Fatty liver affects you even if you are slim. Know How!

Subarna Ghosal

Updated on:

  • Liver is the second largest organ of the body and its main  function is body detoxification and also  fat metabolism.
  • It keeps the body clear of toxins which can create  a risk of diseases.

Definition of Fatty Liver

Fatty liver is a condition which develops when the body creates too much fat or can’t metabolize fat efficiently .

  • The excess fat which is stored in liver cells where it accumulates and causes fatty liver.
  • Fatty liver disease means having extra fat in our liver.

Is Alcohol to be blamed?

  • Heavy drinking increases the circulating triglyceride levels in the blood, thus increasing the fat deposition in the body. This excess fat deposition occurs in the liver as well.
  • With excess fat in the liver, the efficiency with which the liver works is hampered thus affecting the various metabolic processes.

Though the important oint to note here is that, we can have Fatty Liver even if we don’t drink Alcohol.

Symptoms of fatty liver are as follows:

  • Physical weakness
  • Fatigue
  • Confusion
  • Poor Appetite
  • Weight loss.
  • Abdominal pain

Fatty Liver is a Progressive Disease


  • Abnormal bleeding
  • Ascites- Fluid filled abdomen
  • Jaundice
  • Mental Confusion

Factors responsible for fatty liver:

  • The most common cause of fatty liver in most cases is  ALCOHOL USE.

But in many cases, it’s confusing what causes fatty liver in people who don’t drink much alcohol.

  • However, central obesity, overweight, a diet high in refined sugar, high blood triglycerides, diabetes, low physical activity, and genetics- all play a role.

Other common factors responsible  of fatty liver include:

hyperlipidaemia, or high levels of fats in the blood, especially high triglycerides

  • Obesity
  • Diabetes
  • Genetic
  • Rapid weight loss
  • Side effects of certain medicines including methotrexate (Trexall), and valproic acid (Depakote), tamoxifen (Nolvadex), amiodarone (Pacerone)

Types of Fatty Liver

Non-alcoholic fatty liver disease (NAFLD) 

  1. Alcoholic fatty liver disease in other words also called alcoholic steatohepatitis.

Sometimes, the extra fat can trigger changes that stop our liver from working well.

Since the liver filters toxins out of the blood, that could make us sick.

Extent of Damage caused by Fatty Liver

  • The prevalence of Fatty Liver is as high as 1 of 4 people, which is more than diabetes and arthritis also.
  • And lots of those who have fatty liver may not know what it is and whether they have it or not.
  • Most of the times, this liver disease is mild, but it can lead to more serious health problems if let unattended.

But we can often control or reverse fatty liver with lifestyle changes.

Non-alcoholic Fatty Liver Disease

  • This is one of the most common kinds of fatty liver disease.
  • But few people develop a more severe version named as non-alcoholic steatohepatitis (NASH). That’s when our liver gets swollen, which can lead to cirrhosis (scars on the liver) and a higher chance of liver cancer and heart disease.
  • Experts have proposed that NASH is about to become the leading reason for liver transplants.

There are different types of NAFLD:

  • Simple fatty liver: This means that our liver has excess fat, but we may not have any inflammation in our liver or damage to your liver cells. It usually doesn’t get worse or cause problems with the liver.
  • Most people with NAFLD generally have simple fatty liver.

Nonalcoholic steatohepatitis (NASH): 

  • This is much more serious than a normal fatty liver.
  • NASH means we definitely have inflammation in the liver.
  • The inflammation of liver and cell damage that happen with NASH can pose serious problems like –
  1. Fibrosis: scarring of the liver
  2. Cirrhosis which is scarring in the liver, which can even  lead to liver failure and death
  3. Liver cancer

About 20% of people with NAFLD suffering from  NASH.

Alcohol-Related Fatty Liver Disease (ALD)

Some people don’t have any symptoms.

Here liver becomes enlarged, we may have pain or discomfort on the upper right side of our belly.

ALD is preventable. It usually gets better when we stop drinking alcohol.

