I was terrified to get my fatty liver checked – but it’s a good job I did
Thirty-five years ago there was a TV commercial in America for some new prescription drug in which viewers were warned: “Don’t rely on absence of symptoms as a health status indicator.”
It seemed hilarious – a perfect illustration to a 20-something man working in the States of how silly Americans are about health. Surely the British way – only to bother the doctor when you don’t just have symptoms but feel at death’s door – is more sensible?
However, as a rather older man whose contemporaries are starting to enter the dreaded health “snipers’ alley” (a “boy” I’ve known since we were 11 just died of a brain tumour), I am a lot more sympathetic to heading off advancing health problems before the onset of symptoms.
Which is why last week I went into a London clinic for a scan of my liver.
We don’t think much about our liver. Unlike the heart, stomach or lungs, livers are quiet, uncomplaining pieces of offal – even when they’re struggling. I still find it hard to remember from O-level biology what the liver even does. (It filters and cleanses blood and builds substances we need from the nutrients we provide it.)
But liver disease is growing alarmingly, largely due to rising obesity. There has been a four-fold increase in deaths from liver failure over the past 50 years and liver disease is the only major illness with this rising death rate.
There is, however, a silent – but crucially symptomless – alarm signal that your liver could be in trouble. This early warning is a build-up of fat in your liver cells. It means you might be in danger of developing scarring – hard bits or fibrosis in the liver, which can become liver cirrhosis, and that can develop into cancer and liver failure.
The good news is that there’s a simple, 30-second, wholly non-invasive (and available on the NHS) test for “fatty liver”. It’s called a FibroScan – the name of the machine most commonly used. It’s recommended for any adult, but especially any over 50, who is overweight, has diabetes, or drinks alcohol most days of the week. And for the first and last reason, that’s the test I was travelling up to London to get.
Fatty liver sounds almost amusing, which may be why hepatologists – liver specialists – are keen to rebrand it as “steatotic liver disease”, which sounds rather more serious. Doctors are also keen to get away from the idea that liver problems are connected solely with alcohol and drugs. This can be the case, but more innocent aspects of modern living – or just your genes – can bring it about.
Nevertheless, the British Liver Trust has discovered that a startling 73 per cent of people with a liver condition have experienced stigma – which is to say they feel they might be considered alcoholics or drug addicts. Some 29 per cent of these say that stigma has stopped them going to the doctor.
Full disclosure: I was not quite a fatty liver newbie when I went for my FibroScan. I was first warned about fatty liver 18 years ago, when I was 50 and had a private “full body” health MOT. Fifty was an ominous age for me; both my parents had died at 50, my mother of breast cancer, my father of complications from an unusual viral hepatitis – disease of the liver – picked up swimming in an Italian lake.
So back in 2006, when the doctor at the Preventicum clinic reviewed my MRI and mentioned that my liver was showing signs of harbouring fat, the very word liver spooked me.
He said I needed to lose weight – not a huge amount – but most importantly, to have a couple of days a week without alcohol. Then as now, I wasn’t a big drinker – a large glass of wine, a pint of bitter or a large Scotch a day – but the doctor explained that to leave a couple of 48-hour gaps a week would give the liver time to recover.
I never forgot his words, but so far as action is concerned, I did what I imagine most British men would – not very much at all. My stone or two overweight and nightly drink have barely changed in 18 years.
So it was with real fear that I entered the London Digestive Centre in Welbeck Street for a ￡404 session and a consultation with Dr Richard Marley, a consultant hepatologist. I should emphasise that the NHS would have done the same liver scan, but I was impatient and too worried to deal with the obstacle course of getting non-urgent NHS care.
The very chatty and approachable Dr Marley, who is also a consultant at Barts, the teaching hospital in the City of London, confirmed that liver disease, and its precursor, fatty liver, is growing alarmingly.
“When I trained 35 years ago it was not an entity at all. But nowadays, cardiovascular health has improved significantly, along with treatments for a whole host of diseases, but more and more patients are presenting with end-stage liver disease, unaware of the fact they’ve had fatty liver for years.”
