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30% of Americans Have Fatty Liver Disease

Fatty Liver

By: Dr. Joseph Mercola

It’s the most common chronic liver disease, and globally, about 25% of adults have it. If alcohol were factored in, the prevalence would be even higher.

30% of Americans Have Fatty Liver Disease


  • In the U.S., an estimated 30% of adults have nonalcoholic fatty liver disease (NAFLD), the most common chronic liver disease.
  • In people with obesity, up to 90% have NAFLD, as do up to 75% of those who are overweight and 50% of people with diabetes.
  • Even 10% of U.S. children are suffering from NAFLD.
  • The high rates of NAFLD are likely related to the increased intake of toxic industrially processed seed oils and environmental pollutants like glyphosate and PFAS.
  • Lifestyle factors such as diet and exercise play important roles in exacerbating, as well as reducing, your chances of developing NAFLD.

In the U.S., an estimated 30% of adults have nonalcoholic fatty liver disease (NAFLD), the most common chronic liver disease.1 Globally, about 25% of adults are affected.2 These numbers only account for the buildup of excess fat in your liver that is not related to heavy alcohol use. If alcoholic liver disease were also factored in, the prevalence would be even higher.

Further, in people with obesity, up to 90% have NAFLD, as do up to 75% of those who are overweight3 and 50% of people with diabetes.4 Even 10% of U.S. children are suffering from NAFLD.5

Lifestyle factors such as diet, exercise, weight, and smoking all play important roles in exacerbating (as well as reducing) your chances of developing some form of liver disease. Obesity and other signs of metabolic dysfunction, including high blood pressure, insulin resistance, and elevated triglycerides, are also linked to NAFLD.6

Left unchecked, it’s estimated that 100 million people in the U.S. alone will develop NAFLD by 2030.7 There are many steps you can take to reduce your risk, however, so you don’t end up as one of them.

What Is NAFLD?

NAFLD describes excess fat buildup in your liver. Without proper treatment, NAFLD can lead to serious liver problems, including nonalcoholic steatohepatitis (NASH), which causes inflammation and fibrosis or scarring of the liver. NASH may lead to cirrhosis, which increases the risk of liver cancer and end-stage liver disease.8

However, NAFLD also increases the risk of other health conditions, including cardiovascular disease, which is the No. 1 cause of death in people with NAFLD.9 NAFLD often has no symptoms, although it may cause fatigue, jaundice, swelling in the legs and abdomen, mental confusion, and more.

Your liver, as the largest solid organ in your body, carries out more than 500 essential functions to your health.10 This includes the production of bile, which breaks down fats and carries away waste, converting excess glucose into glycogen and regulating amino acids in the blood. It’s also important for detoxification, helping to clear your blood of toxins, and regulating blood clotting, among other functions.11

Fortunately, your liver, more than almost any other tissue in your body, has phenomenal regeneration capabilities. Even if 90% of it has been removed, it can regrow to its normal size.12 Along these lines, NAFLD can often be reversed in its early stages via lifestyle changes, like healthy eating and exercising.

NAFLD’s Dietary Connections

The high rates of NAFLD are most likely related to the increased intake of toxic industrially processed seed oils, often referred to as “vegetable oils.” Examples of seed oils high in omega-6 polyunsaturated fatty acids (PUFAs) include soybean, cottonseed, sunflower, rapeseed (canola), corn, and safflower.13

Eating seed oils high in the omega-6 PUFA linoleic acid (LA) contributes to low-grade inflammation, oxidative stress, endothelial dysfunction, and atherosclerosis.14 As researchers noted in the journal Nutrients, “In addition, a few studies suggested that omega-6 PUFA is related to chronic inflammatory diseases such as obesity, nonalcoholic fatty liver disease, and cardiovascular disease.”15

In order to avoid LA, you’ll need to avoid eating processed foods, fast foods, and most restaurant foods and focus on real food instead. Fatty liver can also be driven by excess sugar when, in addition to seed oils, you consume more than 35% of your calories as fat. This is likely why this condition is now found even in young children.

Choline’s Role in NAFLD

Choline, an essential nutrient, is also important for normal liver function and liver health. Choline plays a role in maintaining membrane integrity and managing cholesterol metabolism, including low-density lipoproteins (LDL) and very low-density lipoproteins (VLDL), helping to move fat out of your liver.16 17

By enhancing the secretion of VLDL in your liver, required to safely transport fat out, choline may protect your liver health.18 Further, choline deficiency may lead to abnormal fat deposits in your liver, causing NAFLD.19

An estimated 90% of the U.S. population is deficient in choline.20 You can increase your intake by consuming more choline-rich foods, such as organic pastured egg yolks, grass-fed beef liver, wild-caught Alaskan salmon, and krill oil. Arugula is also an excellent source.

