Warning Signs You May Have A Fatty Liver

You could have fatty liver right now and never know it. You don’t have any pain, maybe some vague symptoms, but nothing that really screams something’s wrong. But underneath the surface, your liver might be silently accumulating fat and causing inflammation and scarring and moving closer and closer to permanent damage.

So many people don’t realize the damage is happening until it’s too late. And here’s the kicker, you can spot that initial damage to your liver on your routine blood work that you get every year as part of your physical. But most doctors miss them because often those labs are interpreted as normal.

So in this guide, we are going to show you exactly what to look for, both the signs and symptoms of fatty liver, both in your body and also in your blood work.

So you can identify the disease early on because fatty liver disease is silent, but it’s absolutely reversible if you catch it early. And we have to catch it early because once the disease progresses to things like fibrosis or cirrhosis, well then at that point, it may be too late to reverse the damage.

Nothing or No Signs at All

Some refer to it as a silent epidemic. So instead, what we are going to talk about is secondary signs that may point to fatty liver. But because those secondary signs can be vague and not specific, meaning that could point to fatty liver, or they could also point to a completely unrelated condition.

So we will talk about these signs, but in the context of how likely you are to have fatty liver disease. Because if you have certain associated conditions or diseases, then those vague and not specific signs are naturally even more concerning for fatty liver disease.

And those conditions are obesity and insulin resistance. So things like diabetes or prediabetes or dyslipidemia or problems with the cholesterol, especially with things like triglycerides or ApoB. Because the prevalence of fatty liver is about 80 to 90% in adults with obesity. And it’s 30 to 50% in those with diabetes.

And the prevalence is up to 90% in adults with hyperlipidemia. So if you have any of those, then you need to definitely pay attention to the signs and symptoms that we are going to discuss.

Now, that might not give you enough information, but if you combine it with certain lab values on your blood work that we are also going to talk about, well, then you’ll have a good framework to understand the degree of your risk and how urgently you need to intervene.

And by the way, many people will need to intervene earlier than later, because up to one quarter of the global population is currently suffering from fatty liver disease or NAFLD, or actually has been more recently, more appropriately renamed to MAFLD, or metabolic dysfunction associated fatty liver disease. Because of that correlation with other metabolic issues like diabetes or high blood pressure or cholesterol.

And we want to intervene before this progresses to conditions like NASH, where fat buildup in the liver is now accompanied by inflammation and liver cell damage.
And that eventually leads to things like fibrosis, where you get scarring of the liver.

And then ultimately that can lead to things like cirrhosis, which is end stage irreversible organ damage, which at that point, the only treatment available is a liver transplant.

Physical Signs you May Have A Fatty Liver

Persistent Fatigue

Now, the first real life warning sign that you may be dealing with fatty liver is persistent fatigue.

And that is because your liver is like a power station for your body. And there’s a recent review that discussed the central role of your liver in energy generation, where our livers serve a very important function in turning the food that we eat into energy that our bodies can use. So it’s kind of like a power plant that can turn fuel into electricity.

So when you eat, your liver stores extra sugar or glucose into something called glycogen. So it’s like packing away energy for later. And when you’re not eating or you’re in the fastest state, your liver takes that stored energy and you can send it out to the rest of your body. So your body can keep functioning.

But if your liver is damaged, or if it’s accumulating fat, well, then it can’t do that job very well. And that means your body doesn’t get the energy that it needs, even if you’re eating excess food.

And that is what makes you really tired or weak, or it makes you have this profound fatigue.

Another reason for that low energy or fatigue is due to your body’s impaired ability to effectively utilize glucose. So you get those wild swings in blood sugar levels that will make you tired and sleepy.

Unexplained Weight Gain In Your Belly

Okay, the next warning sign that may indicate fatty liver disease is unexplained weight gain in your belly. So if you get fat accumulation around the abdomen, but you haven’t changed your diet or activity, well, that could be a sign of fatty liver and insulin resistance.

Now this abdominal or visceral fat is the fat that builds up around our organs, like your stomach and your liver and your pancreas.
And it’s far more dangerous than the fat you can just pinch under your skin on the surface.

And this visceral fat doesn’t just sit there, it sends extra fat called fatty acids straight to your liver. And too much of it can overwhelm our livers.

As more fat builds up on your liver, it starts hurting your liver cells. And it causes that dreaded inflammation that eventually makes it more difficult for your body to use and utilize insulin, which is what leads to insulin resistance. And on top of that, this visceral fat is a very metabolically active organ.

