One of the most frustrating things for
experts like me is that an estimated four in five cases of liver disease currently go undiagnosed. And yet, given the chance, the organ is incredibly resilient. If the disease is caught early, the damage can be reversed in as little as three to six months with simple lifestyle changes.

Liver disease is the only major disease for which UK death rates are escalating. Cases of metabolic dysfunction-associated steatotic liver disease (MASLD) – previously known as non-alcoholic fatty liver disease (NAFLD), where excess fat is stored in the liver and causes scarring, cirrhosis and ultimately organ failure – have increased by 143% in three decades.

The majority of patients present when their liver tests become abnormal and by that time there is already severe inflammation and scarring in their livers.

Unlike heart issues, for example, where you might experience chest pain or breathlessness and be given a stent or bypass and do very well afterwards, 80% of those with liver disease experience only non-specific symptoms, such as lethargy or poor sleep, until the late stages.

Yet, the liver is the only organ that can repair and regenerate after damage – it will even regrow to full size if you have a section removed. In my work supporting those with MASLD, I’ve helped many patients successfully reverse their liver damage in as little as three months – and it won’t recur unless you go back to your old ways.

When we talk about liver health, most people’s thoughts go straight to their favourite tipple. But the truth is that as many as one in five people in the UK live with liver disease entirely unrelated to alcohol. Many cases are linked to being overweight, but multiple modern lifestyle factors can cause fatty liver.

Here are the ones that are most damaging, and ways to lower their impact.

1. Ultra-processed foods (UPFs)

There’s no doubt that ultra-processed foods are the most damaging element to the liver – probably more so than alcohol. On the whole, young people today are drinking less alcohol than they used to, but UPFs are a constant in their lives. Some of the worst culprits include processed meats and fast foods, all of which are now commonly consumed on a daily basis.

It is important to read ingredient lists. UPFs usually contain five or more additives, preservatives, emulsifiers and sweeteners that would not normally be used in home cooking. Some of those to be wary of and avoid include hydrogenated vegetable oils, fructose syrup and hydrolysed proteins (often used in post-workout whey powders). Our livers have difficulty processing these foods and the additives and ingredients they contain. It converts the sugar elements to fat, and when it’s confronted with substances it doesn’t know, the liver lays down fat in the liver to try to protect itself.

2. ‘Diet’ soft drinks

Diet soda is worse for you than soda with sugar for the same reasons that UPFs are bad for you. While our livers have been processing sugar molecules forever, sweeteners are entirely man-made. The liver has a means of dealing with and clearing out glucose, but because these new sugar substitutes are unfamiliar, they aren’t “detoxed” in the same way and are bundled away in the liver, leading to inflammation in the liver and fat deposition.

While water is always the healthiest option, if you want to drink fizzy drinks, you’re better off avoiding diet options and opting for the standard offering – but only as an occasional treat.

Exercise is a vital liver-protecting tool. Moderate-intensity workouts such as cycling and swimming increase blood flow to the liver, which helps with metabolic processing. And obviously, the more you exercise, the more calories you burn, the fewer are left to be converted into fat in the liver.

3. Sugar and fructose

While sugar is better for the liver than sweeteners, that doesn’t make it good for the liver.

And we’re consuming far larger quantities than many people realise. As well as being pumped into processed foods to make tasteless ingredients more palatable, coffee shops that weren’t around when I was younger are serving frappuccinos loaded with sugar – and people are drinking several of these each day, which taxes the liver.

Meanwhile, sweets, juices and soft drinks are filled with fructose, and while glucose is metabolised throughout the body, fructose is mostly dealt with in the liver, so when too much is consumed, it places the organ under strain and triggers inflammation.

Make sure you’re coming in under the recommended 30 grams of sugar each day, and avoid processed foods made with corn syrups or that claim “no added sugar” but are instead packed with fructose, because this is converted into fatty deposits in the liver. Skip smoothies and fruit juices and eat whole fruit instead.

4. Wellness supplements and herbal remedies

This is a big issue at the moment for the bio-hacking community, who like to stack lots of different supplements on top of one another. But you don’t need to be chasing longevity to damage your liver with herbal remedies. There are plenty of people who will pop to a high-street health shop and pick up something that a friend has recommended, but that may not suit them, or it may interact with other medications they may be prescribed.

