Weight-loss jabs such as Ozempic could throw a lifeline to millions of people battling deadly liver disease – amid growing concern about the spiralling number of cases.
Over the past 20 years, diagnoses have surged by 40 per cent and deaths caused by the condition have risen four-fold.
Even more worryingly, it is estimated that one in three adults have some degree of liver disease, with many totally unaware as it causes few symptoms in early stages.
Once thought of as a condition of old age – or something linked to excessive boozing – the greatest increases have been seen in young people and those who do not drink. Instead, say experts, it has been fuelled by an increase in obesity and diabetes.
And until now doctors have had very little they could do to treat the condition, apart from recommending patients follow a healthy diet, have little to no alcohol and lose excess weight. But the new slimming drugs could transform that.
‘The rise in liver disease is alarming,’ says Professor Philip Newsome, a liver expert at King’s College London (KCL). ‘That’s why the use of weight-loss drugs to treat the condition is really promising. We have compelling research evidence that they can help reverse the damage caused by the condition, which we didn’t think previously was possible.
Michelle Hayward was diagnosed with cirrhosis, but three years later she has turned her life around thanks to Mounjaro
‘We expect the jabs will be available to liver disease patients on the NHS as soon as next year.’
The move comes after a landmark study by researchers at KCL found that nearly 40 per cent of patients treated with semaglutide – the active ingredient in popular weight-loss drugs such as Ozempic and Wegovy – saw severe damage to their liver reversed. It was the first time a treatment had had this effect.
Doctors say that the rise in cases is down to a type known as non-alcoholic fatty liver disease (NAFLD) – a build-up of fat in the liver, usually due to poor diet and a sedentary lifestyle.
There are four stages to the disease which sees excess fat cause inflammation, leading to scar tissue forming in the liver.
Left untreated, over time it can result in end stage liver disease, also known as cirrhosis.
When this sets in, the liver stops functioning as it should – helping to filter toxins from the blood. At this stage patients suffer jaundice – yellowing of the skin and whites of the eyes – as toxic compounds build up in the blood. Fatigue, abdominal pain, extremely itchy skin and abdominal and limb swelling are also common.
However, the British Liver Trust estimates that 80 per cent of people living with NAFLD are going undiagnosed. This is because, usually, there are no symptoms of NAFLD present in the earlier stages and it will only be picked up incidentally if, for example, a test for another condition is carried out.
Last week Mail on Sunday columnist and GP Dr Ellie Cannon wrote that she ‘was concerned that people are living with a life threatening condition without realising it,’ adding that most people ‘wrongly assume that it is from drinking too much booze’. In response we were flooded with letters and emails from readers.
One 57-year-old reader said he was ‘knocked sideways’ by his diagnosis, adding that he ‘thought alcohol was the only cause of liver disease,’ but has been told his diabetes and diet is the cause of his cirrhosis.
And a 74-year-old woman who has recently been diagnosed with fatty liver said she has ‘been teetotal all my life but believe this condition could be due to my being overweight’.
Last year a study by the University of Bristol found that one in five under 50s have the condition and one in 40 have an advanced form of the disease.
Writing to Dr Ellie, a mother of a 28-year-old said that his diagnosis has left her ‘horrified and, to be honest, pretty distraught’.
She said he is in ‘constant pain, sometimes quite debilitating and his mental health is really affected by it all. I am so worried for him’.
Pamela Healy OBE, chief executive of the British Liver Trust, says: ‘Many patients are shocked to learn they have liver damage caused by obesity and poor lifestyle choices and not by alcohol.
‘Anyone who is overweight, and particularly those who’ve have been diagnosed with type 2 diabetes already, need to talk to their GP or diabetes nurse to ensure their liver health is monitored and that they are referred for further tests if required.’
Professor Newsome adds: ‘The problem with most liver disease is that it doesn’t cause symptoms until it advances, which may only come after decades of damage.
‘We need to have a better system in place to catch the condition earlier. That would start with screening of those most at risk, including type 2 diabetics.’
For the millions already living with the condition, this latest research offers hope and a chance of being able to change the course of their disease.
