If you can point to your liver you are probably in the minority. The closest most people get to considering the state of this vital organ is to joke about whether or not it survived the latest boozing session. Few people, however, actually believe that liver damage is a possibility, particularly those under 45. Even fewer realise that other factors, such as being overweight, can harm the organ. Most believe that because they are not actually turning yellow, their liver must be coping just fine. This, it turns out, could be a big mistake.
Drinking too much alcohol, obesity, viral infections, injecting drugs and genetic factors can all mess up the liver, sometimes irreversibly. The bulk of this damage can be done without your body displaying a single warning symptom. According to the British Liver Trust, the two fastest growing causes of liver damage among younger people are obesity and alcohol.
Until relatively recently it was rare for doctors to see anyone under 40 with alcoholic liver disease (cirrhosis). "Previously, the typical cirrhosis patient would be the archetypal male middle-aged heavy drinker," says Dr Mark Wright, consultant in hepatology at Southampton University hospital trust.
"Now, thanks to the steep rise in obesity and the availability of cheap alcohol, we are seeing more and more people with alcoholic or fatty liver disease in their 20s and 30s."
If young people carry on getting fatter and drinking at this rate, he believes there is likely to be an epidemic of liver disease in this country in the next 10 to 15 years. Government figures show that men are still consistently more likely than women to drink more than the recommended limits but, according to the British Liver Trust (BLT), when it comes to liver disease, women are catching up. "We are seeing more women in their late 30s, early 40s who habitually drink too much without realising the effect it is having," he says.
By the time symptoms show up, the damage tends to be advanced, sometimes irreversibly. According to the BLT, the number of young people dying from alcoholic liver disease has increased eight-fold in the past 10 years. Three children under the age of 18 have been diagnosed with alcohol-related liver disease in the past six years, which, when you consider that cirrhosis usually takes 15 years to develop, is shocking.
"I really didn't see my drinking as a problem at all," says Tracey Bunn, 31, a mother of two from Warwickshire who began drinking heavily in her 20s. "My dad was a drinker, and he died aged 61 of something unrelated, so I assumed I would have a fair few years before I needed to cut down."
Bunn's first symptom was sudden and unexpected weight loss when she was 27: "I thought it was great." Then she woke up one day to find that the whites of her eyes had turned yellow and there was a big swelling on the right side of her torso.
In hospital she was told she had alcoholic liver disease and would be dead before Christmas if she didn't stop drinking. It was November. "I turned yellow all over, was vomiting daily, had diarrhoea, exhaustion, bleeding," she says. "The downward spiral was so fast it was terrifying. I looked like a yellow skeleton. One day the veins in my throat burst and I began bleeding from my all orifices. They took me into a side room, and I waited to die." Bunn's situation is at the extreme end of the scale, but it could become a reality for more of us if our boozing and obesity rates continue to climb.
Alcoholic liver disease has four stages. The liver breaks down alcohol into carbon dioxide, water and fat. The fat can build up when you drink too much, causing a "fatty liver". There may be no symptoms and the problem should disappear if you stop drinking excessively. But if you carry on, as Bunn did, your liver can become inflamed but still show no external symptoms.
Ten per cent of people who get this far and continue to drink heavily will hit the third and fourth stages: liver scarring (fibrosis) that may lead to permanent damage (cirrhosis). Depending on the extent of the damage, and whether the drinking continues, the liver may fail altogether. A transplant is then the only hope of survival.
Obesity can do similar damage to your liver. A fatty liver that is not caused by drinking can lead to a condition called non-alcoholic steatohepatitis, or Nash, where inflammation around the fatty liver cells can lead to cirrhosis. The only solution is to lose weight. Until recently, doctors tended to see Nash in middle-aged, overweight, diabetic women. Now Nash has become one of the fastest growing liver problems in young people. Add heavy drinking to Nash and the damage is amplified.
Liver problems are usually picked up during blood tests ordered by a GP for something else, for example as part of a routine medical for life insurance or private health schemes. "Most people I see had no idea that there was something wrong with their liver," says Wright. "They feel perfectly healthy."
But a routine blood test cannot tell doctors the extent of the problem. Until recently, the only accurate way to do this was to perform a liver biopsy - in which doctors remove a tissue sample from the liver using a biopsy needle under local anaesthetic.
However, a newer method of blood testing, such as one launched this month by a biotech company called iQur, offers doctors another way to diagnose the extent of liver damage. "When the liver is becoming damaged and laying down scar tissue, chemical 'markers' can be detected in the blood," explains Wright.
However, marker tests are not yet available from all GPs and clinics - and, says Wright, results can sometimes be ambiguous, so many people will still have to rely on biopsies. The government has no plans for a national liver screening programme, but as young drinkers reach middle age and the true state of the nation's livers begins to reveal itself, this could become a priority. The government did last month announce that by the end of next year, alcohol labels should warn drinkers of the amount of units per glass or bottle and the recommended safe drinking levels. This will be accompanied by a new campaign to raise awareness of the amount of units people consume. Government research has shown that only 13% of the population keeps a check on the number of units they drink each week. And when a Channel 4 documentary, shown last night, tested 80 volunteers for liver damage, over half showed abnormal results.
In the meantime, the advice is to take responsibility for your own health. "If you are drinking above the government's recommended limits, you should definitely cut down," says Wright.
Whether you binge drink or spread your alcohol over a week makes no difference: you will still overload your liver. For some people cirrhosis can develop much faster than the usual 10 or 15 years. However, doctors do not yet fully understand what makes one person's liver zoom quickly towards catastrophe, while another's will linger in the early stages for decades. Genes probably play a role, as do existing health conditions such as diabetes or Nash.
Once there, scars on the liver will not go away, but it is possible to reverse the inflammation that causes the scarring. Bunn stopped drinking at the 11th hour. She now has an enlarged liver and heart, but her liver is at least functioning.
"You can do a lot to heal your liver without any drugs or operations if you lose weight or cut down on drinking," says Wright.
You might, then, want to reconsider your weekend pub binge or your takeaway habit. The road to the transplant unit could be significantly shorter than you think.
· For more information contact the British Liver Trust britishlivertrust.org.uk. Tel: 0870 770 8028.