It causes hormonal signals like cytokines and TNF-alpha to create even more liver inflammation, which is one of the major driving forces that leads to scarring and eventual fibrosis and destruction of your liver.

Ache or Pain in Your Right Upper Quadrant

The last physical sign you gotta know before we get to your labs is mild ache or pain in your right upper quadrant, which is where your liver sits. And that is caused by liver enlargement.

In fact, hepatomegaly, which is a medical term for a liver that is larger than its normal size, is one of the most common physical exam findings in people with fatty liver disease. And a lot of that is caused by just plain fat infiltration and overall inflammation of your liver cells.

But the good news is, if you catch this early, even the simplest nutrition changes can actually reduce your liver back to its normal size.

Non Physical Signs of Fatty Liver

Running Specific Blood Tests

Below are specific blood tests that can tip you off that you may have fatty liver disease brewing. And you have to know this because many doctors will dismiss those lab values as normal.

First, you need to look at things like your liver function tests, like AST and ALT. And AST stands for alanine immunotransferase, and that’s a good biomarker for your mitochondrial function.

And ALT, or alanine immunotransferase, is a good biomarker for how much fat you may have in your liver. So both of these lab values are very useful in grading the severity of your liver disease, where AST is a good indicator of recent changes, like did your last few meals today or yesterday produce any kind of stress on your liver? And ALT is more of a long-term marker for your overall liver health.

Here is how these labs can be misinterpreted.
You may have these labs done, and the lab says they’re normal, or they fall within upper limits of the normal range. But what’s considered normal today was not considered normal just a few decades ago. In fact, in 1970s or 1980s, the upper limit of normal for ALT was 25. But now most labs consider 40 to be the upper limit of normal.

Now, what’s changed? Well, how the lab decides what’s normal and what’s not normal is they take all the normal people and figure out their mean value for a certain test, like ALT. And then they take two standard deviations from that mean, and that’s the range they use to consider what’s normal and not normal.

Now, over time, because more and more people have been developing fatty liver disease, well, these acceptable or normal ranges have also been drifting upward.

So today, ALT of 40 is two standard deviations above the mean, but that was considered abnormal just a few decades ago when the population overall did not have as many metabolic health issues.

The American College of Gastroenterology Guidelines consider a true healthy normal for ALT levels to range from 29 to 33 for males, and 19 to 25 for females.

But even that is a little too high. It is usually recommended that try getting your ALT level down to below 25. And anything above that probably indicates a brewing problem with your liver.

Uric Acid

Now, the next lab that is not routinely ordered, but definitely should be, and it honestly should be part of everyone’s routine assessment, is uric acid.

And sadly, most doctors, at least in the U.S., only order uric acid in the setting of gout. But high levels of uric acid is also a marker of fatty liver disease.

In fact, we have studies that show that uric acid levels were significantly higher in patients with NAFLD than those of individuals in a healthy control group.

In addition to that, uric acid levels showed a positive correlation with the degree of hepatic steatosis, and it showed that uric acid was found to be an independent risk factor for NAFLD.

But it’s not just fatty liver where checking uric acid is helpful. High levels of uric acid have also been linked with other conditions like hypertension, and it’s also a good biomarker for inflammation.

So once we get that uric acid number to below 5.5, it’s amazing how quickly other metabolic issues like high blood pressure and diabetes start getting better.

Now, we have to be careful interpreting high uric acid levels, as sometimes even exercise can cause these transient mild elevations. But that’s a whole other topic for another day.

Check your Homocysteine Levels

Next, another lab that is not routinely ordered by doctors, but is definitely recommended as part of your routine assessment is checking your homocysteine levels.

And all it is is just a measure of your homocysteine, which is a type of amino acid or a molecule that your body uses to make protein. And we have this large cross-sectional study from 2016 that showed that elevated homocysteine levels were positively associated with the prevalence of NAFLD in Chinese adults.

Now, just like with uric acid, homocysteine is also important to manage when it comes to cardiovascular disease and, in some cases, even dementia prevention.

Conclusion

Now, if any of those labs are abnormal, and you want to emphasize we have to follow the correct standards for what’s considered normal and abnormal, and if you have some of those associated symptoms like fatigue or increased belly fat, then you definitely need to talk to your doctor to get a more complete workout for fatty liver disease.

And that can involve additional blood tests like fasting insulin levels or triglycerides, or your doctor may order additional imaging studies like an abdominal ultrasound or a fiber scan, which is just a measure of liver stiffness.