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First-line interventions include: Dietary modification : Adopting a balanced, calorie-controlled diet rich in vegetables, fruits, whole grains, and lean proteins whilst limiting processed foods, saturated fats, and added sugars Regular physical activity : Aiming for at least 150 minutes of moderate-intensity exercise weekly, which improves insulin sensitivity independent of weight loss Alcohol reduction : Even in NAFLD (non-alcohol-related), minimising alcohol consumption supports liver health Management of comorbidities : Optimising control of diabetes, hypertension, and dyslipidaemia through appropriate medications For patients with type 2 diabetes and NAFLD, medications such as pioglitazone (a thiazolidinedione) have shown benefits for liver health in addition to glycaemic control, though this is an off-label use in the UK and carries risks including fluid retention, weight gain and potential heart failure exacerbation

It also works as a substrate for sirtuins - a family of seven proteins (SIRT1-SIRT7) found in different parts of cells

Make seeing your healthcare professional a priority, and while you work toward a diagnosis, you can ask your provider to prescribe B12 injections

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References 1 DobricADe LucaSNSpencerSJBozinovskiSSalingMMMcDonaldCFet al