Liver: your sugar bank, and fatty liver

After a meal your liver takes up glucose and stores it. Between meals and overnight it releases it back out, so you do not run empty. Deposits and withdrawals, which is why calling it a bank is closer to the truth than calling it a filter.

In diabetes the bank stops reading the balance properly and keeps paying out even when there is plenty in circulation. That is why blood sugar can be high first thing in the morning, before you have eaten anything, which puzzles a great many people.

Fat accumulating in the liver is now extremely common, and the assumption most people make is that it means drinking. For the majority it does not. It is much more closely tied to weight carried around the middle, insulin resistance and refined carbohydrate.

It usually causes no symptoms at all and is found incidentally on a scan or a blood test, which is why people are often surprised and sometimes offended by the diagnosis.

Left alone over many years it can progress, and it travels with diabetes and heart risk, so it is worth taking seriously. But the outlook is genuinely good, because the liver is unusually willing to recover.

Losing five to ten per cent of body weight, moving regularly, cutting refined carbohydrate and sugary drinks: these reverse fatty liver in a way that few other conditions respond to.

Keep weight around the middle in check, move most days, keep muscle, go easy on refined carbohydrate and sweet drinks, and be sensible about alcohol even though it is not usually the cause.

Be careful with paracetamol doses and check with a pharmacist before adding supplements, since a good many herbal preparations are processed by the liver. This is general guidance, not medical advice.