Feeling tired all the time? Your liver could be sending you a warning
· Citizen
You’ve been sleeping a full eight hours, yet you’re still dragging by 3pm. 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, managed by BioWell, 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.
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Left unchecked, that struggle can progress into metabolic dysfunction-associated steatotic liver disease, or MASLD – now the most common chronic liver disease in the world.
Not the liver disease you’re thinking of
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. 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.”
What’s actually going on inside your liver
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.
“Often, when people hear ‘fatty liver’, they think the problem is localised to the liver. The liver may be where the condition becomes visible, but the wider metabolic picture is what we need to understand and manage. That means looking at the patient as a whole, rather than treating the liver as an isolated problem,” he says.
So what should you actually do about it?
Dr Vosloo’s advice starts with the basics: a proper medical assessment rather than self-diagnosing from a list of symptoms.
That typically means a doctor reviewing personal and family history, medication, weight, waist circumference, and blood pressure, alongside blood markers such as glucose, HbA1c, cholesterol, triglycerides and liver enzymes.
Depending on those results, further tests may follow to check for fat in the liver or early signs of scarring.
For patients wanting a more structured route, the doctor points to programmes offered by several online medical platforms, such as the one managing his practice, which start with a doctor’s consultation and continue with ongoing monitoring and follow-up.
“We assess the patient’s full clinical picture, request relevant bloodwork where needed, and develop a personalised plan around the factors placing their metabolic health at risk,” he says.
Importantly, medication isn’t the automatic starting point. “Treatment may or may not include medication, but it does not automatically begin there,” says Dr Vosloo. The plan may instead focus on nutrition, physical activity, sleep and weight management (the everyday habits that shape how the body handles sugar, fat and energy), with prescription treatment considered only where clinically appropriate.
Where medication is warranted, GLP-1 receptor agonists may form part of the plan, helping to regulate appetite, improve blood sugar control and support weight loss – easing some of the metabolic pressure that contributes to MASLD. But Dr Vosloo is clear that these drugs aren’t a fit for everyone and need to be prescribed and monitored by a doctor as part of a broader treatment plan.
And whether or not medication is involved, the check-ins don’t stop.
“Regular follow-up remains important, regardless of whether medication forms part of the plan. Changes in weight can provide useful information, but they do not show the full picture, which is why doctors may also monitor blood sugar, cholesterol, triglycerides, blood pressure, liver enzymes and other markers over time.”
The takeaway, in other words: that tiredness, that stubborn weight gain, that shortness of breath climbing the stairs – they might be nothing. But they’re also worth a conversation with your doctor and a set of blood tests, rather than a shrug and another early night.