Fatty Liver / MASLD Symptoms (formerly NAFLD): Here’s What to Look Out For

I have had symptoms associated with fatty liver for a long time, even before being diagnosed with the condition. Back then, I had no idea what these symptoms meant – and most of the time they were just small annoyances.

The dull pain under my right rib that came and went, the exhaustion I couldn’t shake no matter how much I slept, the bloating after every meal. I blamed everything but my liver. Stress, a bad diet, getting older… You name it.

However, as with any disease, the condition is easiest to reverse when you catch it early on, so if you have any of these symptoms (or any other symptoms), you should visit a doctor ASAP.

Let’s see what the fatty liver disease symptoms are – I had most of these before and after being diagnosed, and most people with a fatty liver will experience at least some of them at one point.

I have to repeat that it’s worth noting that fatty liver disease (aka MASLD, formerly NAFLD) won’t always come with symptoms. So, even if you don’t feel anything, you could still have it (which is the scary part).

At the same time, having more of these symptoms – or some of them being more intense – doesn’t necessarily mean that your fatty liver is in a more advanced state or anything of the sort.

But you do need to visit a doctor to tell you exactly where you’re at – or if it’s a fatty liver that’s causing them!

Symptoms of a fatty liver

Back to today’s topic, here are the symptoms I had before being diagnosed with a fatty liver:

1. Pain under the right rib cage

We’re talking about a dull pain that’s easy to live with, not too sharp, not something to write home about.

I couldn’t connect it to things I ate or things I did. It was just a strange pain that came and went, sometimes lasting for hours, sometimes not being there for hours.

This is one of the most common symptoms of people dealing with a fatty liver. Some even complain that the pain is really bad and doesn’t let them sleep or wakes them up. So it can vary in severity.

This pain stays with you well after starting your liver-friendly diet and changing your lifestyle, but gets better over time, as your liver heals. I wrote a lot more about this fatty liver related pain in this article, in case you want to read more.

Of everything on this list, this is by far the most consistent symptom. I would say that virtually everyone I know with a fatty liver has felt this pain at some point.

One thing worth knowing: some doctors will tell you that this pain doesn’t exist, because the liver can’t hurt.

While they are technically correct, as the organ doesn’t have pain receptors, the discomfort you’re feeling comes from the liver pressing against surrounding tissue as it becomes enlarged.

2. Fatigue

I was always feeling extremely tired. Exhausted, actually, and I always thought that it was me working way too hard – but apparently it was not (just) that.

Usually, if you feel extremely tired – especially without any obvious reason – you might have some liver-related problems. Might, as there are other potential causes for this as well (or just your body needing a rest).

3. Bloating

Before being diagnosed with a fatty liver disease, I started to get bloated at all times, even though in the past that rarely happened to me.

Even so, I attributed my bloating to the fact that I was eating a very unhealthy diet, but apparently that wasn’t the case as many people who have a fatty liver complain about getting bloated.

4. Nausea

Nausea came relatively late for me, but when it arrived, it was enough to finally push me into a doctor’s office – especially since I was also having all the other symptoms listed above.

I was nauseous after most meals, and it was noticeably worse after greasy food, fast food, or anything heavy. Things like steaks with fries or fast food (and generally anything with too much fat) made it a lot worse.

I didn’t know back then that we shouldn’t drink alcohol with fatty liver, so I was also drinking beer after the meal or taking a shot before to “help digestion”. Oh my, the damage I was doing without knowing!

Conditions seemed to improve if I took pills to help digestion (I thought that was the problem), but fortunately I decided to go check things out and I am glad I did.

5. Itching

While I didn’t experience this, it is a common cause of liver-related problem, including a fatty liver.

You have inexplicable itching on some areas of your body, usually your arms and legs. This is definitely a sign that you have to visit a doctor! It’s not necessarily a sign of liver problems, but many people I know with a fatty liver have this too.

6. Red spots on the skin

Another symptom that I didn’t personally experience, but many people that were diagnosed with a fatty liver complained that they had it.

Although these red spots are usually associated with other problems (from allergic reactions to a plethora of other things), several people that I had talked to and had a fatty liver also had those, so they could be connected.

7. Your body asking for healthy food (the silent one)

This is something that sounds a bit strange, but some of you might experience it and I certainly did, so I decided to include it on the list, even though it’s not really a medical thing and some might roll their eyes hearing me talk about your body demanding this or that.

I craved things that I never craved before, like eating salads, fresh yogurt and usually light, refreshing foods. I rarely ate fruits back then and I was really surprised to find me craving apples or strawberries back then too.

Of course, I didn’t really listen to my body back then and kept forcing myself to eat pizzas and burgers and all the bad things that people around me were eating…

But since then, I decided to pay more attention to what my body asks. (But not offer it the sugar it wants, for example, as that’s not really the same thing and we always have healthier alternatives).

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Who is most at risk?

While anybody can develop a fatty liver, and it doesn’t always announce itself with the symptoms mentioned above, some people are at a higher risk than others.

The main conditions associated with MASLD are obesity, type 2 diabetes, high cholesterol, high triglycerides, and metabolic syndrome, which is a combination of several of these factors together.

For example, I was well overweight when I was diagnosed (see how I looked before reversing my condition), I had almost zero physical activity, and I ate poorly.

However, even people at a healthy weight can develop MASLD too, so weight alone isn’t the full picture.

If you have any of the above conditions, or a family history of liver disease, I’d recommend asking your doctor for liver function tests even if you feel completely fine – better be safe or catch it as early as possible.

Wrapping up the symptoms

As you can see, the symptom picture for fatty liver disease is a mixed bag. Some signs, like the pain under the right rib and persistent fatigue, are fairly specific to the liver.

Others, like nausea and bloating, can be attributed to dozens of other things and are easy to dismiss.

Except for the pain the upper right side of the abdomen (which I associated with my irritable bowel initially, for example) everything else can be easily ignored as you wait for the problems to pass and they generally do.

But you shouldn’t ignore them! I know now after fortunately deciding to visit the doctor.

As I said, if you have these symptoms, you don’t automatically have a fatty liver or any sort of liver problems. At the same time, many find out that they have a fatty liver during routine checks… so it’s not easy to point a finger on this or that.

It took me 1.5 years to reverse it and maybe I would’ve been able to do it sooner if I went to the doctor faster, when the first symptoms appeared.

Then stick to your diet and you’ll get healthy again! It’s easier than it might seem at first.