Five Warning Signs that You Might Have a Fatty Liver

Note: This article is based on my personal experience and research. I am not a doctor or a dietitian, and this content is for informational purposes only. Always consult with your healthcare provider before making any changes to your diet or lifestyle.

Most people visiting this blog have already received a diagnosis, but you might be here because you suspect something is off: maybe you have a few nagging symptoms, a feeling that your health isn’t where it should be, and you need answers.

Today, I am sharing the top five warning signs of a fatty liver – signals your body sends that you shouldn’t ignore.

The sooner you identify NAFLD, now officially renamed MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease), the sooner you can start working on reversing it.

Please note that I am not an advocate for self-diagnosis based on internet research. But if you have one or, worse, several of these signs, you need to consult a specialist immediately. Let’s get started!

The “Silent” Symptom

Unfortunately, the most common symptom of early fatty liver disease is… no symptom at all. This is why most people get diagnosed after routine checks, like routine blood work or ultrasounds for unrelated issues.

The liver is a resilient organ. It can handle a significant amount of fat accumulation and inflammation before it starts “complaining.” By the time you physically feel something, the condition has often progressed beyond the earliest stages.

It doesn’t help that many of these warning signs and symptoms can be caused by a multitude of other conditions, only one of which is MASLD aka fatty liver.

However, if you have risk factors for fatty liver disease, such as type II diabetes, family history of liver disease, Asian heritage, frequent intake of sweetened soft drinks and/or you are overweight, then fatty liver disease should remain a consideration.

Always consult a doctor because they are qualified to run the necessary investigations and tell you exactly what your problem is, after running lab tests and an ultrasound (at the very least).

Now let’s get a bit more in depth with the most common 5 warning signs that you might have a fatty liver:

1. Your belly is bigger than it should be

Non-alcoholic fatty liver disease is tightly connected to obesity, specifically visceral obesity (fat accumulated deep inside the abdomen).

If you are carrying extra weight, look at where you are carrying it. If the weight is concentrated in your abdomen – giving you a belly that feels firm or protrudes significantly – there is a high risk that your liver is suffering as well.

The “Lean” Exception

I must mention a very important fact here: weight alone isn’t the only factor. You don’t have to be overweight to have a fatty liver (unfortunately for the lean ones out there).

There is a profile known as “TOFI” (Thin Outside, Fat Inside). You might have a normal BMI and look slender, but if your diet is high in sugar, fructose, and processed carbohydrates, you can still develop visceral fat around your organs.

Even more so, if you have a “potbelly” despite being thin elsewhere, consider this a major red flag, as “lean fatty liver” is also common.

2. Pain in the upper right side of your abdomen

The liver itself does not have nerve endings, meaning it cannot “feel” pain in the traditional sense.

However, when the liver fills with fat and becomes inflamed, it swells. This swelling stretches the “capsule” (a thin membrane) that covers the liver. This stretching is what causes the sensation of pain.

So if you’re feeling pain in the upper right side of your abdomen, under your right rib, it’s a potential warning sign of a fatty liver and you should visit a doctor ASAP.

This pain is rarely sharp or stabbing, but instead feels like a dull, throbbing ache, and/or a sensation of fullness or pressure (like a balloon is inflated inside you).

Most people I know have had this symptom before being diagnosed, and it was one of my main symptoms too.

Because this area is also home to your gallbladder, identifying the exact cause is impossible without medical imaging. If you have this specific pain, visit a doctor ASAP.

3. You are tired, weak, and can’t think straight

We aren’t talking about being sleepy after a long day. We are talking about a deep, metabolic exhaustion that feels unique and only those who experience it know how it really feels like – which is something I don’t wish any healthy person to ever feel. I’ve been there and it’s terrible.

A healthy liver cleans your blood. It filters out toxins, ammonia, and byproducts of digestion. Once the liver is damaged by fatty build-up or scarring, its ability to function drops.

The result is blood that isn’t as “clean” as it needs to be. This toxic load circulates to your brain, leading to:

• Brain fog (difficulty focusing or finding words).
• Physical weakness.
• Sudden energy crashes, especially in the afternoon.

This was again one of the things that I felt before being diagnosed. At times, I was so tired that I thought I was suffering from chronic fatigue syndrome. No amount of sleep or rest (or anything, honestly) seemed to fix it.

The good news is that this gets better. My energy returned after I started changing my lifestyle to reverse my condition.

4. You’re losing interest in food and/or feeling nausea

When the liver is under attack from excess fat, the body generates inflammation. This systemic inflammation releases chemicals into the bloodstream that can suppress appetite and mess with your digestion.

In more progressive stages, specifically MASH (Metabolic Dysfunction-Associated Steatohepatitis – formerly known as NASH), you might find that you simply don’t want to eat.

Also, a struggling liver has a hard time processing fats and producing adequate bile. This can lead to a wave of nausea shortly after eating.

In my case, I had a mix of both. My body was strangely craving healthy food, while simply seeing a burger or other greasy foods made me feel sick. Also, after almost every meal – regardless of what I ate – I felt nauseous.

If you are experiencing unexplained nausea after meals, it is a strong indicator that your digestive system is compromised and you should further investigate it.

5. Your skin is itchy

This is not one of the warning signs that I personally had, but many people I know suffered from this before (and sometimes after) being diagnosed.

This symptom, known medically as pruritus, happens when bile salts accumulate in the skin because the liver isn’t filtering them out effectively.

Some sources claim itchiness is only a sign of advanced liver damage, but that isn’t always true. You can experience itchy skin even in earlier stages if your liver is congested or struggling with bile flow.

This itchiness often presents differently than dry skin:

• It can be intense on the palms of your hands or the soles of your feet.
• It often worsens at night.
• Scratching rarely provides relief.

Since itching can be caused by allergies or dermatological issues, it is easy to dismiss. But combined with any of the other signs on this list, it requires a check-up.

And if you have this problem, I strongly recommend looking at my previous article talking about itching (and relief) with fatty liver disease.

Other more advanced warning signs of a fatty liver disease

As fatty liver disease progresses, the symptoms can progress beyond the “non-specific” to those that are a lot more characteristic of liver problems.

Jaundice, ascites (fluid retention in the abdomen) and certain skin changes are some examples of more “classic” liver disease findings.

However, you don’t want to wait until those show up. Instead, if you find yourself suffering from any of the five warning signs listed above, have a discussion with your health care provider.

It is far better to overcall it, then miss the early stages of fatty liver disease. Remember, the sooner you have the diagnosis, the sooner you can do something about it and reverse it (like I did) by changing your diet and way of living.

Final words

Many of these warning signs can be connected to other health problems – indigestion can cause nausea, stress can cause fatigue, gallbladder issues can cause that upper right side pain, and so on.

However, if you have risk factors – such as being obese, having type II diabetes, a family history of liver disease, or a high intake of sweetened soft drinks – these symptoms might be signs that you do have a fatty liver disease.

If you experience them, or if you know somebody who ticks one or more boxes from this list, make a doctor appointment ASAP.

A fatty liver disease is one that can be reversed by following a solid program, and the sooner you get diagnosed (as it has three stages/grades), the easier it will be to reverse it.