Rachel Simmons, RN

She changed her diet. Cut the wine. Took the supplements. Her liver got worse anyway.

There are four stages of liver damage. Most people never hear about them until they are sitting in a hospital bed, staring at a ceiling, wondering how something so quiet moved so fast. I have watched it happen more than seven thousand times. My name is Rachel Simmons. I am a registered nurse. I have spent fourteen years in hepatology units across three hospitals, and I have cared for roughly 7,500 patients with liver disease in various stages. I have held the hand of a 38 year old mother whose liver failed six weeks after her first abnormal blood test. I have listened to a retired schoolteacher explain that his doctor told him fatty liver was "nothing to worry about" for nearly a decade, until the day it very much was. I have watched a grandmother lose forty pounds of fluid from her abdomen in twelve days, only to gain it all back because the damage had gone too far for her body to recover. And two years ago, I sat in a consultation room on the other side of the desk and heard my own numbers read back to me. ALT: 63. AST: 47. Both elevated. Both heading in the wrong direction. I am a hepatology nurse. I eat well. I exercise four days a week. I do not drink. And my liver was quietly, steadily, sliding toward damage I have spent my entire career watching destroy lives. That is the thing about this organ that most people, and too many doctors, still do not appreciate. It does not announce itself. It does not send a warning flare. It moves through four distinct stages, and by the time you actually feel something, you may already be further along than anyone realized. Let me walk you through each stage. Because understanding what happens inside your liver, and why it happens, might be the most important thing you read this year. Stage 1: The Silent Deposit This is where it begins. Fat starts collecting inside liver cells. Not around the liver. Inside the cells themselves. Your blood work may come back normal. Your doctor may tell you everything looks fine. You might feel a little tired in the afternoons, maybe a heaviness after meals, but nothing that sends you to the emergency room. Nothing that makes you cancel plans or call in sick. A woman I cared for, I will call her Gloria, spent the better part of two years feeling unwell before anyone found the problem. She went to her GP multiple times. The first doctor said it was probably stress from work. A specialist suggested it might be perimenopause. Another consultant told her it could be anxiety. For two full years she lived with exhaustion so deep it changed who she was as a person. She had been energetic, social, the kind of woman who organized weekend hikes and hosted dinners. She stopped all of it. She pulled away from friends. She had an aching pain in her upper right abdomen that came and went like a dull pressure, and nobody could explain it. Then a scan ordered for an entirely different reason found fat deposits across her liver. Gloria had never touched alcohol in her life. She later told a journalist, "For the best part of two years before my diagnosis, I felt unwell but could not put my finger on it." She described feeling extremely fatigued, frequently nauseous, and confused about what she was even allowed to eat. This is Stage 1. No drama. No crisis. Just a slow, invisible accumulation that your body tries to manage on its own using a molecule called glutathione. Glutathione is your liver's primary antioxidant defense. When fat deposits are small, glutathione can handle the oxidative stress. It neutralizes the damage, clears cellular debris, and keeps your liver cells functioning the way they are supposed to. But if the fat keeps building, and nothing changes, Stage 1 does not stay Stage 1 forever. Stage 2: The Inflammation This is where the body starts fighting itself. The fat deposits have overwhelmed your liver's glutathione supply. Your cells are under constant oxidative stress, and now the immune system gets involved. Inflammation sets in. Not the kind you can see or feel at first, but the kind that shows up on blood work as rising ALT and AST numbers. And here is what makes Stage 2 so cruel: this is the stage where people do everything their doctors tell them to do, and many of them still get worse. A man I will call Douglas had been diagnosed with fatty liver four months earlier. He followed every recommendation to the letter. Mediterranean diet. No alcohol. Low carb, low sugar. He walked five miles a day and cut out processed food entirely. He was 38 years old, a father of two, and he attacked this diagnosis the way he attacked everything in his life, with discipline and determination. His ALT climbed from 38 to 73. "I am doing everything right," he told me during a follow-up visit. "And my numbers are going in the wrong direction. My specialist told me to lose weight and come back in