The Aspiring Psychologist Podcast - Fatty Liver Disease Explained: Symptoms, Causes & Can It Be Reversed?

Starting point is 00:00:00 Most people think liver disease equals alcohol. It doesn't. Fatty liver disease is rising. It can be genetic but not always. It's often silent. But in many cases, if caught early enough, it can be reversible. So why haven't we heard more about it? Today I'm speaking with Sharon Verma,

Starting point is 00:00:19 an NHS health coach whose father died from the disease and who has made it her life's mission to make sure other families don't learn about it too late. Hope you find it so useful. If you do, please like, comment. share and subscribe for more. Hi, it doesn't a welcome along, Sharon Verma, to the podcast. Hi, Sharon. Hello. Lovely to have you here and thank you for staying in touch since we met at an in-person event.

Starting point is 00:00:49 Just about six months ago probably it was, wasn't? Yeah, it was about six months ago where we met at the event. And I love talking with you, but I also love learning and that's why I've invited you on the podcast because you were telling me about something that I have never, heard of before and I would wager that probably lots of people haven't heard about before and I think it sounds quite important so I thought we'd do a little bit of public information could you tell us what you are now kind of an expert in so I specialize in something called what used to be called non-acolic fatty liver disease but the name has now changed to metabolic dysfunction associated steostatic liver disease.

Starting point is 00:01:34 Now, liver disease affects one in five people in the UK, and it's asymptomatic. So you could easily dismiss this. You may feel fatigued. Maybe you have maybe a dull aches, things that you could easily dismiss. And it's not always picked up in the routine blood tests. Sometimes it may be picked up so your ALT levels may be high,

Starting point is 00:01:54 so your doctor might check that. But more often than not, because our liver is so resilient, it will carry and work in a way even when it's inflamed. And that's when problems start to occur, but it's not spoken about enough. No, let's really go back to basics. What are ALT levels and what does our liver do for us? So an ALT is when your liver is inflamed, it's almost like a stress hormone or protein that gets delivered into the bloodstream.

Starting point is 00:02:24 And when that's elevated, so say, for example, your reading is coming up quite a high, So say it's gone over 35, your doctor may see it and think, oh, okay, it's a little bit abnormal, but it's fine. We'll do another check. But if it's consistently high, then your doctor should really go and do a ultrasound and see the texture of your liver and see if there are any fatty deposits. Because the sooner you catch it, the easier it is to reverse. I see. So in the early stages, it's something that you can reverse. It is. Absolutely. progresses, then it sounds like the liver gets less plastic, more rigid and scarred.

Starting point is 00:03:04 The way to look at the think of your liver, it's a nice, soft texture. When you have a fatty liver, you'll have fatty deposits and the liver will become inflamed. If you cannot calm down that inflammation and say, for example, it progresses to from a mild fatty liver to moderate and then severe, it will start to scar and that leads to something called liver fibrosis. Now, liver fibrosis has four stages. It's known as F0 to F4. F0 to F2 is reversible, so you can stop it. When it gets to F3F4, you cannot stop the scarring in terms of going to liver cirrhosis. You can stop this up and get into cirrhosis, which is end stage liver disease, but you cannot reverse the scarring at that point. When you get to liver cirrhosis, the shape of the liver has now changed. And there are two types. So you've got a decompensated liver. or you'll have a compensated liver. If you have liver cirrhosis and your liver is compensated, your body is still functioning as it should.

Starting point is 00:04:01 Our liver is so loyal or so resilient, it will keep working away. If it is decompensated, that's where your liver is struggling, and you will know about it. You will have yellowing of the skin and eyes. You will have severe itching. You will have fluid buildup. You will maybe hallucinate. You will lose muscle mass.

Starting point is 00:04:21 And at that point, your stages are quite bleak. You're either looking at a liver transplant if you're lucky, or sadly, it will end in death. So for me, due to my personal experience with it, it's really important, A, to get the word out, and B, to get people talking about their liver, getting people to understand how vital this organ is. It's just as vital as the heart. And the way to think about your liver is a bit like the head of an orchestra, the conductor. If it's doing, you know, if he's like doing his thing properly, everything's going to be in sync. You know, the musicians are going to be all playing a nice tune.

Starting point is 00:04:54 It's the same thing with our organs. If the liver's working well, all the organs will function. If the liver is struggling, then your other organs will struggle too. Okay, all right. So it's the kind of, it just quietly ticks away and does what it does. It's incredible. Yeah. And as you were speaking, I was thinking, oh, the itching, that reminds me.

