Liver Disease: Why Feeling Well Doesn't Mean You Are Healthy

You can feel well and still have liver disease. That is the warning from liver and metabolic health specialist Dr Saima Ajaz, who says advances in diagnosis and treatment are changing how doctors identify and manage one of the world's most common liver conditions.

Dr Ajaz, a hepatologist at the Institute of Liver Studies, King’s College Hospital, and Honorary Senior Clinical Lecturer at King’s College London, is co-author of a new review in the Journal of Internal Medicine examining the rapidly changing treatment for metabolic dysfunction-associated steatotic liver disease (MASLD).

The Silent Epidemic of MASLD and Changing Treatments

MASLD is a common form of fatty liver disease in which excess fat builds up in the liver, usually alongside metabolic problems such as excess weight, insulin resistance, type 2 diabetes, high blood pressure and abnormal cholesterol levels. It can cause few or no symptoms in its early stages, but in some people it can progress to inflammation, liver scarring (fibrosis), cirrhosis and, in advanced cases, liver cancer.

The British Liver Trust has described MASLD as a “silent epidemic”, with up to one in five people potentially affected. Some people develop MASH, the more serious inflammatory form of the disease.

The review examines how treatment is moving beyond simply finding fat in the liver. Doctors can increasingly assess whether a patient has fibrosis, or liver scarring, helping to identify those at greatest risk of serious disease.

It also examines newly approved treatments and promising therapies in development, including approaches targeting both the metabolic problems driving the disease and the damage occurring in the liver.

The result is a move towards more personalised care, with treatment increasingly guided by an individual's liver health, metabolic health and risk of disease progression.

Dr Ajaz is also Medical Director and Lead for Longevity at Harley Longevity Club where her expertise in liver and metabolic health is extended to increasing healthspan and lifespan.

A Shift Towards Preventive and Longevity Medicine

For Dr Ajaz, the developments highlighted in the review reflect a wider shift in longevity medicine, from waiting for disease to become established to identifying risk earlier and intervening before serious illness develops.

Dr Ajaz says: "Feeling well is not the same as being healthy. One of the biggest misconceptions is that if something is wrong inside the body, we will know about it. The goal of preventive medicine is not to convince healthy people that they are ill or to scare them, but to use advanced diagnostics to detect health risks and treat them early."

This philosophy underpins her work at Harley Longevity Club, where she looks at health across multiple dimensions rather than relying on a single test.

"Two people can be the same chronological age and have very different levels of cardiovascular fitness, muscle mass, visceral fat, metabolic health and organ function," she explains.

"Chronological age is fixed, whereas biological health is heterogeneous and should be understood through multiple dimensions and over time."

“You can feel energetic and still have high blood pressure. You can exercise regularly and still have metabolic risk. You can look slim and still carry excess visceral fat."

The message from Dr Ajaz extends beyond the liver: feeling well is not necessarily proof that all is well internally. Knowing your risks earlier gives you more opportunity to act.