With liver cancer rates set to double by 2050, here’s how to keep this miraculous organ in shape.
Liz Hoggard
We often take our brilliant, multi-tasking liver (the second largest organ in our body after our skin) for granted, but we wouldn’t get far without it. The 500-plus jobs it does to keep us alive include detoxification, digestion, and nutrient storage.
Our liver really does need some TLC after holiday excess. It’s very effective at detoxifying the chemicals we put into it, but that doesn’t mean it can’t be damaged. Like an elastic band, it can only stretch so far before it breaks.
It’s estimated one in four adults has fatty liver disease. “If you already have a fatty liver because you live an unhealthy sedentary lifestyle where you eat a lot of processed food, it takes a lot less alcohol to do damage,” warns Debbie Shawcross, professor of hepatology and chronic liver failure at King’s College London.
If untreated, fatty liver disease can lead to liver cancer or failure. In fact, the Lancet Commission has revealed that new cases of liver cancer – the sixth most common form of the disease – will rise to 1.52 million a year from 870,000 by 2050 if current trends continue.
But there is good news: one of the unique qualities of your liver is when the liver is fatty or just mildly scarred, the liver cells can regenerate. “Even in your 50s and 60s you can have a huge impact by reducing the amount of alcohol you drink,” says Shawcross.
13 simple ways to support your liver naturally
1. Drink coffee
Coffee is an antifibrotic which stops scar tissue forming on the liver. Three to four cups of coffee a day is the sweet spot.
“It’s the one dietary change I advise my patients with liver disease to make because the evidence it helps is really pretty good,” says Professor Stephen Ryder, a specialist in hepatology and gastroenterology at the UK’s Nottingham University hospital. A 2021 UK Biobank study found that coffee drinkers had lower risks of chronic liver disease (CLD), compared to non-coffee drinkers, and that all types, including decaffeinated, instant and ground coffee, are protective.
“If you have a risk factor, and you have coffee, you are less likely to get liver disease,” says Professor Guruprasad Aithal of NIHR Nottingham Biomedical Research Centre. “If you have liver disease, you are less likely to get scarring or fibrosis. If you have fibrosis, you are less likely to progress. If you have cirrhosis, you’re less likely to get cancer. So at every level there seems to be an association. It’s been tested against tea, which also has caffeine, but it’s actually better than tea.”
2. Eat your sprouts
Eat more brassicas (cabbage, broccoli, sprouts). These cruciferous vegetables, rich in vitamin C, fibre and antioxidants help protect our liver from free-radical damage and reduce levels of inflammation. Studies have examined the anti-inflammatory benefits of Brussels sprouts, focusing on kaempferol, an antioxidant compound present in sprouts. To keep your liver functioning well, experts recommend following a low-glycemic, high-protein Mediterranean diet (fruit and veg, whole grains, nuts and legumes, lean meats and fewer sweets/added sugars). The way food is cooked also matters. Boiled or baked food is liver-friendly; fried is not.
3. Go easy on the white rice
Non-alcoholic fatty liver disease (NAFLD) is a global problem growing in parallel to the epidemics of obesity and diabetes, says Aithal. You can be skinny with a low BMI and still be at risk if you eat a poor diet. In 2022 he carried out a control study including 993 NAFLD patients and 973 healthy individuals and showed NAFLD patients had significantly higher consumption of refined rice, animal fat, red meat, refined sugar and fried foods. “In the body and liver anything excessive gets stored. If excess fat is stored, free fatty acids can stress liver cells so that they don’t function well.”
In his most recent research (about to be published), Aithal found making food swaps – healthier unrefined red rice or lentils in place of white rice – brought glucose down substantially in only four months. “White meat comes out of the research as something which might really reduce fibrosis or scarring in the liver.” Garlic and spices such as chilli, coriander, curry leaves and mustard are also beneficial (capsaicin, a compound found in chilli peppers, reduces liver lipid accumulation and decreases inflammation).
4. Don’t skimp on protein
When the liver isn’t working properly, the body needs more protein than usual – eggs, oily fish, poultry and legumes – to prevent muscle breakdown. “Make sure you get enough protein with every meal,” advises nutritionist Jeannette Hyde, the author of The Gut Makeover, “because you need enough amino acids for the liver to function well.” Vegans often lack protein, so she recommends a palm-size portion of tempeh, tofu, beans or lentils with each meal. “The evidence around beans and lentils is really very good, they’re nutritionally excellent foods, but we grossly under-use them in our diet,” says Ryder.
5. Take three days off booze a week
“It’s a lot better to drink sensibly throughout the year than to do things in extremes,” says Shawcross. She recommends three days off a week, ideally consecutive days, to give our liver a proper break. “The critical thing for me is people making sure alcohol doesn’t become a habit – ie, you get home from work, have a gin and tonic, then it becomes two or three. Three days off, minimum, breaks that habit,” says Ryder. “Don’t drink more than three units a day. Give your liver a proper break in between. And don’t substitute alcohol with fatty or sweet foods,” adds Professor David Nutt, the director of the neuropsychopharmacology unit at Imperial College London and co-creator of the non-alcoholic drink Sentia.
6. Don’t drink on an empty stomach
“The worst thing you can do is drink without food,” says Shawcross. “You very quickly get drunk and the liver becomes overloaded because it can only break down alcohol at roughly one unit of alcohol an hour. But if you have a meal that keeps alcohol in the stomach for longer, it slows absorption of alcohol into the bloodstream.”
