I am not sure I could have blushed a deeper red. At a friend’s dinner party, I was slightly alarmed to see my own GP among the guests, and then utterly mortified when she leaned over to whisper at me as the host filled my wine glass. ‘You shouldn’t be having that,’ she hissed.
She was right. No more than a week before I’d sat in her office to hear the results of a series of tests, which she’d delivered with an equally stern frown.
‘Your blood tests are back and they’re showing your liver is under stress,’ she said. ‘A lot of stress. In fact, you’ve got fatty liver disease.’
This was back in 2008 and I was living on Exmoor with my husband Adrian, our ten-year-old son James, and Asbo, our psychotic Jack Russell terrier. Life was busy and stressful: like many women in their late 40s, I was holding down a career while caring for my son and my elderly mother. The dog’s frequent attempts to savage the postman or dispatch another of next door’s chickens didn’t help.
Yes, I was a bit overweight and yes, I liked a glass or two of wine at the end of the day, but liver disease?
My first reaction was denial. ‘But I don’t drink that much,’ I muttered. ‘In fact, my husband drinks way more than I do.’ OK, that was sneaky, but I was feeling judged. I also felt a wave of shame waft over me. How had it come to this?
‘It’s a common misconception that liver disease is always caused by alcohol,’ my GP continued. ‘Though, of course, drinking too much won’t help.’
My condition, it transpired, was metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD).
Around one in five people in the UK are now estimated to have MASLD, and no, the ‘non-alcoholic’ bit in its former name does not mean you can drink what you like.
Historically there were two main diagnoses. Alcohol-related liver disease (ARLD), as the name suggests, is caused by alcohol. MASLD is triggered by metabolic or lifestyle issues: being overweight, Type 2 diabetes, a poor diet, a high waist measurement, low levels of physical activity and/or spending a lot of time sitting, high cholesterol, and high blood pressure.
To complicate the picture, many people combine the two – metabolic issues with an added dose of too much booze. That third condition is now known as MetALD (metabolic dysfunction plus alcohol-related liver disease). Liver disease loves its acronyms.
Like most people, I only found out my liver was under strain because a routine blood test flagged the problem.
‘Liver disease often develops silently, with no obvious symptoms in its early stages,’ says Vanessa Hebditch, director of policy at the British Liver Trust.
Occasionally people will notice discomfort on the upper right side of the abdomen (I didn’t). The other symptom is ‘tiredness, fatigue or a general feeling of lethargy or having no energy’. Well, show me a midlife woman juggling career and caring who doesn’t feel like that?
The British Liver Trust calls it a silent epidemic. ‘There has been a four-fold increase in mortality over the last 50 years,’ says Hebditch. ‘That’s over 11,000 deaths due to liver disease in the UK each year. It’s the only major disease in which death rates are rising.’
MASLD alone has risen 150 per cent since 1990 and, alarmingly, one in ten children are now estimated to have early signs of the disease. Hebditch says 90 per cent of deaths are linked to preventable factors – alcohol, obesity and unhealthy diets. It seems our modern lifestyle is catching up with us in ever-more scary ways.
Yet very few people go to their GP asking for a liver check. ‘Stigma stops many people seeking help,’ says Hebditch. Research shows clearly that people are worried they’ll be judged for their lifestyle – and often with good cause. Witness my incident at the dinner party.
However, that ticking off did prod me into a shift. A big one. I gave up alcohol entirely for more than a year, lost a lot of weight (three stone) and took up exercise.
Even when I was at my skinniest and my most active, my liver test scores still fluctuated. Genetic high cholesterol was part of the problem, but I also had to admit my sugar habit wasn’t helping. People may mock, but research shows sugar addiction is as real and measurable a condition as drug dependency. It’s also intrinsically connected with MASLD.
Put simply, addictive sugar intake can create insulin resistance which promotes fat accumulation and inflammation in the liver.
Sweet stuff is my kryptonite; if there is anything sweet in the house, I can’t ignore it. My mother always used to say airily: ‘Just eat a square of chocolate a day to satisfy your cravings’.
Not a hope in hell, mum. If there’s chocolate or sweets or biscuits remotely within my vicinity, I won’t relax until I’ve worked my way through them.
I’ve been known to spoon marmalade straight out of the jar. It’s not a good look and it’s certainly not healthy.
So last year I took myself off to a ‘sugar detox’ programme at The Body Retreat (thebodyretreat.co.uk) in Dorset. The aim was to break the habit, to disrupt the cravings, reset my taste buds, and give my liver a fighting chance.
‘Liver health is generally ignored or misunderstood,’ says women’s health expert Juls Abernethy, co-founder of the retreat. ‘Not many women come on our retreats specifically for their livers, but we hear of many who find their test results are much improved afterwards.’
The Body Retreat programme is carefully calibrated. ‘We cut out up to 80 per cent of sugars in the first week,’ says Juls. ‘Then we reintroduce them in a very precise order.’ Of course you don’t need a retreat to do this, but it is much easier when you’re not surrounded by temptation.
I found the first few days really challenging. While the food was tasty and plentiful, my cravings were yelling ‘where’s the sweet stuff?’ so loudly I almost looked around.
It never got easy exactly, and still isn’t, but a seven-day enforced habit change – and the four weeks at-home programme you’re put on at the end of the retreat – helped boost my willpower.
My cravings have certainly subsided now and on good days I think I’ve had a taste bud transplant. Even a blueberry tastes so sweet that I wonder if it’s been doctored.
Talking of doctors, my latest blood tests show my liver is happy too – all results firmly in the ‘healthy’ zone.
Currently there is no approved drug therapy for MASLD, although some liver-specific drugs have reached late-stage clinical trials. There is a suggestion that GLP-1s – fat jabs such as Ozempic – may help by reducing liver fat, improving insulin resistance and helping weight loss.
But mainly, it’s down to us. ‘Prevention and lifestyle changes remain our most effective tools,’ says Hebditch.
She suggests everyone take the free Love Your Liver online risk checker at britishlivertrust.org.uk. ‘It can help you understand your risk and decide whether it might be worth discussing your liver health with a healthcare professional. If you do have concerns, you should never feel you’re wasting your GP’s time. They can assess your risk and, if needed, refer you for further tests.’
It’s such good advice. My diagnosis felt hugely shameful at first but I’m so grateful for it. Nowadays I shout it from the rooftops and regular testing keeps me on track. Let’s all love our livers that bit more.