Starting point is 00:05:16 When I was pregnant, that was something that you really needed to look out for. Because I think livers can flare up during pregnancy. During pregnancy, yeah, yeah, that's right. And then the cirrhosis I have heard about, I'd heard about before, but linked to alcohol. And fatty liver disease is something different to that, isn't it? It is. Fattie liver disease is the first stage. So you have a healthy liver, that liver then turns into a fatty liver, that then goes to fibrosis. And then when it gets a cirrhosis, that's where there's nothing you can do about it then.

Starting point is 00:05:49 Which is why when you're first diagnosed with liver disease, say, for example, you're at the doctors, oh, you've got mild fatty liver disease, go and lose some weight. That is the first advice you will be given. Go and lose some weight. But it's not helpful because you can go onto any kind of diet thinking, I will lose some weight. But what research has shown and what the evidence shows is the Mediterranean style approach is the most, you know, the best approach to help somebody reverse fatty liver disease. Okay, so you might think, well, I'll have small a portions of my chips or smaller portions of my of my curries that might be laced with ghee or whatever or smaller portions of my deep fried food and that will help me lose weight which it will

Starting point is 00:06:35 but it won't necessarily impact on your liver okay okay and how did you come to have such a professional and personal interest in this Sharon so my dad was diagnosed in early 2001 so I would have been about mid-20s and at that point he had a dull ache on the side of his abdomen he ignored it for quite a while until he couldn't ignore it anymore so he went to a and e and there the doctors thought it's probably his appendix but when they checked further they found out he's actually got liver disease so he had a fatty liver and when they told him he's got liver disease his response was liver disease i don't drink alcohol and they said look go and see your doctor your doctor will explain it so the doctor said to him yes he's got a liver disease go and lose some weight

Starting point is 00:07:21 And they gave him a booklet, but no one even thought to ask, can this man read? He couldn't. He couldn't read or write English. And so when he told us, I've got liver disease, we dismissed it. Because we said, Dad, there's no way you've got liver disease. You don't drink alcohol. This liver disease only happens to people who can't handle the drink. You don't even drink.

Starting point is 00:07:39 But it's only after I spoke to the doctor that I understood, this is actually down to his diet, his diet and his lifetime. And he has to lose some weight. And so Dad's method of weight loss was, I will have an apple for breakfast. I will go on long walks. I'll have my main like chapati and curry in the evening and then that will work. And yeah, he lost weight, but he lost muscle mass. He didn't lose the fact that he need to lose. So by the time a year later he goes to get his liver scanned, he's then told your liver's now progressed to liver fibrosis. Again, go lose some weight. There wasn't any thorough checking being

Starting point is 00:08:13 done or monitoring being done until he got to liver cirrhosis. Now when he got to liver cirrhosis, he was told, oh, don't worry, you know, you probably need about two, three years until you need a transplant. That wasn't the case for him. His liver started to deteriorate very quickly. So his liver became decompensated. So dad had acetes, which is fluid buildup in his abdomen, but he would resemble, say, a pregnant woman. It would be that much. And he would have to go to the hospital. He'd be admitted. And a doctor would have to insert a needle about that big into his abdomen. He'd lay still for about eight to nine hours for the fluid to be drained and at first this was being done monthly it then went to bi-weekly it then went to weekly and then it was every other day and my brother and

Starting point is 00:09:00 i you know we could see he's in he's in trouble here so we were calling kings college hospital every single day because they are the most renowned hospital for liver disease patients we didn't know when dad was diagnosed but by time you know it came to dad nearing his end we then found out where he should have been. And when he finally did get to King's Hospital, we were like, oh, just take our liver. And the doctor's like, that's not how it works. One, we need to make sure that your dad's liver is at a point where we can offer him a transplant. Two, we need to make sure if you're healthy enough to have, you know, to give your liver to your dad. And, you know, there's so much more to it. We can't just open you up and give half your liver. And then sadly, dad slipped into a coma

Starting point is 00:09:45 because his liver started to release toxins into his body. And then eight weeks after he turned 60, he passed away. I'm so sorry to hear that. And that is so young. You know, I lost my dad at 71 and I consider that young. But, you know, for you to lose your dad when you were a young woman, I think before you had children as well. Yeah, before I got married.

Starting point is 00:10:11 It's really bitter. It's a bittersweet because, I've got this, you can almost call it a black cloud over my head thinking, I'm now helping people reverse fatty liver disease, but I wasn't able to save him. And it's a guilt that I know I shouldn't have, but I do have. Absolutely. We can only do what we do with the knowledge we've got at the time, right?

