Whether or not you have overdone it during the festivities, it is never too late to give your liver some love. Here, doctors share their advice on how to keep the vital organ healthy all year round.
Drinking less isn’t just for January
“Some of the patients that I look after do Dry January and then on 1 February they go out on a big binge,” says Debbie Shawcross, a professor of hepatology and chronic liver failure at King’s College London and King’s College Hospital. “This is really harmful, because suddenly you’re drinking excessively, causing harm to your liver and undoing all the good of not drinking in January. So while it’s wonderful to give your liver a rest for a month, it is overall a lot better to be drinking sensibly throughout the year than to do things in extremes.”
Stephen Ryder, a specialist in hepatology and gastroenterology at Nottingham university hospitals, can see some merit in a January detox: “It’s not a bad thing to do, because it proves social life and everything else can go on without alcohol. And it reduces people’s overall alcohol intake, so that’s a good thing in terms of general health.”
Recognise the significance of the liver
“Your liver is a huge factory in your body, with hundreds of production lines that are involved in more than 500 key metabolic processes,” says Shawcross. “When we eat a meal, our food is digested in our guts, then all those nutrients pass directly into the liver for processing. That is when the liver is involved in taking all those different things that we have eaten to different production lines to make lots of things – most importantly, the proteins that are the building blocks of our bodies.”
“The two biggest causes of liver disease are related to weight gain or alcohol,” says Ryder. Damaging the liver is known as cirrhosis, says Ahmed Elsharkawy, a hepatologist based at Birmingham university hospitals: “People tend to associate this with alcohol, but it can be caused by anything that injures the liver. With time, it can result in liver failure and cause death or liver cancer.”
Another way of harming the liver is through contracting one of the types of hepatitis, says Elsharkawy. Among other symptoms, this can result in jaundice, which happens “when the liver is overwhelmed and isn’t able to perform the functions that it normally carries out. Bilirubin, the substance that causes you to become yellow, spills out of the liver into the bloodstream if your liver doesn’t have the capacity to deal with it.”
Drink alcohol in moderation
“We’re not telling people not to drink alcohol, because that is an unrealistic message and people will ignore that,” says Shawcross. “We’re just telling people to think about what they are drinking, to drink within sensible limits and, if they are worried that they’ve been drinking too much, to seek help to make sure that they’re not developing liver disease.” She occasionally has a drink herself, “but I look after so many people with such terrible consequences of alcohol that it always makes me think about how much I drink”, she says.
Understand what happens to your body when you drink
“If you have an alcoholic drink, about a quarter of the alcohol is absorbed straight from your stomach into your bloodstream,” says Shawcross. “The rest goes into your small bowel and will eventually pass into your liver for processing. Most is broken down into a chemical called acetaldehyde, and then another enzyme in the liver breaks down the acetaldehyde, which is what builds up and makes us feel really awful. So if you’ve had one too many drinks at a party, it is the acetaldehyde that is building up in your system and making you feel unwell.
“How quickly you absorb the alcohol depends on several factors, including concentration (drinks with a higher alcohol concentration are generally absorbed faster), whether your drink is carbonated (champagne, for example, is absorbed more quickly than non-sparkling drinks) and whether your stomach is full or empty (food slows down the absorption of alcohol).”
Don’t drink alcohol every day …
“We recommend that people have two or three days off a week,” says Shawcross. “These should ideally be consecutive days, to give your liver a proper break.”
… but do drink coffee
Elsharkawy drinks two cups of coffee a day with his liver in mind. “Coffee is an antifibrotic,” he says, which stops scar tissue forming. “Studies have shown that one to two cups of coffee [a day] helps in terms of preventing liver scarring.”
Be aware of safe-drinking guidelines
“The current UK government guidance is that it is safe to drink up to 14 units of alcohol in a week,” Shawcross says. That’s about six medium (175ml) glasses of wine, or six pints of 4% beer, spread over three days. But, she adds, what counts as excessive actually varies for individuals depending on other factors, such as their genetic makeup and size.
“The size of your liver is proportionate to your body mass, so the bigger you are, the bigger your liver is. Men also have about 70% to 80% higher levels of the enzyme that breaks down alcohol to make acetaldehyde than women, so they are able to do that a lot more quickly and efficiently. Also, men have a higher muscle mass and body distribution, so the alcohol is circulating around a bigger area than in a woman’s body.”
Remember that hangovers get worse as you get older
“As we age, the activity of those enzymes goes down,” says Shawcross. “When you are 50, you can’t break down alcohol as efficiently as you can when you’re 20. That’s why the side-effects of the alcohol get worse.”
Beware of binge drinking
“The NHS defines binge drinking as six or more units for a female in one session or eight or more units for a man,” says Shawcross. Six units can be the equivalent of two large glasses of wine, she notes. “There are no ways to speed up alcohol metabolism and no ways to avoid a hangover. It can take the liver several days to recover following a binge of alcohol – sometimes, up to weeks or months, if the damage is severe.”