“I will ask: ‘Well, have you carried extra weight for a long period of time?’ and they will reply: ‘Yes, I’ve been overweight and I have a family history.’ Of course, alcohol is a co-factor, which in some cases contributes, but not always. The long and the short of it is that up to 20 per cent of the population have got a fatty liver and a percentage of those will then go on to get cirrhosis.” He added that “Ozempic, the new miracle weight-loss injection, is being used a lot by people diagnosed with fatty liver”.
We went through to the room with the FibroScan machine. It’s a rather jolly, unthreatening, colourful little console that looked to me like something from a 1970s Star Trek set.
The FibroScan uses ultrasound to calculate the speed a wave goes through your liver. This may sound painful, but the test was as non-invasive as can be imagined. I remember my dad having liver biopsies when he was ill in the early 1970s that were almost mini operations with a huge needle inserted into the liver. I simply lay on a bed and pulled up my shirt a little while he applied the FibroScan probe to my side. For 35 seconds, I felt an odd tapping sensation as the instrument mapped my liver, and it was over. With a nice surprise.
The machine gives two readings, one for liver fat and one for liver damage.
“So a normal liver, soft like you see in the butcher’s, will be less than five,” Dr Marley explained. A badly damaged liver, like a piece of wood with fibrosis, will be more than 15. You’re 4.3 so there’s no damage to your liver.”
And the fat? “The normal would be 235 and bad would be 335 and above. You’re 265, so you’ve a mildly fatty liver. That means you’re not in any great likelihood of getting bad liver disease. But it does increase your risk of type two diabetes in the future. So that will be your main potential health consequence of fat in the liver. But if you were to reduce your waist-to-hip ratio a little bit, this is entirely reversible.”
Delighted, I asked nonetheless if it was odd that I had a slightly fatty liver 18 years ago, I haven’t really done much about it, and still have the problem only mildly.
“Back in 2006, when you had the MRI scan, it wasn’t quantitative,” he explained. “It was yes, you’ve got fat or no, you haven’t got fat. The advantage of this is you can track this and see how things change over time. There might have been change.”
So would an NHS GP have referred me for the FibroScan?
“Yes, compared to 10 years ago, when GPs weren’t very aware of the risks of fatty liver disease. Now, they are much more aware. They will work out from an equation various parameters from blood tests and say what your chance is of significant liver disease and then refer you based on that.”
And lastly, what should I do about alcohol? “Look, alcohol is very calorific, which is not ideal for you. So, be sensible with, maybe, under 14 units a week with that.”
I spoke later to Professor William Alazawi, a consultant hepatologist at the Royal London Hospital, who is one of the world’s authorities on fatty liver, who is involved with getting more FibroScan tests done in the community – even using mobile units to search widely for damaged livers. It is often said that the south Asian population in Britain is especially prone to fatty liver – in the US it’s Hispanic Americans.
But while acknowledging that the condition can affect different groups differently, Prof Alazawi is keen to emphasise that it’s important not to regard it a disease mostly of one ethnicity, just as it’s not restricted to people who drink too much.
“I would say the fact that a quarter of the population in the West has a fatty liver, rising to two thirds of people with type two diabetes and rising to about 80 per cent of people living with obesity means we go beyond ethnic grouping here. But this is a widespread problem. It can affect anyone, everywhere. I’m seeing it across the social spectrum.”
Diet, Prof Alazawi emphasises, is key. “Although not all fatty liver is due to diet alone, risk increases with over-consumption of calories. Eating late at night can also be a problem, so people who are shift workers, for example, are at increased risk. Diets that are rich in saturated fats can be bad for the liver, but they’re also bad for us in every other way. And sugars – foods that contain lots of sugars, particularly fructose-containing sugars, are rapidly turned into fats.”
His overall message is rather encouraging. “I would regard fatty liver as the start of a conversation that will address behaviour and lifestyle, which will reduce the risk not only of a fatty liver but also reduces cardiovascular risk, risk of high blood pressure, cholesterol and developing diabetes. So actually, for people in whom the diagnosis is made early, it is an intervention point, and the news should be delivered as an early warning about which something can be done.”
I’ll drink to that. Possibly just an orange juice, though.