For example, vitamin A, CBD, ashwagandha and dandelion are known not to be liver-friendly. Milk thistle, which is often used as a tonic for the liver, can also be catastrophic. I’ve treated somebody who needed a liver transplant after milk thistle poisoning – she was taking Western medications for arthritis while self‑medicating with herbs she had grown herself and managed to send herself into liver failure.

Even paracetamol, if you’re mixing it with other medications or supplements that use the same detoxification pathway, may significantly increase the risk of liver toxicity, and so it is important to consider all prescribed and self-administered medications.

If you are on medication, always check with a pharmacist before you start taking a new supplement. If you are taking something that is known to be hard on the liver, try not to do additional things that put it under strain, such as drinking alcohol.

5. Menopause

The liver regulates female hormones, and the healthier your liver, it seems, the fewer difficult symptoms of menopause you’ll experience. Before menopause, there are fewer cases of fatty liver among women than men, but after they lose protection from their estrogen, the incidence of fatty liver becomes fairly similar for both sexes.

Most worryingly, if you’ve already got an unhealthy, fatty liver going into menopause, the progression of fatty liver disease and your risk of going on to develop both cirrhosis and cancer become significantly higher. That’s why I believe all women in their mid-40s should have a liver scan, commonly known as Fibroscan (which costs under £250 privately in the UK), to identify MASLD – particularly if they have risk factors such as being overweight or having close family who have been affected. That way, you can intervene at an early stage and change the trajectory of the disease before menopause hits – on average around the age of 51 – to prevent a more serious issue occurring down the line.

6. Food grown and reared with pesticides and antibiotics

For years, people have said animal fat is bad for us, and meat is unhealthy – and that simply isn’t a blanket statement – it depends on the quality of the meat. Organic, grass-raised beef, for example, is full of good nutrients, vitamins and minerals, and it’s a high source of protein, in particular when farmers practice rotational farming.

It is important to check whether the animals are antibiotic and hormone-free, as these chemicals can cause cumulative damage to your liver. “Bad” meat is that which comes from animals that have been administered chemicals or are from farms that apply pesticides. Even if you eat a pork steak rather than bacon that’s packed with UPFs, you’d still be adding to your liver’s toxic load if you eat lower-quality meat.

Conversely, people say all vegetables are great, but if you have vegetables that have been sprayed endlessly with pesticides, then they’re going to be bad vegetables and inflame the liver. So even if you replace all your UPFs with fruit and veg, you could still be loading your systems with chemicals, albeit a different kind.

Wherever possible, eat fruits and vegetables that are grown organically and choose organic meat that is pasture-raised.

7. Microplastics and other chemicals

Microplastics are almost impossible to avoid. They’re in our water, they’re in our food, they’re in the air. The body can’t break down these foreign bodies, so they accumulate in our filtration system – the liver – and ultimately they can damage it and create inflammation. They cause the liver to struggle and lay down fat to try to dampen down the inflammation response. And in most cases, it’s not a major inflammation that triggers fatty liver disease, it’s a slow accumulation over time.

Some people advocate avoiding single-use plastic, wearing natural fibres and using filtration systems to try to remove them from drinking water, which may be helpful for reducing your microplastic load.

Other chemicals such as PFAS (per- and polyfluoroalkyl substances), otherwise known as “forever chemicals”, as well as phthalates and BPA (bisphenol A) which are used to make plastics, are all toxic to the liver and, whenever possible, we need to be reducing our exposure to plastic.

8. Fungal exposure and household mould

We’re exposed to fungus and mould anywhere with damp, and unfortunately that’s a huge problem in a lot of accommodation in Britain, due to inadequate ventilation. When you inhale these spores, not only is it damaging to your lungs, it also gets into the bloodstream and the liver, so you end up with toxicity and inflammation. Many people wouldn’t be impacted by this, but if your immune system is compromised, it could be an issue.

Try to treat any damp issues in your home by regularly opening windows and investing in a dehumidifier if needed. Fungal exposure isn’t something your GP would test for – it’s not something the National Health Service has the resources to do – so if you’re worried, you’d need to see a functional medicine doctor, who can test for antigens and treat fungal damage when required. It is much better to be proactive if you are concerned rather than to wait for chronic disease to develop. – As told to Amy Packer

– Dr Gareth Morris-Stiff is a surgical oncologist, liver specialist and head of the Liver Clinic at Evolution in London.