twelve months. That was the whole plan." He was not angry. He was defeated. I have a word for what I saw in his eyes that afternoon. I have seen it in the eyes of hundreds of patients over fourteen years. It is the look of someone who followed the rules and still lost ground. Douglas is far from alone. They change their diet. They exercise. They give up alcohol for months at a time. They step on the scale and see progress. And then they sit in my office and watch me flip to the page with their ALT and AST, and the numbers have drifted upward anyway. Because by Stage 2, diet and exercise alone are often not enough to rebuild the glutathione reserves your liver has already burned through. A 24 year old man I spoke with was so terrified after his diagnosis that he could barely function. His ALT was only 43, but the discomfort in his abdomen sent him searching online, and what he found made it worse. "I read that fatty liver was fatal, with a ten year lifespan," he told me. He could not sleep. He could not eat without wondering whether the meal was hurting his liver. He was 24 years old and planning his funeral in his head because nobody had sat him down and explained that early fatty liver, caught at Stage 1 or Stage 2, is something most people can still turn around. But turning it around requires more than willpower. It requires giving your liver the raw materials to repair itself. And this is where another critical molecule begins to decline: NAD+. NAD+ is a coenzyme that fuels your cellular repair systems. It activates a family of proteins called sirtuins, particularly SIRT1, which regulate inflammation and help repair damaged liver cells. When NAD+ levels drop, and they drop with age even in healthy people, your liver loses a key part of its ability to fight back. Think of it this way. Glutathione is the fire extinguisher. NAD+ is the repair crew that comes in after the fire is out. If both are depleted at the same time, the damage does not just continue. It accelerates. I have watched patients in Stage 2 describe their exhaustion in language that breaks my heart. One woman, a 52 year old military veteran, put it this way: "I was just so tired. It was a tired I just could not escape, and no amount of sleep was helping. People think you are lazy. You are not lazy. You are absolutely exhausted." She had been dismissed by various doctors for years. First it was "probably stress." Then "maybe depression." The fatigue, the brain fog, the inability to get through a normal day, none of it was taken seriously until a biopsy confirmed she had already progressed to Stage 3 fibrosis. Her words should be printed on every hepatology ward wall: "There are so many things I should be doing, and I just cannot." That is Stage 2 in the body of a real person. Not a chart. Not a number. A woman who cannot get off the couch and has been told for years that nothing is wrong. Which brings us to the worst part. Stage 3: The Scarring This is the stage that changes everything. When inflammation persists long enough, your liver begins replacing damaged cells with scar tissue. This is called fibrosis. And unlike fat deposits, which can shrink with lifestyle changes, scar tissue does not dissolve easily. Sometimes it does not dissolve at all. A woman I will call Phyllis had a FibroScan reading of 22.2 kPa. That number put her deep into the danger zone, well past the threshold where doctors start using words like "cirrhosis" and "irreversible." She had been a heavy social drinker for years. When she finally stopped completely, she assumed the damage would reverse on its own. It took her over twelve months of sobriety, strict dietary changes, and consistent exercise to bring that number down to 9. Her doctors told her she would likely never get it much lower than that, and she would be, in their words, "bucking many a trend" to reach a 7. "I think of how tough it has been and how long and hard these twelve months were just to get to where I am now," she told me. "And how frightening it is knowing how fast it can go back." She still deals with lingering brain fog and neuropathy. She is sober, disciplined, and doing everything right. And she is still paying the price for what happened to her liver before she understood these four stages. At Stage 3, the glutathione-NAD+-SIRT1 cascade becomes critical. Here is what peer-reviewed research shows: When glutathione drops below a certain threshold, oxidative stress begins damaging the mitochondria inside liver cells. Damaged mitochondria produce less NAD+. Lower NAD+ means less activation of SIRT1. And less SIRT1 activation means a process called autophagy, your liver's built-in cellular cleanup system, slows to a crawl. Autophagy is how your liver removes damaged cells before they become scar tissue. When autophagy slows, fibrosis accelerates. The scarring feeds on itself. This is published biochemistry, not marketing language. And it explains