Mum-of-two Michelle Hayward is one of those who has seen a dramatic improvement in her condition after using a weight-loss drug.
Doctors told her there was no way back, when she was first diagnosed with cirrhosis. The prognosis was bleak – the then 58-year-old was told she had just over a decade to live – and left her fearing that she wouldn’t see her grandchildren grow up.
Yet she has defied all of the odds, and just three years later has turned her health around. The key to her recovery: the weight-loss jab Mounjaro.
At her heaviest, Michelle weighed 18st. She was prescribed Mounjaro to treat her diabetes, and in six months shed six stone. At her latest check-up, there was no sign of cirrhosis in her liver.
‘It was a superhuman effort to change my lifestyle as well, but none of that was possible before I started on the drug,’ says Michelle, a business manager from Staffordshire.
‘When I first got diagnosed, the doctors recommended I improve my diet and lose weight, but I kept giving in to my cravings.
‘Using the drug was a massive turning point for me. I was in complete shock after my latest liver scan result – I thought I had been given a death sentence.’
Now she says ‘it’s like being given a new life,’ and she is planning for the future with her grandchildren. ‘Hearing I had cirrhosis was like being given a terminal diagnosis. Now I can buy clothes I like, I want to go on holiday, I want to go out. I’ve got such a positive outlook now – I want to live again.’
Until now a diagnosis of the advanced stage of the disease has been seen as a death sentence. But experts believe that this could be a major development in the treatment of the disease.
‘The general view before was that you couldn’t reverse scarring and certainly not cirrhosis, but our research shows that this may not be the case,’ says Professor Newsome.
‘We now realise that if you treat the underlying cause of liver damage, you can get remarkable remodelling of scarring. You might not get it back to normal, but you can go back to a less harmful position.’
But for the most advanced form of the disease, he warns that the jabs will likely need to be used in combination with other treatments, and that further research needs to be done.
‘These drugs can meaningfully slow or stop the development of the disease, and that is a major win,’ says Professor Naveed Sittar, an expert in cardiometabolic health at Glasgow University.
‘At the moment we believe that the impact is because of the weight-loss effect of the drug, rather than removing the scarring itself. But it wont be long until all patients who are overweight and have liver disease are treated with these jabs.’
And Ms Healy adds: ‘If you’re concerned about your liver health, it is always best to speak to your GP. Too many people wait until the damage is already at an advanced stage, but the good news is that the liver can repair itself to some degree even if there is significant damage.’
I’m only 24 but beer and burgers have left me on the brink of some real problems
Luke Chafer, who had a scan at The Liver Clinic, tucking into poor lifestyle choices
Experts warn that many cases of liver disease are ‘hidden’ and not detected until it is too late to do much about it.
So, with cases on the rise among young people, I went to get tested.
It is estimated that one in five people under the age of 35 has fatty liver disease.
If left untreated it can develop into scarring, which causes long-term harm – and can be deadly.
However, if caught early enough, a healthy lifestyle and diet can help reverse the damage as the liver is able to regenerate.
If doctors suspect you have fibrosis, a late stage of the disease, the NHS can arrange a fibroscan – a type of ultrasound that measures stiffness and inflammation in your liver and the level of harmful scarring.
But The Liver Clinic, a private health provider which has four sites across London and one in Dorset, offers scans for £250.
Honestly, I went to the appointment with a degree of trepidation. I am a not-very-active 24-year-old who enjoys a pint or two too many and I often give in to the craving for a sweet treat or takeaway. So I would be lying if I said I was shocked at the results – but it was certainly a wake-up call.
I have high levels of liver stiffness but a lack of scarring, which is often caused by long-term damage. However, I am on the brink of non-alcoholic fatty liver disease.
At the moment my score is in a grey area – not high enough to be classified as having liver disease but higher than normal. Medically, it is called steatosis grade one – and I won’t need Ozempic. But the doctor did warn me that without a swift lifestyle change I could see a deterioration within months.
It’s a stark threat, and one that had I not been tested I would never have known about – and which begs the question as to why we wait so long before we test those who are likely to be at risk.
