplant or causing death — a risk that rises when people take more than one product containing it (FDA). Long-term use of certain other medicines can also cause cirrhosis (NIDDK).

Herbs and supplements can injure the liver too, and such cases are being reported more often (NCCIH) — see Herbal medicine below.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Gradual weight loss for fatty liver; diabetes, cholesterol and blood pressure care; resmetirom (Rezdiffra) or semaglutide (Wegovy) for MASH with moderate to advanced scarring; stopping alcohol with treatment for alcohol use disorder; cirrhosis care including checks for varices and liver cancer; hepatitis A and B vaccines; transplant for liver failure. Hepatitis B vaccine: $0 under Medicare Part B for people who qualify, if the provider accepts assignment; Marketplace plans cover recommended adult vaccines without a copay in-network. Medicines, scans and transplant: cost estimate being researched. Losing 3%–5% of body weight can reduce liver fat; 7%–10% may be needed to reduce inflammation and scarring. Early alcohol-related liver damage can often recover after stopping drinking. Cirrhosis can’t be reversed, but treating its cause can slow it.
Chiropractic No role in preventing or treating liver disease. Not applicable. We found little research on chiropractic for liver disease. Check any supplement a chiropractor suggests with your doctor first.
Acupuncture No role in treating liver disease. Small trials, mostly from China, have studied it for fatty liver. Not applicable. We found little high-quality research. Reviews call for larger, better-designed trials before any conclusions. Insist on sterile, single-use needles.
Herbal medicine No herb or supplement is proven to treat liver disease. Milk thistle hasn’t shown a benefit; some products, including kava, green tea extract and concentrated turmeric, have been linked to liver injury. Cost estimate being researched. Supplements are a growing cause of liver injury. Show every product to your doctor or pharmacist before taking it, especially if you have cirrhosis.
Massage therapy No role in treating liver disease; relaxation only. Not applicable. May help you relax. Cirrhosis can make you bruise or bleed easily, so tell your therapist and ask for gentle pressure.
MBHA Wellness Coach Gradual weight loss, Mediterranean-style eating, regular exercise, cutting out alcohol, a medicine and supplement review, following acetaminophen label directions, keeping up with vaccines and diabetes care. Cost estimate being researched. Daily habits are the main treatment for fatty liver. A coach supports — never replaces — your medical care.

Approach 1 of 6

Conventional medicine (AMA)

Treatment depends on the cause. Doctors do not have a treatment that cures cirrhosis or reverses its scarring, but treating the cause can prevent or slow liver damage, and treating complications can help prevent liver failure (NIDDK).

Fatty liver disease (MASLD and MASH)

  • Weight loss is the main treatment. If you have overweight or obesity, losing at least 3%–5% of your body weight can reduce fat in the liver, and you may need to lose up to 7%–10% to reduce inflammation and scarring. Physical activity helps even without weight loss. Lose weight gradually: rapid weight loss and malnutrition can make liver disease worse (NIDDK). For some people, doctors add weight-loss medicines or surgery (NIDDK, NHS).
  • Diabetes, cholesterol and blood pressure care. These conditions travel with fatty liver, and heart disease is its most common cause of death (NIDDK). See Diabetes and Cholesterol.

New medicines for MASH

Older NIDDK and MedlinePlus pages still say no medicine is approved for fatty liver disease (NIDDK, MedlinePlus); those pages predate two FDA decisions.

  • Resmetirom (Rezdiffra). On March 14, 2024, FDA approved it as the first treatment for adults with MASH (then called NASH) who have moderate to advanced liver scarring but not cirrhosis, used along with diet and exercise. After 12 months in a trial, more people taking it than placebo had their MASH resolve or their scarring improve. The most common side effects were diarrhea and nausea; warnings include liver injury and gallbladder problems, it should be avoided in advanced (decompensated) cirrhosis, and it can interact with other drugs, especially statins. It was approved under FDA’s accelerated pathway, so an ongoing 54-month study must still confirm its clinical benefit (FDA, Rezdiffra label).
  • Semaglutide (Wegovy). The FDA-approved label for Wegovy injection, a GLP-1 medicine also used for weight loss, now also covers adults with MASH and moderate to advanced scarring without cirrhosis, also under accelerated approval (Wegovy label).

Neither replaces healthy eating and exercise. Ask your doctor whether either is right for you.

Alcohol-related liver disease

Doctors recommend stopping alcohol completely and may refer you for alcohol treatment (NIDDK); this matters at every stage (NHS). Treatment for alcohol use disorder can include counseling such as cognitive behavioral therapy, medicines approved to help people stop or cut back, and mutual-support groups such as AA; a primary care provider is a good first step, and NIAAA’s Alcohol Treatment Navigator helps you find care (NIAAA).

Don’t stop heavy drinking suddenly on your own. Withdrawal can be painful or even life-threatening; get medical help to plan a safe stop (NIAAA, NHS).

