What is the best Tablet to reduce fatty liver?

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as NAFLD, affects up to one-third of the global population. While there is no single best tablet to treat all forms of fatty liver, the approach often involves lifestyle changes and targeted medication for specific patient groups and disease stages.

Quick Summary

Treatment for fatty liver disease is highly personalized, focusing on lifestyle changes first. For advanced cases of MASH with liver scarring, Rezdiffra is the first FDA-approved oral medication. Other tablets, such as pioglitazone and vitamin E, are used in specific contexts, but they come with important considerations and risks.

Key Points

• Lifestyle is Foundational: The most effective treatment for fatty liver disease (MASLD) is consistent lifestyle changes, including weight loss, a healthy diet (like the Mediterranean diet), and regular exercise.

• Rezdiffra is First FDA-Approved Tablet for MASH: For adults with more advanced Metabolic Dysfunction-Associated Steatohepatitis (MASH) and moderate to severe fibrosis (liver scarring), Rezdiffra (resmetirom) is the first FDA-approved oral treatment.

• Other Tablets have Limited or Specific Use: Medications like pioglitazone (for insulin resistance) and vitamin E (for non-diabetics) are used selectively, often with important side effect profiles and limitations.

• Injectables can Help Indirectly: GLP-1 receptor agonists (e.g., Ozempic) and other diabetes/cholesterol medications can benefit liver health by addressing underlying metabolic issues, but they are not tablets for fatty liver specifically.

• Personalized Medical Advice is Crucial: Due to the complexity and different stages of fatty liver disease, a personalized treatment plan from a healthcare professional is necessary.

• New Terminology: MASLD and MASH: The medical community now refers to nonalcoholic fatty liver disease (NAFLD) as Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), and nonalcoholic steatohepatitis (NASH) as Metabolic Dysfunction-Associated Steatohepatitis (MASH).

Fatty liver disease, now often referred to as Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), is a condition where excess fat accumulates in the liver. The severity ranges from simple steatosis (fatty liver) to the more inflammatory form known as Metabolic Dysfunction-Associated Steatohepatitis (MASH), which can lead to significant liver scarring (fibrosis) and cirrhosis. Given this spectrum, the idea of a single “best tablet” is misleading. The most effective strategy is a combination of comprehensive lifestyle changes, and for specific, advanced cases, medication.

The Foundational Treatment: Lifestyle Modifications

For most people with MASLD, the most potent and safest treatment is not a pill but a commitment to lifestyle changes. These adjustments address the underlying causes of fat accumulation, such as obesity and insulin resistance, and are crucial for improving liver health.

• Weight Loss: Losing even a small amount of body weight—3% to 5%—can significantly reduce fat in the liver. A more substantial loss of 7% to 10% or more is linked to reduced inflammation and potential reversal of liver damage, including fibrosis. Gradual, steady weight loss is recommended, as rapid loss can sometimes worsen liver inflammation.
• Healthy Diet: A healthy eating pattern is fundamental. The Mediterranean diet, with its emphasis on vegetables, fruits, whole grains, and healthy fats (like olive oil), is often recommended. Key dietary strategies include reducing sugar and fructose, limiting saturated fats, and increasing fiber intake. Caffeinated coffee may also be beneficial.
• Physical Activity: Regular exercise can decrease liver fat and improve insulin sensitivity. Aim for at least 150 minutes of moderate-intensity exercise per week.
• Avoid Alcohol: Avoiding alcohol is crucial to prevent further liver damage.

FDA-Approved Oral Medication for MASH

Rezdiffra (resmetirom) is the first FDA-approved oral tablet for MASH with moderate to advanced fibrosis (F2 or F3) but without cirrhosis. It works by activating a thyroid hormone receptor in the liver to increase fat metabolism. Clinical trials showed it can improve liver histology and reduce fibrosis. Common side effects include nausea and diarrhea; gallbladder problems have also been reported.

Other Medications Used for Fatty Liver

Other drugs may be used off-label by specialists, often to manage related conditions.

