Being diagnosed with fatty liver disease motivated Rebecca, a GP, to make changes to her diet and lifestyle and reverse the condition. Thank you for sharing your story with us, Rebecca
In 2015 I was working hard as a GP, had two young children and was eating rubbish – I weighed 110kg. I began experiencing pain in my upper right quadrant after meals which continued for several months. I thought it might be gallstones, but a scan revealed a fatty liver.
Fatty liver is considered one of those conditions where once you’ve got it, it’s simply: “Bad luck, mate”. You get your fibrosis score and are potentially on a path to getting worse and possibly developing long-term irreversible liver damage. As a GP I didn’t want that to happen to me. Instead, the diagnosis was a real motivator to make changes to my lifestyle and reverse the fatty changes.
I wasn’t doing any exercise at the time but was working for a practice which was pioneering social prescribing. As a result I became quite obsessed with running and did Couch to 5k. While exercise tends to make you more hungry, running made me think about how I fuel myself. I didn’t worry about fats at all as the latest evidence points to high blood glucose, and therefore sugary and starchy foods, being the cause of weight gain. So instead, I reduced my carbohydrates by not eating bread, pasta and sugar. I lost 30kg, the pain after every meal settled and another scan around 18 months later showed I had a completely healthy liver.
Scan shows fatty liver
But after a few years, heel pain and a knee injury meant that exercise became painful. I gradually regained the weight and by the end of 2022 I was back at 110kgs. Once again, a scan showed a fatty liver. I was stressed at work and asked for help from the obesity clinic via my GP. They put me on a weight-loss programme which has an app and included one session with a health coach.
Fatty liver, diabetes and heart disease are all related via our metabolism and that made me think about things that I could change to improve my health such as sleep, reducing stress, fasting and eating a diet low in processed foods and carbohydrates.
There’s so much evidence around the importance of sleep in metabolic health and cancer prevention. A good night’s sleep reduces sugar cravings and helps you make healthier food choices the following day. For me getting out early, seeing the daylight to support my diurnal rhythm , getting to bed earlier and reducing electronics in the evening all seem to have helped. 
I started running 5km before work and doing intermittent fasting most days. This involves eating within an eight-hour window – so no breakfast, but drinking water through the morning and maybe a cup of tea, then only eating after 2pm – so I just have two meals a day. Because my diet is low-carb I hope that I now have fewer sugar spikes and no hunger pangs in the morning.
My mental health and outlook on life is so much better now
I now try to eat cruciferous vegetables such as broccoli, cauliflower, and kale every day, as well as fermented foods, and I make my own sauerkraut and kimchi. These all contribute to a healthy gut biome, which links in with every other organ system in our body and our metabolic and mental health. It’s not something that people talk about much, but it’s an ongoing area of research that we’re learning more and more about. 
Last year I was chosen to go on the pyramid stage at Glastonbury Festival with two other NHS workers as part of the celebrations for 75 years of the NHS. It was pretty motivating knowing I would be on stage in front of 40,000 people.
It’s all helped me to lose weight and my mental health and outlook on life is so much better now. A year ago I was 105kg and my abdominal girth was 106. Today I weigh 88kg and my abdominal girth is 92. My pulse has gone from the 70s to the 50s and my blood pressure is pretty good too – I check them every time I weigh myself.
My job is hard and sometimes by the end of the day I’m searching around for chocolate. I continually need to remind myself not to interpret my tiredness as hunger, but it’s quite tricky.
Liver’s capacity for regeneration
Luckily, the liver has such a capacity for regeneration that it’s not too late if you get diagnosed with fatty liver disease. NICE (National Institute for Health and Care Excellence) guidance on it says that GPs should: “Give lifestyle modification advice on diet, physical activity and regular exercise to all people with NAFLD. Encourage all gradual and sustained weight loss especially if the person is overweight or obese.” They also recommend the Mediterranean diet and promote water rather than sugar- sweetened drinks.
At work I try to personalise this advice for my patients. I find out what motivates them, how they learn, what their goals are and what’s realistic for their level of motivation. I share what I’ve done myself, as well as suggesting motivational books and podcasts. Changing our habits is hard and qualified support is needed to really affect and sustain behavioural change. I think there should be more funding to support the education of staff in primary care and health coaches should be available to all to support people in making those necessary lifestyle changes.
