Your Liver Is Talking. Here's What Your Labs Aren't Telling You.

I want to tell you something that most people leave their doctor’s office not knowing.

You can have significant liver disease with no symptoms. No pain. No yellowing skin. No dramatic sign that anything is wrong. Just a number on a lab report that gets flagged, mentioned in passing, and then filed away under “something to keep an eye on.”

I’ve had patients come to me who were told exactly that — years ago. One woman I’m thinking of had elevated liver enzymes flagged at 38, was told to cut back on alcohol even though she barely drank, and wasn’t offered any further investigation. She came to see me at 44 with fibrosis showing on imaging. Six years of watching. Six years that mattered.

That number on your lab report is not nothing. It’s your liver trying to tell you that the metabolic pressure you’ve been under has started to leave a mark.

The condition is called MASLD. You may have heard the older name: nonalcoholic fatty liver disease, or NAFLD. In 2023, a global consortium of medical societies formally renamed and redefined it — because the new name tells you exactly what this disease actually is. Metabolic dysfunction-associated steatotic liver disease. The liver problem that comes from metabolic dysfunction. Not from drinking. Not from bad luck. From the same interconnected system we’ve been talking about throughout this series.

This is not a rare diagnosis. It affects somewhere between 25 and 30 percent of the general population. Most of those people have no idea [1].

And before you decide this doesn’t apply to you because you eat reasonably well and don’t drink much — MASLD can and does develop in people with normal weight, normal cholesterol, and no obvious risk factors. If you have insulin resistance, if your blood pressure has been creeping up, if you’ve been told your triglycerides are high — your liver is in this conversation whether or not anyone has put it there [2].