Signs and Symptoms

A liver problem will often cause pain to the right shoulder. It can also cause little red dots or bumps on your skin, liver spots, eczema, itchy skin, hot feet, white tongue, halitosis, and digestive bloating. The liver creates bile, which is important for digestion.

If you have low bile, you will notice:

• Bloating

• Burping/belching

• Headaches

• Fat-soluble vitamin deficiencies

• Cravings for deep-fried foods

• Cravings for sweets after you eat

• Grouchiness in the morning

Fatty liver disease (Metabolic dysfunction-associated steatotic liver disease or MASLD) often presents with no or very mild symptoms in its early stages. When symptoms do appear, especially as the condition progresses to inflammation (MASH) or scarring (cirrhosis), they can include: 

• Persistent fatigue and weakness

• Abdominal pain or a feeling of fullness in the upper right abdomen, where the liver is located

• Unexplained weight gain or difficulty losing weight, particularly around the midsection

• Signs of advanced liver damage (cirrhosis), such as:

  • Yellowing of the skin and eyes (jaundice)

  • Swelling in the abdomen (ascites) or legs/feet (edema)

  • Itchy skin

  • Easy bruising or bleeding

  • Dark urine or pale stools 

Fat Location 

The specific location of "stubborn" fat associated with fatty liver disease is visceral fat, which is the deep abdominal fat surrounding internal organs like the liver, kidneys, and pancreas. 

• Women with this condition often experience an "apple-shaped" body composition, which indicates preferential visceral fat storage.

• This is in contrast to "gynoid" fat (pear-shaped, accumulating in the hips and buttocks), which is associated with a lower cardiometabolic risk. The amount of abdominal (trunk) fat is strongly associated with abnormal liver markers, independent of total body mass index (BMI). 

How Fatty Liver Contributes to Stubborn Fat

Fatty liver disease creates a cycle that disrupts normal fat metabolism and makes weight loss more challenging. 

• Disrupted Fat Metabolism: The liver's main job includes metabolizing fat and converting it into energy. When it is already overloaded with fat, this process becomes less efficient, making it harder to burn existing body fat.

• Insulin Resistance: Fatty liver is strongly linked to insulin resistance. When cells don't respond properly to insulin, blood sugar levels rise, prompting the body to convert more glucose into fat, which is often stored in the abdominal area and further burdens the liver.

• Hormonal Imbalances: A fatty liver can affect several hormonal pathways, including:

  • Thyroid Hormones: It impairs the conversion of inactive thyroid hormone (T4) to active T3, potentially lowering the metabolic rate.

  • Cortisol: Impaired liver function can lead to elevated cortisol levels, which promotes abdominal fat storage.

  • Leptin: Leptin resistance may develop, affecting the hormone that signals satiety, leading to persistent hunger and making weight control difficult.

• Inflammation: Visceral fat and the inflamed liver release pro-inflammatory molecules (cytokines) that interfere with insulin signaling throughout the body, creating a cycle of inflammation, insulin resistance, and further fat accumulation.