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my alt went from 118 to 38 in 4 months. my ast went from 84 to 27. i had spent 8 months before that losing weight to try to bring the numbers down the way my doctor told me to, and in that 8 months the numbers actually got worse. im writing the whole story out because i am still sort of angry about what my doctor missed, and because i know there are women reading this who are exactly where i was a year ago. you are doing everything right and the bloodwork is not cooperating, and your doctor is telling you to just keep doing what you are doing. i was 54 at my first flagged bloodwork. alt 98, ast 72. she called them "mildly elevated." said to try to lose 10 lbs and come back in a year. i did exactly that. 12 lbs lighter, and the follow-up was alt 112 and ast 84. she told me to keep losing and mentioned ozempic. that was the conversation. The nurse who drew my blood that day was the one who mentioned it. I was putting my jacket back on and she asked, almost offhand, if anyone had told me I had fatty liver. I said my doctor had mentioned something mildly elevated. She paused with the clipboard in her hand and said, honey, that's not mildly anything, that's stage 2 fatty liver, and most doctors around here don't want to talk about it because half their patients have it and there's no prescription they can write for it. You need to do your own research on this. I sat in the parking lot afterward for about 20 minutes. I went home and fell down a Google rabbit hole. What came back was terrifying and also clarifying. Fatty liver does not hurt until it does, and by the time it does, you are already in cirrhosis or pre-cirrhosis territory. 2 million Americans are walking around with it undiagnosed. The liver has no pain receptors so you can lose 60% of function before anything shows up. Nearly everyone with insulin resistance develops some version of it. And the standard of care in primary care is, as the nurse said, essentially nothing. I started doing the things. Cut out sugar mostly, cut my carbs down, walked more, added protein. Nothing on my bloodwork moved for 3 months. My ALT actually went up to 81. What changed it was something my sister-in-law sent me in a DM in March. She had been fighting the same numbers for 2 years after her own doctor brushed her off. She found a supplement her functional medicine doctor had vetted for her. Pharmaceutical grade silymarin with three other compounds. She had been on it 4 months when she messaged me. Her ALT had come down from 94 to 38, and her doctor had asked her what she had been doing differently, which she found funny because it was the same doctor who had told her not to worry about it in the first place. I ordered it that night. It is called Happy Liver, by a company called Ritual Labs. I am not a supplement person. I had tried milk thistle once from a drugstore years ago and felt nothing. I ordered this one because my sister-in-law is not someone who talks about supplements, ever, and she told me this specific one was different because of the grade of the silymarin in it. Most of what you buy at the store is not even close to the dose or grade that actually reaches liver cells. I have been on it a little over 4 months now. My last bloodwork 2 weeks ago: ALT 32. AST 24. I have lost another 9lb and nothing else changed in my routine. Nothing else changed in my routine. Just the supplement and the eating I was already doing. My face looks different. I did not realize how puffy I had been waking up until I stopped waking up that way. My rings fit again. My afternoon crash is mostly gone. I still get tired but not in the concrete-vest way I used to get tired around 2 PM. I am writing this because I watched a woman in the fatty liver group last week post that her mother died from liver failure after the family doctor called her Fibroscan a "technical error" and never referred her to a hepatologist. I sat with that for 3 days. My numbers were not as bad as her mother's, but my doctor was just as dismissive, and if my nurse had not said something in the hallway I would still be doing my walks and my diet and waiting for the numbers to come down on their own while the inside of my liver got worse. Advocate for yourself. If your doctor is not taking it seriously, find someone who will. Order your own scans if you have to. And if milk thistle has not worked for you before, it is probably the grade of what you were taking, not the ingredient. I will update in another 6 months when my next labs come in. But here's the link if you want to try for yourself: https://rituallabs.shop/products/happy-liver