You probably know that run-down feeling after a stretch of long days.
Most of us put it down to stress, poor sleep or just getting older. For some, the body is pointing to something else.
Non-alcoholic fatty liver disease is one of the most common liver problems in the country.
About 24% of US adults have it, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Most never know they have it.
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The disease is usually silent in its early years. It is often picked up by accident, when a routine blood test shows raised liver enzymes.
A 2022 review in BMC Endocrine Disorders notes that ALT is more often elevated than AST, and that a large share of patients have no symptoms at all.
Here are eight signs doctors watch for. The first few can show up early.
The others tend to appear once scarring has set in, and together they are a reason to call your doctor.
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The early signs most people brush off
1. Unexplained fatigue. When symptoms do appear, feeling very tired is one of the most common, according to the NHS. It is vague and easy to blame on sleep or stress.
2. A dull ache under the right ribs. The liver sits in the upper right side of the abdomen. The NHS and the BMC review both describe discomfort in exactly that spot as one of the main early clues.
3. Elevated ALT or AST on blood work. ALT and AST are liver enzymes that leak into the blood when liver cells are stressed. Raised levels on a routine test are often what first flags fatty liver, the BMC review notes.
4. Feeling generally unwell. The NHS lists this plain, unspecific symptom alongside fatigue in early disease. It is the kind of thing people shrug off for weeks before mentioning it to a doctor.
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Signs that scarring may have set in
If fatty liver progresses to cirrhosis, the scarring stage of liver damage, the body sends louder signals. These are not proof of fatty liver on their own, but with the earlier clues they warrant a visit.
5. Loss of appetite and nausea. The NIDDK lists poor appetite and nausea or vomiting among the early signs of cirrhosis.
6. Unexplained weight loss. Losing weight without trying is another early cirrhosis clue, per NIDDK.
7. Itchy skin. Itching of the skin can appear early. In more advanced cirrhosis it can become severe.
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8. A yellow tint to the eyes or skin. This is jaundice. NIDDK groups it among the advanced signs, together with dark urine, a swollen belly from fluid buildup, and bruising more easily than usual.
When to call your doctor
Any one of these on its own is rarely a sign of fatty liver.
But if two or more fit, and especially if a routine blood test has flagged raised liver enzymes, book an appointment.
Risk is higher if you have obesity, type 2 diabetes, insulin resistance, high cholesterol or high blood pressure.
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Early fatty liver can often be reversed with weight loss and diet changes. Scarring is harder to undo.
This article is made and published by Mie Hermansen, who may have used AI in the preparation.