Never drink on an empty stomach
“The worst thing you can do is to drink on an empty stomach,” says Shawcross. “If you do, all of that alcohol goes very quickly into your system. You very quickly get drunk and the liver becomes overloaded, because it can only break down alcohol at a certain rate, roughly one unit of alcohol an hour. But if you eat when you drink, that keeps that alcohol in the stomach for longer, so it slows the rate at which it goes into the bloodstream.”
Maintain a healthy, balanced diet
“There is not so much a ‘liver diet’ – it is really just a healthy diet,” says Philip Newsome, who works at King’s College London and is the director of the Roger Williams Institute of Liver Studies. “It is about identifying the easy wins, such as cutting out the additional food that people have in between meals and sugar or sweetened beverages. It is not that you can’t have any treats, just fewer of them. And make sure you try to eat less processed food and more fruit and veg.” Following a Mediterranean diet can help keep your liver healthy.
Lose weight
“Obesity and alcohol cause similar changes to the liver, in that you start off with excess fat deposition in the liver and you see inflammation and scarring in exactly the same way,” says Shawcross. Losing weight is the best way to address metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease.
This can be hard, concedes Newsome: “I think there’s something around setting sensible expectations. The first thing I tell patients is to avoid gaining any more weight. Second, when they are making changes to lose weight, recognising that it is a long game. It is not about losing 5kg in a month and then regaining 3kg and yo-yoing.” More realistic is “a target of losing 10% of your body weight over the next few years. The best way to do that is through calorie reduction, because it’s quite difficult to out-exercise what you eat.”
Do some basic exercise
There is still merit in exercising, though, says Shawcross: “When you exercise, it moves fat out of your liver, into your bloodstream and towards your muscles. We’re not asking everybody to go to the gym and pump weights or do something crazy. We’re just asking people to be more active – to go out and have a brisk walk for 20 minutes each day, to use the stairs instead of the lift – because those sorts of really simple things help liver health.”
If you feel hungry, drink water first
“Often, people mistake thirst for hunger,” says Newsome. “If you feel hungry, have some water first. When you’re having a meal, make sure you have one or two glasses of water first. These are little tricks that for some people can work, in terms of reducing those additional calories that they probably don’t need, but which often become habits.”
Quit smoking
As if there weren’t enough other reasons to stop smoking, it also affects the liver. “Smoking accelerates the scarring, known as fibrosis,” says Shawcross, so smoking and drinking together is a particularly bad idea.
See a doctor – and be honest
Unfortunately, says Shawcross, liver disease is “a silent problem, in that you won’t really notice it. But what happens is that initially your liver becomes fatty and slightly enlarged, then that fat starts to cause irritation to the liver and it becomes inflamed. Then, gradually, over about 15 to 20 years, that inflammation results in scarring in the liver. Eventually, you can develop cirrhosis, where your liver is irreversibly scarred, and it becomes small and shrunken. At that stage, the liver stops doing the things the liver needs to do.”
If you are worried, you can ask your GP for a liver blood test, she says: “While having normal liver enzymes doesn’t mean you haven’t got a liver problem, often your liver enzymes will become raised when you drink alcohol in excess. So you can pick up the early stages of an inflamed liver at that point.”
Be honest with the doctor in terms of how many units you drink, Shawcross adds: “People always tell their doctors what they think their doctors want to hear, rather than the truth. Being really honest with your GP about what you drink and what your lifestyle is like is important to help identify problems. Your GP can also refer you for a liver fibroscan, which only takes five minutes to do and measures how fatty and stiff your liver is. The stiffer your liver, the more likely you are to have scarring.”
A liver transplant could save your life
“Having a liver transplant is a massive operation,” says Elsharkawy. “I say to my patients: it is like putting your heart through running four or five back-to-back marathons. Not everyone’s up to that.” Afterwards, you can live a pretty normal life, but you will be on immunosuppression drugs which come with their own side effects, he says.
“If alcohol is the cause, you have to prove to everyone’s satisfaction that you can be away from alcohol,” says Ryder. “Transplant demand is high and it is important a second, donated liver isn’t harmed.”
Detoxing your liver is a myth
There are certain misconceptions, Ryder says, about the organ’s abilities. “Your liver detoxifies things we choose to take in. But you have to look after it by avoiding the lifestyle factors that damage it. Your liver is very effective at detoxifying chemicals we put into it, but that doesn’t mean it can’t be damaged – and there’s no evidence that things like milk thistle really protect the liver against those injurious factors.”
Elsharkawy adds: “There is no good evidence on dietary supplements for liver health. Sometimes my patients ask about taking turmeric, which is an anti-inflammatory. I find no reason not to take it, but there is no solid data to support that recommendation.”
Your liver can repair itself
“When the liver is fatty or just mildly inflamed or scarred, then there’s a lot of reversibility, so the liver can go back to being a healthy one,” says Shawcross. That’s why it is good to get checked by a doctor as early as possible if you have any concerns.
“I’ve seen people come into hospital who are bright yellow and swollen with extreme liver failure,” says Ryder. “After six months away from any alcohol, you wouldn’t be able to tell them from anybody else at the bus stop. They are back to pretty normal health.”