Cirrhosis care

Vaccines

People with cirrhosis are advised to get vaccines for hepatitis A, hepatitis B, flu, pneumococcal pneumonia and shingles, and a hepatitis C test (NIDDK). CDC recommends the hepatitis A vaccine for people with chronic liver disease, who are more likely to have severe complications from it (CDC), and the hepatitis B vaccine for all adults 19–59 and for older adults with risk factors (CDC).

Liver transplant

When cirrhosis leads to liver failure, the only treatment is a transplant (NIDDK); afterward you take anti-rejection medicines for life (NIDDK).

What it costs

  • Medicare Part B pays in full for hepatitis B vaccines for people who qualify, if the provider accepts assignment (Medicare.gov).
  • Marketplace and many other plans must cover recommended adult vaccines, including hepatitis A and B, without a copay in-network (HealthCare.gov).
  • Prices for Rezdiffra, Wegovy, elastography, liver tests and transplant: cost estimate being researched.

How well it works — what to expect

Losing weight can switch MASH back to simple fatty liver, and regaining weight can switch it back again (NIDDK). With alcohol-related disease, the liver can often recover from early damage if you stop drinking (NHS). Cirrhosis can’t be cured, but treatment can slow it or stop it getting worse (NHS).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic has no role in preventing or treating liver disease. Most people who use it do so for pain (NCCIH), and we found little research on chiropractic for liver conditions. If you see a chiropractor for back or neck pain, tell them about your liver condition and check any supplement they suggest with your doctor first — some herbal remedies can damage the liver (NIDDK). Pain in the upper right belly should be checked by a medical doctor; it can come from the liver (NIDDK) or the gallbladder (see Gallbladder).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture has no established role in treating liver disease. Many of the studies we found on fatty liver were study plans (protocols), animal studies or reports from China. A 2021 review of eight trials said acupuncture may help but called for better studies because of poor quality and small numbers (Chen et al., 2021). A 2025 review of 30 trials reported better liver tests and lipids but said current evidence is insufficient and the findings need large, rigorous trials (Liu et al., 2025). Don’t use acupuncture in place of weight loss, alcohol treatment or medical care.

Sterile, single-use needles only. FDA requires acupuncture needles to be sterile and labeled for single use; complications have come from nonsterile needles and poor technique (NCCIH). This matters more if cirrhosis makes you bleed easily (NIDDK). See also our Hepatitis guide.

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

Read this first. Supplements can injure the liver. Sudden liver damage from supplements is still rare but reported more often, and it can be severe enough to need an emergency liver transplant (NCCIH). In the U.S. Drug-Induced Liver Injury Network, herbs and supplements went from 7% to 20% of cases between 2004 and 2013, and injuries from non-bodybuilding products led to death or transplant more often than those from medicines (Navarro et al., 2014). NIDDK advises talking with your doctor before any supplement if you have fatty liver disease or cirrhosis (NIDDK, NIDDK).

Milk thistle (silymarin)

Milk thistle is promoted for liver problems, but trials for alcohol-related liver disease, hepatitis and fatty liver have been conflicting or too limited to draw conclusions, and two NCCIH-funded trials — including one in people with the inflamed form of fatty liver — showed no benefit (NCCIH).

Products linked to liver injury

  • Kava: rare cases of liver injury, some serious or fatal (NCCIH).
  • Green tea extract tablets or capsules: uncommon liver injury, especially in people with a certain gene variant (NCCIH).
  • Turmeric or curcumin in “highly bioavailable” forms: liver damage has been reported. Studies of turmeric for fatty liver haven’t shown whether it helps. Stop it and call your provider if you notice tiredness, nausea, poor appetite, dark urine or jaundice (NCCIH).
  • Other botanicals often reported in liver injury include Garcinia cambogia, black cohosh, red yeast rice and ashwagandha; an estimated 15.6 million U.S. adults used at least one of six such products in a month (Likhitsup et al., 2024).
  • Iron and vitamin C supplements should be avoided if you have hemochromatosis (NIDDK), and high daily doses of vitamin A are a less common cause of cirrhosis (NIDDK).

What about coffee?

Coffee is a drink, not a supplement, and the research is observational: it shows a link, not cause and effect. A 2016 review of nine studies found that people who drank more coffee had a lower risk of cirrhosis (Kennedy et al., 2016), and a 2017 review of long-term studies found lower risks of liver cancer and chronic liver disease among coffee drinkers (Bravi et al., 2017). Coffee drinkers may differ in other ways, so these studies can’t prove coffee protects the liver. If you enjoy coffee, ask your doctor whether it fits your health; don’t take coffee-extract pills in its place.

Show the label of any herb, vitamin or supplement to your doctor or pharmacist before you take it. We don’t list doses here.

What it costs

Cost estimate being researched.

