Liver disease is often referred to as a “silent killer” – and it’s on the rise in the UK. According to the British Liver Trust, there has been a fourfold increase in death rates in the last 50 years. More than 11,000 deaths each year are attributed to liver disease.
“The liver is just as vital an organ as the heart, yet people often fail to appreciate the importance of keeping it healthy,” says Debbie Shawcross, a professor of hepatology and chronic liver failure at the Institute of Liver Studies, King’s College London.
Shawcross – who also works clinically at King’s College Hospital – describes “an evolving crisis of chronic liver disease in the UK, with the prevalence and mortality increasing exponentially.”
Liver cirrhosis, she explains, “is the third biggest cause of mortality and loss of working life behind ischaemic heart disease [Ischemia is a less-than-normal amount of blood flow to part of your body] and self-harm. It is the only major cause of mortality and morbidity which is on the increase in England. Over the last decade, the number of people dying with an underlying cause of liver disease in England rose by 40 per cent.
She adds that “people die from liver disease at a young age, with more than one in ten in their 40s”.
The liver is the largest solid organ in the body. “It holds approximately 13 per cent of your total blood supply at any given time and also serves as a factory for more than 500 different functions,” Shawcross says. These include absorbing nutrients and detoxifying and removing harmful substances from the blood.
It is responsible for processing digested food from the intestine and breaking it down into energy; controlling levels of fat, proteins and sugar in the blood; and helping to filter the blood and fight infections.
It also neutralises and breas down drugs and toxins; stores essential chemicals like iron and vitamins; makes bile; manufactures and regulates hormones; and makes vital proteins to help your blood clot and repair damaged tissues.
“You only have one liver, and while liver cells do have the capacity to ‘regenerate’ when they are damaged, if the liver is damaged repeatedly, it becomes scarred causing it to shrink and fail to undertake vital functions,” Shawcross adds.
Like high blood pressure, liver disease often presents with no signs or symptoms for many years. “It can take between 10 and 20 years for advanced liver disease – known as liver cirrhosis – to develop,” she says. “The liver becomes small and shrunken from scarring and begins to fail. One in six patients with liver cirrhosis also develop liver cancer.”
Cirrhosis, the end-stage of chronic liver disease, is a progressive condition, resulting from sustained liver injury due to factors such as alcohol excess, viral hepatitis, or metabolic disorders, Shawcross explains. “One third of the global population is now overweight or obese and this results in steatotic liver disease which is caused by fat accumulation in the liver resulting in inflammation and scarring.
“Being overweight and drinking alcohol in excess accelerates liver damage.”
Here are some of the things Shawcross does every day to keep her liver healthy – as well as the things she avoids at all costs.
“Eating an apple (or any stoned fruit such as plums, cherries or nectarines) really can help keep the doctor away. Apples contain pectin, which promotes the growth of bacteria that produce short-chain fatty acids which help maintain a healthy gut and immune system.
Short-chain fatty acids are also important to help keep liver cells healthy and process nutrients efficiently. I make sure there is an apple in my children’s lunchbox and stock up on apples every time we go shopping.”
“Studies have shown that people who drink three or four cups of coffee a day have less risk of developing liver disease than those who do not drink coffee. Coffee has been shown to reduce liver damage, including the process of scarring – fibrosis – that leads to cirrhosis.
A UK Biobank study has shown that all coffee types, including decaffeinated, instant and ground, reduce the risk of developing chronic liver disease and liver cancer.”
“While there is no safe limit of alcohol consumption, it is unrealistic to expect a nation to abstain from alcohol and I often enjoy a glass of wine with my dinner at the weekend and on special occasions.
“However, it is important not to drink more than 14 units of alcohol per week or to drink more than six units of alcohol in one day – which constitutes an alcohol “binge” and is particularly harmful to the liver. It is important to remember also to have two or three days each week when you rest your liver and do not drink alcohol at all.
“Fourteen units of alcohol is equivalent to six pints of average-strength beer or 10 small glasses (125ml) of lower-strength wine. Many pub servings of wine can be as large as 175ml or 250ml so it is very easy to underestimate how much alcohol we are all drinking.”
“About a quarter of the alcohol in a drink is absorbed straight from your stomach into the bloodstream. The rest is mostly absorbed from your small bowel.
“How quickly you absorb the alcohol depends on the concentration of alcohol in your drink (drinks with a higher alcohol concentration are generally absorbed faster), whether your drink is carbonated (champagne, for example, is absorbed more quickly than non-sparkling drinks) or whether your stomach is full or empty. Drinking alcohol with food slows its absorption and therefore lowers the concentration in the blood.”
“With one third of the population now overweight or obese, problems related to fat deposition in the liver is now the most common cause of liver disease. We know that regular exercise that causes our heart rate to rise is just as, if not more, important than eating a balanced diet and maintaining a healthy weight.
“Resistance training which stops muscle wasting can help reduce the amount of fat stored in the liver, protect against getting diabetes, reduce inflammation in the liver and promote metabolic health. Even if significant weight loss isn’t achieved, exercise can still improve liver health by favourably influencing how the liver processes fats and sugar. Try taking the stairs instead of the lift or getting off the bus stop one stop earlier.”
“Sugar-sweetened carbonated beverages such as cola and lemonade are a major source of fructose. The liver rapidly stores fructose but tends to store it as fat rather than glycogen, increasing the chances of developing fatty liver disease, cirrhosis, diabetes, heart disease, and cancer.
Diet drinks contain artificial sweeteners and caramel colourant, which can increase insulin resistance which leads to diabetes and inflammation in the liver. Some studies even show that sugar can be as damaging to the liver as alcohol, even if you’re not overweight.
“Kombucha is a lightly carbonated drink made from the fermentation of specific culture yeast with sugar and black tea. It contains antioxidants, vitamins, and probiotics and can improve digestion and your gut microbiome. I try to swap a can of diet drink for a bottle of kombucha with no sugar added. Fermentation can leave a small quantity of residual alcohol so if you want to avoid that try an unsweetened kefir or live yoghurt drink instead.”
“As a busy professor of hepatology, juggling clinical work, research and teaching, as well as an on-call rota and being a mum of two young children, I rarely get the opportunity to get eight hours sleep.
“When you are tired, stressed or sleep deprived, your body releases more stress hormones which not only makes us feel more hungry, craving sugar and fat, but also promotes fat deposition in the liver. Late nights also make you want to snack before bedtime which promotes weight gain and fat deposition in the liver because there isn’t time to burn off these superfluous calories. When I can get an early night, my liver is happier and I am less likely to snack and gain weight.”
“Drinking six or more units of alcohol in one session constitutes a ‘binge’ and causes more damage to the liver than drinking regularly.”
“Herbal and homeopathic remedies do not improve liver health and many herbal treatments have been shown to be toxic to the liver; associated with liver damage, liver failure and even death.”
“Missing breakfast increases the risk of developing metabolic liver disease, diabetes and cardiovascular disease. Consuming a greater percentage of the day’s calories in the morning may also help reduce the risk of developing a fatty liver.”
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