something I watched happen over and over throughout my career. Patients who did everything right on paper, the diet, the exercise, the sobriety, still progressed to fibrosis. Because nobody was addressing the glutathione and NAD+ depletion driving the real damage underneath the surface. Stage 4: The Point of No Return I do not enjoy talking about Stage 4. But I have sat beside too many beds, held too many hands, and spoken to too many families to keep quiet about it. Stage 4 is cirrhosis. The scarring has become so extensive that the liver cannot function properly. Fluid builds in the abdomen. Toxins the liver normally filters begin accumulating in the bloodstream. Confusion sets in. The skin yellows. The body begins shutting down in ways that are visible to everyone in the room. One of the hardest conversations I ever had was with a mother whose daughter, a young woman with 13 year old twins, was told she had two years to live. She had gone from a fatty liver diagnosis to end-stage cirrhosis faster than her family thought possible. She needed a transplant. That mother told me something I carry with me every day: "I watched my daughter fill with seven stone of fluid. I watched her kidneys start to fail. I watched her children try to understand why their mother could not get out of bed. And nobody ever told us that it started with something as simple as fat in the liver." After her daughter received her transplant and began to recover, that mother went home and asked her own doctor about her liver for the first time. She had been ignoring her own fatty liver diagnosis for years. She told me it became, in her words, "a normal part of my routine" to take care of her liver after that. Because she had seen, up close, what happens when you do not. Stage 4 is where the damage becomes irreversible for many patients. And the tragedy I have witnessed over fourteen years is that for most of them, it did not have to get there. I think about a woman named Steph whose father had 22 abnormal liver function tests over eleven years. Twenty-two tests. Every single one came back flagged. And every single doctor told him fatty liver was nothing to worry about, because that is how the medical profession portrayed it to him. He was blasé about it because they were blasé about it. By the time his symptoms started showing, it was too late. He died at 62. His daughter now gets herself screened regularly. She pushes her GP harder than most patients I have met. She does it because she watched her father trust the system, and the system failed him. Liver disease is quiet. It does not argue. It does not complain. It just advances, one stage at a time, until the body cannot compensate anymore. And most people do not find out what stage they are at until something forces the question. What I Learned When I Became the Patient When my own ALT came back at 63 and my AST at 47, I knew exactly what those numbers meant. I had spent fourteen years watching patients progress through those four stages. I understood the biochemistry. I knew about the glutathione-NAD+ cascade and the role of SIRT1 and autophagy. And I knew that if I did not do something beyond diet and exercise, I might be heading down the same path I had watched thousands of patients walk before me. I started researching what could actually support the glutathione and NAD+ systems at the same time. Not one or the other. Both. That research led me to three compounds that kept appearing in published literature: NAC, or N-acetylcysteine. This is the direct precursor to glutathione. Your body converts NAC into glutathione in the liver itself. It is one of the most studied liver-support compounds in existence, used in hospitals around the world for acetaminophen toxicity because of how effectively it rebuilds glutathione reserves. NAD+. The coenzyme that powers the SIRT1 repair pathway. Without adequate NAD+, your liver's cellular repair systems cannot function properly, and autophagy slows down when you need it most. MCT oil from coconut. Medium-chain triglycerides bypass normal fat digestion and travel directly to the liver through the portal vein. This is important because it means MCT oil can carry fat-soluble compounds to the liver intact, without them being broken down or degraded in the gut first. Now, here is something I learned the hard way as a nurse who has watched patients try every liver supplement on the market. Most NAC products do not work the way people assume. A dry NAC powder pressed into a standard capsule, the kind you find in most supplement aisles, faces a real problem. NAC is sensitive to moisture and oxidation. In a dry capsule sitting on a shelf for weeks or months, it begins to degrade. By the time you swallow it, a significant portion may have already broken down into compounds your body cannot convert into glutathione. This is why so many of my patients tried store-bought NAC on their own and told me