Spotting the Signs: 10 Early Symptoms of Fatty Liver You Shouldn’t Ignore

Non-alcoholic fatty liver disease (NAFLD), now often termed metabolic dysfunction-associated steatotic liver disease (MASLD), is on the rise in India. Sedentary jobs, especially in IT and finance, and refined diets are fueling this trend. Studies suggest that around 25–35% of urban adults may have NAFLD, with over 80% prevalence in some IT cohorts.

Catch it early: simple liver fat can be reversed with lifestyle changes, but it may silently progress to severe conditions like NASH, fibrosis, and cirrhosis if ignored.

Understanding Fatty Liver in India

In MASLD, liver cells accumulate fat (>5% of liver weight), impairing their function. Risk factors include insulin resistance, visceral fat, high-carb diets, poor fibre intake, and sedentary lifestyles. Notably, lean MASLD, or fatty liver, is common among normal-weight individuals of Asian descent.

10 Subtle Signs of Early Fatty Liver

Each below symptom can feel minor—but spotting several together should prompt a liver check.

1. Constant Fatigue

Significantly higher fatigue scores in NAFLD—comparable to cholestatic liver disease—linked more to inactivity and daytime sleepiness than liver damage itself.

2. Muscle Weakness & Low Stamina

Early liver dysfunction alters protein metabolism. NAFLD-associated sarcopenia affects strength even before overt disease, triggering muscle loss and fatigue.

3. Upper-Right Abdominal Discomfort

Mild liver enlargement (hepatomegaly) can stretch its capsule, causing a dull ache or fullness under the rib cage.

4. Bloating, Gas, Indigestion

Reduced bile flow affects fat digestion, a common occurrence in NAFLD, and is often reported alongside gastrointestinal symptoms such as bloating and post-meal discomfort.

5. Loss of Appetite or Mild Nausea

Liver inflammation can disturb gut hormones, leading to early satiety, mild nausea, or aversions.

6. Unintentional Weight Loss

Unexpected weight and muscle loss may occur due to nutrient malabsorption and chronic low-grade inflammation.

7. Dark, Velvety Skin Patches (Acanthosis Nigricans)

Insulin resistance, a strong MASLD risk, is signalled by these patches, which are common in the neck and armpit folds in Indians.

8. Poor Sleep or Daytime Sleepiness

NAFLD patients often have insomnia, restless nights, or sleep disorders due to metabolic disruption and fatty liver’s links to poor sleep quality.

9. Brain Fog & Difficulty Concentrating

Cognitive effects, including reduced attention and memory, are present even in early MASLD, likely due to systemic inflammation.

10. Elevated Liver Enzymes (ALT/AST)

Often, the first objective sign in routine blood work: mild enzyme elevations can reveal MASLD before symptoms appear.

How to Reduce Fatty Liver: Practical Steps

Diagnosing MASLD? These steps are clinically proven to reverse liver fat:

1. Improve Your Diet

• Swap refined carbs (white rice, maida) for whole grains: brown rice, millets.

• Eat fibre-rich staples: vegetables, legumes, and fruits.

• Choose lean proteins and healthy fats (omega-3s).

• Cut out sugary drinks and high-fructose foods.

2. Exercise Consistently

• 150–200 minutes/week of aerobic activity + 2–3 resistance training sessions.

• Losing just 5–10% body weight significantly reduces liver fat.

3. Avoid Alcohol & Smoking

Even mild alcohol can worsen MASLD. Quit smoking to improve insulin and liver health.

4. Monitor Health

Regularly check liver enzymes, glucose, HbA1c, lipids.

5. Manage Other Medical Conditions

Control diabetes, cholesterol, thyroid health, and blood pressure.

Top 5 Evidence-Based Supplements for Liver Support

1. Milk Thistle (Silymarin)

Milk thistle is a herbal extract (from the plant Silybum marianum) long used as a liver tonic in traditional medicine. Modern research on silymarin suggests that it has antioxidant and anti-inflammatory properties, which may protect liver cells. Some clinical trials have observed improvements in liver enzymes (ALT, AST) and even liver histology in patients with NAFLD who took silymarin supplements, although the results have been mixed.

2. Kalmegh (Andrographis paniculata)

This bitter Ayurvedic herb is known for its liver-cleansing and immune-modulating effects. Kalmegh's active compound, andrographolide, has been found to exhibit hepatoprotective effects in multiple preclinical studies. It works by reducing inflammation and oxidative stress in liver tissue. While more human trials are needed, it is widely used in traditional medicine for liver support and detoxification. Picrorhiza kurroa (Kutki) Animal and translational studies report that Picrorhiza kurroa extract reverses liver fat accumulation, sometimes outperforming silymarin in reducing steatosis.

3. Kutki (Picrorhiza kurroa)

Kutki is another classic Ayurvedic herb often used in liver formulations. Its extracts have been shown in animal studies to reduce liver fat accumulation, enhance bile flow, and improve liver enzyme levels. Compared to silymarin, Kutki has demonstrated equal or superior effects in some experimental models, particularly for preventing fatty infiltration and fibrosis.

4. Punarnava (Boerhavia diffusa)

Known in Ayurveda for its rejuvenating and diuretic properties, Punarnava has shown hepatoprotective effects in laboratory studies. It supports liver detoxification and reduces hepatic inflammation, especially in settings of chemically induced liver damage. Though human trials are limited, its long traditional use and early preclinical evidence make it a promising supportive option for liver health. Dandelion Root (Taraxacum officinale) High-fat diet rodent studies find dandelion leaf extract significantly reduces liver fat, improves bile flow, and exerts antioxidant effects.

5. Dandelion Root (Taraxacum officinale)

Commonly consumed in herbal teas and supplements, dandelion root has been studied for its role in improving bile flow and acting as a mild liver stimulant. Animal studies have shown that it helps reduce liver fat accumulation, oxidative damage, and overall liver inflammation. It’s also rich in antioxidants and polysaccharides that may support liver repair mechanisms. Dandelion is often included in liver detox formulations, particularly for those with sluggish digestion or mild fatty liver.

Final Takeaway

MASLD is widespread in India, but with vigilance and effort, it can be reversed. Watch for these 10 symptoms, adopt healthier habits, and consider tested supplements with medical advice and lifestyle changes to give your liver the support it needs.