The liver has a unique
function of processing the chemicals and drugs which
enter the blood stream, via inhalation, ingestion, or
injection. Among these are drugs, industrial solvents,
and pollutants. The liver helps remove these chemicals
from the blood stream by changing them into products
that can be readily removed through the bile or urine.
During this process, unstable toxic products are
sometimes produced, which can attack and injure the
Because of the role
the liver plays in removing toxins (drugs and
chemicals), almost every known drug has been implicated
as a cause of liver damage. Some of these toxins are
predictable liver toxins, which are substances that are
known to cause liver damage, following high exposure or
prolonged exposure. Other substances may only cause
damage in a very small percentage of people and are
called unpredicatable liver toxins. Examples of
predictable liver toxins are below.
Predictable Liver Toxins
Alcohol: Alcohol is
primarily metabolized by the liver, and these
metabolites can cause liver damage.
medications can damage the liver, ranging from mild,
asymptomatic alteration in liver chemistries to hepatic
failure and death. Liver toxicity may or may not be
dose-related. Dilantin (an anti-convulsant) and
isoniazid (an anti-tuberculosis agent) are examples of
drugs that can cause 'viral-like' hepatitis.
environmental and industrial toxins can cause a wide
variety of changes in the liver. If your work or hobbies
involve exposure to toxic chemicals, wear adequate
protective gear. Toxic chemical exposure can damage the
The damage incurred by
exposure to these toxins varies from person to person
and is not necessarily dose-dependent. These exposures
may pose no risk to many people and yet cause serious
problems to other's who have had just brief exposures.
Liver damage that results from toxic exposures can range
from mild, asymtpomatic inflammation to fulminant
failure or progressive fibrotic changes and cirrhosis.
To be safe, always follow the directions on medication
and chemical labels. If in doubt, consult with your
healthcare practitioner, first. And as always, avoid any
unnecessary exposure to alcohol, drugs, and chemicals.
Liver Foundation. Prevention of Liver Disease.
A variety of both
prescription and over-the-counter medications have been
known to cause damage to the liver. The damage may range
from mild changes in liver chemistries to hepatic
failure and death. Furthermore, drug-related liver
toxicity is not necessarily dose-dependent. While most
any drug is capable of causing liver injury. Some of the
prescription and over-the-counter (nonprescription)
medications, as well as herbs and supplements that are
more likely to be toxic to the liver are listed below.
Prescription Medications Potentially
Toxic to the Liver
Some antibiotics such as,
tetracylcines or sulfanamides
Phenytoin (Dilantin) and
valproic acid (Depakene/Divalproex); used to treat
Amiodarone (Cordarone); used to
treat heart rhythm disturbances.
Methotrexate; an anticancer
drug that is sometimes used to treat rheumatoid
Quinidine, Procainamide (Pronestyl)
and Diltiazam (Cardizem); drugs used in heart
Chlorpromazine (Thorazine) and
diazepam (Valium); tranquilizers
Isoniazid (INH) and rifampin;
drugs used to treat tuberculosis
Halothane and isoflurane;
Potentially Toxic to the Liver
Vitamin A - Can be liver toxic
in high doses.
Niacin - Can be liver toxic in
Acetominophen (Tylenol) - It is
generally safe to take acetaminophen in the amount
specified in the labeling. Acetaminophen is the main
ingredient in Tylenol ®, but it is also found in
many non-prescription and prescription products for
headaches, the flu, sinus problems, arthritis or
general aches and pains (e.g. Nyquil, Exedrin,
Percocet, Darvocet, Vicodin, Actifed Cold &
is taken in excessive doses, either at once or over a
period of time, severe damage to the liver may occur.
In fact, an overdose of acetaminophen is one of the
most common causes of liver failure, as well as the
most common cause of drug-induced liver disease in the
United States. Acetaminophen is toxic at lower doses (
greater than 2 grams or 4 tablets per day), in
individuals who are regular, excessive (over two
drinks each day) consumers of alcohol, which is also
toxic to the liver. Overall, persons concerned about
liver damage should avoid alcohol use to be safe.
