Persistent tiredness affects millions of people across the UK, and fatty liver disease is an increasingly recognised contributor to chronic fatigue. Non-alcoholic fatty liver disease (NAFLD) now affects up to one in three UK adults, making it one of the most common liver conditions. Whilst many people with fatty liver remain symptom-free, fatigue is amongst the most frequently reported complaints. The connection between liver fat accumulation and tiredness involves complex metabolic and inflammatory processes that can leave you feeling persistently drained. Understanding this relationship is essential for identifying underlying causes of fatigue and implementing effective management strategies to improve both liver health and energy levels.

Can Fatty Liver Make You Tired?

Yes, fatty liver disease can contribute to persistent tiredness and fatigue, though the relationship is complex and not fully understood. Non-alcoholic fatty liver disease (NAFLD) affects up to one in three adults in the UK, and fatigue is one of the most commonly reported symptoms. However, it is important to note that many people with NAFLD remain entirely asymptomatic, and normal liver function tests do not exclude the presence of significant liver disease.

The mechanisms linking fatty liver to tiredness are likely multifactorial. Metabolic dysfunction plays a central role—NAFLD is closely associated with insulin resistance, which is thought to impair the body's ability to efficiently convert glucose into energy. This metabolic inefficiency may leave you feeling persistently drained. Additionally, the liver's role in processing nutrients, producing proteins, and detoxifying substances means that even mild hepatic impairment can affect overall energy levels.

Systemic inflammation associated with fatty liver disease may also contribute to fatigue. The accumulation of fat in liver cells triggers inflammatory pathways that release cytokines—signalling molecules that are proposed to induce feelings of tiredness and malaise. Research suggests that this inflammatory state affects not just the liver but the entire body, potentially disrupting sleep quality and circadian rhythms.

It's important to note that fatigue in fatty liver disease is often non-specific, meaning it can be difficult to distinguish from tiredness caused by other conditions such as anaemia, thyroid disorders, obstructive sleep apnoea, or depression. Many people with NAFLD also have associated conditions like obesity, type 2 diabetes, or metabolic syndrome, which independently contribute to fatigue. Therefore, whilst fatty liver can make you tired, a comprehensive assessment is essential to identify all contributing factors and ensure appropriate management.

Other Symptoms of Fatty Liver Disease

Fatty liver disease is often called a 'silent' condition because many people experience no symptoms at all, particularly in the early stages. The condition is frequently discovered incidentally during routine blood tests or abdominal imaging performed for unrelated reasons. It is crucial to understand that the absence of symptoms does not mean absence of disease—NAFLD can progress without noticeable signs, making regular monitoring essential for those at risk.

Symptoms that may be associated with NAFLD include:

• Discomfort in the upper right abdomen – a dull ache or feeling of fullness where the liver is located, though this is relatively uncommon in simple fatty liver

• Unexplained weight loss – unintentional weight loss may occur in advanced disease

• Weakness and general malaise – a persistent feeling of being unwell without obvious cause

When fatty liver progresses to non-alcoholic steatohepatitis (NASH), inflammation and liver cell damage become more significant. At this stage, symptoms may intensify, though many people still remain asymptomatic. NASH can eventually lead to fibrosis (scarring) and cirrhosis if left unmanaged.

Signs of advanced liver disease or cirrhosis include:

• Jaundice – yellowing of the skin and whites of the eyes

• Ascites – fluid accumulation in the abdomen causing swelling

• Oedema – swelling in the legs and ankles

• Easy bruising or bleeding – due to impaired production of clotting factors

• Spider naevi – small, spider-like blood vessels visible on the skin

• Confusion or altered mental state – hepatic encephalopathy in severe cases

Regular monitoring is essential for those at risk, including individuals with obesity (BMI >30 kg/m²), type 2 diabetes, high cholesterol, or metabolic syndrome. Even in the absence of symptoms, disease progression can occur, and early detection through appropriate screening and assessment is vital.

When to See Your GP About Tiredness and Liver Health

You should arrange to see your GP if you experience persistent tiredness that doesn't improve with adequate rest, particularly if accompanied by other concerning symptoms. Fatigue lasting four weeks or more warrants medical evaluation, as it can indicate various underlying conditions requiring investigation.