Carbonated alcohol drinks (ie, champagne) are absorbed immediately on an empty stomach, and if the liver can’t metabolise all the alcohol, acetaldehyde builds up, damaging the liver. It’s a serious issue. Figures from the Office for National Statistics in the UK show alcohol-related deaths from liver disease are rising substantially (the highest increase is women in their 50s). The size of your liver is proportionate to your body mass, so the bigger you are, the bigger your liver is. Men have 70 to 80 per cent higher levels of the enzyme that breaks down alcohol than women “so they are able to do that more quickly and efficiently. Also, men have a higher muscle mass and body distribution, so the alcohol is circulating around a bigger area.”
7. Stop snacking and try intermittent fasting
“We have too many ‘eating events’ in our lives,” says Hyde. “We snack day and night. So one of the most powerful things you can do to make your liver work really well is to have a little bit of intermittent fasting in your week.” Stop eating earlier and fast for 14 hours overnight, because that’s when the repair work gets going.
What happens when you fast is the energy in the body gets diverted to doing a clean-up job, rather than digesting foods, and the liver will start to repair itself through a process called autophagy (your body’s process of reusing old and damaged cell parts). This means your liver, or any organ in the body, starts regenerating itself. “It’s the cheapest, easiest thing you can do.” Intermittent or alternate-day fasting can lead to improvements in liver function, a reduction in liver fat accumulation or inflammation. Additionally, total cholesterol levels, known to be associated with NAFLD, may also improve during this fasting period. In 2024 scientists from the German Cancer Research Centre (DKFZ) and the University of Tübingen revealed that intermittent fasting on a 5:2 schedule reduces the development of liver cancer in mice with pre-existing liver inflammation.
8. Boost vitamin C
Hyde recommends taking vitamin C in the form of citrus fruit such as oranges. “The liver guzzles up quite a lot of vitamin C in order to do its job and process things.” She recommends peeling and eating fruit whole rather than squeezing the juice. “You want to get the fruit with all the pith and fibre in it, so it slows down the absorption of sugar from the orange.” Another tip is to have two fibre-rich kiwi fruit (yellow ones are nicer, she promises) with breakfast because they keep you regular. “Once the liver has done its job and is ready to get rid of these toxins, you need to be having a regular bowel movement to clear the whole stuff out.”
9. Ditch the liver supplements
“There’s no evidence at all that supplements of any sort help your liver,” says Ryder. “If you’re eating a good, healthy, balanced diet, you’re getting everything your liver needs. There’s no scientific evidence that things like milk thistle improve liver injury or protect people against various forms of liver disease. It’s much better that people make sure they have a good, complete diet. That’s the best insurance policy, rather than buying something that promises things it probably won’t deliver.”
10. Cut your portions by 10 per cent
Losing weight is the best way to address metabolic dysfunction-associated steatotic liver disease (non-alcoholic fatty liver disease). “The combination of alcohol and being overweight has a synergistic effect,” stresses Salim Khakoo, a professor of hepatology at the University of Southampton. “You might think, ‘Oh, I’m just drinking a bit more than I should. I’m just a bit overweight.’ But those two act in combination to accelerate the course of fatty liver disease.”
He doesn’t advocate crash diets, but avoiding excess sugar in drinks, processed food and sliced bread is key. “You should be aiming for less than 2000 calories a day and if you want to lose weight, 1700 for a man, 1400 for women. Think about the calorific value of food, because your body converts those excess calories into fat, which accumulates within the liver, making you at risk of liver disease. Cut out snacks, avoid sugars, hide your biscuit barrel so you don’t get that visual cue to eat something.”
11. Keep your gut microbes happy
The good bacteria in your gut are literally lifesavers. “The research over the last two decades has shown gut microbes are very important in health and in disease, and they are very much influenced by what we feed them,” says Ryder. “At the moment there are trials going on to treat alcohol-related liver disease with faecal microbiome transplants. By manipulating the microbiome, you might actually improve the disease process. The scientific understanding of why diet matters is stronger than ever. ”
So up your intake of prebiotic foods like garlic and onions and fibre-rich whole grains to keep your gut microbes happy.
12. Move more
Aim for at least 30 minutes of moderate exercise most days. Physical activity encourages the liver to process nutrients and toxins more efficiently. “Every time we exercise, we move sugar stores and fatty acids in our liver out into our bloodstream and towards our muscles,” explains Shawcross. “We’re not asking everybody to do a high-intensity exercise programme or spinning class,” adds Khakoo. “For people with a busy working life, or in sedentary jobs, have a brisk walk each day, try cycling or swimming. If you’re able to walk briskly, try a bit of jogging or Couch to 5k – because these really simple things help liver health.”
13. Drink less, drink better
No one is in any doubt that alcohol is toxic to the liver. And, no, sadly, beer isn’t better than spirits. “It’s the actual alcohol that is damaging, rather than the beverage type,” says Khakoo. “So it is important to know how many units are in your drink. I would approach it by thinking about how to control the amount of alcohol you take in per drink. A small glass of wine is 125ml or about 1.5 units. Compare this with a 250ml (large) glass of wine at 3 units. A lower strength 3 per cent beer is approximately half the units of a strong 5.5 per cent lager. Home spirit measures are notoriously difficult to judge, so use a measure (25ml of standard 40 per cent spirits is 1 unit). Most people think they are having a double, but it is more like a triple.”
The Telegraph, London
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