Other medications commonly
prescribed that increase the toxic effects of
acetaminophen include omeprazole ( Prilosec),
phenytoin ( Dilantin), and isoniazid (INH). It is
always best to consult with your healthcare
providers about taking any non-prescription
medications in conjunction with these prescription
Acetylsalicylic acid (Aspirin)
- Non-steroidal anti-inflammatory drugs (NSAIDs)
These medications have the potential to cause
drug-induced liver disease. Those that are felt to
be most toxic to the liver are: aspirin (ASA),
diclofenac (Voltaren), and sulindac (Clinoril).
Therefore, individuals with liver disease should
avoid using these NSAIDs. Individuals who have
developed complications of cirrhosis, (known as
decompensated cirrhosis), such as ascites (
accumulation of fluid in the abdomen). or bleeding
esophageal varices ( enlarged blood vessels in the
esophagus) are best advised to totally avoid all
Iron - You may need to avoid
iron supplements. Too much iron can damage liver
cells or aggravate liver damage caused by some
viruses. Most adults do not need to take iron
supplements unless there is a history of obvious
blood loss or a known deficiency of iron. Unless
your doctor prescribes iron supplements for you, do
not take any iron supplements or even multivitamins
that contain iron.
Many causes of
cirrhosis do not have any treatment available. For this
reason, many individuals resort to the use of 'health
foods' and 'natural herbs or supplements' to improve the
liver. There is no scientific proof that any of these
products are of benefit to the liver. Most of them are
safe, but there are several herbal remedies that are
known to cause liver damage. Be sure to tell your doctor
before you begin any herbal products so that he or she
may better monitor your condition. Below is a list of
herbs that have been reported to cause liver damage and
should be absolutely avoided by persons with liver
Potentially Liver Toxic Herbs and
Comfrey (Bush tea)
Gordolobo yerba tea
Jin Bu Huan Margosa oil
stress to some degree. Although we often think of stress
as negative, not all stress is bad. In fact, some stress
is a necessary part of life that helps compel us into
action, increasing our alertness and awareness. On the
other hand, learning to manage stress in one's life is
important to avoid the negative effects of 'stress
What Is Stress?
When we encounter a
stress-creating stimulus, our body responds by secreting
hormones that stimulate our nervous system and prepare
us to move, or react. If the stimulus is mild or
perceived as non-threatening, then there is little
hormone release and we react in a healthy fashion. An
example of positive stress is when you get a job
promotion or move to a new home. At times however,
excess stress-creating stimuli may overwhelm our
abilities to respond and cause a negative effect, often
called 'distress'. In this case, the stimuli may present
either a 'real' or 'perceived' threat to us. The body
responds immediately, pouring out hormones, which result
in increased heart rate, blood pressure, and breathing,
as well as sweaty palms and cool, clammy skin. Stressful
events can also trigger emotional feelings of anxiety,
fear, insecurity, and anger.
How Much Stress Is Too Much?
For most people, brief
stressful encounters are well tolerated. Prolonged
stress, however, has been linked to many health problems
including sleep disturbances, ulcers, high blood
pressure, heart disease, stroke, and depressed immune
function. Scientists have been researching the effects
of stress on illness for over fifty years. Many studies
have shown a link between chronic stress and impaired
immune system function. Researchers believe that chronic
stress affects the immune system in a number of ways.
For example, the hormones released in response to stress
may directly impair the function of immune cells. In
addition, stress seems to trigger behaviors such as
smoking, alcohol and drug use, and loss of sleep; all of
which can suppress the activity of immune cells.
