Obese people at risk of developing non-alcoholic fatty liver disease
Hilary Todd was astonished when doctors told her in December 2015 that she needed an urgent liver transplant. “I felt fine,” she says, “I told them, I’m not ill. I really didn’t believe it.”
Yet Todd, 53, had non-alcoholic fatty liver disease (NAFLD) caused by a buildup of fat which, over time, had caused her liver to fail.
Having never consumed alcohol, and being “overweight, but fit from running around the playgroup I ran and from looking after my own three children,” the diagnosis “was a surprise” — all the more so when she was told that she needed “to get on the transplant list while I was still well enough to have the operation. By the time I was ready in October 2016, my main hepatic portal vein was so blocked, I was two weeks away from being inoperable.”
Todd had an advanced case of fatty liver disease — in up to 12 per cent of cases, NAFLD develops into non-alcoholic steatohepatitis, or NASH, which can lead to severe scarring and liver cancer.
Her initial diagnosis, however, is surprisingly common; though most people associate the condition with excessive alcohol intake, the British Liver Trust estimate that more than one in five people in the U.K. are now in the early stages of NAFLD. (According to the Canadian Liver Foundation, 23 per cent of obese Canadians are at risk of developing serious liver damage from fatty liver disease. NAFLD is the most common liver disease in Canada, affecting more than seven million people.) Most will have no idea they are even at risk.
“Alcohol is still the most common cause for admission to hospital with liver disease,” explains Dr. Phil Harrison, consultant hematologist at London Bridge Hospital’s Liver Centre, “but now it’s closely followed by NAFLD.”
“NAFLD takes up the bulk of our outpatient clinic work,” says Jonathan Fallowfield, senior clinical fellow and honorary consultant hematologist at the University of Edinburgh. “Over the last decade, we’ve noticed it becoming more prominent, and it will soon be the most common reason for liver transplants.”
He says that many “don’t realize the significance” of what is happening and are only usually diagnosed after being “picked up with abnormal liver tests after being investigated for something else. They’re often overweight or obese, but they may have no symptoms.”
Men are more likely to suffer NAFLD than women, with older people, lower-income families and those who drink too much most at risk. It can affect anyone, however, and last summer it was revealed that fatty liver disease was a contributing factor to the death of singer George Michael.
It is not fully understood yet, Harrison says. “The fat which gets deposited is not the same as fat we see around the waist. It gets into the liver cells where it can stop the liver doing its work of detoxifying.
Bleeding was the first symptom Todd suffered, but as it started when she was 43 — most people are not considered at risk until they are in their 50s — doctors couldn’t detect an underlying problem.
After a family trip to the local swimming pool 10 years ago, “I threw up a sink full of blood in the changing room. It was frightening,” Todd says. She was taken to hospital with a suspected bleeding ulcer and suffered a stroke the next day.
After three days in intensive care, she was diagnosed with esophageal varices, but liver biopsies — the most effective way to diagnose the condition — were inconclusive.
She spent the following seven years being monitored regularly, but it was only in late 2015, when a blood test indicated her condition had deteriorated, that Todd was placed on the transplant list.
As liver transplants are the only cure for advanced liver disease, the main aim of doctors is to encourage weight loss.
When his 69-year-old mother was diagnosed with liver disease, Asanka De Silva began developing LivOn!, a coffee drink low in calories, sugar and fat, to help tackle the issue. “The only thing useful for liver health with any clinical evidence behind it is drinking coffee,” he says. It’s not fully understood how coffee benefits the liver, though a 2016 report from the British Liver Trust found that consumption may prevent the cancer, while five cups a day could potentially cut the risk of liver disease by 80 per cent.
“It’s crucial to remember that much liver damage is reversible,” says Fallowfield. “When people lose between seven and 10 per cent body weight through dieting or weight-reduction surgery, NASH resolves dramatically. It’s never too late.”
Sugar is a problem, Harrison adds, and “we need to watch our weight and avoid too many carbohydrates and keeping calories down.”