Most people think liver disease is only caused by alcohol. It isn’t. In this episode of Psychology, Actually, we explore fatty liver disease (now known as metabolic dysfunction-associated steatotic liver disease), a common but often silent condition affecting 1 in 5 people in the UK.

I’m joined by NHS health coach Sharan Verma, who shares both professional insight and her personal experience of losing her father to the disease. We discuss symptoms, diagnosis, reversibility, and why so many people are unaware they have it until it’s progressed.This episode also explores the psychological impact of illness, caregiving, and grief including how difficult it can be to witness physical decline in someone you love.If you’re interested in health psychology, prevention, or understanding how physical and emotional wellbeing connect, this episode offers an important and eye-opening perspective.

Highlights

• 00:00 Why liver disease isn’t just about alcohol
• 01:22 What fatty liver disease actually is
• 02:15 Early symptoms and why it’s often missed
• 03:04 Stages of liver disease and reversibility
• 04:47 Why awareness needs to change
• 06:48 Sharan’s father’s diagnosis and missed opportunities
• 08:59 Rapid deterioration and hospitalisation
• 09:49 Losing a parent to liver disease
• 10:30 Guilt, hindsight and what we didn’t know
• 11:29 Stigma and misunderstanding around liver disease
• 12:44 Genetics and family patterns
• 14:01 Living with increased health risk
• 15:12 The emotional impact of watching someone decline
• 15:39 Physical changes at end of life
• 16:18 Trauma, memory and grief
• 17:36 Where the liver is and what it does
• 18:46 Diet, lifestyle and prevention
• 21:47 Barriers to healthy eating
• 22:03 Risk factors and population differences
• 22:42 Where to learn more

Links:

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#fattyliver #fattyliverdisease #liverdisease

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 Sharan Verma, 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 and. Welcome along Sharan Verma to the podcast. Hi, Sharan.

Hello.

Lovely to have you here. And thank you for staying in touch since we met at an in- person event just about six months ago probably it was, wasn't

It? 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 specialise in something called what used to be called non-alcoholic fatty liver disease, but the name has now changed to metabolic dysfunction associated stereostatic liver disease. 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 a routine blood test. Sometimes it may be picked up so your ALT levels may be high, so your doctor might check that. But more often than not, because our liver is so resilient, it will carry on working away 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. And when that's elevated, so say for example, your reading is coming up quite 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're doing 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. But if it progresses, then it sounds like the liver gets less plastic, more rigid and scarred.

The way to look at the think of your liver, it's nice soft texture. When you have a fatty liver, you'll have fatty deposits and liver will become inflamed. If you cannot calm down that inflammation and say, for example, it progresses 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 F3, F4, you cannot stop the scarring in terms of going to liver cirrhosis. You can stop yourself 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. Our liver is so loyal, 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. 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 to 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 he's like doing his thing properly, everything's going to be in sync. The musicians are going to be all playing a nice tune. It's the same thing with our organs. If the liver's working well, all the organs will function. If the liver's 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 when I was pregnant, that was something that you really needed to look out for because I think livers can flare up during pregnancy. Am I

Right? 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 diseases is something different to that, isn't it?

It is. Fatty liver disease is a 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 to cirrhosis, that's where there's nothing you can do about it then, which is why when you're first diagnosed with liver disease, so say for example, you're at the doctor's office and 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 best approach to help somebody reverse fatty liver disease.

Okay. So you might think, "Well, I'll have smaller portions of my chips or smaller portions 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, 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, Sharan?

So my dad was diagnosed in early 2001, so I would've 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&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 you've 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, you've got a liver disease, go and lose some weight. 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. 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 their drink. You don't even drink." But it was only after I spoke to the doctor that I understood, this is actually down to his diet, his diet and his lifestyle, 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 chipatti 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 needed 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 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 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 a CTs, 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 biweekly, it then went to weekly, and then it was every other day.

And my brother and I, we could see he's in trouble here. So we were calling King's 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 the time 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 give your liver to your dad, and 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 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. I lost my dad at 71, and I consider that young, but for you to lose your dad when you were a young woman, I think before you had children as

Well. Yeah, right before I got married, it's really bitter. It's 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. Well, we can only do what we do with the knowledge we've got at the time, right? And this is why this kind of public information is so important because actually people will learn about livers, we'll perhaps learn about this fatty liver name, although they've changed that now. Could you remind us the new name and really slowly for us so that we can really hear the words?

Abbreviation is known as mazled, but the actual wording is metabolic dysfunction associated stereostatic liver disease.

Okay. But you might still hear it called fatty liver disease.

Your doctor may call it NAFLD, which is non-alcoholic fatty liver disease.

NAFLD.

N-A-F-L-D.

Okay.

Which is what it used to be called, but now they changed it to muscled.

