Fatty Liver Grade 1, Grade 2 & Grade 3 Explained: Everything You Should Know

If you’re reading this, chances are you’ve been diagnosed with fatty liver disease and want to know exactly what your diagnosis means. Here’s the good news: no matter the grade, fatty liver can be reversed with the right lifestyle changes which include dieting and exercising.

Fatty liver disease is divided into different grades of severity, with lower numbers indicating milder stages. The higher the number, the more advanced the condition and the more time will be required to reverse it.

But let’s jump into more details on what these grades mean for your liver and how you can take action – I’ll share my own experience and what worked for me, not just generic study findings and textbook material.

Grade 1 Fatty Liver: Here’s what It Means

fatty liver ultrasound

Grade 1 fatty liver is the mildest stage, but one that still indicates that your liver has an unhealthy amount of fat cells: between 5% to 33% of your liver is made up of fat cells.

The fat sits mostly on the liver’s surface and isn’t significantly impacting liver function yet. Therefore, it’s relatively harmless and diagnosis in this stage is usually the easiest to reverse.

Most of the time, doctors will detect grade 1 fatty liver during a routine ultrasound, as there might be no symptoms at this stage.

Even blood test results can come back normal with Stage 1 fatty liver disease (NAFLD/MASLD). So unless there’s an ultrasound made or there are no symptoms, in most cases it will go unnoticed.

But if you do catch it early on, it’s also the easiest to reverse with the proper lifestyle changes (like cutting back on saturated fats, saying goodbye to sugar, and getting a bit of exercise).

Grade 2 Fatty Liver: Here’s what It Means

Grade 2 fatty liver means that about 34% to 66% of your liver is now made up of fat. This is when things start to change inside the liver, as the fat cells no longer sit on the surface, but they start mixing with the liver cells, creating balloon-like structures that make it harder for the liver to work properly.

At this stage, you might start experiencing symptoms – like mild pain in the upper right abdomen, unexplained fatigue, bloating, and nausea.

Blood test results can show elevated liver enzymes – mainly ALT and AST – although that’s still not always the case.

Inflammation of the lobes of the liver themselves may also begin to occur during grade 2 fatty liver disease. An ultrasound will confirm the diagnosis, as well as other NAFLD-specific tests like a fibroscan, liver biopsy, but also a MRI scan.

This is the stage where I was diagnosed, and I’ll be honest: hearing the words “moderate fatty liver” felt heavy. But I managed to reverse it, one step at a time, by seriously adjusting my diet and getting serious about exercise.

How fast will you reverse Grade 2 Fatty Liver?

Reversing grade 2 fatty liver is possible, but it will usually take longer than reversing grade 1. I needed 18 months to get the confirmation that my fatty liver was reversed, so expect a similar timeline, anywhere from a year to 18 months.

This depends on how consistent you are with lifestyle changes – and you should be VERY serious, otherwise the condition might get even more serious.

If you want to get more in-depth with potential timelines depending on your current stage, I have an article on how long it takes to reverse fatty liver disease.

Grade 3 Fatty Liver: Here’s what It Means

Fatty Liver Stages

Grade 3 fatty liver, the most severe stage, means more than two-thirds (66%) of your liver is composed of fat cells.

At this point, the liver is inflamed and may even be scarred (aka show signs of fibrosis, due to the fat cells bursting).

Chronic inflammation makes it harder for the liver to process nutrients and filter out toxins, which can lead to more serious issues and at this stage you will usually have all the symptoms associated with NAFLD (MASLD).

While there is no direct medication to treat fatty liver disease, all measures including lifestyle changes – especially switching to a healthy diet and exercising – are mandatory to get back in shape.

Left untreated for too long, a fatty liver in stage three can lead to much more serious health issues and permanent liver damage. In the end, it can become life-threatening, so it’s not something to ignore or even take lightly.

Fortunately, even Grade 3 fatty liver disease can be reversed. It might take up to two years in most cases (potentially more), but if you start now and commit to lifestyle changes, you can slowly progress back through the stages, from grade 3 to grade 2 and then to grade 1.

I recommend reading my book on how to reverse fatty liver disease – From Fatty Liver to Healthy Liver (at Amazon – both Kindle and paperback, but also Google Books or Apple Books). It guides you through all the steps you should take to reverse the condition and it’s based on personal experience and plenty of research.

The bottom line? Take action now! Reversing grade 3 is a long road, but it’s well worth the journey.

Can All Grades of Fatty Liver Be Reversed?

reversing fatty liver through exercising

Yes! The beauty of the liver is its ability to heal, as long as we do everything we should to help it heal faster.

The process does take time and commitment, especially as the grade progresses, but here is what you can expect, depending on each grade you’re at:

  • Grade 1: Following the required lifestyle changes, many people can reverse this stage in up to six months.
  • Grade 2: Expect around a year to 18 months to reverse your condition.
  • Grade 3: It might take around two years (or even a bit more) to see full reversal, but reversal is still possible.

Note: Depending on your age and how serious you are with adjusting your diet and exercising, the timelines above can be shortened greatly. I talked to younger people, in their 20s, who managed to reverse their NALFD in as little as two months!

Final words

From grade 1 to grade 3, fatty liver disease is a spectrum, but it’s not a life sentence.

The differences in each grade are dependent on the contribution of fat cells to the overall weight of the liver as well as the impact of excess fat cells on the functionality of the organ.

Reversing this condition is absolutely possible at every stage with a proactive approach and consistent lifestyle changes. The goal is simple: get your liver back to a healthy state by reducing fat cells to less than 5% of its total weight.

Additional References

Apart from personal experience and general research, here are some of the main sources I have used when researching for this article:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659893/

https://www.medicalnewstoday.com/articles/hepatomegaly-enlarged-liver

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