But if we don’t give up the habit of alcohol, ALD can cause serious problems. Like:

  • Alcoholic hepatitis.  Characterized by the swelling in the liver that can cause fever, vomiting, belly pain, and jaundice.
  • Alcoholic cirrhosis. This is characterized by a  build-up of scar tissue in the liver.

The symptoms of Alcoholic Fibrosis may be similar to Alcoholic Hepatitis-

  •  Confusion and changes in behavior
  • Enlarged spleen
  • Liver failure, which can be fatal
  • Large amounts of fluid build-up in your belly (ascites)
  • High blood pressure along with Portal Hypertension
  • Bleeding in our body

Alcohol-related fatty liver disease usually comes first. It can get worse and become alcoholic hepatitis.

Over time, it may turn into alcoholic cirrhosis.

  • With BOTH ALD and NAFLD, there are usually no symptoms.

Few people may have signs such as tiredness or pain in the upper right side of the belly where your liver is.

If one has NASH or cirrhosis, they suffer from symptoms like

  • Larger-than-normal breasts in men
  • Red palms
  • Jaundice
  • Swollen belly
  • Enlarged blood vessels underneath your skin

Risk Factors of Fatty Liver

For ALD, the cause is too much alcohol.

The chances of Fatty Liver increse if-

  • if we drink a lot and
  • We Are obese
  • We malnourished/undernourished
  • Have chronic viral hepatitis, especially hepatitis C

There are various reasons responsible for people with NAFLD having simple fatty liver. One of the main reasons is definitely Genetics.

NAFLD or NASH is more likely if:

  • If we are overweight
  • Our  body doesn’t respond to  insulin as it should (called insulin resistance) or if we have type 2 diabetes
  • If we have high levels of triglycerides or “bad” (LDL) cholesterol or low levels of “good” (HDL) cholesterol
  • If we have metabolic syndrome.

Around  20 % of people with non-alcoholic steatohepatitis condition will progress to cirrhosis.

Who’s at risk for fatty liver?

  • Overweight or obese.
  • Having  diabetes type 2 may increase our risk for fatty liver as fat accumulation in the liver has been linked to insulin resistance
  • An excess amount of alcohol i
  • Those who are taking more than the recommended doses of certain medications, such as acetaminophen (Tylenol) etc
  • Pregnancy
  • High Cholesterol
  • High Triglyceride level
  • Undernutrition
  • Metabolic syndrome
  • Low physical activity

Fatty liver diagnosis :

Physical exam

  • If your liver is inflamed, the doctor may be able to detect it by examining or palpating the abdomen for an enlarged liver.
  • However, our liver can be inflamed without being enlarged.
  • But we should inform Doctor if we are experiencing fatigue or loss of appetite.
  • Also, tell the doctor about any history of alcohol, medication, and supplement use.

Blood tests

Although this doesn’t confirm a diagnosis for a fatty liver, it does relate to liver inflammation.

Further analysis is definitely necessary to find the cause of the inflammation.

Imaging studies

  • Abdominal Ultrasonography to detect fat in our liver. Other imaging studies can also be done, like  CT or MRI scans.
  • There is another test similar to ultrasonography is a Fibro Scan.
  • A  Fibro Scan utilizes sound waves to determine the density of the liver and the corresponding areas of fat and normal liver tissue.
  • Imaging studies can detect fat in the liver, but they can’t help the doctor to confirm the extent of the damage.

Liver biopsy

Liver biopsy is still said to be one of the best ways to determine the severity of liver disease.

During a liver biopsy, the doctor will insert a needle into the liver and remove a piece of tissue for the test

They will give us a local anaesthetic to lessen the pain.


The first-line of treatment to reduce our risk factors.

  • Avoiding alcoholic beverages
  • Managing your blood cholesterol levels
  • Reducing the intake of refined  sugars and saturated fats
  • Losing weight
  • Controlling blood sugar levels

Dietary Modifications for Fatty Liver

If one has a fatty liver because of obesity or unhealthy eating habits,  it is definitely because of modifiable factors and hence a change in lifestyle will benefit to a great extent.

