Hannah barely drank and walked 10,000 steps a day. But she turned out to have a near-deadly liver disease now afflicting 15 MILLION Brits. Here are the troubling signs she missed

When Hannah Fewtrell found herself, at the age of 49, constantly exhausted with low mood – shadows etched beneath her eyes, no matter how much she slept – she put it down to the menopause.

Yes, the recruitment consultant from Lapworth, Warwickshire, was carrying a little extra weight, but she was otherwise in good health.

She walked miles each day with her dog, spent weekends cooking for her extended family and had no reason to suspect anything more sinister was at play.

But in October last year a scan revealed the shocking truth: her symptoms weren’t hormonal at all, but the result of a common and often overlooked liver condition.

Hannah was diagnosed with non-alcoholic fatty liver disease – now officially renamed metabolic dysfunction-associated steatotic liver disease (MASLD) – a condition thought to affect up to 15 million Britons.

As the name implies, the condition is not linked to heavy drinking – the more commonly known cause of liver problems. Instead, MASLD occurs when excess fat builds up inside the liver, and it is said to be on the rise in the UK, linked to spiralling rates of obesity and type 2 diabetes.

Experts warn sedentary lifestyles and an increasing reliance on ultra-processed, high salt, fat and sugar foods are also driving the condition to develop in ever-younger adults.

Professor Penny Manousou, who heads the fatty liver research group at Imperial College London, says: ‘It’s a lifestyle issue.

A generation of children have grown up inactive, sitting in front of an Xbox and eating processed food – and so we’ve seen obesity in younger and younger age groups.

‘Obese children are likely to remain obese in adulthood and this is when the problems with the liver begin to ramp up.’

Where liver disease was once largely confined to the elderly and heavy drinkers, it is now rising rapidly among younger adults.

Cases in children have doubled over the past two decades. The British Liver Trust estimates the condition may now affect one in five people in the UK – though Prof Manousou warns the true figure could be as high as 40 per cent.

Worryingly, around 80 per cent of those affected remain undiagnosed, as the disease often has no obvious symptoms – or it has symptoms that are mistaken for less serious problems.

In most cases, it is only spotted during routine blood tests or liver function tests carried out for unrelated issues.

While not everyone with fat in their liver will go on to develop serious complications, the build-up can impair the organ’s normal function and cause inflammation.

Over time, healthy liver tissue is replaced by scar tissue – a process that can ultimately lead to cirrhosis and liver failure.

However, if caught early, there is now strong evidence that the damage can be halted – and maybe even reversed. Studies show that losing weight can transform the disease from a silent killer into a manageable condition.

Professor Philip Newsome, a liver specialist at King’s College London, says: ‘We used to believe that cirrhosis was permanent, but we now know that if you tackle the cause of the injury – whether that’s fat, alcohol or viral causes such as hepatitis B – the scarring can reduce. When caught earlier, before cirrhosis sets in, we can definitely see a reversal.’

Hannah is proof of that. A private fibroscan at The Liver Clinic in London – a test that uses ultrasound waves to measure liver stiffness and detect scarring or fat build-up – showed she had stage three fatty liver disease, just one step away from cirrhosis.

‘I was in shock,’ she admits. ‘I’m not that old and I thought I looked after myself. I wasn’t really overweight, my partner and I only drank at the weekends and I was hitting 10,000 steps a day.

‘But my skin was dry, I had dark circles under my eyes and I looked permanently exhausted, even after a full night’s sleep.

‘My mood was low and I was constantly arguing with my partner. The diagnosis totally changed my mindset.’

She was referred to a nutritionist and lost a stone in weight. At her most recent scan in March, she was told the condition of her liver had improved massively.

‘I feel so much better,’ she says. ‘I have so much more energy. I am sleeping better and I am much less bloated – I recently went on holiday and I felt so confident.’

The science is clear about what works to prompt such astonishing changes. Studies suggest losing at least five per cent of your body weight can reduce inflammation and fat in the liver.

There are specific ways of achieving this that are most effective, experts say.

The highly successful DiRECT trial, which proved type 2 diabetes could be reversed – using meal replacement shakes and soups to put participants on an 800-calorie-a-day regime over 12 to 20 weeks – noted a ‘significant’ reduction in liver fat.

While Professor Manousou says that some patients might find extreme low-calorie diets helpful as an ‘initial boost’ to lose a few pounds, it is not the best long-term approach.

‘It works, but it isn’t sustainable in the longer term,’ she says. ‘What is clinically proven to help is the Mediterranean diet. We know that, even if you don’t lose weight, it will help reduce your liver fat.’

The diet involves eating lean meat and fish, wholegrains such as brown rice and pasta, nuts and seeds, beans and lentils, healthy fats such as olive oil, and plenty of fruit and vegetables.

‘Whatever you eat, it should be unprocessed,’ she adds. ‘Avoid the takeaways and the sugary snacks.’

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Although the condition isn’t caused by drinking alcohol, even moderate drinking may worsen it – so cutting down or even abstaining is recommended.

One major analysis of the evidence found that the most effective way to reverse fatty liver disease was to combine diet with exercise – and, in particular, to combine aerobic exercise such as brisk walking, running, cycling or swimming with resistance or strength training, which involves using weights or doing yoga or pilates.

