Signs your liver is healing from MASLD

Last updated Sep. 3, 2024, by Lindsey Shapiro, PhD
Fact-checked by Marta Figueiredo, PhD

The liver is a remarkably resilient organ, with the ability to regenerate and heal itself when it has been damaged. For this reason, it is possible for liver injury from metabolic dysfunction-associated steatotic liver disease (MASLD), a type of fatty liver disease formerly known as nonalcoholic fatty liver disease (NAFLD), to be reversed.

Once the recovery process has begun, there may be several signs your liver is healing from fatty liver, but it is possible that only a doctor will be able to identify the change by doing clinical tests.

The more damaged the liver becomes, however, the less likely it will be able to recover entirely. So intervening early on before damage is too severe is critical.

Changes in living habits, including eating a healthy diet and exercising, are some ways to reverse the effects of the disease.

The nomenclature for fatty liver disease and its types was updated in 2023 to be more precise and avoid stigmatizing language. Fatty liver disease in general is now formally known as steatotic liver disease (SLD).

Can your liver heal itself?

The liver serves a number of important roles in the body, including helping filter toxins from the blood, regulating metabolism, and producing a digestive fluid called bile.

MASLD is a liver disease in which fat accumulates in the liver due to certain risk factors, such as being overweight or obese, type 2 diabetes (marked by high blood sugar), high blood pressure, or elevated fatty molecules in the blood (triglycerides or cholesterol).

At first, liver fat accumulation does not cause obvious problems for most people with MASLD because the liver itself has not been significantly damaged. But if fat continues to build up, it can progress to liver inflammation and scarring (fibrosis).

This can lead to a more severe condition called metabolic-associated steatohepatitis (MASH), which was previously known as nonalcoholic steatohepatitis (NASH). Eventually, cirrhosis can develop, causing permanent scarring that affects liver function and can eventually result in liver failure or liver cancer.

Not all people with MASLD will go through all of these disease stages. For those that do, progression to cirrhosis can take years to several decades. Keep in mind less than 5% of people with MASLD are estimated to develop cirrhosis over 15 years.

The liver is an organ that can regenerate damaged or lost tissue, which is why it has the ability to fight the damage and heal itself. Even when up to 90% of its original tissue is lost, the liver can regrow to a normal size, and relatively quickly, if there aren’t other intervening factors.

The process of the liver healing is not unlike the way skin heals from a cut. In response to damage or injury, hepatocytes, the main functional liver cells, divide to produce large numbers of new cells at a relatively fast rate, allowing the damaged cells to be replaced with healthy ones. However, when the damaging insult persists, as in the case of MASLD, the liver’s ability to regenerate becomes limited, with the processes that prevent formation of scar tissue going awry.

Similar to what happens with scars on the skin, when liver tissue is repaired instead of regenerated, it can no longer heal itself or function properly. That’s ultimately what leads to cirrhosis, where too much scar tissue can make it harder for the liver to perform its functions.

Treating MASLD early on gives the liver a better chance of being able to recover completely. Lifestyle changes, such as proper diet and exercise, can help to lower fat deposits in the liver, stopping the disease from getting worse and facilitating liver healing.

But while it’s possible to reverse MASLD entirely, once it has progressed to MASH, it becomes increasingly harder to revert back to an entirely healthy liver.

A person with cirrhosis may eventually require a liver transplant. In some cases, it involves a living donor giving a part of their healthy liver, which then grows to a normal size in the recipient’s body.

Signs of liver healing

How can I tell if my liver is healing? Getting a full picture of your liver health will likely involve monitoring how you feel, as well as going to the doctor for clinical tests.

When the liver is damaged, a person may experience various symptoms, including nausea, loss of appetite, weight loss, and abdominal pain and swelling. Liver damage also may result in itching and jaundice, or yellowing of the skin and white part of the eyes, due to high blood levels of bile acids and bilirubin, a yellowish byproduct of red blood cell breakdown that is incorporated into bile.

People with advanced liver disease, such as cirrhosis, also may experience changes in brain function due to toxin buildup in the blood.

As the liver recovers, those symptoms may lessen. Some signs your liver is healing itself may include:

• increased energy and less fatigue, due to better digestion and metabolism
• improved appetite and weight normalization or stabilization, also related to improved digestion, metabolism, and hormonal balance
• decreased jaundice as a consequence of the liver’s better ability to eliminate bilirubin
• less pain, associated with reduced inflammation in the liver
• reduced brain fog, or clearer thinking, due to the liver’s improved ability to clear the blood from toxins.

Still, it isn’t always easy to tell on your own whether the liver is getting better. Liver disease can progress to a substantial degree before a person can tell something’s wrong. The best way to know for sure that the liver is healing is by regularly going to the doctor. They may do a variety of tests to monitor your liver health and function.

Clinical signs your liver is healing from MASLD may include:

• normalization of liver size, which could be increased or reduced with liver damage, and reduced liver stiffness, as assessed by a physical exam
• changes toward normalization of levels of certain liver enzymes, bilirubin, and other liver damage markers on blood tests
• less fat accumulation, fibrosis, or other signs of damage on liver imaging tests.