they saw nothing change in their labs. They were taking degraded product and expecting meaningful results. One woman I cared for, I will call her Theresa, took milk thistle for six straight months. She even told her gastroenterologist about it. After half a year, she could not see any improvement in how she felt or in her blood work. So she stopped. "Maybe I was expecting too much from a supplement," she said. But the problem was not her expectations. The problem was that what she was taking could not deliver what her liver actually needed at the cellular level. Another patient tried a popular milk thistle blend and within a week developed bloating, stomach pain, and constipation. She had been excited to find something specifically for her liver, and it made her gut symptoms worse than before she started. These are not rare stories. I heard versions of them hundreds of times over my career. People trying. People hoping. People spending money month after month on products that either degraded before they reached the liver or contained ingredients their particular body could not tolerate. And what frustrated me most was this: many of my patients who tried supplements on their own never told their doctors. A woman I cared for said it plainly, "None of my doctors ever asked what I was taking, and I did not volunteer it." She had been managing her liver on her own for years, bouncing between products, reading labels in the pharmacy aisle, and never once getting a clear answer from any healthcare professional about what was worth trying and what was a waste of money. That woman is not an outlier. She is the majority of liver patients I have worked with. People trying to help themselves, with no guidance, taking products that were never designed to survive the journey from the bottle to the liver cell. I knew there had to be a better option. What Changed for Me After all that research, I found a formula called The Vital Labs NAC 600. It combines all three compounds, NAC, NAD+, and MCT oil from coconut, in a single softgel. The NAC is suspended in the MCT oil, which does two things: it shields the NAC from the oxidation and moisture that degrade dry powders, and it delivers the compound directly to the liver through the portal vein, the same route the liver uses to receive nutrients from digestion. Each softgel contains 300 milligrams of NAC. The daily dose is two softgels, for a total of 600 milligrams of NAC per day. The formula is manufactured under controlled manufacturing conditions and third-party tested for purity and potency. It uses clinical-quality NAC, not the commodity bulk powder found in most store-bought liver supplements. I want to be very clear about something. I started taking this alongside, not instead of, the dietary changes and exercise I was already committed to. I continued seeing my hepatologist on schedule. I did not stop any monitoring or skip any appointments. This is not a replacement for medical care. It is a daily support layer that addresses what diet and exercise alone often cannot touch, the glutathione and NAD+ depletion that drives liver damage at the cellular level. My Results I started taking two softgels a day with breakfast. Week one, I noticed my energy held steadier through the afternoon. I have always had a slump around 2 PM, the kind where you stare at a chart and read the same line three times. That slump was noticeably less pronounced. Week three, my digestion felt calmer. I had accepted occasional bloating as just part of my life. It was mostly gone. Week six, I went in for blood work. ALT: 31. Down from 63. AST: 24. Down from 47. Both back within normal range. My hepatologist reviewed the results and asked what I had changed. I told him about the NAC, NAD+, and MCT oil combination I had been taking alongside, not instead of, my existing routine. He reviewed the research, checked for interactions with everything in my medical history, and said he had no objections. He said something that stayed with me: "Most of my patients take something. I would rather they take something with published evidence behind it." I have since mentioned this formula to colleagues and to patients who ask what else they can do alongside, not instead of, the medical plan their doctors have set. The feedback has been consistent. People who take it daily and recheck their labs after six to eight weeks tend to see movement in the right direction. Not every single person. Not overnight. But consistently enough that I believe this deserves your attention. One man, a father of two who was 38, tracked his own ALT the way some people track their stock portfolio. He started at 58, watched it drop to 35 over a few months, then down to 20. He told me he went from feeling like he was aging too fast to feeling like he was 25 again. He did it with diet and exercise and a daily liver-support routine, and he credited the combination, not any single piece of