Specific circumstances that should prompt a GP consultation include:

• Persistent fatigue affecting your daily activities, work, or quality of life for four weeks or more

• Unexplained symptoms such as abdominal discomfort, particularly in the upper right side

• Risk factors for liver disease – including obesity (BMI >30 kg/m²), type 2 diabetes, high cholesterol, high blood pressure, or a family history of liver disease

• Abnormal liver function tests identified during routine blood work

• Concurrent symptoms such as unintentional weight loss, loss of appetite, or nausea

Call 999 or go to A&E immediately if you develop:

• Vomiting blood or passing black, tarry stools (melaena)

• Severe confusion or significant changes in mental state

Seek urgent medical attention (same-day GP appointment or NHS 111) if you develop:

• Yellowing of the skin or eyes (jaundice)

• Dark urine combined with pale stools

• Severe abdominal pain or swelling

• Easy bruising or unusual bleeding

Your GP will typically conduct a comprehensive assessment including a detailed medical history, physical examination, and blood tests. Initial investigations usually include liver function tests (LFTs), full blood count, HbA1c (for diabetes screening), thyroid function, lipid profile, and urea and electrolytes. Depending on findings and to exclude other causes of liver disease, your GP may also arrange hepatitis B and C serology, ferritin and iron studies, and autoimmune liver markers where appropriate. An ultrasound scan may be arranged to visualise the liver and assess for fatty infiltration.

NICE guidance recommends a stepwise approach to fibrosis risk assessment in people with suspected NAFLD. The first step is to calculate a non-invasive fibrosis score such as the FIB-4 score or NAFLD fibrosis score. For adults under 65 years, a FIB-4 score below 1.3 suggests low risk of advanced fibrosis, whilst a score above 2.67 suggests higher risk. For adults aged 65 and over, a FIB-4 below 2.0 suggests low risk. If the initial score is indeterminate or suggests higher risk, your GP may arrange an Enhanced Liver Fibrosis (ELF) blood test as a second-line assessment. An ELF score of 10.51 or above indicates likely advanced fibrosis and warrants specialist referral. In secondary care, specialists may use transient elastography (FibroScan) for further assessment. Early detection and intervention can prevent progression to more serious liver disease, making timely medical consultation essential.

Managing Fatigue with Fatty Liver Disease

Managing fatigue associated with fatty liver disease requires a multifaceted approach focusing primarily on addressing the underlying liver condition whilst implementing strategies to improve energy levels. The cornerstone of NAFLD management is lifestyle modification, which can simultaneously improve both liver health and fatigue.

Weight management and dietary changes are fundamental. NICE recommends a gradual weight loss of 5–10% of body weight for people with NAFLD, as this has been shown to reduce liver fat, inflammation, and fibrosis. Aim for steady, sustainable weight loss and avoid rapid weight loss or crash diets. A Mediterranean-style diet rich in vegetables, fruits, whole grains, lean proteins, and healthy fats (particularly olive oil and oily fish) is beneficial. Limiting refined carbohydrates, added sugars, and saturated fats helps address insulin resistance and metabolic dysfunction.

Alcohol consumption should be kept within UK low-risk guidelines: do not regularly exceed 14 units per week, and spread your drinking over three or more days if you do drink. If you have advanced fibrosis, cirrhosis, or other complications, your specialist may advise complete abstinence.

Regular physical activity is crucial for managing both fatty liver and fatigue. Whilst it may seem counterintuitive when feeling tired, moderate exercise actually improves energy levels by enhancing metabolic efficiency, reducing insulin resistance, and improving sleep quality. The UK Chief Medical Officers recommend aiming for at least 150 minutes of moderate-intensity activity weekly, such as brisk walking, cycling, or swimming. Start gradually if you're currently inactive, and build up slowly.

Sleep hygiene deserves particular attention, as poor sleep quality can worsen fatigue. Establish regular sleep patterns, create a comfortable sleep environment, limit screen time before bed, and address any underlying sleep disorders such as obstructive sleep apnoea, which is common in people with NAFLD.

Managing associated conditions is equally important. Optimising control of type 2 diabetes, hypertension, and dyslipidaemia not only protects the liver but can improve overall wellbeing and energy levels. Your GP may prescribe medications such as metformin for diabetes or statins for high cholesterol—statins are safe and indicated for cardiovascular risk reduction in people with NAFLD. Currently, no medicines are licensed specifically to treat NAFLD. In selected cases, specialists may consider disease-modifying treatments such as pioglitazone or vitamin E, but these are initiated only in specialist care according to NICE guidance.

Psychological support shouldn't be overlooked. Living with chronic fatigue can affect mental health, and conditions like depression and anxiety can worsen tiredness. Cognitive behavioural therapy (CBT) and other psychological interventions may help manage fatigue and improve coping strategies. If fatigue persists despite lifestyle modifications and optimal management of fatty liver disease, further investigation for other causes of tiredness may be warranted.

Frequently Asked Questions