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What To Do After a Fatty Liver Diagnosis
Understanding What Treatment Options Best Fit You
Nicholas Kruzdlo
Physician Reviewed
Nov 17, 2025
Any new medical diagnosis of Fatty Liver can be scary. With contradicting information everywhere, the road to clarity and improved health can be full of distractions. Fad diets, extreme protocols, liver detox supplements, and not knowing your more specific Fatty Liver diagnosis can make you feel like it's you against the world.
There is a path to clarity, and it all starts with understanding where you stand in the world of Fatty Liver. Once you know where you stand, you can properly design a path to prosperity through proper treatment strategies. Fatty Liver Disease is an overarching term that encompasses many more specific diagnoses. Some are more serious than others. So, let's break down Fatty Liver to see where you stand.
Understanding Fatty Liver
The first and most important step is to understand Fatty Liver Disease. Fatty Liver Disease can be divided into several categories and can be caused by different things. The most common cause of Fatty Liver Disease is a fat buildup caused by metabolic dysfunction and not alcohol, autoimmune issues, or Hepatitic A,B, or C. Metabolic dysfunction is a set of conditions encompassing Insulin resistance (T2D or Pre-diabetes), high blood pressure, high cholesterol or triglycerides, and an elevated BMI, causing fat to accumulate in the organs. Fatty Liver Disease caused by metabolic Dysfunction is called Metabolically Associated Steatotic Liver Disease (MASLD) and Metabolically Associated Steatohepatitis (MASH).
The overarching term Fatty Liver Disease does not provide enough information to know where you stand and how Covenant can help. The term Fatty Liver Disease directly highlights the fat accumulation in the liver, but does not speak to the amount of Fibrosis that is present. Fatty liver disease is broken down into MASLD and MASH, depending on a patient's level of fibrosis or scarring on the liver. The less severe of the two distinctions is Fatty Liver Disease without inflammation or MASLD. This is an early stage in the disease state. While fat is accumulating in the liver, the fat has not yet caused liver cells to die, meaning there is no scarring.
The more severe of the two is Fatty Liver disease with Inflammation and scarring (MASH). This is seen in patients who have had the disease for several years. The fat has sat in the liver long enough to cause liver cells to die. Once dead, these liver cells are replaced by scar tissue. This form of Fatty Liver must be taken more seriously as the path to cirrhosis has been laid down.
-Fatty Liver without scaring – MASLD/NAFLD
-Fatty Liver with scaring – MASH/NASH
Understanding My Diagnosis
Fatty liver is usually diagnosed by imaging done on the body, sometimes by accident. The most common forms of imaging for Fatty Liver Disease diagnosis are Ultrasounds, MRIs, FibroScans, MREs, etc. Each type of imaging uses different techniques, but they will use similar terminology to describe what the imaging saw. We must break down the two most important terms…
Fibrosis (F0-F4) – Fibrosis refers to the amount of fibrous tissue on the liver. - Fibrosis of the liver will be classified on reports on a scale from F0 to F4. F0 shows no scarring. F1 shows mild fibrosis, F2-F3 show moderate/severe fibrosis, and F4 may suggest cirrhosis.
Steatosis (S0-S4) – Steatosis is a fancy way to say fat. - Steatosis or the fat content of the liver will be classified on reports on a scale from S0 to S3. S0 shows no excess fat. Stages S1, S2, and S3 signal increasing levels of excess fat.
Although steatosis (fat) and fibrosis (scarring) can be confused, it is essential that we are able to distinguish between the two because they are significantly different. If you see steatosis in your diagnosis, this means excess fat is present in the liver. This is consistent across all Fatty Liver diagnoses. The difference is the progression of Fibrosis. Look and listen for these terms from your doctors to try and figure out where you stand. A steatosis score of one, two, or three with a fibrosis score of 0, you have MASLD. If you have a score above one in both steatosis and fibrosis, you have MASH. These two forms of Fatty Liver Disease require different treatment plans.
