A fatty liver, also known as hepatic steatosis, occurs when too much fat builds up in the liver. This is a common condition that affects up to 25% of people globally. While a fatty liver often causes no damage by itself, it can lead to inflammation and liver scarring over time in some people. So how might you feel if you have a fatty liver? Here are some of the most common symptoms and signs.
Fatigue and Weakness
One of the most frequent complaints with a fatty liver is a feeling of tiredness and lack of energy. This fatigue results from the extra work the liver has to do to process the excess fat. Your body’s energy production may also be impaired when fat accumulates in liver cells.
Some people describe the fatigue as an overall lack of vitality or chronic weakness. The exhaustion tends to build up over weeks and months rather than coming on suddenly. It can make usual activities more challenging and sap your motivation to exercise or socialize.
Upper Abdominal Discomfort
As the liver becomes occupied with fat, it can cause a feeling of vague abdominal discomfort under the right ribcage. This may manifest as a dull ache or tender sensation in the upper right quadrant of the abdomen.
Some people experience bloating, fullness, or sensations of pressure as well. The discomfort tends to be mild in simple fatty liver, but can become more pronounced if inflammation develops.
Loss of Appetite and Nausea
A stressed, fatty liver releases chemicals that can suppress your appetite. As a result, people with a fatty liver often notice a reduced desire to eat. Food may become unappealing, especially fatty or greasy items. Prolonged loss of appetite can lead to weight loss.
Nausea is another common digestive symptom. You may feel queasy, particularly after eating a meal. Nausea and loss of appetite can also produce a sensation of early fullness while eating.
Brain Fog and Sluggish Thinking
Many people with a fatty liver report problems with concentration, memory, and clear thinking. Doctors refer to these cognitive symptoms as “brain fog.” Mental fatigue, forgetfulness, and reduced alertness are common. Multi-tasking, quick decision making, and handling complex information can become more difficult.
These brain manifestations likely stem from subtle changes in liver function and inflammation markers that affect brain health. The fatigue and loss of motivation associated with a fatty liver may also impair mental sharpness.
Increased Infections and Illness
Your liver plays an important role in immune function and inflammation regulation. When it’s infiltrated with fat, its ability to fight infections can become impaired. People with a fatty liver often notice they catch colds, viruses, and bacterial illnesses more frequently. Recovery from infections may take longer as well.
Even in the absence of a specific pathogen, a fatty liver can trigger low-grade systemic inflammation that produces vague feelings of being unwell. General malaise, sweating, and mild fever may come and go.
Skin Changes
Skin manifestations provide visible clues that may reflect an underlying fatty liver. These include:
- Red palms – Palmar erythema or redness of the palms occurs when substances produced in the liver affect blood vessels.
- Yellow palms – Excess fat can also cause a yellowish discoloration of the skin on the palms and soles known as xanthalasma.
- Spider angiomas – These are small clusters of dilated blood vessels that can appear on the skin as the liver becomes impaired.
- Itching – Mild itching or pruritus on the arms, legs, or skin with no rash may be noticed.
Dark Urine
Liver dysfunction from fatty infiltration can sometimes produce darkening of the urine. The urine may appear brown, amber, or tea-colored rather than the usual pale yellow. Bilirubin, a pigment handled by the liver, builds up in the blood and kidneys causing this discoloration.
Unexplained Weight Loss
Gradual unintentional weight loss is another sign that should prompt concern for a fatty liver. Even though weight gain and obesity often precede fatty liver, unexplained weight loss may develop once the liver becomes impaired. This occurs because of poor appetite, inadequate digestion, and inefficient metabolism of calories when liver function declines.
What Causes Fatty Liver?
Recognizing what allows fat to accumulate in your liver is key to prevention and treatment. The most common causes include:
Obesity
Being overweight or obese is by far the greatest risk factor for developing a fatty liver. Up to 75% of obese adults have excess fat stored in the liver. This results from a surplus of dietary calories, increased transport of fats to the liver, and inadequate oxidation of fats. Losing weight through diet, exercise, and lifestyle changes is crucial for treating obesity-related fatty liver.
Insulin Resistance
Insulin resistance reduces the liver’s ability to process fats and sugars appropriately. Fatty acids accumulate as a consequence. Insulin resistance underlies type 2 diabetes and metabolic syndrome. Actions that improve insulin sensitivity such as weight loss, exercise, and some medications can help reverse fatty liver.
Dyslipidemia
Blood fat disorders characterized by high triglycerides and low HDL cholesterol create an imbalance that promotes liver fat storage. Management of dyslipidemia through diet, exercise, statins, or other lipid-lowering drugs can improve these drivers of fatty liver.
