Fatty Liver with Normal Blood Tests? This Is Why It Can Happen

Before I was diagnosed with a fatty liver, I did various blood tests recommended by the doctor because I wasn’t feeling well. All sorts of tests.

They all came back normal or at least nothing there showed signs of extreme worry: my cholesterol was indeed at the top limit, but still not on the red. So was my glucose. ALT, AST and everything else was within the lines and looking good as well…

My blood test showed normal results, yet was was still diagnosed with a fatty liver. How is this possible? We’re going to talk about this in today’s article!

First of all, one thing is clear: just from looking at my blood test results, nobody could’ve guessed that I had a fatty liver. A

And this is the reason why just getting your bloodwork done is not enough to either confirm the diagnosis or to confirm the fact that you have reversed your NAFLD. Things could look fine, but you could still have it!

The only way to diagnose it is by running an ultrasound, a CT scan or a MRI. If you want to know exactly how severe it is, as these tests won’t be 100% accurate regarding the severity, you can go for a liver biopsy or a pretty expensive blood test (called FibroMax) which is also accepted generally as an indicator.

The FibroMax was the way I went, because it was a non-invasive procedure. Also, my doctor estimated by the looks of the ultrasound that it wasn’t very bad and recommended it instead of the biopsy.

However, you don’t really need to either the liver biopsy or the FibroMax test unless your doctor really recommends getting the extra work done, as they are really good nowadays when it comes to guessing the severity of your fatty liver looking at the ultrasound results alone.

But one thing is clear: blood work alone is not enough to tell you if you have a fatty liver or not! I had normal results and many others were diagnosed without anything wrong shown by their test results.

Fatty Liver blood tests

It is true, most of the people suffering from a Fatty Liver don’t have normal blood test results – and they usually have high levels of cholesterol and triglycerides, as well as AST and ALT numbers.

However, these high levels don’t automatically mean that you have a Fatty Liver, just as well as normal blood tests don’t necessarily rule it out. As it was my case: I was apparently healthy, but fortunately further tests were done and my fatty liver was found, helping me reverse it since.

If you’re starting your journey of reversing yours and you’re overwhelmed with all the healthy food options that you have to buy, you can check out my handy monthly shopping list for fatty liver, which will make it a lot easier for you in this regard, at least.

When should you get an ultrasound done for fatty liver?

Now, I wouldn’t suggest anyone to get an abdominal ultrasound just because their blood tests are normal.

Of course, if that’s the case, this most likely means that you are well and healthy!

But if you have any of the symptoms of a NAFLD and especially if you don’t find anything else to relate them to – or if your doctor recommends it – definitely get an ultrasound done! It is painless and fast and it tells you accurately if you have a fatty liver or not.

Fatty Liver Ultrasound

Don’t let it be too late because the sooner you catch a fatty liver, the easier it is for you to reverse it! It took me 1.5 years to do it, but others have done it in under an year, following a clean diet for NAFLD.

Being overweight should also ring the alarm and you should regularly get an ultrasound if you are overweight, as this is one of the main risk factors for a fatty liver.

I was 210 pounds when the fatty liver was discovered (pretty much for a 6 foot man), and I had been there for years. So if there’s fat on your belly, you might have fat in your liver too and it’s better to be safe than sorry.

It’s worth mentioning that overweight people don’t automatically have fatty liver, just as thin and fit people aren’t guaranteed not to have it. But usually, most of the people diagnosed with a fatty liver are at least overweight.

So keep an eye on your symptoms (from more common ones to itching), your weight and way of living, but also on heredity (did other people in your family have liver-related problems?) and potential medication you’re taking.

With all these in mind and with your blood tests done (they still need to be done, even if they are not a sure-fire way to get diagnosed), talk to your doctor and see what other tests have to be made to properly diagnose you.

In conclusion, you can still have a fatty liver even if your blood test results come back normal.

They usually won’t when you’re suffering from NAFLD, but it’s not uncommon for them to look good and you to still have it.

