Tony Oakley liked to think he was pretty healthy — he drank only at weekends and went to the gym a couple of times a week.
The last time he’d had time off sick was six years ago, and that was only because he broke his leg.
So imagine his shock when last May he was warned he could be dead within ten years because of liver disease.
‘I was really, really shocked,’ says Tony, 50, who is married with four grown-up children and works as a customer relations director for a City bank.
‘At the weekend I have a few beers but don’t drink during the week — at the most I have 16 units a week.’ (This is the equivalent of six pints of lager — comfortably under the recommended weekly maximum of 21 units for men.)
‘I had no symptoms either — my liver problem only got picked up because I
had a blood test when I got diagnosed with gout in my big toe.
‘I knew I was overweight — I’d got into the habit of snacking at work on biscuits, and got up to 17st (I’m 5ft?10ins) but because I kept fit and was never ill I thought I was fine.’
Like Tony, few people realise it’s not just alcohol that can damage the liver — so can too much food.
He had what is called non-alcoholic fatty liver disease. Most sufferers are only moderate drinkers or may even be teetotal.
‘The risk factors essentially revolve around obesity,’ says Dr Ashley Brown, a liver specialist at St Mary’s Hospital in West London.
‘It’s a bit like pate de foie gras — which is made by force-feeding geese, making their livers swell. A similar thing happens in people.’
As we put on weight, our bodies become less sensitive to insulin. Insulin helps store sugar in the cells but if it is less effective, the sugar gets stored as fat in the liver.
‘This causes inflammation in the same way as too much alcohol does,’ says Dr Brown.
‘Over years this can lead to scarring, and that can lead to cirrhosis.’
As a result, the normally smooth liver becomes full of nodules and hard gristle, meaning it cannot function as normal.
This can have a profound effect, for not only is the liver vital for processing digested food, it clears the body of infections and helps neutralise toxins and drugs. So cirrhosis can be life-threatening.
And, as the British Liver Trust warns, obesity not alcohol will become the main cause of liver cirrhosis if current trends continue.
Obesity – not alcohol – will become the main cause of liver cirrhosis
It’s not just cirrhosis: non-alcoholic disease can lead to liver cancer, stroke and other cancers, too.
It’s estimated more than half-a-million people in the UK could soon have non-alcoholic liver disease, although Dr Brown says it may be much more, as it is ‘significantly under-diagnosed’.
In the past ten years the number of hospital admissions has more than doubled to nearly 2,000, and already it causes almost 700 deaths a year.
Last month a report from the National End of Life Care Intelligence Network warned that while deaths from other serious conditions such as cancer and heart disease were falling, those from liver disease have increased over the past decade by a quarter.
‘Non-alcoholic fatty liver disease is already a big problem and one that’s going to get even worse,’ says Dr Phillip Harrison, a liver specialist at the London Liver Centre, London Bridge Hospital.
‘It’s like a juggernaut about to hit us.’ Worryingly, even children are developing it because they’re overweight.
And you don’t need to be obese to have a fatty liver. For some people being just a few stone overweight is enough.
‘There is a genetic element to it: not every overweight person will develop it, and some people don’t need to be obese for this to happen,’ says Dr Brown.
‘Some people who are quite thin but what we call TOFI — thin on the outside, fat on the inside — can get it.
‘They’ve been overweight and lost weight but they may still have fat stored round their organs.’
This is because losing weight by cutting calories isn’t enough to shift liver fat — you need to exercise, too.
There are also a tiny minority who get fatty liver disease yet have never been overweight — why this happens is not clear.
As well as obesity, fatty liver disease is linked to high cholesterol, high blood pressure and type-2 diabetes.
‘If you have any of these conditions, your risk of developing it increases,’ says Dr Brown.
Yet while drinkers know they’re putting their livers at risk, those who are overweight don’t, and because the disease is silent with no obvious symptoms, it can go undetected until it is too late. It is usually spotted by chance when people are in their 40s and 50s.
‘Normally it gets picked up when someone is having a general health screening or blood test for another condition,’ says Dr Brown.
It is diagnosed with blood tests to check the levels of enzymes that can indicate inflammation. Scans or even a liver biopsy may also be done.
Often it causes no symptoms other than mild tiredness, says Dr Brown.
‘Whereas heart problems might lead to breathlessness, for example, the liver is like a plodding donkey that carries on without any complaint — until it is too late.
‘And GPs and the public are not particularly switched on about it, as it was only first described about 15 years ago.
‘I work in A&E, too, and I see people whose liver disease has not been picked up who are now in liver failure.
‘Or they are referred to me with late-stage liver cancer, and this is the first they have known of their liver disease.’
Tony, from Dartford in Kent, knows he is lucky to have been diagnosed when he was.
‘I’d had a pain in my toe for a while and decided to use the private health cover I get at work,’ he says.
‘I didn’t even know my liver function was being tested, and when the doctor said “one of your liver function tests is not right” I didn’t really take it seriously.’
Soon after, in May 2011, he had more blood tests and an ultrasound.
‘I went back for the results a few days later, and the doctor read me the riot act,’ says Tony.
‘He said my liver was suffering as a direct result of my weight. I had a BMI of about 30, putting me in the obese category.
‘What the doctor said made me realise it was time to do something.’
The good news is that a fatty liver is treatable, says Dr Brown.
‘If you start to lose weight and exercise then the liver can start to heal and the fibrosis or scarring will be broken down faster than it is produced.’
Sometimes weight-control drugs such as orlistat (which reduces the amount of fat the body absorbs) may help. Scientists are also developing ‘anti-fibrotic’ drugs to stop the liver scarring, but these are in the early stages.
After his diagnosis Tony cut out cake, biscuits and foods that quickly break down into sugars, such as white bread, and had brown or wholemeal alternatives.
He went to the gym more regularly and stopped drinking completely for three months. When he next saw his specialist six months later, he had lost more than 1 stone.
‘This time the tests showed that my liver was fine,’ he says.
‘The doctor was amazed, and I was really chuffed that I’d managed to undo the damage I had done.
‘This has been the wake-up call I needed — I want to be around to see my grandchildren.’