stress is an important factor in maintaining immune
function, reducing infections, and fostering healing,
all important in liver disease. To manage stress
effectively, you need to be aware of your major sources
of stress. Since it is easy to underestimate or overlook
some factors that create stressful reactions for you, it
may help to keep a 'stress diary' for a week or two. In
the diary list of all events that seems stressful to you
and note what kind of stressful effects you feel. For
example: 'being late to work' may be a stressful event,
and you may feel 'anxious and get tightness in your
stomach' when this occurs. With this information, you
can then identify steps to change the stressful
situation and monitor your physical response to this
change. In this case, you may decide to get up a half
hour earlier, to avoid being late to work, and see if
this reduces your anxiousness and tightness in your
There are many methods
to reduce stress. Some have been shown to be
particularly beneficial in maintaining immune function
and aid in healing . Furthermore, recent research
suggests that maintaining an 'optimistic, positive
outlook' can ward off the 'immune-suppressing' effect of
stress. Becoming familiar with the major stressors in
your life, learning to manage those stressors, and using
techniques to promote relaxation, are important steps in
maintaining a strong immune system and staying well.
Exercise Regularly. Exercise is
the simplest and most effective means of stress
reduction and can have beneficial effects on the
Limit Stress Triggers. Identify
and take control of your stressors. If you feel
overwhelmed with responsibility, look for ways to
eliminate some commitments. It may mean postponing
school, reducing your work hours or getting help
with childcare and housework.
Secure help from your support
network (partner, family, friends and professionals,
Limit Chemicals Which Intensify
Avoid excessive intake of
caffeine and other stimulants.
Relax Deeply And Often.
Learn to reduce stress by using
relaxation techniques or meditation.
Learn New Skills.
Seek out other tools to reduce
stress, for example visualization. Your imagination
is a powerful tool. Imagining, or visualizing
restful scenes and positive, healing images helps to
reduce stress and also aids in healing and recovery.
The Meditation Room
We all have stress in
our lives, it's what we do about it that makes the
Everyone makes choices
about what to do to feel better. We may do mindless
things such as eat a whole chocolate cake, buy ten pairs
of shoes, get a drastic haircut, drink too much, drive
too fast, or take to our bed and sleep to hide. As you
nod your head in agreement to having tried at least one
of these options, I ask you to consider the exact
opposite possibilities. We can choose to take a brisk
walk, volunteer your time, visit a friend or family
member you've neglected lately, develop a hobby and add
mindful relaxation to or meditation to your life.
Meditation is the best gift we can give ourselves. It's
easier than you think. In fact, you probably do it
already without knowing it.
Meditation is not
spacing out while you chant repetitively. It's not
losing touch with reality, nor is it losing control. It
is not hearing voices or having an invisible force tell
you how to live your life. Meditation is about mindful
relaxation. It's about doing NOTHING. During this period
of time you will learn to calm your mind in a way that
leads to a deep personal connection that might be called
It requires you to
give yourself the gift of time. You begin by claiming
20-30 minutes of your day, no matter how busy, for
yourself. That move alone begins the process of better
self-care. You take this time as if it were a package.
Take it to a private,quiet place. Close the door, turn
off the telephone, turn on some soothing music, light a
candle and sit down. The rest is up to you. With daily
practice of the suggested meditations available in the
meditation room or one of your own, you will learn to
quiet your mind and experience truly
"thought-free" moments. NOTHING will occur!
You're on your way, now breathe....
presents us with challenge and stress is a natural
response. Without some stress, motivation to act would
be very low. But, if stress is excessive or lasts for a
long time, health begins to suffer. The immune system is
compromised. Rest and deep sleep can be disrupted. When
stress levels are high and self calming skills are low
or seldom used, the body becomes more vulnerable to
infection, immune disorders and, it is believed, cancer.
skills are an important skill for living well. They help
your body resist and fight cancer, and other major
diseases of our times. Without healthy relaxation
skills, some people turn to unhealthy patterns such as
over-eating, excessive alcohol use, cigarette smoking
and withdrawal from physical and social activities.
Alone or in combination, these behaviors increase vulnerability
to the ill effects of stress.
Managing stress well
does not mean avoiding it altogether. This would be
nearly impossible to do.
Instead, become aware
of stress and your body's reaction to it. Awareness,
positive thinking and effective relaxation skills, will
help you meet life's challenges while becoming
healthier. Odds are you will probably enjoy the good
feelings that also result from these relaxation skills
and the time you set aside to practice them.
