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When gastroenterologist, Raymond Kenny, MD, shares a lecture, he tells the audience to look left and right: one of those three individuals has liver disease. The vast majority, however, do not realize anything is wrong—they do not look sick or have any of the telltale symptoms like abdominal pain, yellow-colored skin, or weight loss. Yet, all the while, damage is occurring to this vital organ that performs nearly 200 essential functions including filtering blood, producing essential proteins, generating bile for proper digestion, and removing toxins. 


Patients who walk into Dr. Kenny’s office are surprised to find out they have liver disease. For many, the first sign is an abnormal blood test or ultrasound that was ordered for another condition. “There is a silent majority who come to me that never knew they had a problem,” he says.  

Dr. Kenny uses the acronym HAVE (hereditary, autoimmune, viral, and environmental) to explore the various causes of liver disease. The environmental category, which includes everything from the food we eat to the alcohol we drink and the exercise we receive, is typically the most common culprit. 

“Most people think if they do not drink, they will not get liver disease,” explains Dr. Kenny. “But the most common type of liver disease is actually non-alcoholic fatty liver disease(NAFLD),  a subcategory of NAFLD known as nonalcoholic steatohepatitis (NASH), which occurs  when inflammation develops in the fatty liver occur. Alcoholic liver disease is the second cause, followed by viral infections like hepatitis B and C, and then autoimmune diseases.”  

The liver is a metabolic factory, describes Dr. Kenny. This busy organ processes everything that we ingest, detoxifies the blood through transport and metabolism, and then secretes the remnants into the bowel. As a result, any substance can be toxic to the liver from medications to alcohol and excess fat. 

Nearly four million people living in the U.S. have chronic or advanced liver disease and 700,000 people have cirrhosis. Thankfully, the liver is resilient and has the ability to repair itself. Over time, however, if the liver becomes damaged enough it can lose its ability to regenerate. 

While there are some medications that can help in the early stages of disease, the best way to keep your liver function at its best is to prevent problems from occurring in the first place. Here are five ways you can keep your liver healthy.   

1. Maintain a healthy weight. Researchers estimate that 110 million Americans have non-alcoholic fatty liver disease or NASH. Ninety percent of them are overweight or obese. The medications that are available today will not significantly change the course of this disease. Instead, Dr. Kenny says the best way to treat NASH is with weight loss and regular cardiovascular exercise. “The good news is that if you are successful in losing seven percent of your body weight, the inflammation on the liver will go away,” he explains.  


Dr. Kenny’s advice: There is no official screening recommendation for NASH. However, your risk greatly increases if you have a BMI greater than 30, if your waist size is greater than 38 inches for men, or if you have a dress size above 14 for women. Discuss these risk factors with your primary care physician—they may suggest you have an ultrasound or a blood test that measures liver function.  

2. Limit alcohol consumption. Excessive alcohol intake puts you at increased risk for several liver diseases including fatty liver disease, alcoholic hepatitis, and cirrhosis. Alcohol consumption will also make NASH worse.  

Dr. Kenny’s advice: Keep your alcohol intake to no more than two drinks per day for men and one drink per day for women. If you have been diagnosed with NASH it is best to either severely limit or abstain from drinking entirely.  

3. Get vaccinated. There are three types of viral hepatitis that can attack the liver: type A, B, and C. Of the common viruses that attack the liver, both hepatitis A and B are preventable through vaccination, but there is not yet an effective vaccine for hepatitis C. While hepatitis A infection is more prevalent in less developed parts of the world like Africa, Asia, and Central America, infection rates in the U.S. have been increasing. In recent decades it has become routine to vaccinate children against hepatitis A and B as part of their regular immunizations. If you are under the age of 30, it is likely you received both hepatitis A and B vaccines as a child. If you are older, you should discuss these vaccines with your doctor.

Dr. Kenny’s advice: Know your vaccine status. If you have chronic liver disease you should be vaccinated with TWINRIX, which protects against both hepatitis A and B. In the event that you travel across the globe to any area where hepatitis A is prevalent, it is important to tell your physician and be immunized before the trip. Vaccination for Hepatitis B should be part of routine childhood vaccinations. It should also be given to people  at occupational risk or those who are in close contact with patients who have chronic hepatitis B. 

4. Take medication as prescribed.  The liver is constantly interacting with medications and processing them. Any time you have been on a certain medication for a period of time, a drug reaction can occur. If you take regular prescriptions, your physician will probably check your liver panels regularly for any abnormalities. Drug-induced liver disease is very common. One medication that is known to have toxic effects on the liver is acetaminophen (brand name: Tylenol). 

Dr. Kenny’s advice: Do not exceed the recommended dosage for any medication. Read the labels of extra strength and over-the-counter drugs carefully. Many common cold medications, for example, contain some amount of acetaminophen. Be cautious not to accidentally exceed the limit on the bottle.  

5. Eat nutritious foods. Avoid fad diets. Simple sugars like high-fructose corn syrup, that are found in carbohydrates like white pasta and bread, can damage the liver. “High-fructose corn syrup is found in most of the items we like to eat in our cabinet and anything with high-fructose corn syrup generates fat in the liver,” explains Dr. Kenny. It is important to make healthy choices and read nutrition facts carefully.  

Dr. Kenny’s advice: The effect of fad diets like intermittent fasting on the liver is still largely unknown. When it comes to liver health, the best nutritional advice is to follow a simple low-carbohydrate plan like the Mediterranean Diet. Research has also shown that diets that are low in fat reduce weight and improve cardiovascular risk factors. Also, read the labels and avoid products that contain high fructose corn syrup.