For over 30 years, day in and day out, I have been caring for patients with a wide range of liver ailments. Some are relatively minor and don’t cause much of a problem, while others are serious and life threatening.

In addition to caring for all these patients, I’ve had the opportunity to listen to their clinical history, which means I have heard their life story. While listening to these patients, I soon develop a very clear window and sequence of events as to how the person – sitting in front of me – got here, needing to see a liver specialist.

All too often, there were early warning signs or symptoms indicating a problem, months, years, or even decades earlier. Lab work during an annual physical exam was abnormal, or specific complaints were never explained fully to their medical provider. These findings may have been ignored by the treating physician, or simply ignored by the patient. Our default setting when dealing with bad news regarding our health, is to ignore it as long as we can. 

Our goal in all that we do as a practice, as well as for the community at large, is to educate, bring awareness, and make you better consumers of health care. This is the mantra we share daily with our patients and every week when we broadcast on the radio. 

Here are 5 expert tips that you should all be familiar with to maintain a healthy liver.

Limit the Alcohol: by far, excess alcohol contributes to a large number of acute and chronic liver problems that we see. Alcohol is both a known toxin to the liver, but it is also a carcinogen, increasing the risk of developing liver cancer.

There is a gross misunderstanding by the public that only wine and distilled alcohol products, such as whiskey, vodka, and tequila, are the big offenders with regard to the liver. It’s hard to imagine, but a large number of people still believe that beer should not be categorized in the same light as wine and distilled alcohol. The truth is, and this is the point to remember, is that a serving of beer, wine, and distilled spirit (approximately 1.5 ounces) all contain the same amount of alcohol, which is roughly 10 to 12 grams of alcohol.

The guidelines for consumption in adults is no more than one alcoholic beverage for women, and no more than two alcoholic beverages for men each day. Don’t try and outsmart the system by consuming your seven alcoholic beverages allotted to you, if you’re a woman, on Friday and Saturday night. That may be far worse for you.

Know Your BMI: BMI stands for a body mass index. Normal weight should have a BMI between 18.5-24.9. Overweight individuals will have a BMI between 25 and 29.9. Obesity is a BMI greater than 30, with morbid obesity being a BMI greater than 40.

Obesity, and thus an elevated BMI, is directly associated with an increased risk of developing hypertension, type 2 diabetes or prediabetes, and an elevation of your cholesterol and triglycerides. Collectively, the presence of obesity, hypertension, type 2 diabetes, and hyperlipidemia is called metabolic syndrome. Not only does this put you at risk for cardiovascular disease (heart attack, stroke, kidney failure), it also puts you right in the crosshairs for developing non-alcoholic fatty liver disease. Fatty liver disease is currently a leading cause of chronic liver disease, the development of cirrhosis, and liver cancer. It is the leading liver disease that requires liver transplantation.

Clearly stated, without obesity, we wouldn’t see metabolic syndrome, and without metabolic syndrome, we wouldn’t see fatty liver and all of its devastating complications.

Get Vaccinated: with all the talk of vaccination over the past 18 months, a la COVID-19, we’ve lost sight of other vaccine requirements including hepatitis A and hepatitis B. These vaccines have been around for over 25 years, and they are safe and effective.

Hepatitis A is a viral infection that affects the liver and is spread through fecal-oral transmission. It’s always gross to talk about this, but an individual that currently is infected with hepatitis A commonly sheds the virus through their stool (poop). After having a bowel movement and wiping their private parts, a small bit of highly infectious stool, if not properly cleaned from their hands, is then spread to an unknowing victim.

Most of the time, outbreaks of hepatitis A will be seen in the food industry, where a small bit of infected stool material gets into your food, which you ingest. Like I said, super gross to think about, but this is a reality. This is why stringent hand washing, especially for people in the food industry, is so vital to our public health. Hepatitis A usually is not fatal, except in the very young, the old, or those individuals who have other underlying forms of liver disease, or other chronic illnesses.

In rare circumstances, people with acute hepatitis A can progress to liver failure and the need for a liver transplant.

In a similar fashion, hepatitis B is also a viral infection that affects the liver and is typically spread through blood and body fluids, and sexual transmission. Once exposed to hepatitis B, the vast majority will develop antibodies to it, clearing the virus naturally.