In fact, some experts believe NAFLD is largely the result of shunning choline-rich foods like liver and egg yolks, which is then worsened by consuming too much linoleic acid. As noted by Chris Masterjohn, who has a Ph.D. in nutritional science:21

“After studying the relevant literature and tracing it much further back in time than anyone else ever bothers to, I’ve come to the conclusion that neither fat nor sugar nor booze are the master criminals here. Rather, these mischievous dudes are just the lackeys of the head honcho, choline deficiency. That’s right, folks, it’s the disappearance of liver and egg yolks from the American diet that takes most of the blame.

More specifically, I currently believe that dietary fat, whether saturated or unsaturated and anything that the liver likes to turn into fat, like fructose and ethanol, will promote the accumulation of fat as long as we don’t get enough choline. Once that fat accumulates, the critical factor igniting an inflammatory fire to this fat is the consumption of too much PUFA (polyunsaturated fat from vegetable and perhaps fish oils).”

Environmental Pollution Plays a Role

Exposure to pollutants that act as endocrine and metabolic disruptors is another contributing factor in rising rates of NAFLD. Persistent organic pollutants (POPs), endocrine-disrupting chemicals (EDCs), heavy metals, and micro- and nanoplastics have all been implicated in both the development and progression of NAFLD.22

Glyphosate, the active ingredient in Roundup herbicide, is one particularly pernicious toxin to your liver. As more and more glyphosate has been sprayed on agricultural lands, parks and backyards, entering our food and water supplies, NAFLD rates have trended upward.23

Further, when researchers from the University of California (UC) San Diego School of Medicine analyzed urine samples from 93 patients who had been diagnosed with NAFLD, those with the more severe form, NASH, had significantly higher residues of glyphosate in their urine.24 This association held true regardless of other factors in liver health, such as body mass index, diabetes status, age or race.

In a UC San Diego news release, lead study author Paul J. Mills, Ph.D., explained, “There have been a handful of studies, all of which we cited in our paper, where animals either were or weren’t fed Roundup or glyphosate directly, and they all point to the same thing: the development of liver pathology … The increasing levels [of glyphosate] in people’s urine very much correlates to the consumption of Roundup-treated crops into our diet.”25

Researchers from King’s College London also showed an “ultra-low dose” of glyphosate-based herbicides was damaging.26 After a two-year period, female rats showed signs of liver damage, specifically NAFLD, and progression to NASH. The authors noted that glyphosate may bring about toxic effects via different mechanisms, depending on the level of exposure, including possibly mimicking estrogen and interfering with mitochondrial and enzyme function.

CoQ10, organ meats, blood pressure

PFAS Linked to Fatty Liver

PFAS are endocrine-disrupting chemicals that accumulate in body tissues, such as the liver and are also known to accelerate metabolic changes that lead to fatty liver. “This bioaccumulation,” researchers wrote in Environmental Health Perspectives, “coupled with the long half-lives of many PFAS, leads to concern about the potential for PFAS to disrupt liver homeostasis should they continue to accumulate in human tissue even if industrial use is abated.”27

The researchers from the Keck School of Medicine of USC conducted a systematic review and meta-analysis, yielding 85 rodent studies and 24 epidemiological studies. Four types of PFAS — PFOS, PFOA, perfluorohexanesulfonic acid (PFHxS), and perfluorononanoic acid (PFNA) — accounted for most known human exposure.

The study compared PFAS exposure to indicators of liver injury, including serum alanine aminotransferase (ALT), NAFLD, NASH, or steatosis, a fat buildup in the liver. A meta-analysis of the human studies showed that higher ALT levels were associated with exposure to PFOA, PFOS, and PFNA.

In addition to promoting liver inflammation and the accumulation of triglycerides, exposure to PFAS may also lead to reduced choline bioavailability, triggering steatosis due to choline deficiency.28 Grease-resistant to-go containers, papers, and wrappers often contain PFAS; this includes fast food containers and wrappers, microwave popcorn bags, pizza boxes, and candy wrappers.

You can also be exposed to PFAS via contaminated drinking water and soil, as well as via exposure to consumer products that contain PFAS, including nonstick cookware, stain-resistant clothing and upholstery, cleaning products, and personal care products.

Tips for Liver Health

The single most important step to protecting your liver health is lowering your seed oil content as much as possible. Please review the comprehensive article and video on LA I posted earlier this year. Limiting alcohol and environmental pollutants like glyphosate and PFAS is also important, but be sure to add in choline-rich foods like pastured egg yolks, which are known to support liver health.