To maintain liver
health, it's clear that one should avoid any unnecessary
exposure to liver toxins. Most all drugs have been
identified as potential sources of liver injuries, and
recreational drugs are no exception. In fact,
intravenous recreational drug use is one of the most
common methods of exposure to hepatitis B and C
infections. Avoiding the use of any recreational drug,
particularly, intravenous drugs will greatly reduce your
risk of contracting hepatitis.
For those who already
have liver disease, it is doubly important to avoid use
of any drugs. Drug abuse is often associated with
unhealthy lifestyles such as poor nutrition, smoking,
and alcohol abuse. All of these behaviors can reduce a
person's resistance to infection and depress healing.
If recreational drug
use is a habit, it may be prudent to seek the help of
drug abuse counselors and treatment programs. Just like
heart disease or diabetes, persons with substance abuse
disorders, need to learn behavioral changes and may need
to take medications as part of their treatment regimen.
Behavioral therapies can include counseling,
psychotherapy, support groups, or family therapy.
Treatment medications offer help in suppressing the
withdrawal syndrome and drug craving and in blocking the
effects of drugs. The good news is, such treatment
programs are very effective in reducing the many health
problems associated with drug use, including liver
damage and inflammation.
Special Report Recommendations and Reports. Primary
seen them in a magazine or in the doctor's office, or
perhaps in an online publication" says one
recovering alcoholic. "Twenty questions which
determine whether or not you have a problem with
alcohol. If you answer 'yes' to three or more questions,
you definitely have a problem. Well, of the twenty
questions, there was only one that didn't apply to me. I
never drank in the morning. Except, Bloody Mary's at
brunch on Sunday. But everyone does that, don't they?
Still, you couldn't tell me I had a drinking problem. In
fact, I was rarely sick and I actually felt better and
more in control, when I'd had a drink or two. That is
until a year ago when I developed what is called
alcohol-induced liver disease (ALD). I had nausea,
fatigue and frequent diarrhea. My healthcare provider
told me, if I didn't quit drinking, I would likely
develop liver failure in the very near future. As a
husband and father of a two-year old and a four-year
old, I knew I had to quit."
All too often,
symptoms of alcohol abuse (high tolerance for alcohol,
digestive problems, poor nutrition, and impotence) are
ignored until there is major internal damage requiring
hospitalization. In reality, chronic heavy drinkers may
metabolize alcohol differently so that they may not feel
the adverse effects of alcohol (dizziness, headache,
nausea, etc.) like most people. Regardless of these
metabolic differences, the chronic exposure to alcohol
places a heavy toll on the liver.
How Does Alcohol Damage the Liver?
When alcohol is
metabolized by the liver, some products are generated
such as acetaldehyde that are actually more toxic than
alcohol itself. In addition, it is thought that alcohol
consumption leads to release of free radicals
(substances generated during metabolic processes and
normally 'cleaned up' by free radical 'scavengers').
These free radicals can damage liver cells and trigger
inflammation in the liver. Long term alcohol consumption
results in chronically high levels of free radicals and
inflammation, which ultimately leads to destruction of
liver tissue and scarring. With progressive scarring,
liver function deteriorates to the point of liver
failure and its associated complications.
consumption of alcohol can cause a variety of
alcohol-induced liver diseases (ALD) including excess
fat in the liver (fatty liver), alcoholic hepatitis
(inflammation in the liver), and cirrhosis (permanent
scarring of the liver). Roughly one out of five people
with heavy alcohol consumption* will develop the
devastating health problem of liver cirrhosis. These
individuals often die from liver failure and its
associated complications such as gastrointestinal
bleeding, infection, or kidney failure. In addition,
excess alcohol consumption increases the risk of
pancreatitis (inflammation of the pancreas),
cardiomyopathy (damage to the heart muscle), trauma
(accidents occurring during drunkenness), and the
development of fetal alcohol syndrome (damage to the
unborn child from excess alcohol during pregnancy).