Rapid Weight Loss
Aggressive calorie restriction and bariatric surgery lead to sudden weight reduction. This rapid influx of fat released from adipose tissues can overload the liver’s processing capacity and actually worsen fatty liver temporarily. Gradual, steady weight loss is the safer approach.
Nutritional Factors
Diets high in processed carbohydrates and sugars seem to increase the risk of fatty liver, while Mediterranean diets lower risk. High fructose intake from processed foods and sugary beverages promotes liver fat synthesis. Excess iron and inadequate vitamin E and D also appear to contribute.
Genetic Factors
Variations in genes involved with liver fat metabolism can predispose certain individuals to develop a fatty liver even with milder dietary and weight influences. Certain ethnic groups, such as Hispanics, also have higher rates of fatty liver.
Gut Microbiome
Imbalances in the intestinal bacteria allow increased release of inflammatory toxins into the portal vein carrying blood to the liver. This exposure drives immune reactions that can exacerbate fat deposition. Treatments that improve gut microbial balance may relieve fatty liver.
Medications
Some medications can increase risk of fatty liver. Examples include methotrexate, tamoxifen, amiodarone, valproic acid, glucocorticoids, and antiretroviral drugs used to treat HIV infection. Talk to your doctor about medication options if fatty liver develops.
When to See a Doctor
Make an appointment with your physician if you develop any of the concerning symptoms and signs described. Blood tests to check liver function along with an ultrasound scan of the liver can confirm if excess fat has accumulated. These are usually ordered once abnormalities are suspected on lab tests.
Your doctor will also check for conditions that can progress to later damage such as non-alcoholic steatohepatitis (NASH) or alcoholic liver disease. Seeking medical care early provides the best opportunity to prevent progression and reverse fatty buildup through lifestyle improvements and treatment.
With an accurate diagnosis from your doctor, you can take actions to protect your liver health. Losing weight, modifying your diet, taking helpful supplements, and treating related conditions like diabetes or high blood fats can all help stabilize and improve fatty liver.
Natural Remedies
Nutritional and lifestyle changes form the cornerstone of natural treatments for fatty liver. Key strategies include:
Weight Loss
Losing 3-5% of your body weight can dramatically improve liver fat levels. This should be achieved through permanent lifestyle adaptations of diet and exercise rather than extreme short-term dieting. Losing just 10-15 pounds makes a major difference if you have a fatty liver.
Limit Refined Carbs and Added Sugars
Minimize intake of rapidly absorbed carbohydrates like white bread, white rice, cereals, crackers, baked goods, sugary beverages, candy, pastries, and desserts. These drive insulin resistance and liver fat production.
Choose Plant-Based Proteins
Get protein from nuts, seeds, beans, lentils, whole grains, and soy rather than red meat and fatty animal products. Plant proteins are naturally lower in saturated fats.
Increase Fiber Intake
Soluble fiber found in oats, nuts, seeds, beans, lentils, fruits, and some vegetables enhances satiety, feeds healthy gut bacteria, and promotes weight loss to relieve a fatty liver.
Moderate Alcohol
Avoid excessive intake, but moderate alcohol (1 drink daily for women, 2 for men) may protect the liver. Binge drinking and alcohol abuse obviously exacerbate liver fat.
Drink Green Tea
Compounds in green tea called catechins have been shown in studies to help reduce liver fat and associated insulin resistance. Three to five cups spread throughout the day can aid liver function.
Take Milk Thistle
Milk thistle (silymarin) is an herbal supplement with antioxidant and anti-inflammatory properties that can help stabilize liver cell membranes and reduce fat deposition. It is considered safe and well tolerated.
Increase Physical Activity
Engage in regular moderate cardio and strength training exercise 5 days per week. Physical activity reduces fatty liver independent of weight loss by burning visceral fat and improving insulin sensitivity.
Get Adequate Sleep
Chronic sleep deprivation impairs glucose and fat regulation. Aim for at least 7-8 hours nightly. Establishing consistent sleep and wake times aligned with your circadian rhythm may optimize metabolic health.
Medical Treatments
If natural fatty liver remedies prove inadequate after 3-6 months, prescription medications and procedures may be appropriate:
Metformin
This diabetes drug enhances insulin sensitivity and reduces liver fat synthesis. It is often effective for fatty liver related to metabolic syndrome and prediabetes.
Statins
These cholesterol medications have the additional benefit of lowering liver fat. Statins like atorvastatin and rosuvastatin are commonly prescribed.
Liraglutide
This injectable diabetes drug promotes insulin release and weight loss. Studies confirm it lowers liver fat and may reverse early fibrosis.