Starting point is 00:10:36 And this is why this kind of public information is so important because actually people will learn about liver, we'll perhaps learn about this fatty liver name, although they've changed that now. Could you remind us the new name and get really slowly for us so that we can really hear the words? Abbreviation is known as mazzled, but the actual wording is metabolic dysfunction associated steostatic liver disease. Okay, but you might still hear it called fatty liver disease. your doctor may call it Nathold, which is non-alcoholic fatty liver disease. N-A-F-L-D, which is what it used to be called.

Starting point is 00:11:21 But now they changed it to muzzled. And it feels like it should have been a simpler name, but I feel like they've made it more complicated. Yeah. But there is a reason why they've done that, and I understand why they've done that, because there's a real stigma around liver disease. You tell anyone, I've got, you know, I have an issue with my liver. First thing people think of is alcohol. And I hold my hand up.

Starting point is 00:11:41 I was one of those people before dad was diagnosed. And that's the start of reality of liver disease. You know, it's not spoken about just enough. It's got the stigma behind it. People feel like it's their fault. It's not, it can happen to anyone. Yeah. And yeah, it is the alcohol.

Starting point is 00:12:00 And it's similar to pancreatitis, right? Because you think, oh, pancreatitis, that's often alcohol. But actually this is, this is not that. And, you know, like you said, your dad didn't drink. So it definitely wasn't that. Do you know when you look at family history, was anyone in his family struggling with this, even if you maybe didn't realize at the time?

Starting point is 00:12:19 Yeah, well, funn't you say funny enough, but after Dad passed away, we then found out that Dad's dad had liver, a fatty liver as well. So it's obviously genetics in my family. But we never, I never knew my granddad had a fatty liver. You know, had we have known Grandad had that, then maybe we would have been more aware of it from, you know, when my dad was diagnosed, but we weren't aware.

Starting point is 00:12:44 And is it, is it only with hindsight that they were like, oh yeah, he always was a bit yellow and he did always have sort of yellow whites of his eyes? Or did he always, was he already getting treatment for his liver when he was alive? He used to live in Nairobi, Kenya, and apparently he was getting treated there, but he never told his children or his grandchildren. It was something he kept to himself. But had they have actually just explained what was happening with him, it would have educated the whole family. And that's what's lacking.

Starting point is 00:13:14 Even now, the education isn't there. Even now, like, you know, I've been part of the NHS for about three years now. And I've seen firsthand how liver patients are being let down. I've seen how liver patients are told, oh, yeah, just go lose some weight. But there's no help behind it. You know, there's no follow-up.

Starting point is 00:13:32 There's no, okay, you know what, come back in six months. Let's read your blood. Let's go and make sure you're getting your scans done. there have been times where a case has been sent to me saying, this is a fatty liver patient, please help them. So when I've called them, I've been, oh yeah, your doctor sent through the referral. I can see you've been diagnosed with fatty liver disease. And the patient is, I haven't got a fatty liver.

Starting point is 00:13:51 What are you talking about? No one's told me. And that is, the change has to start. We need to see change within the NHS, for sure. Absolutely. And with genetics and the way heritability works, how's your liver, Sharon? My liver so far is so good. So far, so good.

Starting point is 00:14:12 I had a liver scan done with the British Liver Trusks. They do something called The Love Your Liver Road Show. There are charity, is self-funded. So I went along, had my liver checked. And the synographer said to me, you know, your fatty range is fine. Your liver stiffness is fine. Because we know that your dad died from this, you cannot be too relaxed with your diet because your likelihood of getting it has, you know,

Starting point is 00:14:36 is increased tenfold. So you need to make sure you're doing everything you can, within reason, to make sure that you don't develop this disease. And so sometimes I can become quite overfocus with my health and become quite anxious about, is it going to harm my liver? Am I okay to have this? And I know that I shouldn't be doing that, but it's just always at the back of my mind that,

Starting point is 00:14:56 Sharon, you might develop this and you don't want your children to go through what you've been through, you know, with your dad. You don't want them to see that decline in somebody's health. and, you know, so I try and make a conscious effort to do whatever I can to support my liver health. Amazing. And actually it is incredibly difficult to watch someone become very unwell, to become frail. It's distressing, you know, and someone that was previously very strong and capable to then not even be able to do things like stand up or wash or walk to the toilet.

Starting point is 00:15:32 And you said that your dad had lost so much weight. You gave us a really powerful example of that before we recorded. Would you ride us through that? Yeah, so Dad was in hospital. He just had his, a CT drained. And he was like, I can't find my watch. I'm like, Dad, it's okay, we'll find it. He said, no, no, I was wearing it.

