Fatty liver disease, also known as non-alcoholic fatty liver disease, is when people put on weight and fat builds up around the liver.
According to Dr Khalid Zalmay, a family doctor in the UK, there’s been an upward spike in cases over the last few years, and it’s one of the main reasons people get scarring in their liver – a condition known as cirrhosis.
Dr Zalmay has more than 100,000 subscribers on YouTube, and in one of his videos warned liver scarring is the most common reason why people need liver transplant.
He explained there are four stages of fatty liver disease:
Stage 1 – simple or early fatty liver
Dr Zalmay said: “This is usually a build up of fat in the liver cells which may only be diagnosed on a blood test or liver function tests.”
Stage 2 – non alcoholic steatohepatitis
Dr Zalmay said this is “a more serious version of fatty liver disease where the liver has become more inflamed”.
Stage 3 – fibrosis
Dr Zalmay explained: “This is where there’s ongoing inflammation which has caused scarring of the liver and nearby blood vessels. But the liver is still able to function normally so far.”
Stage 4 – cirrhosis
Dr Zalmay said: “This is the most severe stage and this happens after years of inflammation and scarring, where the liver starts to shrink, it becomes really scarred and lumpy.”
He added: “In this final stage the damage is permanent and it can lead to liver failure where your liver stops to work properly. Sometimes it can also increase your risk of getting liver cancer.
It can take years for the two most worrying stages – fibrosis and cirrhosis – to develop, and obviously the earlier you detect it the easier it is to do something about it.
Early signs of fatty liver disease
Fatty liver disease is notoriously difficult to pick up before it starts damaging the liver, said Dr Zalmay, so it’s important to look out for the following early signs and symptoms:
- Fatigue
- Weakness
- Discomfort, fullness or ache in the right side of your abdomen just under your ribs
- Unexplained weight loss
With fatigue and weakness, Dr Zalmay said: “We don’t know exactly why this happens but we know that your liver regulates much of your storage and release of energy production for your body.
“So when we deposit fat in those areas where it really shouldn’t be there, perhaps that starts to affect how efficiently the liver can do its job.”
Discomfort, fullness or an ache in the right of your abdomen may occur as the fat deposits around the liver may cause the liver to enlarge, said Dr Zalmay. As it grows bigger it starts to cause a dull ache as it presses against other structures in that area.
But not everyone will get this symptom. Dr Zalmay added: “There are lots of things that can give you pain in this region, like gallstones, so if you’re getting this, best to get it seen by a doctor and investigated.”
As a doctor, unexplained weight loss is always a worrying symptom, said Dr Zalmay. But some people may dismay this as a sign of fatty liver disease as the condition is linked to obesity.
Dr Zalmay explained some reasons for this: “It’s thought as you get progression through the stages some people may experience weight loss this may down to the inflammatory process that’s going on in the liver. All these inflammatory molecules will be whizzing around your bloodstream and sometimes you’re not able to break down toxins as well so you get a build up of inflammatory molecules, toxins which can sometimes give you nausea. If you’re not feeling quite right, you’re probably not going to be eating as much as usual.
“As the liver is working harder trying to cope with extra stress and pressure this increases the resting energy consumption of the liver – how much energy it takes in – you’re burning off more calories at rest. These two mechanisms together could be a reason why people may lose weight – but will still don’t know for sure. Not everyone will have weight loss. A sign of unexplained weight loss in any patient needs investigating.”
Signs and symptoms that can develop in the later stages
Dr Zalmay said the following symptoms can appear as fatty liver disease processes:
- Itchy skin
- Oedema
- Jaundice
- Loss of libido
- Bruising easily
- Darker colour urine
- Pale poo
One “red flag” symptom that shouldn’t be ignored is:
If this occurs you need to see a healthcare professional urgently, said Dr Zalmay, as this is a sign blood can’t flow through the liver properly.