it, with turning things around. A woman whose FibroScan had been in the danger zone told me she felt less anxious just knowing she was doing something proactive every morning, something she could point to and say, "I am giving my liver what it needs today." She was still seeing her hepatologist. She was still following her diet. But the daily softgel gave her a sense of control in a situation where most patients feel they have none. That sense of control matters more than most people realize. If You Are Reading This You might be at Stage 1 right now and not know it. You might be at Stage 2, watching your ALT and AST climb despite doing everything your doctor suggested. You might be a parent or spouse whose own liver health has taken a back seat while you worry about someone you love. Whatever stage you are at, the science is clear. Supporting your liver's glutathione and NAD+ systems matters. And doing it with a formula that actually reaches the liver intact, without degrading in a capsule or breaking down in your gut, matters even more. The Vital Labs NAC 600 comes with a 60 day money back guarantee. Try it. If you are not satisfied for any reason, you get your money back. You can learn more and place your order here: https://thevitallabs.com/nac600-nad This is meant to be taken alongside, not instead of, whatever your doctor has recommended. Do not stop prescribed medication. Do not skip follow-up appointments. Do not use this as a reason to delay seeing a specialist if you have symptoms. But if you are looking for something you can add to your daily routine, something that supports the biochemistry your liver depends on every single day, something manufactured under controlled conditions and third-party tested for purity, this is what I take myself. Every single day. Without exception. Rachel Simmons, RN Hepatology Nursing, 14 Years https://thevitallabs.com/nac600-nad P.S. If you are taking a statin and your liver enzymes have started to climb, you are not alone. I have cared for patients whose ALT shot from normal to over 140 within three months of starting atorvastatin. One woman told me her heart surgery had to be delayed because her liver was, in her own words, "in a mess" from the statin damage. She eventually switched to injections because every oral statin hurt her liver. Stopping your statin is not the answer. Your cardiologist prescribed it for a reason, and your heart needs it. But supporting your liver while you take it is a conversation worth having with your prescriber. The Vital Labs NAC 600 is what I take alongside, not instead of, my own health routine, and many of my patients have found it worth asking their doctor about. P.S. If you are going through menopause and your liver enzymes have started creeping upward for no obvious reason, please hear me: you are not imagining it. Hormonal shifts during perimenopause and menopause can change how your liver processes fat, and many women in this stage find that their weight simply will not budge no matter what they try. One woman I know stopped drinking entirely after menopause, then swapped her evening wine for cheese and crackers, and her liver numbers still climbed. Another told me she felt like she was "guiding her own doctors" because nobody connected her rising enzymes, her fatigue, and her stubborn weight gain to her liver. The Vital Labs NAC 600 is designed to be taken alongside, not instead of, whatever your menopause clinician or GP has recommended. It supports your liver's own repair systems during a time when your body is changing in ways nobody warned you about. P.S. If you have done everything right and your numbers are still not where they should be, I need you to hear this. You are not failing. One woman changed her entire diet, gave up alcohol, exercised consistently, lost weight, and was devastated when her follow-up showed fatty liver had not improved. Her specialist later told her that sometimes "the liver stays the same" despite doing everything right, and that genetics may play a larger role than anyone expected. Your liver may need more support than lifestyle changes alone can provide. The Vital Labs NAC 600 gives your liver the glutathione and NAD+ building blocks it needs, alongside, not instead of, the hard work you are already putting in every day. P.S. If you quit drinking and your GGT has stalled, I understand the frustration better than most. One woman I worked with saw her GGT drop from 280 to 146 after three months of complete sobriety. Then it sat at 147 for another six months. She felt like her body was punishing her for past choices. She wondered whether her GP even believed she had stopped drinking. The truth is, GGT can take a year or even longer to fully normalize after heavy drinking. Your liver needs consistent daily support during that time, not just the absence of alcohol. The Vital Labs NAC 600 is something you can take alongside, not instead of, your