Starting point is 00:15:48 I can't find it. And we were searching away, and then he just, we could hear something. And his watch had basically gone from his wrist all the way up to his shoulder. Now, this is a man who used to be very built to the point where his wrist and his watch used to be quite snug on his wrist. And that same watch was now on his shoulder. And that just shows how much muscle he had lost, how much weight he had lost, he'd become a former shell of himself. When I think back to it, it's really heartbreaking. It's harrowing, isn't it? And when we're thinking about trauma work, that's one of the kind of bumps in the road that might keep kind of tripping you,

Starting point is 00:16:25 tripping you up. And it stays with you, you know, you can't, I mean, yes, people say time heals. It does in a way, in terms of you get used to your new normal, but I will never ever forget the pain he went through and what we've been through. Yeah. Well, thank you for talking to us about this and for sharing it. I know it's really challenging.

Starting point is 00:16:48 Do you talk to your children about their granddad? Yeah, I tell him stories about their granddad, what he liked, what he didn't like. You know, he was such a jolly character that I try and keep his memory alive. And the girls know why I do what I do now. Because my youngest one was like, you know, what is liver disease? Why do you talk about it so much?

Starting point is 00:17:08 And I was like, well, you know, this is what took your granddad. So if I can help one family out there to not go through what we've gone through, that's a huge win. Yeah, absolutely it is. And let's go right back to basics. Can you tell us where is our liver? Where would we find that in our body? And if we were getting some liver gripe, I seem to remember when I've had hangers,

Starting point is 00:17:31 was in the past, it's like that sort of dull ache on the back. Like, go just through that. So on the right side, you know where underneath the rib cage, the very bottom part, if you were to put your hand along there, where your hand covers, the area that covers, that's where our liver is sitting. I'm just doing it now, giving myself a little feel under my ribs. Okay. I mean, you know, it's huge.

Starting point is 00:17:56 It's about 1.8 kilogram in men, 1.6, I believe, 1.5, 1.6 for women. you know, it's doing over 500 functions a day. It's a powerhouse and it doesn't get the same, I don't think it gets the same respect as the other organs. You know, everyone talks about how vital the heart is, the kidney. The liver never really gets a mention. No. It really doesn't.

Starting point is 00:18:22 You're right. You're right. You know, we're bucking that. You change. We're changing that narrative. So obviously, if people are diagnosed with this, we would hope that they will end up in the right part. or that they will be given the right advice, not just lose weight, but something more specific.

Starting point is 00:18:37 But so that people are heading in the right direction, what kind of foods would be great to include in their diet and which ones should we exclude? So you should be focusing mainly on whole foods. So it's going to be plenty of fiber, plenty of protein, reducing the ultra-processed food consumption, and just going back to basics. I think we try and overcomplicate it so much that there needs to be a Pacific diet that if you actually just pull things back and go back to basics. So you've got your vegetables on your plate, you've got some carbohydrates on your plate, you've got your protein on your plate, you've got a bit of healthy fats.

Starting point is 00:19:12 That's all we need. And the more variety and the more color we can add to the diet, the more our liver's going to thrive. It really struggles when we're giving it high fat, high sugar foods. And if you add alcohol to the mix, your liver then has to stop everything that is doing and eliminate the toxins from the alcohol first. So whenever I work with a fatty liver patient, I will always say, don't drink alcohol. Please try and refrain from it.

Starting point is 00:19:36 And let's focus on, let's look at what can we add to your diet. What are you having now that you think actually you could actually add a little bit more of? You know, what are you maybe not having more of that you can actually get done? Let's make it as simple as possible. Whether it's going to test going in as vegetable steam bags, quick, easy win. You know, whether it's getting frozen vegetables instead of the fresh ones, if you can't afford the fresh ones. just quick, easy wins that we can do.

Starting point is 00:20:02 And how can we now add more to volume to your plate? I love frozen fruit and veg. I've just been to Aldi and bought some frozen fruit now just before we met. Okay, so really in an ideal world, if someone's got this diagnosis, really we ought to be hopefully saying we're not going to be drinking anymore. But then it's sometimes I think it sounds like we're having to retrain people on how to eat well for nutrition. for fibre, not just, you know, I think one of my friends very rarely cooks and hasn't necessarily been taught to cook. Lots of people haven't, have they? I was. I was, most things from scratch,

Starting point is 00:20:44 but not everybody is. And, you know, certainly your dad maybe didn't have much of a hand in cooking his own foods. And I don't know, maybe he was an avid chef. But no, everything was made for him. My mom used to make everything. So I learned how to cook from mum. But yeah, you know, we also live in a culture now where we want everything very quickly. Everything's, you know, we've got it on our fingertips, whether it's Uber Eats, all the things in, but we're not really thinking about what's gone into that, what's gone into it. And you can make your own version at home quite easily as well.

