Fatty Liver Disease: Symptoms, Diet and How to Reverse It

Most people find out they have a fatty liver by accident. An ultrasound done for stomach pain, or a routine blood test with a slightly high ALT, shows “grade 1 fatty liver” and the doctor says to watch your diet. It sounds minor, and in the early stage it is. But fatty liver is now one of the most common liver problems in Pakistan, and left alone it can slowly turn into scarring. The good news is that in its early stages it can be reversed.

What is fatty liver disease?

A healthy liver holds a little fat. When fat makes up more than about 5 percent of the liver’s weight, it is called fatty liver. Doctors now call the most common type metabolic dysfunction-associated steatotic liver disease (MASLD), which you may still see written as NAFLD. It has nothing to do with alcohol. Fatty liver caused by drinking is a separate condition.

Over the years the condition can move through stages:

• Simple fatty liver: fat is present but there is no real damage. This stage is reversible.
• Steatohepatitis: fat plus inflammation, which starts to injure liver cells.
• Fibrosis: scar tissue begins to form.
• Cirrhosis: widespread scarring that can lead to liver failure or liver cancer.

Fatty liver symptoms

In most people there are no symptoms at all, which is why it goes unnoticed for years. When symptoms do appear they are vague:

• Constant tiredness
• A dull ache or feeling of heaviness in the upper right side of the abdomen
• A slightly enlarged liver found on examination

Signs of advanced liver damage are different and need urgent attention: yellow eyes or skin (jaundice), swelling of the legs or belly, severe itching, easy bruising, vomiting blood or black stools, and confusion.

What causes it?

• Extra weight, especially around the waist
• Diabetes or insulin resistance, including prediabetes
• High triglycerides and high cholesterol
• Sugary drinks, sweets, bakery items, white bread and deep-fried food
• Rapid weight loss or crash dieting
• Some medicines, and in a few people an underactive thyroid or PCOS
• Family history

How it is diagnosed

An abdominal ultrasound is the usual first test and grades the fat from 1 to 3. Blood tests include ALT, AST and a lipid profile, along with fasting sugar or HbA1c. If your doctor wants to know whether scarring has started, a FibroScan or other fibrosis test may be advised. Note that ALT can be normal even when there is fat in the liver, so a normal report does not always mean a normal liver.

How to reverse fatty liver

Lifestyle change is the real treatment, and it works. Losing 5 to 10 percent of your body weight can remove fat from the liver and reduce inflammation.

• Cut out sugary drinks, packaged juices, sherbet and sweet chai as far as you can.
• Replace maida and white bread with whole-wheat roti, daliya, oats and brown rice in sensible portions.
• Fry less. Choose grilled, baked, steamed or shallow-fried food.
• Eat more daal, chana, vegetables, salad, fruit and fish. Keep red meat portions small.
• Walk briskly or exercise for at least 150 minutes a week.
• Lose weight gradually. Crash diets can make the liver worse.
• Avoid alcohol completely.
• Keep diabetes, blood pressure and cholesterol under control, and ask your doctor about hepatitis A and B vaccination.

Some studies suggest that moderate coffee drinking, without sugar, is linked with less liver scarring, but it is a bonus and not a treatment.

Are there medicines for fatty liver?

Weight loss and controlling diabetes and cholesterol remain the foundation. Doctors sometimes add vitamin E in selected patients, and may prescribe liver-supporting medicines such as ursodeoxycholic acid or silymarin. The evidence for these supplements is mixed. They can support a healthy lifestyle but they cannot replace it. Please also be careful with herbal and “liver detox” products of unknown origin, because some of them have themselves injured the liver.

When to see a doctor

• Yellow eyes or skin, dark urine or pale stools
• Swelling of the abdomen or legs
• Vomiting blood or passing black stools
• Persistent pain in the upper right abdomen or unexplained weight loss

Key takeaways

• Fatty liver usually has no symptoms and is often found on ultrasound.
• It is strongly linked with weight, diabetes and high cholesterol, and can be reversed early.
• Weight loss, less sugar and fried food, and regular exercise are the main treatment.
• Do not take unverified herbal liver products, and see a doctor about any warning signs.

Related medicines on Medimart

These are commonly used by doctors for liver health and fatty liver:

• Ursodeoxycholic acid: a bile acid used in several liver conditions
• Silymarin (milk thistle): a plant-derived liver-support supplement
• Vitamin E: an antioxidant sometimes advised in selected patients
• L-ornithine L-aspartate: used in some liver disorders

Prescription medicines are supplied only against a valid prescription. Please take them only as advised by your doctor.

Browse liver care medicines on Medimart with delivery across Pakistan. Prescription medicines are supplied only against a valid prescription.

This guide is for general information and does not replace advice from a doctor. If your report shows fatty liver, please discuss it with your doctor.