Therefore, if you or your doctor suspect a fatty liver, an ultrasound is the easiest way to tell if indeed you’re dealing with one or not. Alternately, you can go for a CT scan or a MRI.

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17 thoughts on “Fatty Liver with Normal Blood Tests? This Is Why It Can Happen”

  1. Thanks for this post. I know it’s a few years old. I just saw my CT results that say fatty liver is present, but my blood work is normal. My gastroenterologist did a colonoscopy after the CT. He said there was nothing to work about. I’m skeptical. I know I need a diet so I’m doing that no matter what he said. Just seems odd that the blood doesn’t reflect the CT interpretation.

    • Yes, it might sound strange, but there are actually many people who are in the same situation: blood work is good, fatty liver is present. I personally believe that this is a good thing, meaning that the fat in the liver hasn’t started to fully affect everything else and I consider it a sign that we’ll have an easier time reversing it. But it’s still something that shouldn’t be ignored.

  2. I would also like to thank you for your post and your post on the symptoms of fatty liver. I was having upper right quadrant pain that came and went and usually last for 30 min to an hour. IMO, it wasn’t severe enough that I needed to seek emergency help, but it was noticeable and bothered me mentally.

    I went to the doctor, who though that it may be my gallbladder, even though there was no discernible pattern to the pain. Like, it didn’t start after I ate or anything. I had blood work done and all of my labs were normal. I then had an ultrasound done and low and behold, I have hepatic steatosis…or a fatty liver. I am overweight so I definitely am making some lifestyle changes, but there is peace of mine in at least knowing what was causing my pain.

  3. Hello! I was diagnosed initially with fatty liver in December of 2017. My liver enzymes were high (ALT 127 and AST 95). Went to a liver doctor and had an ultrasound done, which showed that everything was normal and also a Fibroscan, which showed everything was within normal range. Since December, I have lost about 25 lbs by dieting and exercising. I am at a normal healthy weight now. (weigh 145 and am 5 ft 5 in) My blood tests keep getting worse. My total bilirubin is now at the highest point it can be without being flagged high. My other bilirubin levels keep rising, but are within normal range. I was tested positive for AMAs, my MVP is high as well. I am concerned it is PBC, but the ultrasound showed normal ducts. Did anyone else have abnormal blood work – specifically AMA positive with just fatty liver? My doctor hasn’t gotten back to me. I am getting pretty nervous about this. I also have pain in my upper right side which comes and goes. I will mention that my AST and ALT have gone down since December, but are still high.

    • I can’t really say about the blood tests, Sheri, since I am not a doctor, but I can confirm that many of those suffering from a fatty liver experience that upper right side pain. Stick to the diet and exercise daily – that’s all I can think of now until the doctor gets back to you with some positive news.

  4. This blog changed my life – Thank you Lynn for your selfless contribution to society and not having people pay even a cent for help! That truly says something about you and your character. I know you are being blessed in helping all of us help ourselves through this scary and uncertain experience. Your experience gave me hope when doctors and hours of web searches and articles couldn’t answer my questions. With your blog and prayer I was able to navigate and lose 40 lbs after 5 pregnancies and 3 of which I had gestational diabetes – 2 I was able to keep at bay through diet and exercise but the last one I had to use insulin injections. And then prior to my 2017 ER experience and diagnosis I had been having right side under the rib cage pain for 3 years!! I went to the doctor a couple times and they just thought it was ulcers etc. The sever pain would knock me to the floor and I would be laying there for 30 mins to 1 hour and that’s when I had had enough. The pain just kept getting worse.
    I can’t thank you enough. I have been pain free for 2 years and am living the mediterranean lifestyle. No alcohol hardly any sugar, low carbs and lots of exercise. I hope others can find strength through my post as I have through yours….well we gain much more from your posts but just know they are not alone! You can beat it and reverse it.

    • Marilee, it felt so good to read your comment – I am so happy to see that my hard work here is actually helping people reverse their condition and get their lives back. Reading what I have to say is just part of the whole: actually changing your diet and lifestyle is the biggest challenge and I am happy to hear not only that you managed to do this, but it also helped you reversed your fatty liver. Keep it up!