Prof Newsome says: ‘While studies show exercise in itself isn’t a great way of losing weight, people who exercise more have less liver fat.

‘That remains the case even if they don’t lose weight. It may be to do with improving muscle function, which increases the ability of muscles to burn fat for energy, making it less likely to accumulate in the liver.’

Studies suggest the optimal amount of exercise is between 150 and 300 minutes a week, spread over three to five days.

Ideally this should include three aerobic sessions and two strength training sessions. And the latter could be ‘even more important’, says Prof Manousou. ‘We think it makes an even bigger difference to liver fat than cardio,’ she says.

‘A study we’re about to publish shows that, if you ask a patient to sit on a chair and stand up five times, the time it takes for them to do that correlates with their disease severity. It’s to do with leg muscle function.

‘Once you can do that faster, it’s likely you’ll have reduced your disease severity.’

You don’t need an expensive gym membership, the experts add – strength training can involve squats, raising cans of beans, or walking up and down the stairs.

‘The point is to get your heart rate up and become slightly breathless,’ says Prof Newsome. ‘That doesn’t mean running 5k three times a week. It may just be walking to the end of the street and back, and doing that a little faster each week.’

Jules Hutton, 54, adopted a Mediterranean diet and started going to the gym four times a week when she was diagnosed with ‘moderate’ fatty liver disease in 2021 after having an ultrasound for an unrelated abdominal issue.

The mother-of-two, who lives in Warrington, Cheshire, swapped her usual breakfast cereal for porridge or Greek yogurt and fruit, had omelettes or stir-fries rather than lunchtime sandwiches, and modified her family’s evening meals to include more vegetables and lean protein.

Her Body Mass Index dropped from 26.5 – which is slightly overweight – to 21, and scans show that, four years on, she has still successfully reversed the disease.

‘I feel 100 per cent better,’ she says. ‘The thing with this condition is that there are no symptoms and I’d thought I was relatively healthy. But now I’ve got so much more energy.’

Hannah took a similar approach, swapping carbs and Sunday roasts for scrambled eggs, homemade soups and meat skewers with salad, and stir-fries and curries with lentils and chickpeas.

She also curbed her sweet tooth by swapping her favourite Cadbury’s Dairy Milk for a square of good-quality dark chocolate.

‘If I’d left it any longer, there’s a chance it could have become really bad,’ she says.

‘It’s scary because I felt OK, I was functioning – but when it comes to liver disease and liver damage, you don’t know the extent of it.’

Not everyone can stick to the lifestyle changes that are needed, but even here there is good news. Drug treatments being trialled are demonstrating ‘significant improvements’, says Prof Newsome, and can reduce liver fat, reduce inflammation and reduce scarring.

One such drug is semaglutide, the active ingredient in weight-loss jabs Ozempic and Wegovy. Prof Newsome adds: ‘I’m going to be presenting work in the US in November which suggests it’s not just the weight loss that has the effect – something else is also going on to reduce liver fat.

‘When we compared people who lost the same amount of weight through diet and exercise to people on semaglutide, the latter had a much bigger increase in beneficial effects on the liver. We still don’t really know why.’

Another drug in late-stage trials is resmetirom, which targets a specific receptor in the liver to prevent the build-up of fat.

It can also reduce inflammation and fibrosis.

It is already approved in the US but Prof Manousou says it only works in ‘around 20 per cent’ of patients – and is expensive, costing £35,000 per patient, per year.

A third drug at an earlier stage is efruxifermin, which has been shown to combat liver cirrhosis.

‘Drugs might be helpful for some people but they’re not a solution,’ Prof Manousou says.

‘The bottom line is that if you exercise and eat healthily, you won’t get fat in your liver.

‘But if you don’t, it will accelerate the process of getting fat in your liver.’

A host of supplements are marketed as being able to ‘boost liver health’ – but the evidence behind them is shaky at best.

Milk thistle is among the most popular, often touted as a way to detox the liver or cure hangovers. Other widely promoted options include vitamin E, omega-3 fatty acids and plant extracts such as curcumin, silymarin and berberine.

One herbal product, called De-liver-ance, has gained a cult following thanks to claims – based on mouse studies – that it can reduce liver fat.

Sam Cook, a father-of-three from London, was diagnosed with late-stage fatty liver disease at the age of 42. Now 55, he credits the supplement – which costs more than £20 for a single dose – alongside diet and exercise, for helping him reverse the condition and lose more than two stone.

But liver specialists caution there is currently no robust clinical evidence that any supplements work.

‘The likelihood of it being a placebo effect is high,’ says Professor Penny Manousou, a liver specialist at Imperial College London.

She warns that some herbal supplements may even harm the liver or interfere with other medications, adding: ‘Long-term use of vitamin E has also been linked to prostate cancer in some men and an increased risk of bleeding.’

Dr Thomas Drake, a research fellow at the Usher Institute in Edinburgh, insists the best way to improve liver health remains simple: adopt a healthier lifestyle. ‘If you commit to it, most people can start to see positive results in just a few months,’ he says.

• The British Liver Trust recommends asking your GP for a liver blood test if you are concerned about liver health. The charity is also running a nationwide Love Your Liver roadshow, which gives everyone the opportunity to have a liver scan. For more details, along with information and support about fatty liver disease, visit britishlivertrust.org.uk.