Fatty Liver

Fatty liver means fat has accumulated inside the liver cells themselves. A small amount is normal. It becomes a disease when the fat makes up more than about a twentieth of the liver's weight, at which point the liver is working under a load it was not built for.

In most people the driver is insulin resistance. The body stops responding properly to its own insulin, fat is released from stores faster than it is burned, and the liver becomes the place it is parked. Weight carried around the middle, type 2 diabetes, high triglycerides, low HDL cholesterol and high blood pressure all travel with it, and Indians develop the pattern at waist measurements that would be considered unremarkable elsewhere. Alcohol causes the same accumulation through a different route, and the two can be present in the same person.

What matters is where you sit on a spectrum. Fat alone is the mildest stage and does little harm for years. In a minority, the fat sets off inflammation, the liver repairs itself with scar tissue, and repeated over a decade or more that scarring stiffens the whole organ. Most people never travel the length of that spectrum, and the purpose of assessment is to work out how far along it you are.

Fatty liver is usually found when someone was looking for something else. An ultrasound done for an unrelated reason reports a bright liver, or a routine blood panel shows liver enzymes a little above the normal range. Neither finding, on its own, says how much damage there is.

Your doctor's examination is about the company the liver keeps. They measure your waist and your weight, take your blood pressure, feel for an enlarged liver under the right ribs, and check your skin and eyes for any sign that the liver is failing to do its work. They will ask directly and in detail about alcohol, because the amount changes the diagnosis, and about every medicine, supplement and traditional preparation you take.

They will then exclude the other causes of a fatty or inflamed liver, since hepatitis B and C, thyroid disease and certain medicines produce a similar picture and are treated in completely different ways. The last judgement is how likely scarring is, which is assessed from your age, your diabetes status and the pattern of your blood results together. If that assessment suggests scarring is a real possibility, your doctor will arrange a further step and explain what it would change about your treatment.

This is measured in months and years. There is no tablet that clears fat from the liver, and the treatment is a sustained change in body weight and activity.

Losing about a twentieth of your body weight clears much of the fat. Losing around a tenth also settles the inflammation and can improve early scarring. The rate matters as much as the target: losing it slowly, over six to twelve months, works and holds, while rapid crash dieting can make the liver worse. Expect liver enzymes to be rechecked at three to six months, and expect them to lag behind the changes you are making.

Around 150 minutes of moderate exercise a week improves the liver independently of what the scales say, so the effort counts even in a month when your weight has not moved. Bringing blood sugar, blood pressure and cholesterol under control is part of the same treatment. Alcohol is stopped. None of this requires time off work, and all of it requires the kind of persistence that is easier with a review date in the diary.