  5. Im 18 on my ct scan which was for a pain in my stomach i read ct scan which i probably shouldn’t of because now I think im dying i show I have mild Hepatic Steatosis. As of recently I have this pain upper right quadrant that comes for about 2-3 minutes then goes away its off and on. At Er they said my blood work was normal never mentioned Hepatic steatosis i got blood work like3-4 times. I know I should change something but what are the chances of me have liver failure or cirrohsis?

    • Sorry to hear about this – but as long as your blood tests are normal and the results only mention the mild Statosis, that’s what you have. In other words – you have a fatty liver. Unfortunately, many doctors downplay it which is really sad, especially for somebody of your age.

      But having the advantage of youth means that you will be able to reverse this very quickly. If you are overweight, you must lose weight at get back to a normal BMI. This is essential in battling fatty liver (aka hepatic steatosis). Even if you are not overweight, you should still change your lifestyle: start exercising (cardio is the best and easiest to do) and eat healthy. Cut out sugars, fats, sodas and sugary drinks, as well as alcohol. It’s a bit challenge for somebody this young, but the other option is much worse in my opinion.

      Relax though – this is definitely the end of the world. This is something you can reverse and as long as the results don’t say otherwise, you’re nowhere near cirrhosis or liver failure. The pain you feel is also experienced by most people with a fatty liver. Just work on your diet and stick to it and you will be able to reverse this.

  6. I was looking for cause of abdominal and pelvic pain by getting a ct scan. The radiologist MD saw the fatty liver. I then got asked to take blood tests. I have blood tests which show everything is fine. They did not test for cholesterol or triglycerides.

  7. I am lean and I eat well. No alcohol or caffeine intake. Hardly any sugar. I found out over the weekend so I have no one to talk to. I’m terrified. I can’t lose weight, I’ll be a skeleton. Does excercise make a difference if I’m lean. How did I get here, what can I possibly do if I don’t fit the criteria?

    • Difficult to say in this case. Are you taking any medication? Supplements for muscle building or anything like that? These could also cause a fatty liver.

  8. Ultrasound shows I have liver enlargement and my blood test are normal I don’t have pain but I have abdominal swelling when I eat food no alcohol or smoking but I drink coffee with sugar or tea 3 or 4 times a day so I don’t exercise.

  9. I know this post is so old but I just wanted to thank you for this information and sharing your experience. I’ve had stomach problems going back at least 10 years and always just accepted that this is how my body is.

    Flash forward to 2021 and I finally started seeking help again thanks to my fiancé who empowered me to advocate for myself. After waiting a year for an EGD that didn’t give many answers, my provider ordered an ultrasound to check for gallstones.

    They noted in the ultrasound that I showed fatty liver but when I followed up with my provider she said it was nothing because my liver enzymes (taken about 2 weeks before) are normal. I’m not one to overly worry about things but I’m a Hispanic female with a family history of liver disease and diabetes.

    I’m 32 and could always be better with my diet but I don’t drink, smoke, I do cardio 3-4 times a week along with weight training, I generally follow a pescatarian diet, I’m very conscious of not overdoing it with sugar and other fats.

    To me, the fact that my numbers are normal but it’s visible on the ultrasound and I’m a reasonably healthy, young-ish person is all the more reason to maybe ask some questions about what is going on. Especially as I take medications that are indicated to potentially cause liver issues.

    I know how stressed and under staffed our healthcare system is and that as a result things tend to be reactive rather than proactive, but it’s been so frustrating to not feel well but continually be told everything is normal.

    So yeah, just thank you for sharing your story so I don’t feel so crazy worrying about these results when my provider says I’m fine. (I did request a consult with hepatology which she put in but only before reminding me that I am fine and nothing is wrong since my numbers are normal.)

    • Happy to hear that this is helping, even a bit. I’m not a doctor, but I know that if fatty liver appears on ultrasound, then it’s a fatty liver. Most likely, though, it is in its very early stages (or at least not advanced), and you will have an easier time reversing it.


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