  • By reducing the number of calories, we eat per day can help us to lose weight and heal the liver.
  • In the initial stages, we can improve and reverse the fatty liver disease by reducing or eliminating fatty foods and foods high in sugar from the r diet.
  • Choosing a balanced diet with healthier foods like add more fresh fruits, fresh vegetables, whole grains, and healthy fats like nuts( but portion control is needed ) and avocados.
  • We need to replace red meats with lean proteins such as soy, lean chicken, turkey, and fish.
  • Sweetened drinks and sodas should be avoided.

Doctors recommend weight loss for non-alcoholic fatty liver.

  • Weight loss can help in reducing the amount of fat in the liver also can ease inflammation, and fibrosis.
  • If the doctor thinks that a certain medicine is the cause of our NAFLD, we should stop taking that medicine. But check with our doctor before discontinuing.
  • It is said that there are no medicines that have been approved to treat NAFLD.

One of the most important aspects for treatment of alcohol-related fatty liver disease is to avoid or stop drinking alcohol.

Both the alcoholic fatty liver disease and one type of non-alcoholic fatty liver disease (non-alcoholic steatohepatitis) can lead to cirrhosis.

Doctors can treat the cirrhosis with medicines, operations, and other medical procedures.

If the cirrhosis leads to liver failure, we may need a  liver transplant.

Let’s follow some healthy ways to manage Fatty liver:

  • Try to stop drinking alcohol or limit our intake to 1 drink or less per day for women and 2 drinks or less per day for men.
  • So, protecting our liver is one of the best ways to manage liver and its complications.

We can start by taking several steps:

Limit or eliminate alcohol

Try to maintain a healthy, balanced diet.

Control of the levels of circulating blood sugar

Try to aim or at least 30 minutes of exercise 5 to 6 days of the week.

Eat a healthy diet, limiting saturated fats, salt and sugar

Try eating lots of fruits, vegetables, and whole grains

If possible consult doctor and get vaccinations for hepatitis A and B. As if one has hepatitis A or B along with fatty liver, it is more likely to lead to liver failure.

People having chronic liver disease are more susceptible to infections, so the other two vaccinations are also important.

Talk with the doctor before using any supplement, such as vitamins or any complementary medicines or alternatives.

Guidelines to be followed:

  • But Remember if fatty liver persists and isn’t reversed, it can progress into liver disease, cirrhosis, or cancer.
  • The transformation to cirrhosis is definitely dependent on the cause.
  • In the case of alcoholic fatty liver, if we are continuing to drink alcohol in excess quantity can lead to liver failure.
  • The progression of the non-alcoholic fatty liver disease varies, but in most people,  it does not lead to liver scarring.
  • However, if one is diagnosed with steatohepatitis, he /she has a higher chance of developing scarring and liver disease.

To reduce our risk of non-alcoholic fatty liver disease:

  • Try maintaining a  healthy plant-based diet that’s rich in fruits, vegetables, whole grains and healthy fats.
  • If we are overweight or obese, reduce the number of calories you eat each day and get more exercise.
  • Exercise most days of the week.

If we have complications due to NASH, like cirrhosis or liver failure we may  need to have a liver transplant.

Lifestyle changes can help with NAFLD:

  • Weight loss helps to reduce fat, inflammation and scarring in our liver.
  •  By losing just 3% to 5% of our body weight can cut down on how much fat is in the liver.
  • Try to be active by exercising  30 minutes a day  5 /6 days  of the week
  • But if we are not already exercising regularly, must get our doctor’s advice first and start slowly.
  • Try not to do things that will make it work harder.
  • Skip alcohol.
  • Try to have medications and over-the-counter drugs only as instructed.

Always consult your doctor before you try any herbal remedies.

Overall try to keep a healthy, mainly plant-based diet, maintain atleast 30mins of exercise a day, and take the prescribed medications only. And also in this way we maintain our cholesterol and triglyceride levels balanced.

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