Are we damaging our liver?
You would be astonished to know that we are indirectly causing severe damage to our liver mostly by our lifestyle. There are many causes of liver inflammation, scarring, liver cirrhosis and liver failure – the majority of which are preventable provided we pay attention to what we eat and what care we take. In other words, the majority of the causes of liver disease are lifestyle-related and are preventable. Let us understand those causative factors in detail.
Many people even with some serious liver issues and complications seem to appear normal because liver disease and the damage induced to liver by any of the causative factors are slow and progresses gradually. In other words, liver disease is a silent killer.
The silent progression of liver disease and its slowness gradually leads to a stage wherein the liver becomes so damaged that it no longer works (end-stage liver disease or liver failure) – owing to which the person cannot thrive. The following are the major causes of liver disease and liver failure.
Alcohol (Chronic alcohol abuse): Alcoholic hepatitis: Liver inflammation that results from heavy or long-term drinking.
One of the common causes of liver damage (jaundice) and liver cirrhosis is an infection by viruses. Hepatitis viruses are common viruses that cause liver damage. They spread through contaminated water or food (hepatitis A and E) and also through blood and semen (hepatitis B and C). Viruses cause liver inflammation, scarring and cirrhosis and thus affect liver function.
Infections caused by Hepatitis A and E Viruses
Hepatitis caused by hepatitis A virus spreads through contaminated food and water and also through the person who is infected with hepatitis A virus. A person overcomes this type of infection on its own. Hepatitis E is a virus that spreads when a person is exposed to contaminated food and water. You can prevent yourself from getting infected by avoiding unhygienic food – in which the possibility of contamination is very high.
Other Viral Infections
In addition to hepatitis A, B, C, D and E viruses, there are some other viruses like herpes simplex virus, cytomegalovirus, the Epstein-Barr virus that can also cause liver damage and liver cirrhosis.
Spread of Hepatitis B and C – How it happens?
Hepatitis B and C viruses spread through blood and cause severe damage to the liver if not addressed in time. Hepatitis D virus transmission occur through exposure to body fluids [sexual contact, contaminated blood, unsterile needles (used by drug abusers)]. For the survival of this virus in the body, hepatitis D virus requires concomitant infection with hepatitis B.
Who are at Risk of hepatitis B and C viral Infections?
Individuals who are at risk of hepatitis B, and C viral infections are the ones who
• Do unsafe Blood transfusion
• Get Tattoos or body piercings Done unsafely
• Involve in injecting drugs using shared needles
• Get exposed to other people’s blood and body fluids
Unprotected sex: high-risk sexual behaviours and unprotected sex can increase the risk of hepatitis B viral transmission and hepatitis B-induced liver cirrhosis.
Medications Can Cause Liver Damage
You may be very familiar with antipyretic, analgesic or pain-relieving medicines, but need to be very careful about their use, as they can potentially damage your liver – acetaminophen, paracetamol, Tylenol and other OTC drugs can cause liver inflammation and liver damage if you use them recklessly for long.
Unwarranted and uncontrolled use of acetaminophen in large doses can potentially induce liver inflammation and liver damage – which could eventually lead to liver failure.
Be cautious when you use prescription medicines especially the ones used to control high blood pressure as they can damage your liver. Statin drugs that are prescribed in appropriate doses can also pose a threat to your liver as these drugs can cause liver inflammation and scarring. Blood tests that measure the levels of certain liver enzymes help in detecting the inflammation of the liver. Early detection of liver damage usually helps in further deterioration of the liver by stopping the medicine.
Antibiotics including isoniazid (laniazid, nydrazid and INH), tetracycline, Augmentin XR, Augmentin, Clavulanic acid, amoxicillin, nitrofurantoin (Macrobid, furadantin, Macrodantin) can also cause liver inflammation and damage, but the problem will resolve when the medicines are stopped. Other drugs that are used to treat autoimmune disorders can lead to liver scarring and liver cirrhosis. The drug (disulfiram) that is used to treat alcoholics can cause liver inflammation.
Use of Herbal & Dietary Supplements
Many people take herbal and dietary supplements assuming those to be devoid of side effects and natural, but, in reality, they are not – as excessive use of supplements including vitamins and minerals can cause liver inflammation, scarring, liver cirrhosis and even liver failure. Some potentially damaging supplements include comfrey, Kava kava and vitamin A. Some mushrooms are also poisonous for liver and consumption of unidentified wild mushrooms can be lethal for you.
