Brits certainly have a reputation for being big drinkers. We could probably have stopped at the word ‘reputation’ and you’d have known exactly what we were talking about. While the UK isn’t even in the top 10 in Europe for individual alcohol consumption, or even in the world, we’re known for our boozy habits abroad and our weekend binges, and that reputation doesn’t seem to be going anywhere fast.
This drinking habit isn’t merely affecting our nation’s name around the world: it’s also a cost to our health. It’s a well-known fact that drinking alcohol has various consequences, most of them disastrous for our bodies, and it shouldn’t come as news to many that the effects of alcohol on the liver can be serious.
Liver disease has been on the rise in the UK for many years now, with twice as many people dying nowadays as a result of the condition than they did in 1991[1]. It is often referred to as the ‘silent killer’, as it develops and progresses with no signs or symptoms until the damage is at an advanced stage. The British Liver Trust assert that 7 in 10 people in the UK who have liver disease don’t even know they have it.
With these high rates of liver disease and our high levels of alcohol consumption, it stands to reason that the finger is being pointed at our drinking habits. However, other EU countries also have a high alcohol consumption, with France, Germany and Slovenia following hot on our heels in litres of pure alcohol consumed per person[2]. The WHO’s statistics assert that wine-friendly France only consume 0.5 litres per person less than the average Brit, yet their cirrhosis-related mortality rates are now decreasing[3]. So does it stand to reason that alcohol is the culprit behind our liver disease crisis? Or are there other factors we can work on to stop the ‘silent killer’ in its tracks?
The link between liver disease and obesity
Just over 25% of adults in the UK are now categorised as obese[4], and 63% of the population are overweight according to the OECD’s 2017 Health at a Glance report[5], securing us the position of the most overweight nation in Western Europe. Interestingly, the only other country ranking above the UK in the report is Finland, who are also experiencing an increase in liver disease mortality rates.
Dr Andrew Peter Holt, specialist hepatologist in the management of complex liver disease, asserts that “Few people appreciate that the recent rise in liver disease has very little to do with changes in alcohol consumption and a lot more to do with increasing levels of obesity and diabetes.” In fact, non-alcoholic fatty liver disease (NAFLD) is thought to occur in 1 in 5 adults in the UK, increasing to 4 in 5 in obese adults[6].
The liver naturally should have little to no fat, and when excess fat cells build up in the liver, this can lead to NAFLD, which over time can progress and lead to serious liver damage, including cirrhosis (scarring) of the liver. High levels of fat in the liver are directly connected to being overweight and obese, rather than consuming excess alcohol. As obesity levels have risen in the UK, so have rates of NAFLD among the population.
NAFLD is also connected to other conditions, including type II diabetes, high cholesterol, high blood pressure, and metabolic syndrome – conditions which are also linked to excess weight. Therefore while alcohol has a huge impact on the liver, and also implicates a great cost to our health services, it is not the only contributing factor to the increasing levels of liver disease across the country. The rise of obesity in the UK is having disastrous consequences on our liver, with an estimated 1 in 5 people in the UK being in the early stages of NAFLD[7].
And NAFLD can have serious effects if not caught in the early stages and controlled.
“Fatty liver affects up to a third of adults in the western world and increases the risk of liver fibrosis and cirrhosis” states Dr Holt, referring to the final two of the main NAFLD stages, where the condition has progressed to scarring on the liver and causes permanent damage.
NAFLD at one point was considered to be a rare, harmless condition, as a fatty liver can remain inflammation-free and not cause any symptoms: but it is now one of the most common forms of liver disease leading to permanent liver damage, thanks to unhealthy habits and the rise of obesity and other related conditions.
Reducing your chances of liver disease
1. Get a liver check-up
Thanks to advances in diagnostics, it’s now entirely possible for liver diseases to be recognised in their early stages and controlled before liver damage becomes serious.
