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Key considerations include: NICE guidance (NG49 and QS82) does not recommend alkaline water for liver disease Alkaline water is not a licensed medicine or medical device under MHRA regulation No UK guidelines or high-quality clinical trials support alkaline water for NAFLD or NASH Patients with fatty liver disease should be cautious about unproven remedies and focus on evidence-based interventions supported by the NHS, NICE, and the British Liver Trust