Rising Liver Disease Cases Demand Immediate Attention, Experts Warn

• Older adults with diabetes or obesity are most affected — The study highlighted that MASH with moderate to advanced fibrosis is particularly common in people over age 50 and those living with Type 2 diabetes or obesity.

In these groups, the disease often advances without noticeable symptoms, leading to missed opportunities for prevention. By the time these individuals receive a diagnosis — often triggered by unrelated imaging or advanced symptoms — the window for full recovery has usually closed.

• Current diagnostic systems are outdated and missing early-stage disease — Right now, liver disease is often diagnosed using liver enzymes like alanine aminotransferase (ALT) and aspartate aminotransferase (AST), but the cutoffs are too high and outdated.

According to the paper, many labs still use upper limits that miss early fibrosis. The researchers suggested lowering the thresholds to align with more modern standards of ALT greater than 33 IU/L for men and greater than 25 IU/L for women.

However, in my interview with Dr. Bryan Walsh, a naturopathic physician extensively trained in molecular biological pathways and an associate professor at the University of Western States, he explains that the medical literature "very clearly show that, a) men and women should have a different AST and ALT reference range, and b), [the ideal range] is not much above 20 U/L."

• Primary care providers are missing clear opportunities to screen — People with cardiometabolic diseases, including prediabetes, obesity, and Type 2 diabetes, typically have frequent doctor visits, which represent missed chances to test for liver fibrosis. The paper recommends using these visits to incorporate routine screening tools into electronic health records. The goal is to make liver checks as common as blood pressure, cholesterol, or A1C testing.

• Fibrosis silently progresses due to chronic metabolic dysfunction — The researchers explained that chronic inflammation caused by insulin resistance, toxic fat buildup, and oxidative stress leads to scar tissue forming in the liver. Over time, this scarring disrupts blood flow, stiffens tissue, and triggers a cascade of dysfunction that affects your entire body, from your metabolism to your immune system.

• The earlier fibrosis is found, the more reversible it is — Fibrosis at the minimal scarring stage can often be reversed through diet, lifestyle, and targeted therapies if caught in time. But once fibrosis progresses beyond this point, reversing the damage becomes far more difficult, even with aggressive treatment. Early detection isn't just helpful — it's necessary for meaningful recovery.

• Patients delay or avoid care because of shame tied to the disease label — Researchers found that patients with liver conditions often experience guilt, internalized shame, and discrimination from health care providers and insurers, especially when their disease is linked to alcohol. Even people with metabolic liver conditions like MASH, who don't drink heavily or at all, often fear judgment and delay seeking help. This contributes to late-stage diagnoses and reduced survival.

• Language influences medical bias, policy, and treatment decisions — The paper showed that stigmatizing language has real consequences in care delivery. People with liver disease often receive worse care, are deprioritized for transplants, and face lower-quality pain management simply due to the perceived behavioral causes of their illness. This bias also extends into health care funding and policy, reinforcing a cycle of neglect.

• Reframing liver disease in human terms helps improve outcomes — Instead of labels like "alcoholic" or "fatty liver," the authors recommend phrases like "person with steatotic liver disease" or "individual managing MASH." These terms reduce identity-based judgment and shift the focus toward solutions and support. Just as cancer and mental health advocacy have benefited from reframing language, liver care should follow the same path.

• The researchers called for broad changes in global disease classification systems — According to the paper, global coding systems like the International Classification of Diseases still use outdated and stigmatizing terms, reinforcing harm at every level of care. By updating these systems to reflect person-first, nonjudgmental language, health care providers could help increase early screening, reduce treatment delays, and improve survival rates.

• Patients typically remain undiagnosed until severe symptoms appear — Researchers noted that early signs, like fatigue, mild abdominal discomfort, or bloating, are either too vague or too easily dismissed, both by patients and providers. This is especially dangerous for people with underlying metabolic conditions, such as insulin resistance or obesity, who are already at higher risk.

• Common liver disease triggers were categorized into four main types — The review grouped liver disease into four overlapping causes: alcohol use, hepatitis viruses, fatty liver related to metabolic dysfunction, and autoimmune or genetic disorders. In real life, many of these overlap. A person might have mild alcohol intake and also be overweight or diabetic, which accelerates progression. This complexity is part of why the disease goes undetected — it doesn't follow one clear path or profile.

