You may not notice anything wrong with your liver at first, warns Dr Gerhard Vosloo, but small things may start to feel off over time: you feel tired even after a full night’s sleep, your energy dips more than you are used to, or your weight starts creeping up despite your best efforts. As the underlying strain on your metabolism builds, maintaining your strength and fitness may become harder, and you might find yourself getting winded more easily.
These changes can have many causes, but they may also form part of a bigger picture in which the body is struggling to manage sugar, fat, and energy efficiently – the kind of dysfunction that, over time, can lead to metabolic dysfunction-associated steatotic liver disease (MASLD), the most common chronic liver disease worldwide.
MASLD is different from the liver diseases most people are familiar with. It is not caused by a virus or harmful alcohol use, but is closely linked to metabolic risk factors that can often be identified through routine checks of blood sugar, cholesterol, blood pressure, weight, and liver health.
Dr Gerhard Vosloo, Founder and Head Consulting Practitioner of Dr GL Vosloo Medical Practice, managed by BioWell, says, “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.”
Observed on 28 July, World Hepatitis Day draws global attention to viral hepatitis, particularly hepatitis B and C. Dr Vosloo believes it also presents an opportunity to widen the conversation by drawing attention to MASLD and the underlying metabolic dysfunction that can lead to it.
Protecting liver function by prioritising metabolic health
Dr Vosloo explains: “Every time you eat, your liver helps determine what should be stored, used for energy, or sent elsewhere in the body. If the body becomes less responsive to insulin, that system starts falling out of balance. 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.”
“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.”
Understanding what is happening should begin with a proper medical assessment rather than interpreting symptoms in isolation. A doctor can review the patient’s personal and family history, medication, weight, waist circumference, blood pressure, and blood markers such as glucose, HbA1c, cholesterol, triglycerides, and liver enzymes. Depending on what the results show, further testing may be needed to look for fat in the liver or signs of scarring.
“Through the BioWell platform, patients can access our structured metabolic management programme online, starting with a consultation with one of our doctors and continuing through regular monitoring and follow-up,” Dr Vosloo says. “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.”
“Treatment may or may not include medication, but it does not automatically begin there. The plan may address nutrition, physical activity, sleep, weight management, and other habits affecting the way the body handles sugar, fat, and energy, with prescription treatment considered where clinically appropriate. Where justified, GLP-1 receptor agonists may form part of that plan by helping to regulate appetite, improve blood sugar control, and support weight loss, which can ease some of the metabolic pressure contributing to MASLD.
He notes that these medications are not suitable for everyone, however, and should be prescribed and monitored by a doctor as part of a broader treatment plan. “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.”
