JH: March is almost over, and we haven’t finished going through all the highlighted diseases like we promised at the first of the month. We do have time this month to talk about one more – liver disease – but will have to do Chronic Fatigue Syndrome in April.

RM: Sounds good. One thing though. We should say that March is the month that liver disease is highlighted in Canada, while October is Liver Awareness Month in the US. 

JH: But since it’s so important to us all year round, we’ll talk about it now, and again in October.  First question: is there anything that women our age especially need to know about the liver?

RM:  One thing that I think is important to know is that alcohol is not the only thing that can cause liver disease.

JH: Good point. Many of my patients who don’t drink heavily are surprised when they are found to have a problem with the liver.  I then tell them that many other things can harm the liver in the same way that alcohol does.

RM: Like what?

JH:  There’s a condition known as “fatty liver” in which fat accumulates within the liver.

RM: Yes – and isn’t it also called “nonalcoholic fatty liver disease” ?

JH: That’s right. What’s frightening about it is that the fat may cause no damage to the liver, but the condition can progress to cause inflammation, and even go on to cirrhosis, just like liver disease caused by excess alcohol.

RM: That is frightening because cirrhosis – a term that means hardening or scarring of the liver in which the normal functioning liver cells are replaced with scar tissue – can lead to liver failure. 

JH: Then, one would eventually need a liver transplant because we can’t survive without a functioning liver.  So, alcohol is definitely not the only cause of cirrhosis and liver failure.

RM: Back up just a minute. Why can’t we survive when the liver no longer functions?

JH:  I had a professor in medical school who described the liver’s function in our bodies in an easy-to-remember short phrase: “The liver is the metabolic brain of the body.”  It metabolizes, or breaks down, most of the substances that come through the body so that the useful parts can be used, and the toxic parts can be eliminated.

RM: So if the liver isn’t functioning, all the toxins and waste build up somewhat similar to what happens when both kidneys fail. The difference is that dialysis can sustain us when we have kidney failure, and there’s no similar treatment for liver failure.

JH: What are some of the things that can lead to fatty liver?

RM:  High cholesterol, high triglycerides in the blood, obesity, malnutrition, gastric bypass surgery, rapid weight loss, and Type 2 diabetes are some risk factors, just to mention a few. But important to remember is that not everyone with one of these abnormalities or diseases gets fatty liver. The cause of fatty liver is not fully understood yet.

JH:  The other thing that some people don’t realize is that some medications can cause liver damage, and even liver failure.  This is called “drug-induced liver disease”. 

RM:  What are some of those drugs?

JH: There are many: isoniazid – a drug used to treat tuberculosis; niacin – used to treat high cholesterol; nitrofurantoin – an antibiotic often used to treat urinary infections; and acetaminophen – that’s the generic name of Tylenol.

RM: Tylenol? You mean that if we take that routinely for a headache, we can get liver disease?

JH:  No – not if it’s taken as directed on the bottle which says that we shouldn’t take more than  8 Extra-Strength pills  in a twenty-four hour period.  Most of us don’t do that, so it’s not so much of a worry.

RM: But what if we take some Tylenol and take a few drinks of alcohol, which we know can damage the liver. Can both of those together in smaller doses add up to cause liver damage?

JH: Absolutely. Great point.  Someone who drinks more than two alcoholic beverages a day should not take more than 4 Extra-Strength pills in a day.  Taking more Tylenol than that, in addition to the alcohol, can hurt the liver.

RM: So, to keep our livers healthy, we shouldn’t be taking in lots of different substances?

JH: Exactly right. Which makes it so important that we always follow the directions on pill bottles, and that we educate ourselves as to which common substances we put in our bodies can hurt the liver.

RM:  I’m getting tired here, so I know our readers are too. Quickly, what are the other things that can cause liver damage?

JH: The different types of viral hepatitis – Hepatitis B and Hepatitis C can lead to chronic liver damage, but do not always do that.  In addition, certain hereditary diseases, like Wilson’s disease, can lead to liver damage.

RM: So, to keep our liver healthy, we need to be aware of : 1) a family history of liver disease; 2)  exposure to one of the hepatitis viruses; 3) the medications we take  and whether they can damage the liver; 4) our weight and cholesterol level in order to be checked for fatty liver if they are high; 5) how much alcohol we are drinking per day.

JH: Right. And, we need to be able to tell our healthcare provider all of that. We need to know that early in its course, liver disease may cause no symptoms at all, or may just cause severe fatigue or itching. By the time other symptoms appear, such as swelling in the legs or abdomen, the disease is advanced.

RM: And that liver disease can be diagnosed through simple blood tests, known as the liver function tests.

JH: And that a diet of nutritious foods, maintaining a healthy weight, and drinking alcohol in moderation will go a long way in keeping the liver healthy.

RM: Whew! Huge topic, and we could talk about it for an even longer time.

JH: But we’ll table this discussion for now. It’s very appropriate that next we’ll talk about Chronic Fatigue Syndrome because that’s almost where I am right now!

To learn more about your liver and how to take care of it, go to:

http://www.liverfoundation.org/

http://www.cdc.gov/hepatitis/index.htm