Private fatty liver disease clinic in London, same-day gastroenterology.

What the blood tests mean

• ALT and AST — enzymes released when liver cells are irritated. Mildly raised levels are extremely common and by themselves say little about how damaged the liver is.
• GGT — often raised with alcohol, fatty liver and certain medicines.
• ALP and bilirubin — point more towards the bile ducts or gallbladder.
• Albumin, clotting and platelets — these reflect how well the liver is working, which matters far more than the enzymes.
• A mildly abnormal enzyme with normal function tests is usually not alarming. It still needs an explanation.

Fat is common; scarring is what matters

Fat in the liver alone rarely causes harm. In a minority it provokes inflammation and then fibrosis — scarring — which can progress to cirrhosis over years. The whole point of assessment is to work out which group you are in, and that is done with a score rather than a guess.

A raised score does not mean cirrhosis; it means the next test is worthwhile. That is usually an elastography scan, which measures liver stiffness painlessly.

What to check alongside

• Alcohol intake, honestly — the threshold at which alcohol contributes is lower than most people assume, and alcohol and metabolic causes commonly coexist.
• Weight, blood pressure, HbA1c and lipids — fatty liver is a marker of metabolic risk, and most people with it die of cardiovascular disease rather than liver disease.
• Viral hepatitis B and C, which are treatable and frequently undiagnosed.
• Iron studies for haemochromatosis, and autoimmune and thyroid screening where the picture warrants it.
• Medicines and supplements — including bodybuilding and herbal products, a common and under-recognised cause.

Treatment

There is no medicine licensed in the UK specifically for fatty liver. The treatment is metabolic, and it genuinely works — fibrosis can improve and even reverse.