Amanita Phalloides is a type of wild mushroom. It is also known as the death cap. The toxins that are present in it are poisonous to the liver and thus lead to liver failure within a couple of days after consumption. Those who eat mushroom must take note of what they are eating – which type of mushroom is it.
Fat accumulation in the liver (non-alcoholic fatty liver disease)
Obesity Leads to Fatty Liver Disease: Fatty, obese or overweight individuals should pay attention because high body fat, obesity and high cholesterol levels can lead to fatty liver. When fat cells build up on the liver, it is known as non-alcoholic fatty liver disease. This is common in obese individuals. In heavy drinkers, alcoho- induced fatty liver disease is very common.
Exposure to certain chemicals or toxins: Chemicals present in the cleaning substances, degreasers, carbon tetrachloride and other industrial toxins can also damage the liver.
Other causes of Liver Damage
Oxalosis: Kidneys remove calcium oxalate crystals, but when their function becomes inefficient, calcium oxalate crystals are not removed through the urine. This is known as oxalosis. It may lead to liver damage.
Primary sclerosing cholangitis is a disease of the liver that slowly damages the bile ducts. This condition is found in young people.
Inflammation of the bile ducts may be due to a condition called Primary Biliary Cholangitis (PBC). This condition, over a period of time, destroys small bile ducts. It is also known as primary biliary cirrhosis.
Genetic Disorders that lead to Liver Damage
Galactosemia is an inborn error of metabolism or genetic disorder wherein a person cannot metabolize or process galactose – a type of sugar found in several foods. This genetic disorder can cause liver damage.
Alagille syndrome and Alpha-1 antitrypsin deficiency are genetic disorders that can lead to liver disease. Alpha-1 antitrypsin deficiency is associated with liver and lung disease while Alagille syndrome results in fewer bile ducts than normal.
Lysosomal acid lipase (LAL) is an enzyme that breaks down cholesterol and fats in the body cells, but deficiency of this enzyme due to a genetic condition called Lysosomal acid lipase deficiency (LAL-D), fats and cholesterol accumulates in the liver and cause liver damage.
Slow Progression of Liver Disease in Stages
Stage 1: Early-stage liver disease is mostly asymptomatic. Liver gets inflamed and becomes tender. The person having liver disease doesn’t feel any problems at all and looks healthy.
Stage 2: Fibrosis/scarring: The first stage inflammation of liver if untreated or left unchecked, may lead to liver scarring. Thus, scar tissue builds up gradually and progressively replacing healthy liver cells. Scar tissues stop blood flow to the healthy cells and thus prevent them from doing their job. When this happens, the liver works very hard to compensate for its lost function.
Stage 3: Cirrhosis: Liver cirrhosis is associated with extensive scarring of the liver tissues and cells resulting in the loss of functions of liver cells. Scar tissues take over healthy liver cells – liver fails to function properly due to less healthy tissue to do the job. Liver cirrhosis progressively causes significant damage to a large number of liver cells leading to the failure of liver function. It happens over a period of time. It is a late-stage liver disease.
Stage 4: End-stage liver disease or Liver failure: It is associated with several other conditions including ascites (fluid accumulation in the abdomen), loss of kidney function, internal bleeding, swollen liver and lung problems. End-stage liver disease can be cured by a liver transplant.
Irrespective of the cause (whether it is a viral infection, a toxin, a chemical, a drug, a supplement or an individual’s own immune system) and the type of liver disease you have, the damage to your liver progresses in stages as mentioned above and the basic danger of liver damage remains the same – liver disease progressively leads to a stage where the liver becomes so damaged that it no longer function. When the liver fails to work, it becomes life-threatening.
The life-threatening condition of the liver is liver cirrhosis – liver failure. If a person develops this condition, then treatment options may be very limited. Therefore, the need of the hour is to detect and diagnose liver disease in the early stage itself (inflammatory or the fibrosis stage). Early-stage liver disease can be treated successfully as the liver has the ability to heal itself and recover.
Talk to your gastroenterologist about the risks and whether you are at risk owing to any of the above-mentioned risk factors. If so, should you need to undergo any tests?
Dr. Nagarjuna Yarlagadda
MBBS, MD, DM (Gastroenterology – PGI)
Chief Gastroenterologist, hepatologist & Therapeutic Endoscopist
Medical Director, Sunshine Hospitals, Hyderabad