Sally sat down in my surgery looking baffled.
With her youngest off to university, she had decided to take a fresh look at her own health, and a private blood test had led to a diagnosis she never saw coming: liver disease.
‘But I don’t drink,’ she said. ‘Not a drop.’
I hear this all the time. Most of us think liver disease only happens to heavy drinkers. Alcohol still matters. It is the deadlier cause, doing serious harm more quickly, but it is not the most common type.
In the UK, that title belongs to fatty liver disease, now officially called metabolic dysfunction-associated steatotic liver disease, or MASLD.
It affects around one in four adults, according to the British Liver Trust, and numbers are climbing alongside rising obesity, type 2 diabetes, high blood pressure and high cholesterol.
When we take in more energy than we burn, the excess is stored, and some of it ends up in the liver.
Being over 50, being overweight or inactive and polycystic ovary syndrome (PCOS, recently renamed PMOS) all raise the risk. Sally ticked several boxes.
When it comes to tackling fatty liver disease, it’s what’s on your plate that counts, says Dr Philippa Kaye. There is growing evidence that some foods are far easier on the liver than others – and can even reverse some of the damage
It is usually silent and often found by chance. Left unchecked, the fat triggers inflammation and then scarring, which can lead to cirrhosis – permanent damage to the organ that can result in life-threatening complications.
But here’s the good news: caught early, reversible, and with the right changes the damage can start to undo itself within months.
The single most effective treatment is weight loss, and you don’t need to fit back into your wedding dress. Losing 5 to 10 per cent of your body weight reduces liver fat, while 10 per cent or more can improve scarring or reverse the condition entirely.
Exercise helps too, cutting liver fat even before the scales move. Aim for 150 minutes a week.
For more advanced disease, there are prescription medicines that can tackle the condition – and there is now even evidence that the weight-loss drug semaglutide, also known as Wegovy, can heal some liver scarring.
But what’s on your plate really counts. There is growing evidence that some foods are far easier on the liver than others – and can even reverse some of the damage.
These are the tips I give every patient.
Start with cutting out sugary drinks. Fizzy drinks, energy drinks, sweetened coffees and large glasses of fruit juice are loaded with sugars such as sucrose and fructose, which the liver breaks down into fat.
Losing these from your everyday diet is one of the quickest wins there is.
Coffee, on the other hand, deserves a special mention. Studies consistently link two to three cups a day with less liver fat and less scarring.
It’s not concrete evidence just yet and for some people it may increase anxiety.
And if you do drink coffee, skip the syrups and sugar.
Next, the white stuff. White bread, white pasta, white rice, pastries and biscuits are rapidly broken down into sugar.
A better option is to switch to porridge oats, brown rice and wholemeal bread, which release energy slowly and come with fibre. Fill up on beans, lentils and chickpeas too. They are cheap, filling and packed with fibre and protein.
Then look at the type of fat you are consuming. Research suggests saturated fat, found in butter, cream, fatty meat, cakes and pastries, piles fat on to the liver more readily than other fats.
Cook with olive oil instead, snack on a small handful of unsalted nuts such as walnuts, and eat oily fish, for example salmon, mackerel or sardines twice a week. Their omega-3s – healthy unsaturated fats – have been shown to help reduce liver fat.
Make red meat an occasional treat and keep processed meats such as bacon, ham, sausages and salami to a minimum. Chicken, fish, eggs, tofu and pulses are better everyday choices.
Tackle ultra-processed food head-on too. Ready meals, takeaways, crisps, packaged snacks and sugary cereals combine refined carbs, sugar and saturated fat with little fibre, which is exactly the mix your liver struggles with.
Cooking simply from scratch, even a few nights a week, makes a difference.
Pile on the fruit and vegetables: leafy greens, broccoli, peppers, berries and apples.
If this sounds familiar, it’s because it is essentially the famous Mediterranean diet. That is the eating pattern with the strongest evidence for fighting against fatty liver, and the same one that protects your heart, brain and waistline.
And while fatty liver disease isn’t triggered by alcohol, there is good evidence that drinking it can worsen the condition.
With a fatty liver, every drink forces an already struggling organ to work harder.
Stay well within 14 units a week – that’s four to six glasses of wine or six pints of beer – but ideally drinking as little as possible. Quitting smoking can also help ease the pressure on the liver too.
This isn’t just advice for those with a diagnosis. With a quarter of adults affected, millions of Britons have fatty liver disease without knowing it.
Sally has already started making changes and will have regular checks. I’m hopeful her next blood test will look very different. We’ve all heard about eating for a healthy heart, and it turns out your liver wants exactly the same thing.
