Question

I’ve recently been feeling more fatigued than usual. I’ve also lost a bit of weight and had some tummy pains – which are higher up than the sort of spasmodic pain I sometimes get with my irritable bowel.

My GP did some blood tests – all of which were OK apart from some minor abnormalities in my liver function tests. To cut a long story short I then had a visit to hospital and an ultrasound scan of my liver. It turns out that I have what the hospital doctor calls a fatty liver. He says it’s a fairly common condition – especially if you have diabetes, high blood pressure or are overweight and possibly ME/CFS. Could this be connected to having ME/CFS as well? As I’ve only put on weight since developing the condition.

Answer

Firstly, your story illustrates how important it is for people with ME/CFS to check with their GP if they develop new symptoms (especially weight loss) or an existing symptom changes in character. The full medical name for this condition is non-alcoholic fatty liver disease (NAFLD) and I’ve heard from several people with ME/CFS over the years who have developed NAFLD. So patient evidence says possibly – but there’s no hard research evidence to link it to ME/CFS.

What is important here is that NAFLD can cause quite debilitating fatigue – so it’s a diagnosis that should always be considered when someone has ME/CFS symptoms, especially when they also have abnormal liver function tests. There are several things that can increase the risk of developing NAFLD – the main ones being:

• Over 50,
• Overweight – especially where there is excessive fat around the waist,
• Diabetes,
• An insulin resistant condition,
• High blood pressure,
• High cholesterol,
• Hypothyroidism – low thyroid function,
• Cigarette smoking.

In the early stages there may not be any symptoms at all and the condition is picked up because, like you, there is an abnormality on the liver function tests that can’t be explained.  The diagnosis is then confirmed with an ultrasound scan.  Other tests may also be needed – such as a liver biopsy. When symptoms do start to occur common ones include fatigue, weakness, stomach pain (often in the top right under the ribs) and weight loss.

When it comes to treatment, there isn’t any specific drug treatment.  But lifestyle changes should help to stop progression to a more severe form of the condition where inflammation leads to scarring and sometimes to shrinkage and loss of liver function (cirrhosis). Medical and self-help treatment includes:

• Making sure that blood pressure, cholesterol, diabetes and thyroid function are all under good control
• Loosing weight if necessary
• Eating a healthy balanced diet that includes plenty of fruit and vegetables and is low in salt sugar and fat
• Stopping smoking
• Avoiding excess alcohol
• Taking some regular exercise if you are able to do so

NHS:

Non-alcoholic fatty liver disease (NAFLD) is the term for a range of conditions caused by a build-up of fat in the liver. It's usually seen in people who are overweight or obese. Early-stage NAFLD does not usually cause any harm, but it can lead to serious liver damage, including cirrhosis, if it gets worse. Having high levels of fat in your liver is also associated with an increased risk of serious health problems, such as diabetes, high blood pressure and kidney disease. If you already have diabetes, NAFLD increases your chance of developing heart problems. If detected and managed at an early stage, it's possible to stop NAFLD getting worse and reduce the amount of fat in your liver.

Non-alcoholic fatty liver disease (NAFLD) | January 2022