Key takeaways
Early liver damage is usually silent. Blood tests and your risk factors tell you more than symptoms.
The 7 warning signs range from vague (tiredness, itching, poor appetite) to urgent (jaundice, swelling, confusion).
Fatty liver (MASLD) and alcohol are the most common causes, and both respond to lifestyle change.
Losing 3–5% of your body weight can be enough to reverse early fatty liver. Expect weeks to months, not days.
Yellow skin or eyes, vomiting blood, black stools or confusion need medical help the same day.
7 signs your liver is struggling
People often search for the "7 signs your liver is dying". It is more useful to talk about the signs your liver is struggling, because most of them can be acted on. The National Institute of Diabetes and Digestive and Kidney Diseases lists these among the signs of liver disease:1
Tiredness or weakness that rest doesn't fix.
Discomfort in the upper right side of your belly.
Itchy skin with no rash.
Poor appetite, nausea, or weight loss you weren't trying for.
Dark urine.
Yellowing of your skin or the whites of your eyes (jaundice).
Swelling in your belly, ankles or feet, bruising easily, or new confusion.
The first four are vague and have many possible causes. The last three suggest more advanced disease and need a doctor soon.
Liver disease symptoms in women
In women, liver disease symptoms often get blamed on something else. Fatigue gets put down to stress, and itching to dry skin. Yet tiredness and itchy skin are the classic early symptoms of primary biliary cholangitis, an autoimmune bile-duct disease that is far more common in women.2 Women's livers are also more sensitive to alcohol, so liver damage can start at lower amounts than in men, and the risk of fatty liver rises after menopause.
Where do you feel liver pain?
Liver pain is usually felt as a dull ache or a feeling of fullness in the upper right side of your belly, just under your ribs. It can spread to your back or your right shoulder blade. The liver tissue itself has very few pain receptors, which is why it can be damaged for years in silence. What you feel is the stretching of Glisson's capsule, the thin, sensitive layer that wraps the liver. Pain in that area can also come from your gallbladder, stomach or bowel, so it needs an examination rather than a guess.
What causes liver damage?
The most common causes are:
Fatty liver. Fat builds up in the liver, usually alongside excess weight, type 2 diabetes or high cholesterol. It is now called metabolic dysfunction-associated steatotic liver disease (MASLD), formerly NAFLD.3
Alcohol. Regular drinking above recommended limits is the other big cause of fatty liver, and the two often add up.
Viral hepatitis. Hepatitis B and C can damage the liver for years before causing symptoms.
Medicines and supplements. Too much paracetamol (acetaminophen) is a leading cause of sudden liver injury, and some herbal products can harm the liver too.
Which tests show how your liver is doing?
Because the early stages are silent, tests tell you far more than symptoms. Ask your doctor about:
Liver blood tests, including ALT, AST, GGT, bilirubin and albumin.
An ultrasound scan to look for fat in the liver.
A FIB-4 score or a FibroScan, which estimate scarring (fibrosis) without a biopsy.
5 signs your liver is healing
Healing is mostly measured, not felt. These are the signs your liver is healing that doctors look for:
ALT and AST levels trending back towards normal.
Less liver fat on a scan, or a lower stiffness score.
A smaller waist and steady weight loss.
More energy and a better appetite.
Jaundice, itching or swelling settling down.
How long does it take for the liver to heal?
It depends on the cause and the stage. In a 12-month lifestyle programme, 64% of people with fatty liver reached normal liver fat levels, compared with 20% of those who received usual care. Even losing 3–5% of body weight brought remission for 41% of participants, and losing more than 10% did so for 97%.4 If alcohol is the main cause, liver fat often starts to clear within weeks of stopping drinking. In short, expect weeks to months, not days. Scarring that has progressed to cirrhosis may not fully reverse.
What should you do?
Cut back on alcohol or stop entirely, and aim to lose 7–10% of your body weight if you are overweight. Move most days, and cut down on sugary drinks and ultra-processed food.
Nutrition professionals often work with co-factors such as choline, inositol and CoQ10 (see our article about CoQ10), and with herbal extracts such as artichoke (Cynara scolymus), milk thistle (Silybum marianum), bergamot (Citrus bergamia) and turmeric (Curcuma longa). In one trial, bergamot phytosome taken for 12 weeks reduced visceral fat, the fat stored around the organs, in people with raised cholesterol.5 These need to be added carefully, depending on the stage of liver disease and your blood results, to avoid side effects and interactions.
If you feel your indulgences are catching up with you, try our Full Body Detox.
If you know you may be carrying more fat than you would like, try Something® for liver fat.
When to see a doctor
Get medical help the same day if you notice yellowing of your skin or eyes, vomiting blood, black or tarry stools, a rapidly swelling belly, or new confusion or drowsiness.
Book a routine appointment and ask for liver blood tests if you have ongoing tiredness or discomfort under your right ribs, or if you drink above recommended limits, are overweight, or have type 2 diabetes.
The bottom line
Your liver rarely complains until damage is advanced, so don't wait for symptoms. If you drink regularly, carry extra weight around your middle or have type 2 diabetes, ask for liver blood tests. The encouraging part is how well an early-stage liver recovers: modest weight loss, less alcohol and regular movement can bring liver fat back to normal within a year. For the science behind fatty liver, read our clinical overview of MASLD.
References
National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & causes of cirrhosis. https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis/symptoms-causes
National Institute of Diabetes and Digestive and Kidney Diseases. Primary biliary cholangitis: definition & facts. https://www.niddk.nih.gov/health-information/liver-disease/primary-biliary-cholangitis/definition-facts
Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79(6):1542-56. doi:10.1016/j.jhep.2023.06.003. https://pubmed.ncbi.nlm.nih.gov/37364790/
Wong VW, Chan RS, Wong GL, et al. Community-based lifestyle modification programme for non-alcoholic fatty liver disease: a randomized controlled trial. J Hepatol. 2013;59(3):536-42. doi:10.1016/j.jhep.2013.04.013. https://pubmed.ncbi.nlm.nih.gov/23623998/
Rondanelli M, Peroni G, Riva A, et al. Bergamot phytosome improved visceral fat and plasma lipid profiles in overweight and obese class I subject with mild hypercholesterolemia: a randomized placebo controlled trial. Phytother Res. 2021;35(4):2045-56. doi:10.1002/ptr.6950. https://pubmed.ncbi.nlm.nih.gov/33188552/