• Researchers identified the biggest diagnostic blind spots in clinical care — Despite known risk factors, physicians rarely screen for liver fibrosis unless liver enzymes are elevated or symptoms appear. But, as mentioned, liver enzyme tests are often normal in the early stages, so fibrosis silently continues. The review emphasized that relying on enzymes alone is a flawed approach. Noninvasive imaging and biomarker tests are far better tools for early-stage detection.

• Cutting-edge diagnostics are emerging, but underused — The paper introduced newer testing methods gaining ground in research and clinical practice, including elastography — a type of ultrasound that measures liver stiffness — microRNA markers, and polygenic risk scores. These tools catch liver damage before symptoms arise, especially in people with metabolic dysfunction. However, access and awareness remain low, particularly outside specialist settings.

• Doctors are being urged to start checking liver health like they check blood sugar — The ADA recommends a simple two-step screening process that starts with a blood test called the fibrosis-4 index (FIB-4). If that's high, it should be followed by a scan that checks how stiff your liver is. This reveals early signs of liver damage before symptoms ever show up.

• Liver disease in diabetes affects your whole body, not just your liver — When liver damage progresses, it raises your risk for heart disease, kidney problems, cancer, and even early death. People with both diabetes and liver disease are even more likely to die early compared to those without either condition.

• Catching liver issues early gives you the best shot at recovery — The good news is that liver scarring is often reversible — if you catch it in time. Simple lifestyle shifts, like cutting out harmful oils, losing belly fat, and improving your diet, can go a long way toward stopping the damage before it turns into something more serious.⁷

1. Cut out vegetable oils and alcohol immediately — If you're eating packaged foods made with soybean oil, canola, corn oil, or anything that says "vegetable oil," your liver is under attack. These oils are high in linoleic acid (LA), a mitochondrial poison that disrupts cellular energy, promotes fat accumulation in your liver and drives inflammation. Toss out the junk and cook with butter, tallow, ghee, or coconut oil instead.

Cutting back on alcohol is just as important as eliminating vegetable oils. Both alcohol and polyunsaturated fats like LA overwhelm your liver in similar ways. When your body metabolizes vegetable oils, they turn into toxic byproducts called oxidized linoleic acid metabolites, or OXLAMs. These are a type of reactive aldehyde — unstable, highly damaging molecules that disrupt cell membranes and set off chronic inflammation.

Alcohol does something very similar. It's broken down into acetaldehyde, another reactive aldehyde that harms your mitochondria and accelerates aging at the cellular level. Both types of aldehydes interfere with your liver's ability to detoxify, regenerate, and store energy. If you already have signs of insulin resistance, belly fat, or elevated liver enzymes, avoiding both vegetable oils and alcohol gives your body the best chance to reverse the damage before it becomes permanent.

2. Add choline-rich foods to help your liver move fat out before it causes damage — Choline is essential for clearing fat from your liver. Without enough of it, fat starts to pile up in your liver cells, eventually leading to inflammation and scarring. Think of choline as the nutrient that keeps your liver's traffic flowing — without it, everything gets backed up.

The best food source is pastured egg yolks, but be sure to look for low-PUFA eggs. Grass fed beef liver is another option that delivers a highly absorbable form of choline. Choline isn't optional — it's required for making phosphatidylcholine, a molecule your liver needs to package and export fats. Without it, those fats get stuck, and that's when the damage begins.

3. Consider a choline supplement if your diet falls short — If you avoid animal products, getting enough choline becomes a real challenge. Plant-based sources like cruciferous vegetables offer only small amounts, and you'd need to eat unrealistic quantities to meet your needs. In that case, a supplement isn't just helpful — it's often necessary to avoid deficiency.

One underrated option is citicoline, a form of choline that's been largely overlooked because most products use doses that are far too low to have a real effect. But at therapeutic levels — between 500 milligrams (mg) and 2,500 mg per day — citicoline supports your liver's ability to export fats, while also helping your brain make acetylcholine, a key neurotransmitter. If you're dealing with liver stress, insulin resistance, or brain fog, this is a smart addition to your routine.

4. Move every day and keep your waist in check — I'm not talking about running marathons. Just take a brisk walk after meals, stretch, and do a bodyweight circuit a few times a week. The goal is to keep insulin low and blood flowing through your liver. If your waist is over 40 inches (men) or 35 inches (women), focus on trimming visceral fat — it's the type that's directly tied to liver scarring.