sobriety, your diet changes, and your doctor's monitoring plan. It gives your liver the glutathione precursor it needs while it heals at its own pace. P.S. If liver disease runs in your family, please do not wait for symptoms before you act. One woman I know lost her father at 62. He had 22 abnormal liver function tests over eleven years, and every single doctor told him fatty liver was nothing serious. By the time his symptoms started showing, it was too late. His daughter now gets screened regularly and has made liver health part of her daily life. If a parent, a sibling, or a child of yours has been diagnosed with liver disease, the most important thing you can do is ask your own doctor for a baseline liver panel and a FibroScan. And while you build that baseline, The Vital Labs NAC 600, taken alongside, not instead of, proper medical screening, can be part of the daily routine that protects what you cannot afford to lose. P.S. If you are watching someone you love struggle with liver disease, I know what that feels like from the other side of the bed rail. One mother watched her 35 year old daughter, a young mother of twins, fill with fluid until she could barely stand. She watched her daughter's kidneys begin to fail. She watched those teenage children try to understand why their mother could not get out of bed. Another woman texted her husband the diagnosis because she could not bring herself to say the words out loud. She turned her back on her young children so they would not see her cry. These are the moments that fracture families. If someone you love is dealing with liver problems, encourage them to see a hepatologist, not just a general practitioner. And if you are worried about your own liver because of what you have watched them go through, The Vital Labs NAC 600 is designed to be taken alongside, not instead of, medical care and proper screening. It is one daily step you can take while you still have the chance to take it. P.S. If you are taking a GLP-1 medication like Ozempic, Wegovy, or Mounjaro for weight management and you are hoping it will fix your liver along the way, please understand something. These medications can help with weight, and losing weight does help the liver. But your liver still needs glutathione and NAD+ to repair the cellular damage that has already been done. One man I know lost weight on a GLP-1, felt great about the number on the scale, then watched his ALT and AST climb right back up because the underlying inflammation had not been addressed. Weight loss treats one part of the equation. It does not rebuild the antioxidant and repair systems your liver depends on. The Vital Labs NAC 600 is meant to be taken alongside, not instead of, whatever your endocrinologist or weight management doctor has prescribed. It fills a gap that weight loss on its own cannot close. P.S. If you started taking a liver supplement, felt better, then stopped because you thought you were past the worst of it, and your symptoms came back, you are not imagining things. One woman took a liver-support blend for months, watched her lab numbers stabilize, felt her energy return, and decided she probably did not need it anymore. Within two months the fatigue crept back, her old symptoms returned, and her numbers started drifting upward again. She went back on the formula and everything improved once more. Your liver does not stockpile these compounds. Glutathione is used up and depleted every single day by normal metabolic processes. NAD+ levels decline with age regardless of how clean your diet is. Consistency is what keeps the repair systems running. That is why I take The Vital Labs NAC 600 every day, not only when something feels wrong. P.S. If you have been standing in the pharmacy aisle or scrolling through supplement websites, staring at milk thistle, turmeric blends, and liver detox formulas, wondering whether any of them actually do what they promise, I can tell you what I have seen over fourteen years in hepatology. Most of my patients who took plain milk thistle for months reported no measurable improvement in their liver function tests. Some developed bloating, stomach pain, or constipation that was worse than what they started with. Turmeric in dry capsules is poorly absorbed without fat. And most "liver cleanse" products contain long ingredient lists with tiny doses hidden behind proprietary blend labels. The reason I chose The Vital Labs NAC 600 is straightforward. It contains three compounds, NAC, NAD+, and MCT oil from coconut, each with published research supporting their role in liver health. They are delivered in a softgel that protects the active ingredients from degradation and carries them to the liver intact. Clinical-quality ingredients. Third-party tested. Manufactured under controlled conditions. No filler herbs. No mystery blends. If you are going to invest in your liver, invest in something your liver can actually use.