Liver

How the liver works, what can harm it, the tests doctors use and how to look after it.

The liver is the largest organ inside the body. It processes nutrients from food, stores energy, makes bile and many of the proteins in the blood, and breaks down substances such as alcohol and medicines so that they can be removed. Liver tissue can regrow after injury, and liver disease often causes no symptoms until it is advanced.

Blood from the intestines passes through the liver before reaching the rest of the body. Liver cells, called hepatocytes, take up nutrients, store glucose as glycogen and make cholesterol and clotting proteins. They process many substances in two steps: the first changes a substance chemically, and the second attaches it to molecules such as glutathione so that it can leave the body in bile or urine.

What strains it

Excess fat stored in liver cells, often linked to weight, waist size and blood sugar
Alcohol, which the liver must process before almost anything else
Some medicines and supplements taken without guidance
Viral hepatitis
Sugary drinks and highly refined foods, which the liver turns into fat

Habits that protect it

Keep your waist in check: under 90 cm for men and 80 cm for women is the guide commonly used for South Asian adults
Limit alcohol and keep several alcohol-free days each week
Choose whole grains, pulses, vegetables and fruit over refined foods
Move for at least 150 minutes a week
Take medicines and supplements only as advised

See a doctor if you notice

Yellowing of the eyes or skin
Persistent tiredness with discomfort under the right ribs
Dark urine or pale stools
Swelling of the abdomen or legs

The health journey

Your health journey

Six stages, and where to find help at each one. Scroll sideways on smaller screens.

01 Lifestyle

Excess fat stored in liver cells, often linked to weight, waist size and blood sugar
Alcohol, which the liver must process before almost anything else
Some medicines and supplements taken without guidance

02 Early signals

Yellowing of the eyes or skin
Persistent tiredness with discomfort under the right ribs
Dark urine or pale stools

03 Understanding

04 Testing

Liver function tests, including ALT, AST, bilirubin and albumin
Ultrasound of the abdomen
FIB-4, a fibrosis score calculated from routine blood tests
Transient elastography, a painless scan of liver stiffness

05 Management

Keep your waist in check: under 90 cm for men and 80 cm for women is the guide commonly used for South Asian adults
Limit alcohol and keep several alcohol-free days each week
Choose whole grains, pulses, vegetables and fruit over refined foods

06 Long-term wellbeing

Regular check-ups, as your doctor advises
Revisit the health checks
Formulations for the liver

Should my liver tests be checked or repeated?
Could my weight or waist size be affecting my liver?
Are any of my medicines, herbal products or supplements hard on the liver?
Do I need an ultrasound or a liver stiffness scan?

Liver

Fatty liver affects roughly one in three Indians

38.6% of Indian adults have fatty liver

Non-alcoholic fatty liver disease is closely tied to weight, waist size and blood sugar. In people with risk factors such as diabetes or obesity, more than half were affected. Because fatty liver rarely causes symptoms in its early stages, it is often found by chance on an ultrasound.

A meta-analysis of fifty Indian studies found non-alcoholic fatty liver disease to be common in adults and children alike.

People with risk factors52.8%

All adults38.6%

Children35.4%

People without risk factors28.1%

View the data as a table

Group	Pooled prevalence
People with risk factors	52.8%
All adults	38.6%
Children	35.4%
People without risk factors	28.1%

Source: Shalimar et al. Journal of Clinical and Experimental Hepatology, 2022
Source last verified 8 October 2026 · Download the data (CSV)

Explore liver

Evidence library

Research

Appraised studies relevant to the liver, including results that did not support a treatment.

Case series Safety signal

Liver injury associated with ashwagandha supplements

Rare but real. Anyone with liver disease, or who develops jaundice, itching or dark urine while taking ashwagandha, should stop and see a doctor.

Liver International, 2020 · 5 participants · Ashwagandha

Randomised controlled trial Mixed or partial

Silymarin in biopsy-proven non-alcoholic steatohepatitis

Silymarin did not improve overall disease activity, but the fibrosis signal deserves further study. It is honest to call the evidence promising but unconfirmed.

Clinical Gastroenterology and Hepatology, 2017 · 99 participants · Milk thistle

Observational study Supportive

Lifestyle weight loss and liver histology in NASH

Some of the strongest evidence in liver medicine: meaningful, sustained weight loss can reverse the inflammation of fatty liver and even some scarring.

Gastroenterology, 2015 · 293 participants

Randomised controlled trial Supportive

Vitamin E or pioglitazone for non-alcoholic steatohepatitis (PIVENS)

A landmark trial showing that a nutrient at therapeutic dose can change liver histology. It applies to the dose and population studied, and decisions belong with a doctor.

New England Journal of Medicine, 2010 · 247 participants · Vitamin E

Case series Safety signal