Understanding My Next Steps
Each stage of FL disease requires different treatments to maximize the chance of healing your liver. These stages are below with different treatment pathways. Additionally, see how Covenant Metabolic Specialists can help you within each stage.
I have Fatty liver with no mention of fibrosis or scarring.
Thankfully, this form of fatty liver disease is easiest to treat because it has been caught early. Your diagnosis mentions fat and steatosis (S1-3), but there is no mention of fibrosis (F0), scarring, or stiffening. Covenant recommends lifestyle modifications in this stage of fatty liver disease. Weight loss of 5-10% of total body weight can completely reverse the excess fat that has built up in your liver. Combine strength training, walks, and the Mediterranean diet, high in protein, healthy fats, and organic fruits and vegetables, to achieve this weight loss. No fibrosis is present, and therefore, no medication is needed in this early stage. Lifestyle modifications alone are enough to return to a healthy liver!
I have Fatty Liver with minor scarring (F1) mentioned in my report.
Your Fatty Liver Disease diagnosis now falls under early MASH. With fat and scarring present in your liver. Fortunately, while the scarring has started to occur, it is still minor. The liver is special because it can replace scar tissue with healthy tissue, unlike the brain and heart. Because you have very little fibrosis, the ratio of healthy liver tissue to unhealthy is good enough that the liver can recover without the use of medications. Yet medication can be used to speed up the process of scar tissue removal. With a healthy Mediterranean style diet full of organic non GMO meats, fruits, and vegetables, strength training, and weight loss, the liver may be able to recover. Covenant would recommend a visit to our clinic for an in-depth evaluation of your liver with a FibroScan to monitor disease progression.
I have Fatty Liver with major scarring (F2-F3) mentioned in my report
Your Fatty Liver Disease diagnosis now falls under MASH. With fat and scarring present in your liver. The level of scar tissue is now at a level that is increasingly concerning. The liver is special because it can replace scar tissue with healthy tissue, unlike the brain and heart. But to the moderate/severe amount of fibrosis, the ratio of healthy liver tissue to unhealthy tissue may not be high enough for the liver to recover on its own.
Covenant Metabolic Specialist works with patients like you every day. With access to cutting-edge medication through clinical trials, Covenant can help. Covenant will pair these incredible medications along with lifestyle modifications, including a Mediterranean style diet full of organic non GMO meats, fruits, and vegetables, strength training, and weight loss. Covenant will walk alongside you in your treatment of MASH. With years of training, our expertise will allow a sense of peace in your journey to a healthy liver.
I have Fatty Liver with Cirrhosis or an (F4) fibrosis level in my report.
Your Fatty Liver Disease diagnosis has progressed from MASLD to MASH and now Cirrhosis. Cirrhosis only focuses on the fibrosis score and no longer takes into account the fat content. It is important to understand that you can reach cirrhosis through other pathways, including alcohol, drugs, viral infection, and autoimmune issues. Each type of cirrhosis may have slight differences in treatment. In Cirrhosis caused by metabolic factors, fat has caused so much inflammation over many years, causing a large amount of scar tissue. Only a few years ago, cirrhosis could only be cured through liver transplants. Today, through the use of cutting-edge medications in clinical trials, Covenant is stopping and even reversing cirrhosis in our patients.
It is important to understand that due to the large amount of scar tissue, this is the hardest stage of Fatty Liver Disease to treat. If you are Cirrhotic, it is important to receive annual EGDs, MRIs, and Ultrasounds to closely monitor the disease with a doctor of your choice. While Cirrhosis can be scary, knowing where you stand, and new medications are bettering patient outcomes daily.
Receiving Proper Treatment
Understanding where you stand in the Fatty Liver Disease umbrella is crucial. With a proper understanding of your diagnosis, finding the right treatment plan for you becomes easier. Covenant is here to help all patients experiencing some form of Fatty Liver Disease.
If you are early on in your Fatty Liver journey and just need answers, our clinic serves as a place to get clarity. Not only with in depth results, but with patient education, so you know where you stand. If you know where you stand and treatment through clinical trials is something you can benefit from, our team is here to walk with you in your journey to a healthy liver.
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