Roughly 15% of those exposed to hepatitis B will progress to a chronic state, where you are unable to naturally clear the infection on your own. Those with chronic hepatitis B are at risk for cirrhosis, liver cancer, and progressive liver deterioration and may need a liver transplant.

There are several effective antiviral agents to treat hepatitis B in those that progressed to a chronic state. In both hepatitis A and hepatitis B, the goal is prevention. Talk with your health care provider about getting vaccinated.

Fortunately, both hepatitis A and B can be administered together in one vaccine preparation.

Over the Counter Medicines Are Not Safe: there is a certain sense that medications that are administered by prescription are more dangerous then over the counter medicines that you may get at a pharmacy, supermarket, or gas station convenience store.

While in some regard that is a true statement, and prescription drugs do need to be very judiciously managed and administered, the fact that a product is available without a prescription does not ensure its safety. With regard to the liver, one of the biggest offenders, and cause of liver headaches for us, is acetaminophen, which is the active ingredient in Tylenol.

Acetaminophen is everywhere. There are hundreds upon hundreds of products that contain acetaminophen. The uninformed consumer is at risk for accidentally overdosing themselves or a loved one with too much acetaminophen. In addition to acetaminophen, which is some regards is Public Enemy #1 with regard to liver toxicity, there is a never ending list of available products that the general public can buy, that may pose a problem for their health and their liver.

Many over the counter products that claim to provide you with more energy, stamina, and clear skin have a number of unproven and untested compounds in them, which when taken, or mixed with other over the counter remedies, can culminate in liver injury. These drug-liver interactions may simply cause a slight elevation of your liver chemistries on blood work, cause you some gastrointestinal upset, or in the most extreme case, lead to significant liver injury, and liver failure.

The bottom line is to read all labels, be aware of over-the-counter products that are made up of multiple individual compounds within one tablet or pill, and make sure that there is no drug interaction with other prescription medications that you’re taking. Lastly, be very careful of your alcohol intake and these over-the-counter products which can potentiates the risk of a liver injury.

Know Your Numbers: typically, when you go see your doctor and blood work is ordered, various blood chemistries will be obtained. In most cases, a complete blood count (CBC) is ordered which takes a look at your white blood cells, your hemoglobin and hematocrit, and your platelets. This will give your treating practitioner an idea if you have an infection, or if you are bleeding and anemic. The other chemistries will take a further look at your kidney function, electrolytes such as potassium and calcium, thyroid, and cholesterol.

The liver tests, sometimes called “liver chemistries”, will be designated by the ALT and AST on the lab report. Other liver tests will include bilirubin, and alkaline phosphatase. For more details on the exact nature of the liver tests, you could either check out my book Eating Yourself Sick, or other resources we have on our practice website at www.texasliver.com.

Elevation of the ALT or AST simply indicates inflammation of the liver. Side note, inflammation of the liver is what we call “hepatitis”. Inflammation of the liver does not happen for no reason. There usually is some underlying problem resulting in these lab elevations and the resultant inflammation of the liver. Inflammation that goes unchecked does have the potential, long term, to result in scarring of the liver and the development of cirrhosis. Additional side note, “cirrhosis” of the liver means scarring of the liver.

There is no guarantee that any elevation of the liver enzymes is going to result in you feeling bad. You could feel perfectly well, healthy, and full of vitality but yet, these elevated liver enzymes are an early indication that something is not right within the liver. If you’re waiting for a pain, and ache, or something else to be wrong, that day may never come, and you’ve missed the opportunity for an early diagnosis and intervention.

Additionally, there is no definite correlation between the elevation of these liver tests, and the degree to which there is concern. Very modest elevation of the liver enzymes can be associated with more serious chronic ailments. Thus, the attitude should be that any elevation of the liver tests should warrant a thorough investigation.

Screening for hepatitis A, B, and C would be in order, investigating for the presence of an autoimmune disease should be considered, as well as other hereditary problems that lead to excessive iron and copper in the body and liver. Of course, excess alcohol in many cases may be the culprit for these elevated liver tests, as well as fatty liver disease which we discussed above.