Your liver could be in real trouble right now, without you even realising it. About one in five adults in the UK have what used to be known as ‘non-alcoholic fatty liver disease’ but is today called ‘metabolic dysfunction-associated steatotic liver disease’, or MASLD.
The rebrand matters more than it sounds. Many people wrongly assume that liver disease is always caused by alcohol. If they aren’t knocking back the wine every night, they think their liver is fine. But it isn’t always the case.
Including the word ‘metabolic’ in the new name highlights that other factors, such as diet, can also cause this disease.
There are three types of liver disease worth knowing about:
- Alcohol-related liver disease is exactly what you expect;
- MASLD, which is driven by the modern curse of too much weight around the middle, type 2 diabetes, a poor diet, high cholesterol, high blood pressure and life spent in a chair; and
- MetALD, the nastiest, which is metabolic damage layered on top of a regular habit of drinking more than you should.
Many of my patients over the years have fallen into that third camp and had no clue.
Just a few glasses of wine a week can raise the risk of liver disease
They weren’t alcoholics. They weren’t even heavy drinkers in their own mind. A bottle of wine over dinner a few nights a week, a cheeky gin on a Friday and two dry evenings to prove they were in control. Their livers begged to differ.
The British Liver Trust calls this a ‘silent epidemic’, and that is no exaggeration. Death rates from liver disease in the UK have quadrupled over the past 50 years.
It is the only major disease in this country where mortality is rising rather than falling. MASLD alone has gone up 150 per cent since 1990.
Worryingly, one in ten children is now thought to have early signs of the condition.
Around 90 per cent of liver-related deaths are considered preventable. Yet most people have no idea they have it. In the early stages there are almost no symptoms. A dull ache in the upper-right side of the tummy, perhaps. Fatigue, possibly.
The good news is that in the early and middle stages, fatty liver is astonishingly reversible.
The liver has a remarkable ability to regenerate itself, but it needs your help. So here are the ways you can support your liver and face a healthy future together…
Lose deep fat
This is the visceral fat stored deep in the abdomen. Even a five to 10 per cent reduction in body weight can dramatically cut liver fat and, in some cases, reverse the disease altogether.
You don’t need to get to a size eight. You just need to take some of the pressure off the machinery, particularly around the middle.
Move your body
In particular, lift something heavy. Strength training is one of the most powerful tools we have against fatty liver.
Muscle is metabolically active tissue. The more of it you have, the better your body handles sugar and fat.
Twice-weekly training sessions with dumbbells can boost the metabolism
A brisk daily walk is a fine start, but two sessions a week with dumbbells, resistance bands or your own body weight is better.
Eat good food
You must eat like someone who loves food but hasn’t lost their mind. A Mediterranean-style diet of vegetables, oily fish, nuts, olive oil, beans and wholegrains is the most evidence-based dietary key we know of for a healthy liver.
Cut right down on ultra-processed food, biscuits, pastries and fizzy drinks.
Cut the glass of juice
Please stop thinking fruit juice is virtuous. A glass of orange juice delivers a hit of fructose that goes straight to the liver, which converts it to fat faster than almost anything else in your diet.
Drink coffee
Yes, really. One of the most consistent findings in liver research is that two to three cups of proper coffee a day is linked to lower rates of fatty liver, fibrosis and even liver cancer. Green tea has similar, if weaker, evidence behind it.
Drinking coffee has been linked to a reduction in liver cancer risk
Booze less
And I can already hear readers groaning… but do something about alcohol.
I am not a killjoy and I am not asking anyone to become a teetotaller. But if you drink most nights, giving your liver three or four properly dry days a week will make a real difference.
But bingeing at the weekend and kidding yourself that a few alcohol-free weekdays cancel it out doesn’t work either. Your liver takes a bigger hit from a single heavy session than from the same number of units spread across seven days.
Is milk thistle worth it?
As for supplements, I get asked about the herbal remedy milk thistle all the time.
The evidence is patchy. Some small studies suggest modest benefits in fatty liver. None of the serious trials have shown it does much.
If you are carrying a bit of weight around the middle, drink most nights, or have high blood pressure, ask your GP for a liver function test. Forewarned is forearmed. You don’t have to live a boring life to look after your liver, just a wiser one.