How Much Alcohol Causes Liver Damage?
The amount of alcohol
consumed before liver damage occurs is extremely
variable. Some people are very sensitive to the effects
of alcohol, while others are seemingly invulnerable to
its harmful effects. In general, the greater the amount
and the longer the duration of alcohol consumption the
more likely that injury to the liver will occur.
While the relationship
between alcohol and the development of liver disease is
not fully understood, research is suggesting several
variables that influence one's vulnerability to ALD.
Genetic factors may cause functional changes in liver
cells that influence metabolism of alcohol and other
liver toxins. Animal research indicates that certain
dietary factors (high-fat, low-carbohydrate diets) in
combination with high alcohol consumption results in
more rapid progression of liver damage.
Gender may also play a
role. Although the reasons aren't completely clear,
women develop ALD after consuming lower levels of
alcohol over a shorter period of time compared with men.
This may be in some part due to women having a decreased
amount of the enzyme needed to metabolize alcohol. In
addition, women have a higher incidence of alcoholic
hepatitis and a higher mortality rate from cirrhosis
than men. Finally, the presence of HCV may increase a
person's susceptibility to ALD and influence the
severity of alcoholic cirrhosis.
At present there are
no laboratory tests that effectively detect one's risk
of developing ALD. Likewise, abstinence is the only
therapy for ALD. With abstinence, fatty liver and
alcoholic hepatitis are frequently reversible, and
survival is improved. For those with terminal liver
failure, liver transplantation remains the only
effective treatment. However, a period of abstinence
(usually 6 months), is required even for those who are
candidates for liver transplantation. And even for those
individuals, there is no guarantee that a donor liver
will be available.
The Message: Don't
defined 'heavy drinking' as the daily consumption of
five to six standard drinks, each drink equivalent to
approximately 12 ounces of beer, 5 ounces of wine, or
1.5 ounces of distilled spirits.
U.S. Department of Health and Human Services (1998).
National Institute on Alcohol Abuse and Alcoholism No.
Watterlond, Michael. The
telltale metabolism of alcoholics. Science.1983. pgs
Smoking and Tobacco
You know smoking and
tobacco use is bad for you. But, what's in tobacco and
what risk does smoking or tobacco use pose to the liver?
Tobacco contains all sorts of things that most people
would never even consider exposing themselves to. Tar,
arsenic, formaldehyde (which is used to preserve dead
mammal tissue), the chemical DDT, carbon monoxide (the
noxious byproduct of cars), and nicotine (the addictive
drug) are some of the hazardous substances found in
In addition to raising
the risk of heart attack, stroke, cancer, and chronic
breathing problems, tobacco is toxic to your body.
Tobacco is the cause of more health problems and early
deaths than all illegal drugs. In addition, tobacco is
highly addictive. The longer you use tobacco the more
your body craves it. Many people try smoking, mistakenly
thinking they won't get addicted. If you don't smoke,
don't start! If you do smoke, the sooner you quit the
The key to protecting
the liver, is to avoid any unnecessary exposure to
toxins. First and foremost is avoiding toxins from drugs
and alcohol. And second in line is avoiding toxins from
tobacco. If you want to protect your liver by
eliminating alcohol and tobacco you may find these facts
Heavy drinkers who
smoke are more likely to get heart disease, lung disease
and cancers of the head, mouth and throat. They are also
more likely to die earlier than others in the general
public. Smoking and drinking are activities that usually
go together. Smoking tends to create a stronger craving
for alcohol, and vice versa. So quitting smoking can
help to reduce your desire for alcohol.
If you feel that there
is too much stress in your life to quit smoking right
now, remember, you will always have stressful times.
Rather than using stress as an excuse for smoking,
consider learning effective stress management techniques
such as relaxation or meditation.
Make no mistake,
quitting smoking is no easy task. However, there are
numerous programs and even medications which have proven
very effective in helping smoker's quit. While your on
the road to better health, why not quit smoking? Your
body will thank you!
Family Physician: Health Info Handouts. Internet
Found November 2000