Starting point is 00:21:16 But again, it's, I think it comes down to how educated somebody is. It also comes down to access to finances. You know, are they able to afford food? I mean, healthy food, I don't, I never, understand why healthy food is a lot more higher to buy than say something that's processed and you know it's labelled as convenience i think if we can try and change that around and that's going to come back to the government having to do something you know to help people that's the change that's needed absolutely um are any particular cultural faith you know

Starting point is 00:21:53 backgrounds more likely to experience fatty liver disease or or is it just depends on who's eating the right stuff and who isn't. I know that the South Asian population are more prone to developing it, but at the end of the day, if you are above a healthy weight range, if you've got any other metabolic conditions, whether it be type 2 diabetes or rate cholesterol levels, your likelihood of developing fatty liver disease increases, hence the name that's been changed in metabolic associated.

Starting point is 00:22:23 So I wouldn't say it's only just one set of, you know, a group of people, but it is if you have a metabolic condition, you must, must, must try and, you know, get on top of that so that you don't develop the fact you live. Okay, thank you so much. Where can people learn more about you and your work, Sharon? So you can find me on Instagram under Renourished with Sharon. I have a website at Sharon Vermeer.com.

Starting point is 00:22:49 And really my goal is to make people think about liver disease and bring liver to the, you know, give liver the limelight that it needs. get people talking about it, get people understanding how vital our liver is. Because if we don't have that liver functioning well, none of the other organs are going to function well. And by the year 2030, it's been predicted that liver disease will take over cardiovascular liver disease if we do not get to grips with it now. Wow. Well, then it really was important that I invited you on the podcast

Starting point is 00:23:19 because we've got to do what we can do to get this, you know, to get this more amplified. And I really do appreciate. I honestly appreciate you allowing me to you know, to come onto your platform and just get this message out there. So thank you so much. Well, you're welcome. And thank you for educating me and helping me then to share this with my audience. Because, you know, I feel like I've heard about most sort of diseases and, you know, conditions. And, you know, you told me what you did.

Starting point is 00:23:47 And I was like, say what now? So, yeah, thank you. And keep doing what you do. And let's see what we can do to not have livers overtake hearts by 2030. because that's a staggering figure. Thank you so much, Sharon. Thank you so much. What a pleasure to speak with Sharon. I love seeing her posts pop up on Instagram. So if you are not following her already, please do go and give her a little follow there. I would love to know what this has brought up for you. Is fatty liver disease something that you'd heard about before? Has this been, you know,

Starting point is 00:24:21 useful for you to learn more about livers and liver disease. I found it fascinating and some of this knowledge will will stay up here in future for when my clients might mention it. And then it helps me join up the dots and, you know, feel like I know a little bit more about stuff, which is of use to clients, but also can help me to counter fake news, right? That is really helpful when we've learned from evidence-based care, we can hear things maybe in the media, maybe even sometimes in health services that we're like, actually, I'm not sure that's right. And we can use that to help our clients to advocate for themselves and their family too. I appreciate this.

Starting point is 00:25:08 It is not your average episode of the podcast, but I just thought it was really, really important to have this conversation. So I do hope that you will agree to. touched on grief today and if you would find it helpful, please do check out the Grief Collective Stories of Life, Loss Learning to Heal. It's 54 real life stories about things and people and situations that people have grieved for. It's incredibly powerful. I will let you into the secret that one of the 54 people is me. There's links in the show notes and in the description and please do, if you've read it already, please do leave me a review on Amazon or

Starting point is 00:25:52 Goodreads. If you love learning more about the way that I see the world and kind of insights and nuggets from my professional life, but also my personal life at times too, or if you just really would like to support me as a creator to do the work I do for public service, for the podcast, for all these things in the media, it'd be lovely if you came and joined. My members only area, which you can do on YouTube, Captivate or Patreon or with Apple. If you want to check it out for three days on Apple, you can do that as well. We've got the backstage crew there, which is where you'll get the inner work, exclusive subscriber content episodes. And we've also got the first look where you can access the normal podcast episodes early. Thank you so much for

Starting point is 00:26:38 being part of my world. The next episode will be along on YouTube from 10 a.m. on Saturday. and wherever you get your podcasts from 6am on Monday. Thank you again and I'll see you soon.

The Aspiring Psychologist Podcast - Fatty Liver Disease Explained: Symptoms, Causes & Can It Be Reversed?

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