Nope, not all liver diseases are related to booze.
It's our biggest internal organ—and technically our biggest gland, too—and yet if you stick to your recommended one drink a day or fewer for women (or two drinks a day or fewer for men), you probably assume you won't have anything to worry about when it comes to your liver.
That's because when most of us think of liver problems, we think of cirrhosis, the long-term damage to the liver that can eventually lead to failure of the organ. Cirrhosis is a pattern of chronic scarring of the liver that blocks blood flow and halts its many essential processes, commonly associated with excessive alcohol consumption.
But there's so much more going on in the liver aside from filtering out alcohol that can directly affect your health. "People think their livers really can only be a problem if they do something wrong to it," says Robert S. Brown Jr., M.D., gastroenterology and hepatology professor at Weill Cornell Medicine's Center for Liver Disease and Transplantation in New York City.
"Liver disease cuts across all socioeconomic statuses, genders, ages—everyone needs to take good care of their livers." Here are some facts that are important to keep in mind, no matter what you think you know about this essential organ.
Cirrhosis isn't the only type of liver disease you should be concerned about. One liver condition increasing in prevalence lately is what's called non-alcoholic fatty liver disease, or NAFLD, which occurs when too much fat builds up in the liver.
"Because of the obesity epidemic, we're seeing more and more cases of people with diabetes, pre-diabetes, or other symptoms of metabolic syndrome who are developing fat in their livers that looks just like the fat in the livers of people who drink excessive alcohol," says Brown.
"We really think that NAFLD is the liver manifestation of the metabolic syndrome," says Sujit Janardhan, M.D., Ph.D., a member of the American Liver Foundation's Medical Advisory Committee and an assistant hepatology professor at Rush University Medical Center in Chicago.
More fat in the liver in turn increases a person's risk of liver cancer and transplant, adds Brown. The good news is that diet and exercise can help. Just a small reduction in bodyweight of around seven percent can reduce liver inflammation and seems to be linked to reduced scar tissue in the liver too, says Janardhan.
But there are also causes of cirrhosis that have nothing to do with drinking alcohol, like hepatitis and primary biliary cholangitis, or PBC, an autoimmune disease the leads the liver to attack cells that form the bile ducts. PBC leads to inflammation and scarring, which when severe enough, results in cirrhosis. "As a result, PBC is one of the leading causes of cirrhosis," says Brown, "and it's much more common in women."
"Evolution or God or whoever you choose to believe in wouldn't leave you with such a big organ if it wasn't doing something important," says Brown. Those important tasks are plentiful, numbering in the hundreds depending on how you count, he says, including helping in digestion and blood clotting, eliminating bacteria and viruses, building protein, and storing sugar and fat.
"People forget that everything you breathe, drink, and eat gets processed by the liver," says Janardhan. "It's a big manufacturing plant in your body." Take away all those functions and you'd have a pretty tough time surviving. "Because it's involved in so many different pathways and has so many different functions in the body, the complications of liver disease can be rather vast," he says.
In addition to being the biggest internal organ, it's the only one that can fully regenerate, says Brown. Liver cells are constantly trying to repair damage in a way that essentially rebuilds the organ. It's why liver transplants can be done using just a portion of the donor's liver.
When there's a hefty amount of repairs needed, some of the repair comes in the form of scarring, the very same scarring that in excess becomes cirrhosis. So while it's awe-inspiring to consider the mere fact that our livers regenerate, it's also important not to tax them too much. "We just have to not punish our liver on a regular basis," says Brown.
The hepatitis C virus is spread mainly through blood, so injecting drugs and engaging in certain sexual behavior puts people at higher risk of contracting the liver disease. But risky behaviors aside, around 75 percent of all people living in the U.S. with hepatitis C have one thing in common: They were born between 1945 and 1965.
As such, the U.S. Preventive Service Task Force and the Centers for Disease Control and Prevention (CDC) recommend everyone whose birthday falls in that two-decade span should be screened once. "There's a stigma associated with hepatitis C that's preventing people from being tested for it and consequently being treated for it," says Janardhan.
It's not entirely clear why baby boomers are at a higher risk, according to the CDC, but infections could be the result of contaminated blood transfusions, since hep C wasn't widely screened for until 1992. (Of course, if you have other risk factors, like any history of blood transfusions before 1992, an accidental needle stick while working in a healthcare setting, or drug use or sexual history, you need to be screened on an ongoing basis, he adds.)
Some of the most common symptoms of PBC are symptoms you might experience every day for no serious reason, like itchiness, fatigue, and dry eyes, says Brown. "It's only when you have advanced liver disease that you notice specific symptoms related to cirrhosis," he says, which can include nausea, weight loss, swelling, confusion, and the classic yellowing of skin and eyes. "Many liver diseases are asymptomatic and only found because of screening," says Brown, which is why some doctors will include liver tests as a part of your regular blood work.
As the liver processes everything we eat and drink, it filters out the poisonous stuff, otherwise known as toxins. You probably think of alcohol here again, but the liver also strains out toxins in food and medications. "As we get older and take more medications, it's almost more important to pay attention to the health of our livers," says Janardhan. "Liver function may start to decline, so the risk of developing a liver injury from medication increases."
Luckily, "the liver does that job pretty darn well," says Brown. But rather than shelling out for a juice cleanse or soup detox, he recommends flipping the script. "I think we should just not toxify ourselves rather than try to detoxify ourselves."
That doesn't just mean cutting back on the wine: All the standard healthy habits—eating a balanced diet, maintaining a healthy body weight, and getting regular physical activity—also affect liver health, says Brown. "Unless you're born with or genetically predisposed to liver disease, ultimately liver health is within our control," he says.