You could have a fatty liver and not know it.

In a recent forum held by Parkway Hospitals Singapore, Dr. Lee Kang Hoe, senior consultant at the Asian American Liver Center-Gleneagles Singapore, likened a fatty liver to hypertension—both are silent killers.

“One day you walk around and feel absolutely fine. And the next day you get a stroke. It’s the same with fatty liver. If you leave it alone, untreated, the repercussions could be deadly,” Lee said.

The liver, the third largest organ in the body, weighs around 3.2 to 3.7 pounds. While it’s normal to have some fat in the liver, fatty liver or steatosis occurs when more than five to 10 percent of your liver weight is made up of fat. In some cases, scarring can occur, leading to cirrhosis, liver failure or cancer.

What you eat and drink is processed by the liver. The liver filters harmful substances from the blood stream, a process that can be interrupted when there’s too much fat. One of the best characteristics of the liver, Lee said, is its ability to repair itself. But repeated damage can cause scarring or cirrhosis.

Lee said that fatty liver is often discovered in middle-aged patients, or those aged 40 to  60.

Two types

There are two types of fatty liver: alcoholic liver disease and nonalcoholic fatty liver disease. Aside from alcoholism, Lee said, fatty liver is caused by obesity, hyperlipidemia or high levels of fats in the blood, diabetes, genetic inheritance, rapid weight loss, and as a side effect of certain medications such as aspirin, steroids, tamoxifen and tetracycline.

When the body cannot metabolize fat faster than it can create it, fatty liver occurs. Excess fat is then stored in the liver cells until it accumulates to become fatty liver disease. Eating a high-fat diet may not give you fatty liver disease, in the same way that not all overweight or obese people will develop the disease.

Diet and exercise

“But we strongly urge people to make a lifestyle change. This is, in most cases, a reversible disease. If you’ve put on some weight and do not exercise, then go on a diet and start a moderate exercise routine,” Lee said.

Alcoholic liver disease (ALD) is caused by too much consumption of alcohol. Heavy drinking damages the liver, and the liver can no longer break down the fats.

Abstinence is the solution, Lee said, and in six weeks the fat will disappear. Should you continue to drink, cirrhosis could occur.

How much is too much alcohol consumption? Normal alcohol intake is one drink a day for women, and two drinks a day for men. Beyond that, you could be at risk for ALD.

In some cases, how long one has been drinking is irrelevant. Genes may also play a role in ALD and may have an effect on how your body breaks down the alcohol.

Other factors that could affect your chance of getting ALD are: Hepatitis C (which can lead to inflammation in your liver), too much iron in your body, and being obese.

Nonalcoholic steatohepatitis (NASH), fatty liver not caused by alcohol consumption, causes the liver to swell. This can impair liver function.

Symptoms, which can occur during the late stage, include appetite loss, nausea, vomiting, abdominal pain  and yellowing of the skin (jaundice). Untreated, it can progress to permanent scarring and liver failure.

“What you put in is what you get. Consuming food that is high in the glycemic index causes your sugar to rise very quickly. When insulin levels rise, you will deposit fat in your liver,” Lee said.

Sugar, weight management

There is no specific treatment to fatty liver, no medication or surgery, but you can manage it and even reverse it in some cases. If you have diabetes, for example, managing your sugar intake can have a positive impact on your liver.

If you are overweight or obese, managing your weight by going on a diet and exercising can reduce your risk of developing the disease, or reverse the situation if you already have it.

With the liver’s ability to repair itself, having a fatty liver may not necessarily cause you to develop fatty liver disease.

“You must not lose more than 1 kg per week (1-2 pounds per week),” Lee said. Anything more than that may also cause fatty liver disease. Calorie reduction, he said, can help you lose weight and heal your liver.

Consulting a doctor and undergoing medical tests is the only way you can determine if you have fatty liver.

“It used to be that the ability to store fat in the liver was an advantage, during a time when food was scarce,” Lee said.

“Today, we have too much food, we don’t have lean months anymore. Developing a fatty liver is to our disadvantage.”