• Pioglitazone (Actos): This diabetes medication improves insulin sensitivity and has shown benefits in improving liver histology in patients with MASH. However, it can cause weight gain and fluid retention and may carry a risk of bone fractures.
• Vitamin E: This antioxidant has improved liver enzymes and some histological features in non-diabetic patients with MASH. Its effect on fibrosis is less clear, and high doses over the long term are linked to potential risks, including increased all-cause mortality and prostate cancer. It is not for diabetics or those with advanced cirrhosis.
• Other Diabetes Medications: Some GLP-1 receptor agonists and SGLT2 inhibitors can improve liver fat and aid weight loss, indirectly benefiting liver health. GLP-1 agonists are injectables.
• Statins: These are safe for most MASLD/MASH patients without severe cirrhosis and are important for managing cardiovascular risk.

Comparison of Key Fatty Liver Treatments

Treatment	Indication	Main Action	Efficacy	Side Effects & Considerations
Rezdiffra (resmetirom)	MASH with fibrosis F2/F3 (without cirrhosis)	Activates thyroid hormone receptor in liver; boosts fat metabolism	Resolves MASH and improves fibrosis in significant number of patients	Nausea, diarrhea, potential gallbladder issues
Pioglitazone (Actos)	Off-label for MASH (esp. with T2D)	Improves insulin sensitivity	Improves steatosis, inflammation, and ballooning; mixed results on fibrosis	Weight gain, fluid retention, potential bone fracture risk
Vitamin E	Off-label for non-diabetic MASH	Antioxidant effects; reduces oxidative stress	Improves liver enzymes, steatosis, and inflammation; uncertain effect on fibrosis	Potential long-term risks at high doses (e.g., mortality, prostate cancer)
Lifestyle Changes	All stages of MASLD/MASH	Weight loss, improved diet, increased exercise	Most effective treatment for fatty liver; can reverse damage with sufficient weight loss	Requires significant personal commitment and discipline

Conclusion

In summary, the most impactful treatment for fatty liver involves dedicated lifestyle modifications. For those with more advanced MASH and liver fibrosis, Rezdiffra (resmetirom) is the new FDA-approved oral medication used with diet and exercise. Other medications like pioglitazone and Vitamin E may be considered for specific patients but have side effect considerations. A personalized treatment plan with a healthcare professional is essential.

American Liver Foundation: Nonalcoholic Steatohepatitis Treatment

Frequently Asked Questions

What is the best initial treatment for fatty liver disease (MASLD)?

The best initial treatment for fatty liver disease is comprehensive lifestyle modification, including dietary changes, regular exercise, and weight loss. For many, this is the most effective way to manage and even reverse the condition.

Who is Rezdiffra (resmetirom) for?

Rezdiffra is the first FDA-approved oral medication for adults with a specific form of fatty liver disease called MASH (Metabolic Dysfunction-Associated Steatohepatitis) who have moderate to advanced liver scarring (fibrosis F2 or F3) but not cirrhosis.

Can pioglitazone be used for fatty liver?

Pioglitazone, typically a diabetes drug, can be used off-label for MASH. Studies have shown it improves liver inflammation and fat accumulation, but it is associated with side effects like weight gain and fluid retention.

Is Vitamin E a safe treatment for fatty liver?

Vitamin E may be beneficial for some non-diabetic patients with MASH due to its antioxidant properties. However, its effectiveness against fibrosis is uncertain, and long-term use at high doses carries safety risks. It's not recommended for everyone.

What are GLP-1 agonists and how do they help with fatty liver?

GLP-1 agonists are medications (often injectables like Ozempic and Mounjaro) primarily for diabetes and weight loss. By helping with weight management and improving metabolic factors, they can indirectly reduce liver fat and improve liver health, but they are not tablets and are not specifically FDA-approved for fatty liver.

Should I take herbal remedies or supplements for fatty liver?

Always consult a doctor before taking any herbal remedies or supplements. Some 'natural' products can be harmful to the liver in high doses or interact negatively with other medications. The evidence for many supplements is limited and inconclusive.

Are cholesterol medications like statins safe for fatty liver?

Yes, statins are generally safe for people with fatty liver disease without severe cirrhosis. Since fatty liver is linked to a higher risk of heart disease, statins are often recommended to manage associated high cholesterol.