When fatty liver occurs associated with alcohol misuse, it is considered a separate condition called alcohol-associated liver disease, which was previously known as alcoholic fatty liver disease. Signs your liver is healing from alcohol overconsumption may be similar to those seen when healing from MASLD.

How long does it take the liver to heal?

How long it takes for the liver to heal depends on the extent of the damage and the person’s overall health status.

If the liver lost more than half of its cells in the absence of an underlying disease, it could completely regenerate in a month. With MASLD, however, how quickly you see signs your liver is healing will depend on how damaged the liver was to begin with and what steps are being taken to stop the disease from progressing.

5 steps to promote liver healing

Once a person has been diagnosed with MASLD, it is important to make lifestyle changes right away that can help promote the liver’s healing. While not a guarantee that the liver will completely recover, these changes give the liver the best possible chance of healing or prevent existing damage from getting worse.

Diet

Eating a healthy diet can help relieve and possibly reverse MASLD by lowering the amount of fat stored in the body.

While there is no one specific diet recommended for managing fatty liver, experts generally agree that whole grain carbohydrates, non-starchy vegetables, healthy fats, and lean proteins can help liver health, while refined grains and sugar, starchy veggies, and saturated or trans fats should be avoided.

Staying hydrated with water and other non-sugary drinks also is important for a healthy liver.

Although MASLD is not caused by alcohol misuse, alcohol is metabolized by the liver, producing byproducts that are toxic to liver cells. This can further worsen preexisting liver inflammation and damage in people with MASLD and is why limiting alcohol intake or avoiding it altogether is recommended to help the liver heal.

The Baylor College of Medicine provides a free, in-depth dietary guide for people with MASLD. But you should always talk with their care team about what is the safest and healthiest diet for you.

Exercise

Regular exercise is another way to help the liver recover from MASLD. It can help boost metabolism, improve circulation, control blood sugar, maintain a stable weight, and lower fat liver content. Exercise has been shown to reduce inflammation and may help lower the risk of liver fibrosis or cancer.

The three main types of exercise that might help recover liver health include:

• aerobic exercise, or cardio, such as walking, swimming, or biking
• strength training, including weight lifting or pushups
• balance and coordination exercises, like yoga or tai chi.

As with diet, there is no one specific exercise routine that will work for all people, and every individual will have different abilities based on their current health status.

People with MASLD should talk with their doctors about what type of exercise is safe and likely to be most effective for them.

Weight management

The American Association for the Study of Liver Diseases recommends that overweight people with MASLD should aim to slowly and safely lose a minimum of 3%-5% of their total body weight, based on data showing that this can reduce liver fat and ease symptoms. However, the more advanced the disease is, the more weight loss may be necessary.

Each person should work with their care team to come up with an appropriate diet and exercise regimen to help you safely lose weight.

Stress management

Research suggests there is a relationship between liver disease and stress, and that excessive stress can trigger and worsen MASLD. It may be related to the release of stress hormones and other molecules that may increase appetite, reduce metabolic rate, impair liver blood flow, and lead to chronic inflammation and injury.

A 2020 study involving more than 170,000 apparently healthy adults showed that higher perceived stress was significantly associated with a greater prevalence of MASLD, particularly among men and obese participants.

Managing stress also may be a good way to keep the liver, and the rest of the body, healthy in MASLD. Stress-reducing strategies may include exercise, meditation, yoga, prayer, or other hobbies you find calming.

Medical treatment and harmful substances

In addition to the natural ways to improve liver health, disease-specific medications also may play an important role in preventing additional liver injury. 

Medications to manage MASLD-related cardiometabolic risk factors are an important part of reversing liver damage. This may include treatments to control diabetes, lower fatty molecules in the blood, and reduce blood pressure.

Given that most medications, both prescription and over the counter, are metabolized in the liver, improper or excessive usage of certain ones can worsen liver damage. People should always use prescribed medications exactly as directed by their doctor, avoid mixing any medication with alcohol, and talk with their healthcare providers about any nonprescription medications or supplements they use.

Avoiding substances, including legal or illicit ones, that may cause liver damage will help with liver detox and make the liver better able to heal itself. It may include quitting smoking, as nicotine is known to damage the liver. The National Institutes of Health has a database of substances, including medications, illegal drugs, and herbal and dietary supplements, that are toxic to the liver.

Lifestyle changes to promote long-term liver health

To maintain a healthy liver and prevent MASLD from coming back or getting worse, it’s important to maintain a healthy lifestyle — not just until you see signs your fatty liver is healing.

Changes a person might have made to promote liver health should be continued throughout life, including eating a diet that is best for liver health, being active, and avoiding direct contact with toxins.

It also is recommended people with MASLD adopt strategies to prevent hepatitis A, B, and C, as these viral infections cause liver inflammation that can lead to further organ damage. Preventive strategies include getting vaccinated against hepatitis A and B, practicing safe sex, avoiding sharing needles, and regularly washing your hands.

Adopting a healthy lifestyle that can prevent damage to the liver can have a wide range of health benefits, such as preventing cardiovascular and kidney disease, which people with MASLD have a higher risk of developing.

If a person has been diagnosed with MASLD, they should have their liver checked regularly, even if the disease is under control or reversed, so that doctors are able to identify any problems and intervene right away.

Liver Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.