Our liver is the most complex of all the body organs. If the liver were a department at a factory, it would be the most overworked one. It takes on so many jobs daily and nightly and performs most of them silently, without letting us know what’s happening. It will repair and regenerate itself over and over…until it can’t.
It is slightly scary that our liver can be damaged up to 70%, yet show no symptoms of a disease. This is one of the main reasons why non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH) are now estimated to affect one in three persons in the UK. Yet, the number of diagnosed people is so much lower.
What are the signs you should watch out for as it comes to your own liver health?
A few decades ago, problems with the liver were mainly seen in people who consumed a lot of alcohol, and liver cirrhosis was primarily the disease of the alcohol-dependant. Nowadays, more and more 30 and 40- year olds are showing up with non-alcoholic fatty liver disease (NAFLD). Some people with NAFLD will progress to develop non-alcoholic hepatic steatosis, or steatohepatitis (NASH), which is the state of liver characterised by inflammation and leading to fibrosis, scarring of the liver. There are 4 stages of fibrosis, from the minor Stage 1, which is reversible, to Stage 2 - still potentially reversible, then to Stage 3 - advanced fibrosis, with a lot of damage to the liver and Fibrosis 4 - irreversible, cirrhosis or liver failure.
How does the liver get damaged? What makes the liver deteriorate so quickly in people of such young age?
Every day the liver performs more than 500 functions: it manufactures about 13,000 chemicals and has more than 2,000 enzymatic systems. It is involved in the metabolism of carbohydrates, fats and proteins, it makes and breaks down several hormones, including testosterone, estrogen, cholesterol, it processes all food, medications, supplements, toxins, alcohol, making sure the body is not poisoned by some of these substances. It acts as a storage for many minerals and vitamins, such as vitamins A, D, E, vitamin B12, also zinc, iron, copper, magnesium. Practically all vitamins and minerals we intake need to be enzymatically processed by the liver before we can use them. The liver breaks down toxins that we may consume either with food, or that enter our body from the environment. It also breaks down toxins that are the end-product of bacterial metabolism. In a lot of cases, the liver ‘humanises’ nutrients for us, so that our body can utilise them. The liver will try to detoxify what it can, but if it can’t break down a certain substance, it stores them there.
In order to be able to carry out its detoxification Phase I and Phase II, the liver needs a large spectrum of antioxidants to assist in its chemical processes. Vitamin A, E, B6, B12, B3, zinc, selenium, manganese, copper, etc. are among the antioxidants our liver needs every day in order to function properly. When the diet is depleted of these nutrients, the liver struggles to work efficiently. Part of the liver damage we see in younger people may be due to this factor. The modern western diet is not rich in natural vitamins and minerals. An average British person consumes about 13g of fibre per day (the recommended amounts are 50g of fibre daily), where vegetables and fruit should provide adequate amount of fibre in one’s diet.
Our diet has seen a dramatic change from predominately relying on whole foods about 40-50 years ago to being centred on processed and fast foods in many households nowadays. It is the modern diet rich in sugars, inflammatory oils and bad fats that is causing the current liver disease crisis among the 30-40 year olds. The added-sugar foods - cakes, tarts, donuts, biscuits, croissants, pastries, as well as a wide variety of sweets and chocolates occupy a prominent place in many supermarkets and food corner shops, it is hard to avoid them even if you are trying to be on a healthy diet. The other category food that affects the liver functioning are foods with inflammatory oils and bad fats - all fast food and processed food. They ‘need to rely on’ the use of vegetable oils - they are cheap to procure and extend the shelf-life of the product. But because these oils are highly processed and in case of fast food often re-used for more than 15 times (for French fries, for example) they cause inflammation in the body. Chronic inflammation is the main cause of most modern day diseases, such as the metabolic syndrome diseases - to which belong non-alcoholic fatty liver disease (NAFLD), insulin resistance, obesity, diabetes type 2, high blood pressure, heart disease.
The development of fatty liver disease is essentially caused by the imbalance between fats intake, their synthesis and metabolism in the liver; all of these processes are controlled by several mechanisms that maintain lipid (fats) homeostasis.
De novo lipogenesis is the term that is often associated with the progression and development of fatty liver disease via the diet route. De novo lipogenesis is the process by which the liver makes fat from sugars and starch. When there is excess glucose (from sugars and starches) in the body, it gets stored as fat, specifically ‘designed by evolution’ in order to ensure our survival in periods of starvation. Physiologically the human body did not change that much for thousands of years; what has changed is the sources of sugar that were scarce for our hunter-gatherers (such as fruit and berries in season and a very occasional mouthful of honey), nowadays are found everywhere, and for so many people are the staples of their diet.
To know if you are storing additional fat (sometimes not seen by the eye), look at your triglycerides blood test. Any excess calories in our diet are converted to triglycerides by the liver, and stored in our fat (adipose) cells until required. Several hormones regulate the release of triglycerides from fat cells to be used as energy when we need it.
The current guidance for triglyceride levels in adults is to aim for a blood triglyceride level of less than 1.7mmol/l, with some researchers advocating for levels below 1.2mmol/l.
Having a blood test with high triglycerides should be a first sign of taking action to change your dietary patterns.
Symptoms of liver damage are not easy to spot. Your liver could have had a lot of damage before it shows any signs of a real problem.
Things to spot:
Fatigue that is nearly constant
Morning tiredness that does not go away with good sleep routine
Insomnia
Feeling queasy after a meal
Trouble digesting food with fats and oils
Lack of appetite
Foul-smelling stool, pale or tanned in colour
Darkened urine
Muscle aches and muscle fatigue on little exercise
Hormone imbalances
Check with your doctor if you can have a liver function test, where your liver enzymes are analysed for potential anomalies.
Non-alcoholic liver disease is preventible and reversible (up to Fibrosis level 3) with the right dietary changes. Like most of the other body organs, your liver prefers fresh food, rich in antioxidants, such as vegetables, fruit, legumes, beans, whole grains. It also needs an abundant amount of healthy fats present in the diet - avocados, nuts and seeds, extra virgin olive oil, fatty fish, etc.
It does take time and patience to change your lifestyle patterns for the better, but once you do, the changes in the physical symptoms you experience - increased energy, drive for life, good sleep and healthy digestion - will make you want to go on like this forever. Ready to change your eating habits to promote long-term health?
See my programmes and reach out to chat how I can help YOU.