"In the very early stages of simple fatty liver, the patient looks absolutely normal," says Dr Geeta Billa, Director, Gastroenterology and Hepatology at Dr L H Hiranandani Hospital, Mumbai. "They cannot know they have fatty liver unless they do a blood test or an ultrasound of the abdomen." WHEN DARKENED SKIN AND FATIGUE SET IN Many assume that changes in skin tone or low energy are signs of fatty liver. But Dr Billa clarifies that these occur only when liver disease has advanced. "Darkened skin occurs only when the liver disease progresses, whether it's due to hepatitis, autoimmune causes, or cirrhosis," she explains. Energy crashes follow a similar pattern. "As long as the liver can compensate, energy levels remain normal. Fatigue and tiredness appear when the liver is unable to cope," she adds. In other words, by the time these symptoms show up, the disease has already moved beyond its reversible stage. WHAT EARLY SIGNS DO PEOPLE USUALLY MISS? Fatty liver often hides behind vague, non-specific symptoms or none at all. "At an early stage, there is no way you can pick up these diseases unless you look for them," says Dr Billa. Routine fatigue, abdominal heaviness, or mild digestive discomfort are often mistaken for lifestyle stress. The only way to catch it early is through routine health checks, liver function tests, ultrasound scans, or fibroscans. These can detect fat accumulation long before symptoms appear. RESERVING FATTY LIVER: WHAT REALLY WORKS? The good news is that the liver is one of the body's most regenerative organs. If detected early, fatty liver can be completely reversed. "The liver keeps regenerating until a point comes where too many liver cells die to be replaced," notes Dr Billa. She recommends focusing on three pillars:

• Weight management: Losing even 10 per cent of body weight can reduce liver fat.
• Diet control: Cut down on sugar, alcohol, and refined carbs. Include fibre, leafy greens, and healthy fats.
• Managing underlying conditions: Control diabetes, triglycerides, and cholesterol.

"With proper care, we've seen significant improvement within six months to one year," she adds. WHY AWARENESS AND EARLY TESTING MATTER Fatty liver is silent but serious, left unchecked, it can progress to cirrhosis or liver failure. The key is awareness and timely medical evaluation. Routine tests, healthy eating, and regular exercise can make all the difference. As Dr Billa puts it, "The liver dies, but it regenerates, if you give it a chance."