I’m not sure I could have blushed a deeper shade of red. At a friend’s dinner party, I was somewhat alarmed to see my own doctor among the guests, and then utterly shocked when she leaned over to whisper to me as the host filled my wine glass. “You shouldn’t have that,” she hissed.
She was right. Less than a week earlier, I sat in her office to hear the results of a series of tests, which she had delivered with an equally stern frown.
“Your blood tests are back and they show that your liver is under stress,” she said. ‘A lot of stress. In fact, you have fatty liver disease.”
This was 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 had a career while caring for my son and my elderly mother. The dog’s frequent attempts to abuse the postman or send another neighbor’s chicken did not help.
Yes, I was a bit overweight and yes, I liked a glass of wine at the end of the day, but liver disease?
Jane Alexander remembers her GP telling her: ‘Your blood tests are back and they show that your liver is under pressure. In fact, you have fatty liver disease
I gave up alcohol completely for over a year, lost a lot of weight (three stone) and started exercising, says Jane
My first reaction was denial. “But I don’t drink that much,” I muttered. ‘My husband even drinks a lot more than I do.’ Okay, that was sneaky, but I felt judged. I also felt a wave of shame wash over me. How had it come to this?
“It’s a common misconception that liver disease is always caused by alcohol,” my doctor continued. ‘Although drinking too much doesn’t help, of course.’
My condition, it turned out, was metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD).
It’s estimated that around one in five people in the UK have MASLD, and no, the ‘non-alcoholic’ part in the former name doesn’t mean you can drink whatever you want.
Historically, there were two main diagnoses. Alcohol-related liver disease (ARLD), as the name suggests, is caused by alcohol. MASLD is caused by metabolic or lifestyle problems: obesity, type 2 diabetes, a poor diet, a high waist size, little physical activity and/or spending a lot of time sitting, high cholesterol and high blood pressure.
To complicate the picture even more, many people combine the two: metabolic problems with an extra 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 discovered that my liver was under pressure because a routine blood test revealed the problem.
‘Liver disease often develops quietly, with no obvious symptoms in the early stages,’ says Vanessa Hebditch, policy director at the British Liver Trust.
Occasionally people notice discomfort in the upper right side of the abdomen (I didn’t). The other symptom is “fatigue, exhaustion, or a general feeling of lethargy or lacking energy.” Well, show me a midlife woman who combines career and care, who wouldn’t love that?
The British Liver Trust calls it a silent epidemic. “Over the past fifty years, mortality has quadrupled,” says Hebditch. ‘That’s more than 11,000 deaths every year in Great Britain due to liver disease. It is the only major disease where mortality rates are increasing.’
MASLD alone has increased by 150 percent since 1990 and, alarmingly, an estimated one in ten children now show early signs of the disease. Hebditch says 90 percent of deaths are linked to preventable factors: alcohol, obesity and unhealthy diet. It seems that our modern lifestyle is catching up with us in increasingly scary ways.
Yet very few people go to the doctor requesting a liver check. “Stigma prevents many people from seeking help,” says Hebditch. Research clearly shows that people fear they will be judged for their lifestyle – and often for good reason. Witness my incident at the dinner party.
However, tapping out has changed me. A big one. I gave up alcohol completely for over a year, lost a lot of weight (three stone) and started exercising.
Liver health is generally ignored or misunderstood, says female health expert Juls Abernethy, co-founder of a ‘sugar detox’ program at The Body Retreat
Even when I was at my thinnest and most active, my liver test scores still fluctuated. Genetically high cholesterol was part of the problem, but I also had to admit that my sugar habit wasn’t helping. People may joke about it, but research shows that sugar addiction is just as real and measurable a condition as drug addiction. It is also intrinsically linked to MASLD.
Simply put, addictive sugar intake can cause insulin resistance, which promotes fat deposits and inflammation in the liver.
Sweet stuff is my kryptonite; If there’s something sweet in the house, I can’t ignore it. My mother always said light-heartedly: ‘Just eat a block of chocolate a day to satisfy your cravings’.
No hope for hell, Mom. If there is chocolate, candy, or cookies remotely near me, I won’t relax until I work my way through it.
I have been known to spoon marmalade straight from the jar. It doesn’t look nice and it’s certainly not healthy.
So last year I took myself to a ‘sugar detox’ program at The Body Retreat (thebodyretreat.nl) in Dorset. The goal was to break the habit, disrupt cravings, reset my taste buds, and give my liver a chance.
“Liver health is generally ignored or misunderstood,” says women’s health expert Juls Abernethy, co-founder of the retreat. ‘Not many women come to our retreats specifically for their liver, but we hear from many that their test results are much better afterwards.’
The Body Retreat program has been carefully tailored. “In the first week we eliminated up to 80 percent of the sugars,” says Juls. “Then we reintroduce them in a very precise order.” Of course, you don’t need a retreat for this, but it is much easier when you are not surrounded by temptation.
I found the first few days really challenging. While the food was tasty and plentiful, my cravings screamed ‘where’s the sweet stuff?’ so loud that I almost looked around.
It never became easy, and it still isn’t, but a seven-day forced habit change – and the four-week home program you get at the end of the retreat – boosted my willpower.
My cravings have definitely 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 has been tampered with.
Speaking of doctors, my latest blood tests show that my liver is happy too – all results are firmly in the ‘healthy’ zone.
Currently, there is no approved drug treatment for MASLD, although some liver-specific drugs are in late-stage clinical trials. It’s suggested that GLP-1s – fat sticks like Ozempic – may help by reducing liver fat, improving insulin resistance and aiding weight loss.
But it’s mainly up to us. “Prevention and lifestyle changes remain our most effective tools,” says Hebditch.
She advises everyone to use the free Love Your Liver online risk checker britishlivertrust.org.uk. ‘It can help you understand your risk and decide whether it’s worth discussing your liver health with a healthcare provider. If you are concerned, you should never feel like you are wasting your doctor’s time. They can assess your risk and refer you for further investigation if necessary.’
It’s such good advice. My diagnosis felt extremely shameful at first, but I am so grateful for it. These days I shout it from the rooftops and regular testing keeps me on track. Let’s all love our liver a little more.
