3.AUG.2018 4 MIN READ | 4 MIN READ

What happens when the liver stops functioning correctly? What is fatty liver, and how does it affect your overall health?

Last updated on 19 October 2020

Unlike the tummy, intestines, heart or lungs, not many people know what the liver really does. Do you?

The easiest way to think of your liver is like a factory. It controls everything from production and processing to storage and elimination, taking care of over 500 important tasks and kick-starting several thousand chemical reactions every day. One of its main functions is to convert the nutrients from our food into energy, producing substances our body needs like proteins and antibodies. As if it wasn’t already busy enough, the liver also stores these substances until your body is ready to use them.

Dr Lui Hock Foong, gastroenterologist at Gleneagles Hospital, breaks down the most persistent myths about this condition and shares the facts you really do need to know.

If you’ve concerns about your liver, don’t hesitate to speak to a specialist.

Myth 1: Fatty liver isn’t anything to worry about

Myth fatty liver is not serious
Fatty liver, as the name suggests, refers to a build-up of fat in the liver (anything over 5% of the total organ size).

Many people with fatty liver don’t even know they have the condition. Sometimes, it causes no problems at all. But that doesn’t mean you should ignore it. Fatty liver can increase your risk of more serious conditions including cirrhosis (scarring of the liver), liver disease or liver cancer. Why? This is because a build-up of fat damages your liver cells and causes inflammation. Your liver is the only organ in your body that can regenerate itself by replacing old, damaged cells with new ones. As your liver struggles to get rid of the fat, scar tissue builds up, making it difficult for your liver to transport nutrients around the body and increasing pressure in the surrounding veins.

Liver cirrhosis may be attributed to a variety of causes including chronic alcohol abuse, chronic viral hepatitis, fat accumulating in the liver, iron build-up in the body, and other medical conditions such as cystic fibrosis, biliary atresia, and certain genetic disorders.

Signs and symptoms of liver cirrhosis are often only manifested when liver damage is extensive. These include:

  • Fatigue
  • Easily bleeding or bruising
  • Loss of appetite
  • Nausea
  • Swelling of legs, feet or ankles
  • Weight loss
  • Itchy skin
  • Yellowing of skin and eyes
  • Accumulation of fluid in the abdomen
  • Spiderlike blood vessels on the skin
  • Redness in the palms of the hands

Potential complications from liver cirrhosis include bruising, bleeding, kidney failure, liver cancer, diabetes and eventually, liver failure.

Myth 2: Only alcoholics get fatty liver

Myth only alcoholics get fatty liver
Whether you feel dependent on alcohol or not, drinking anything over the recommended ‘safe limit’ may put your body at risk of fatty liver.

“The safe limit for men and women is 14 units of alcohol per week,” clarifies Dr Lui. “A unit of alcohol corresponds to 1 small glass of wine (125ml), 1 shot of hard liquor or half a pint of beer.”

Other factors may also put you at risk of developing the condition. A high-fat, high-sugar diet can be a large contributing factor. In fact, if you are overweight or have diabetes, your risk of developing fatty liver is more than 30%.

Other potential causes include:

  • Family history of fatty liver
  • Rapid weight loss
  • Taking regular medications like steroids

Non-alcoholic fatty liver sometimes develops when the liver naturally struggles to break down fats, which can lead to non-alcoholic steatohepatitis (NASH), or swelling of the liver.

What is non-alcoholic steatohepatitis?

NASH is a form of non-alcoholic fatty liver disease in which inflammation of the liver (hepatitis) and liver cell damage are present in addition to fat in the liver. People with non-alcoholic fatty liver disease are more likely to have NASH if they have one or more of the following conditions:

  • Obesity, especially large waist size
  • High blood pressure
  • High levels of triglycerides or abnormal levels of cholesterol in the blood
  • Type 2 diabetes

Symptoms of non-alcoholic steatohepatitis (liver swelling):

NASH is often a silent disease with few or no symptoms. If symptoms are present, they may manifest as feeling tired or having discomfort at the upper right side of the abdomen. Left untreated, NASH can lead to complications, such as liver cirrhosis or cancer.

Myth 3: Drinking hard liquor is worse than drinking beer or wine

Myth hard liquor is worse than beer or wine
The type of alcohol you drink doesn’t make a difference – it’s all about how much of it you drink. “The safe limit is fixed at 14 units a week,” explains Dr Lui. “Below this limit, alcoholic fatty liver is less likely to occur. Regularly go above this limit and you’re more likely to do yourself harm.”

Myth 4: Fatty liver disease is a rare condition

Myth fatty liver is rare
Unfortunately, fatty liver is becoming more and more common worldwide. Unhealthier diets, binge drinking culture and a higher rate of obesity in developed countries may the reason for this.

“The new epidemic of liver disease is fatty liver,” says Dr Lui. “About 25 – 30% of the general population may have fatty liver, and of these, around 15% have the more serious type that can lead to cirrhosis and cancer.

“Fatty liver is still less common in Singapore than in other countries, perhaps because alcohol is more expensive here, but that doesn’t mean we should ignore the risks. In the USA, fatty liver is now the second most common reason, and will soon become the most common reason, for liver transplantation. We need to be thinking about our lifestyles and diets so that we can prevent something similar happening here.”

Myth 5: Fatty liver disease is irreversible

Myth fatty liver is irreversible
Currently, there is no medication that can reliably treat fatty liver. However, you can make certain lifestyle changes to reduce your risks or even reverse the condition.

Lifestyle and home remedies to reduce risk of fatty liver disease:

  1. Avoid alcohol as it puts extra stress on the liver
  2. Reduce your sugar intake
  3. Cut out fatty foods and go for a healthy plant-based diet to keep your cholesterol and triglycerides at healthy levels
  4. Exercise regularly
  5. Maintain a healthy weight
  6. Monitor your blood sugar levels

If you are overweight or obese, try to lose weight by reducing the number of calories you consume each day and increasing your physical activity.

“Eating a healthy diet with plenty of fresh fruits, vegetables, whole grains and lean meats like chicken and fish can make a big difference in managing the condition,” says Dr Lui.

Myth 6: Women are more likely to develop fatty liver

Women are more likely myth
“While this was thought to be the case in the past, present studies point to equal risk for both men and women,” clarifies Dr Lui.

If you’re concerned about your risk of fatty liver or want more lifestyle tips to maintain good liver health, speak to a gastroenterologist.


Article contributed by Dr Lui Hock Foong, gastroenterologist at Gleneagles Hospital


Biggers, A. (2017, August 10). Fatty Liver (Hepatic Steatosis). Retrieved 6 July 2018 from https://www.healthline.com/health/fatty-liver#symptoms

Newman, T. (2018, March 2). What Does the Liver Do? Retrieved 6 July 2018 from https://www.medicalnewstoday.com/articles/305075.php

Cirrhosis (2018, December 7) Retrieved September 21, 2020, from https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-causes/syc-20351487

Non-alcoholic Fatty Liver Disease & NASH (n.d.) Retrieved September 21, 2020, from https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash

Nonalcoholic Fatty Liver Disease (2019, August 29) Retrieved September 21, 2020, from https://www.mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/diagnosis-treatment/drc-20354573

Lui Hock Foong
Gleneagles Hospital

Dr Lui Hock Foong is a gastroenterologist practising at Gleneagles Hospital, Singapore. He specialises in digestive disorders and liver transplant for liver diseases such as liver cancer and liver failure.