Most of us don't think much about our liver unless something goes wrong. Yet the liver is one of the hardest-working organs in the body. It helps control blood sugar and cholesterol, processes nutrients, breaks down alcohol and medicines, produces important proteins and removes waste products from the bloodstream.

One of the most important things we're learning about liver health is that liver problems can develop quietly for many years. You can feel perfectly well — and even have liver blood tests that aren't particularly abnormal — while excess fat and, in some people, scarring are developing in the liver.

Fatty liver is increasingly common

Put simply, fatty liver occurs when too much fat accumulates in the liver in association with metabolic problems such as excess abdominal weight, insulin resistance, high blood sugar, abnormal cholesterol or triglycerides, and high blood pressure.

It is estimated to affect around one in four adults worldwide, making it one of the most common forms of chronic liver disease.

For many people, fatty liver remains relatively mild. However, in some people it progresses from simple fat accumulation to inflammation and eventually fibrosis (scar tissue). Advanced fibrosis can lead to cirrhosis, liver failure and an increased risk of liver cancer.

Fat accumulating in the liver is often a sign that the body is struggling to handle excess energy efficiently.

This means fatty liver isn't just about the liver. It is closely connected with insulin resistance, type 2 diabetes and cardiovascular disease.

People at greater risk include those who:

• Carry excess weight, particularly around the waist
• Have pre-diabetes or type 2 diabetes
• Have high triglycerides or other cholesterol problems
• Have high blood pressure
• Drink significant amounts of alcohol
• Have a family or genetic predisposition to liver disease.

Importantly, you don't have to be overweight to develop fatty liver.

What about alcohol?

Alcohol remains an important cause of liver damage.

The liver has to process almost all of the alcohol we drink, and regular alcohol consumption can contribute to liver fat, inflammation and eventually fibrosis.

Alcohol and metabolic problems can also occur together. Someone with fatty liver due to insulin resistance or excess weight may therefore be adding another source of stress to the liver by drinking regularly. Modern liver disease classifications recognise this overlap rather than assuming liver disease must be either 'alcoholic' or 'non-alcoholic.'

Having alcohol-free days and reducing your overall alcohol intake can therefore be an important part of looking after your liver.

The encouraging news: the liver can recover

The liver has a remarkable ability to repair itself, particularly when problems are identified before advanced scarring develops.

For people carrying excess weight, even relatively modest weight loss can make a meaningful difference. Current liver guidance indicates that losing around 3–5% of body weight can reduce liver fat, with greater weight loss generally producing greater improvements in inflammation and fibrosis.

Exercise is also valuable — and not simply because it burns calories.

Both aerobic exercise and resistance/strength training can improve metabolic health. Building and maintaining muscle helps the body dispose of glucose more effectively and improves insulin sensitivity, reducing some of the metabolic pressure being placed on the liver.

What should you eat?

There isn't a special 'liver detox diet.'

A Mediterranean-style eating pattern is a good starting point:

Eat more: vegetables, fruit, legumes, nuts, whole grains, fish, olive oil and minimally processed foods.

Eat less: highly processed foods, sugary drinks, excess refined carbohydrates, processed meats and foods high in saturated fat.

Reducing excess calories is particularly important if weight loss is needed.

And despite the advertising, your liver doesn't need a juice cleanse or detox program. Your liver is already your body's detoxification system.

Looking after your liver

The fundamentals are surprisingly simple:

Maintain a healthy waistline and weight. Move regularly and include some strength training. Keep blood pressure, cholesterol and blood sugar under control. Limit alcohol. Don't smoke. Eat mostly minimally processed foods. And don't rely on supplements or detox products to undo an unhealthy lifestyle.

If you have diabetes, excess abdominal weight, abnormal liver tests, regularly consume alcohol or have other risk factors for liver disease, it's worth discussing your liver health with your GP.

The liver is remarkably resilient. Finding a problem early gives you the best opportunity to do something about it.

As always our pharmacists remain available to talk to you about this or any other health related issues.