Vitamin B12 and folic acid may also be protective and have been found to decrease the progression of NASH.29 Niacinamide, also known as nicotinamide (NAM), is another option. It’s a precursor to nicotinamide adenine dinucleotide (NAD+), a vital signaling molecule that’s believed to play an important role in longevity. However, supplementation with NAM has also been found to decrease oxidative stress and prevent fatty liver.30

N-acetylcysteine (NAC), a precursor needed for glutathione biosynthesis, is another liver-supportive agent to be aware of. NAC is used as an antidote for acetaminophen toxicity,31 which causes liver damage by depleting glutathione. Research published in Hepatitis Monthly has shown NAC supplementation helps improve liver function in patients with NAFLD.32 Adding 5 to 15 grams per day of the amino acid glycine would also be useful.

Another option is milk thistle, which contains silymarin and silybin, antioxidants that are known to help protect your liver from toxins and even help regenerate liver cells.33 Supplements should always be used in combination with living a healthy lifestyle, including eating right and exercising. If you’re overweight, losing 7% to 10% of your body weight can improve NAFLD, including lowering liver fat content, liver inflammation, and fibrosis.34

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Disclaimer: The entire contents of this article are based upon the opinions of Dr. Mercola unless otherwise noted. Individual articles are based upon the opinions of the respective author, who retains copyright as marked.

The information in this article is not intended to replace a one-on-one relationship with a qualified healthcare professional and is not intended as medical advice. It is intended to share knowledge and information from the research and experience of Dr. Mercola and his community. Dr. Mercola encourages you to make your own healthcare decisions based on your research and in partnership with a qualified healthcare professional. 

If you are pregnant, nursing, taking medication, or have a medical condition, consult your healthcare professional before using products based on this content.

Dr. Mercola

Dr. Joseph Mercola is a physician and New York Times best-selling author.

He was voted the 2009 Ultimate Wellness Game Changer by the Huffington Post and has been featured in several national media outlets including Time magazine, LA Times, CNN, Fox News, ABC News, the Today Show and The Dr. Oz Show.

His mission is to transform the traditional medical paradigm in the United States into one in which the root cause of disease is treated, rather than the symptoms.

In addition, he aims to expose corporate and government fraud and mass media hype that often sends people down an unhealthy path.


  1. PLOS One March 27, 2017
  2. Nutrients. 2023 May; 15(10): 2323
  3. National Institute of Diabetes and Digestive and Kidney Diseases, NAFLD, Definition & Facts
  4. PLOS One March 27, 2017
  5. National Institute of Diabetes and Digestive and Kidney Diseases, NAFLD, Definition & Facts
  6. The Washington Post May 22, 2023
  7. The Washington Post May 22, 2023
  8. Environmental Health Perspectives April 27, 2022, Intro
  9. National Institute of Diabetes and Digestive and Kidney Diseases, NAFLD, Definition & Facts
  10. Johns Hopkins. Liver: Anatomy and Functions
  11. Johns Hopkins. Liver: Anatomy and Functions
  12. National Institutes of Health March 9, 2021
  13. Int J Mol Sci. 2020 Feb; 21(3): 741
  14. BMJ Open Heart 2018;5:e000946. doi: 10.1136/openhrt-2018-000946
  15. Nutrients 2020, 12(11), 3365; doi: 10.3390/nu12113365
  16. The Choline Council, Facts About Choline and NAFLD
  17. Fatty Liver Diet Guide 2012-2015
  18. Veterinary Journal, 2008;176(1):10
  19. Oregon State University Linus Pauling Institute
  20. Nutr Rev. 2009 Nov; 67(11):615-23
  21. November 23, 2010
  22. Nutrients. 2023 May; 15(10): 2335
  23. World J Gastroenterol. 2017 Dec 21; 23(47): 8263–8276
  24. Clin Gastroenterol Hepatol. 2019 Apr 4
  25. UC San Diego Health May 14, 2019
  26. Scientific Reports January 9, 2017
  27. Environmental Health Perspectives April 27, 2022
  28. Environmental Health Perspectives April 27, 2022
  29. Journal of Hepatology, 2022; doi: 10.1016/j.hep.2022.06.033
  30. The Journal of Nutritional Biochemistry May 21, 2022
  31. Front. Pharmacol., 10 August 2022
  32. Hepatitis Monthly, 2010; 10(1):12
  33. Indian J Biochem Biophys. 2006 Oct;43(5):306-11
  34. Curr Obes Rep. 2019 Sep; 8(3): 220–228