Approach 5 of 6

Massage therapy

Massage doesn’t treat liver disease, but a gentle massage may help you relax. The risk of harm appears low; rare serious problems such as blood clots, nerve injury or fractures have mostly involved vigorous methods like deep tissue massage or people at higher risk of injury (NCCIH). Cirrhosis can make you bruise or bleed easily and raise the risk of weak bones and falls (NIDDK), so tell your therapist about your liver condition, ask for gentle pressure, and avoid deep pressure on a swollen belly. We found little research on massage for liver disease.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

For fatty liver disease, daily habits are the treatment. An MBHA Wellness Coach helps you build them — alongside your medical care, never instead of it.

Lose weight gradually

Healthy food choices, smaller portions and physical activity can improve fatty liver, and slow, steady weight loss is safer than rapid loss (NIDDK). Your coach can help you set realistic goals. MBHA plans a separate Weight Control guide.

Mediterranean-style eating

NIDDK suggests swapping saturated and trans fats for unsaturated fats, choosing more fruits, vegetables and whole grains, and avoiding sugary drinks such as soda, sports drinks, sweetened tea and juice (NIDDK). Mediterranean-style eating has also been studied: a 2022 review found it lowered a liver enzyme and liver stiffness in people with fatty liver, though the data were limited and cutting calories remained the cornerstone (Haigh et al., 2022). If you have cirrhosis, your needs are different — follow your dietitian, and avoid raw or undercooked shellfish, fish and meat and unpasteurized milk (NIDDK).

Move more

NHS suggests at least 150 minutes of exercise a week for fatty liver (NHS), and exercise helps reduce liver fat (MedlinePlus).

Alcohol

If you have fatty liver disease, keep alcohol to a minimum (NIDDK); if you have cirrhosis or alcohol-related liver disease, stop completely (NIDDK). CDC says people with some liver diseases shouldn’t drink at all, and that even moderate drinking carries health risks (CDC). Your liver can process only small amounts (CDC). Your coach can help you cut back, find support and connect with treatment — with your doctor’s help if you drink heavily (NIAAA).

Medicine safety

  • Acetaminophen: follow the label. Check the Drug Facts label of every product for acetaminophen (sometimes shortened to APAP), don’t take two products that both contain it, and talk with your health care professional first if you have liver disease or drink three or more alcoholic drinks a day (FDA).
  • If you have cirrhosis, ask your doctor before taking any prescription or over-the-counter medicine, including pain relievers such as NSAIDs and sleep aids, and any supplement (NIDDK).
  • Keep a written list of all medicines, vitamins and supplements you take and bring it to every visit (MedlinePlus). Your coach can help you build it.

Vaccines and diabetes control

Ask about vaccines for hepatitis A and B, flu and pneumococcal disease (MedlinePlus). If you have diabetes, keeping it under control is part of protecting your liver — see our Diabetes guide. Your coach can help you keep track of appointments, shots and blood tests.

Another approach

Common liver conditions at a glance

Main types of liver disease covered in this guide
ConditionMain causeMain treatment
MASLD (fatty liver)Fat build-up linked to obesity, type 2 diabetes and metabolic syndromeGradual weight loss, activity, managing related conditions
MASHFatty liver with inflammation and damageWeight loss; resmetirom or semaglutide for moderate to advanced scarring without cirrhosis
Alcohol-related liver diseaseDrinking too much over a long timeStopping alcohol completely, with treatment for alcohol use disorder
CirrhosisLong-term damage from alcohol, fatty liver, hepatitis B or C and other causesTreating the cause and complications; transplant for liver failure
HemochromatosisInherited iron overloadRegular blood removal

Sources: NIDDK, NIDDK, FDA, Wegovy label, NHS, NIDDK, NIDDK.

Another approach

How liver disease is diagnosed

Because liver disease is often silent, it is usually found when a routine blood test or scan done for another reason looks abnormal (NHS). Your doctor will ask about alcohol, medicines, supplements and family history, and examine you for signs such as an enlarged liver, jaundice or swelling (NIDDK).

  • Liver blood tests (a liver panel) measure enzymes such as ALT and AST, plus bilirubin, albumin and clotting time. They can show inflammation or damage but usually can’t name the cause on their own. Testing may be advised even without symptoms if you have obesity, diabetes, alcohol use disorder or a family history of liver disease (MedlinePlus).
  • FIB-4 and APRI scores are calculated from routine blood test results and help doctors identify or rule out advanced scarring (NIDDK).
  • Imaging — ultrasound, CT or MRI — can show fat in the liver but not inflammation or scarring (NIDDK).
  • Elastography (including transient elastography, often called FibroScan, and MR elastography) measures liver stiffness, a sign of scarring. It can find scarring early, before symptoms, and can sometimes be used instead of a biopsy (MedlinePlus).
  • Liver biopsy is the only test that can prove MASH and show how severe it is, but it isn’t needed for everyone (NIDDK).
  • Other blood tests look for hepatitis B or C, autoimmune liver disease (NIDDK) and iron overload (NIDDK).

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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