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 told anyone, "I have an issue with my liver." First thing people think of is alcohol, and I hold my hand up. I was one of those people before dad was diagnosed, and that's the start reality of liver disease. It's not spoken about just enough. It's got the stigma behind it. People feel like it's their fault. It can happen to anyone.

Yeah. And yeah, it is the alcohol. And it's similar to pancreatitis, right? Because you think, "Oh, pancreatitis, that's often alcohol, but actually this is not that. " And 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 realise at the time?

Yeah. Well, funnily enough, I shouldn't 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 I never knew my granddad had a fatty liver. Had we have known granddad had that, then maybe we would have been more aware of it when when dad was diagnosed, but we weren't aware.

And 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 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 it's lacking. Even now, the education isn't there. Even now, 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, "Oh yeah, just go lose some weight." But there's no help behind it. There's no follow up. There's no, "Okay, you know what, come back in six months, let's redo your blood, let's go and make sure you're getting your scans done." There've 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. 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, Sharan?

My liver so far is so good. So far, so good. I had a liver scan done with the British Liver Trust because they do something called the Love Your Liver Roadshow. Their charity is self-funded. So I went along, had my liver checked, and the sonographer said to me, "Your fatty range is fine, your liver stiffness is fine, but because we know that your dad died from this, you cannot be too relaxed with your diet because your likelihood of getting it 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 over focused with my health and become quite anxious about, is this 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, Sharan, you might develop this and you don't want your children to go through what you've been through, with your dad.

You don't want them to see that decline in somebody's health. And 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. 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. 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 a CT drained and he was like, "I can't find my watch." We're like, "Dad, it's okay, we'll find it. " He's like, "No, no, I was wearing it. I can't find it. " And we were searching away and then 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 wrists 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 up.

And it stays with you. 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. Do you talk to your children about their granddad?

Yeah. I tell them stories about their granddad, what he liked, what he didn't like. 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, "What is liver disease? Why do you talk about it so much?" And I was like, "Well, 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 hangovers in the past, that sort of dull ache on the back. Get us through that.

So on the right side, do you know where the underneath the ribcage, the very bottom part, if you were to put your hand along there, where your hand covers the areas it 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, it's huge. It's about 1.8 kilogramme in men, 1.6, I believe, or 1.5, 1.6 for women. 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. Everyone talks about how vital the heart is, the kidneys, but the liver never really gets a mention.

No. It really doesn't. You're right. You're right. So we're bucking that. We're changing that narrative. Yeah. So obviously if people are diagnosed with this, we would hope that they will end up in the right pathway or that they will be given the right advice, not just lose weight, but something more specific, 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 fibre, 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 specific 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 bit of healthy fat. That's all we need. And the more variety and the more colour 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 it's 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. And let's look at what can we add to your diet?" What you have in now that you think actually you could actually add a little bit more of. 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 Tesco and get in those vegetable steam bags, quick easy win, 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. And how can we now add more to volume to your plate?

I love frozen fruit and veg. I've just-

I do as well.

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 sometimes I think it sounds like we're having to retrain people on how to eat well for nutrition, for fibre, not just ... 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. Yeah, I was. Most things from scratch, but not everybody is. And 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 for mom. But yeah, we also live in a culture now where we want everything very quickly. We've got it on our fingertips, whether it's Uber, eats, delivery, all the things in, but we're not really thinking about what's gone into it. And you can make your own version at home quite easily as well. But again, I think it comes down to how educated somebody is. It also comes down to access to finances. Are they able to afford food? I mean, healthy food ... I never understand why healthy food is a lot more higher to buy than say something that's processed and is labelled as convenience. I think if you can try and change that around and that's going to come back to the government and having to do something to help people, that's the chain that's needed.

Absolutely. Are any particular cultural faith backgrounds more likely to experience fatty liver disease, 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 two diabetes or radical cholesterol levels, your likelihood of developing fatty liver disease increases, hence the name that's been changed to metabolic associated. So I wouldn't say it's only just one set of a group of people, but it is if you have a metabolic condition, you must, must, must try and get on top of that so that you don't develop a fatty liver.

Okay. Thank you so much. Where can people learn more about you and your work, Sharan?

So you can find me on Instagram under renourished with Sharan. I have a website, Sharanverma.com. And really my goal is to make people think about liver disease and bring a liver to the ... 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. I invited you on the podcast because we've got to do what we can do to get this more amplified.

And I really do appreciate. I honestly appreciate you allowing me 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 I feel like I've heard about most sort of diseases and conditions. And you told me what you did 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, Sharan.

Thank you so much.

What a pleasure to speak with Sharan. 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 useful for you to learn more about livers and liver disease? I found it fascinating and some of this knowledge will stay up here in future for when my clients might mention it. And then it helps me join up the dots and 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. 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 too. We 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 Good Reads. 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.

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