Feeling tired all the time? Your liver could be sending you a warning

Your jeans have been feeling tighter for months, even though nothing has really changed. A flight of stairs leaves you more breathless than it used to. It’s easy to write these off as “just life” – work stress, getting older, needing a holiday.

But according to Dr Gerhard Vosloo, founder and head consulting practitioner at Dr GL Vosloo Medical Practice, these small, easy-to-ignore changes can sometimes point to something bigger happening beneath the surface: the body starting to struggle with how it manages sugar, fat and energy. Left unchecked, that struggle can progress intometabolic dysfunction-associated steatotic liver disease, or MASLD – now the most common chronic liver disease in the world. Mention “liver disease” and most people picture heavy drinking or a virus like hepatitis.

MASLD is neither. According to Vosloo, it’s driven by metabolic risk factors; the kind picked up through routine checks of blood sugar, cholesterol, blood pressure, weight and liver health, rather than through a lifestyle “vice” or infection. That distinction matters, particularly with World Hepatitis Day observed on 28 July.

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The day is traditionally centred on viral hepatitis, especially hepatitis B and C, but Dr Vosloo believes it’s also a natural opening to talk about MASLD and the metabolic dysfunction driving it. “Metabolic health is about far more than body weight, because the same underlying problems that make it harder for the body to manage blood sugar, fat, and energy can quietly place the liver and overall health at risk. This month, we should go further than raising awareness of hepatitis by encouraging people to speak to their doctor about the metabolic markers they cannot see or feel.” Every meal you eat sets off a small logistical operation inside your liver: deciding what gets stored, what gets burned for energy, and what gets shipped elsewhere in the body.

When the body becomes less responsive to insulin, that system starts to break down. “More sugar is converted into fat, more fat reaches the liver, and some of it begins to build up in liver cells. Most people experience no noticeable symptoms, but the build-up can progress to inflammation and, in more serious cases, scarring that affects how well the liver works,” Dr Vosloo explains.

It’s a slow, largely silent process, which is precisely why it tends to fly under the radar until it’s more advanced. Dr Vosloo is also keen to push back on the idea that this is purely a “liver problem” to be treated in isolation.

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