Orlistat
This drug blocks fat absorption from the gut and modestly reduces liver fat when combined with dietary changes. It aids weight loss efforts.
Bariatric Surgery
Procedures like gastric bypass and sleeve gastrectomy promote major weight loss for obesity. They frequently resolve fatty liver by restoring metabolic balance.
Vitamin E
High-dose vitamin E (400-800 IU daily) has antioxidant activity and trials found it decreased liver fat and inflammation in non-diabetics.
Omega-3 Fatty Acids
Fish oil supplements may improve liver fat when triglycerides are elevated. Benefits appear greatest at doses above 2 grams daily of EPA and DHA.
Does Fatty Liver Become Cirrhosis?
Cirrhosis represents late-stage scarring of the liver with extensive architectural disruption. It rarely develops in uncomplicated cases of fatty liver. However, when fat accumulation incites chronic inflammation, this can sometimes progress to advanced scarring.
Risk Factors for Progression
Certain conditions increase the risk of worsening from simple fatty liver to cirrhosis:
- Non-alcoholic steatohepatitis (NASH) – This inflammatory form of fatty liver causes ballooning liver cell degeneration that can lead to fibrosis.
- Alcohol overuse – Excess intake promotes liver inflammation that worsens fat deposition.
- Obesity – Being overweight stresses liver cells and increases fibrosis risk.
- Insulin resistance – Impaired insulin action and type 2 diabetes accelerate liver injury.
- Dyslipidemia – High blood fats perpetuate liver inflammation.
Progression to cirrhosis is gradual, usually taking at least 10-20 years. Not all fatty livers will advance if risk factors are modified.
Monitoring Progression
Your doctor will monitor blood tests of liver function, inflammation markers, and imaging studies to check for worsening fatty liver or development of cirrhosis. Yearly ultrasounds of the liver look for signs of fibrosis. Newer elastography scans also detect stiffening of liver tissue from scarring.
Preventing Cirrhosis
The most important things you can do to avoid progression to cirrhosis are:
- Maintain a healthy weight and lose weight if overweight.
- Exercise regularly with a mix of cardio and strength training.
- Follow a Mediterranean style diet rich in plants and healthy fats.
- Treat associated diabetes, high blood pressure, and dyslipidemia.
- Strictly avoid alcohol and substance misuse.
- Take medications if prescribed, such as metformin or statins.
- Discuss supplements like vitamin E, milk thistle or fish oil.
Implementing lifestyle and dietary modifications under a doctor’s care provides the best chance at stabilizing fatty liver, resolving inflammation and stopping fibrosis from advancing.
Prognosis of Fatty Liver
The long-term outlook depends on the specific type of fatty liver disease and other medical factors:
| Type | Prognosis |
|---|---|
| Simple Fatty Liver | Generally benign prognosis if managed. 5-year survival over 90%. |
| NASH | Higher mortality than simple fatty liver. Advanced fibrosis worsens outlook. |
| Alcoholic Fatty Liver | Relatively benign if alcohol intake stops. Continued drinking hastens cirrhosis. |
Key determinants of long-term outlook with fatty liver disease include:
– Severity of liver abnormalities at diagnosis – Higher liver enzyme levels, lower platelet counts, and imaging evidence of fibrosis imply increased risks.
– Presence and management of liver inflammation – Uncontrolled inflammation accelerates fibrosis and subsequent cirrhosis risk.
– Weight trajectory and insulin sensitivity – Sustained weight loss efforts and control of diabetes improves prognosis.
– Elimination of alcohol use and smoking – Continued substance abuse makes cirrhosis complications more likely.
– Engagement with medical care – Monitoring and proper treatment lowers risks of progression.
With early diagnosis and proper management under a doctor’s supervision, most cases of fatty liver can achieve stabilization and avoid future cirrhosis. Losing weight, improving diet, exercising, controlling other diseases, and avoiding alcohol and smoking are key steps. Seeking medical care at the first signs of symptoms provides the best outlook.
Conclusion
Fatty liver disease arises when excess triglycerides accumulate in the liver’s cells. This often occurs against a backdrop of obesity, insulin resistance, high blood fats, and poor dietary habits. Symptoms caused by a fatty liver can include fatigue, abdominal discomfort, appetite changes, and brain fog. Natural treatments emphasize weight loss, dietary improvements, exercise, and supplements. If fatty liver becomes severe or progresses to liver inflammation, medications and surgery may be warranted. Regular medical monitoring and management are crucial to avoid long-term cirrhosis complications. Implementing lifestyle changes and following up appropriately on concerning symptoms provides the best opportunity for stabilizing liver health.