“It is very easy to arrange a quick review and have a liver MOT,” explains Dr Holt. “Ask whether your specialist regularly uses blood tests such as the extended liver fibrosis screen (ELF test) or non-invasive machines such as FibroScan which can demonstrate whether you have a problem to fix before it’s too late.” Identifying problems early on is important, and while few patients are in fact referred to a specialist hepatologist such as Dr Holt without the presence of symptoms or risk factors, speaking to your GP is the first step towards getting the referral you need for testing.
2. Change your habits
If obesity and being overweight make up a large chunk of the liver disease epidemic in the UK, then it stands to reason that losing weight and following a healthy lifestyle will go a long way to reducing your chances of developing NAFLD or other types of liver disease. Even if you’re already in the early stages of NAFLD, diet and nutrition can make a huge difference in how it progresses. Simple changes to make can include cutting out or cutting down on refined sugars and saturated fats and switching to healthy high-fat foods (they exist!) instead, like avocados, nuts, and fatty fish.
3. Moderate your drinking
While obesity is a significant factor behind the UK’s liver disease problem, the combination of being overweight and drinking in excess can significantly increase the amount of fatty deposits building up in the liver.
4. Exercise
Exercise is important if you’re looking to lose weight, but it’s also a key part of prevention. Keeping your weight under control can help stop excess fat building up in the liver, and therefore help to prevent against NAFLD. It’s even been suggested that those who carry weight around their middle (an ‘apple-shaped’ frame) are more prone to developing NAFLD, so if this is you, keeping the pounds off to prevent excess weight around the waist is crucial.
The internet can help you and your liver
It can be difficult to know where to start when taking control of your diet and your health – your doctor can help advise you to begin with, but if you want to track your progress and feel supported while you’re on your way to a healthier liver, there’s an app for that. Here are some of our favourites:
Spruce (iOS only)
Spruce is an app set up by the British Liver Trust with the aim of helping people drink less. It allows you to identify patterns in drinking behaviour, and develop a drinking plan to then monitor your progress. You can plan out ‘dry days’ where you won’t consume any alcohol, and the app even gives tips on how you can cut down on or cut out alcohol altogether.
NHS weight loss plan
The NHS, together with The British Dietetic Association, have developed a free 12-week diet plan designed to help you drop weight safely, in a way that’s sustainable – meaning you develop healthy habits throughout the plan. It comes with a weekly progress chart, so you can check in on how you’re doing, and along with the diet plan, you can also post on the online community for support and advice.
Change4Life Food Scanner
If you’ve ever wanted to know how much of something you’re consuming but don’t even know where to start with those confusing food labels – this is the app for you! This free app lets you scan bar codes in the supermarket to check how much sugar, saturated fat, and salt the product contains. If you want to cut down on your saturated fats and refined sugar, this app makes the weekly shop that little bit less confusing and helps direct you to the healthier choices with a simple traffic light system. It’s also designed to be family-friendly, with mini-missions and challenges for kids to undertake while helping you with the shopping. On top of this, it’s packed full of advice on how much you really should be consuming to improve your diet and nutrition overall.
Source: Change4life
Preventing liver disease doesn’t
have to be complicated – speak to your GP about the potential risks and to get
assessed if you’re concerned. If you want to know more about your personal
risks, the British Liver Trust have an online screening test you can take, which takes into
account your weight, lifestyle, and drinking habits. They also offer
comprehensive advice on how to reduce your chances of developing liver disease
based on your answers. If in doubt, speak to your doctor – they can help guide
you and refer you for specialist help if necessary.
[1] https://www.britishlivertrust.org.uk/about-us/media-centre/facts-about-liver-disease/
[2] https://www.euronews.com/2017/05/17/which-eu-state-is-the-world-s-heaviest-drinking-country
[3] https://easl.eu/wp-content/uploads/2018/09/EASL-HEPAHEALTH-Report.pdf
[4] House of Commons Library: Briefing Paper 3336, Obesity Statistics, C. Baker, 2018
[5] https://read.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2017_health_glance-2017-en#page82
[6] https://patient.info/healthy-living/alcohol-and-liver-disease/non-alcoholic-fatty-liver-disease
[7] https://www.britishlivertrust.org.uk/liver-information/liver-conditions/non-alcohol-related-fatty-liver-disease/
Join the discussion