There is some overlap in discussing the causes and effects of liver damage. For example, a hepatitis B infection can lead to cancer of the liver, and most of the common causes of liver damage, whether stemming from chemical poisoning, infectious disease, or a hereditary condition-can lead to cirrhosis, the progressive destruction of functioning liver tissue and its replacement with inert scar tissue. Cirrhosis and other liver diseases take the lives of over 25,000 Americans each year, ranking third as a cause of death for Americans aged 45-65 (after heart disease and cancer) and eighth as a cause of death in the United States overall.

Bearing this overlap in mind, what follows are lists of (mostly avoidable) risk factors for liver damage and of diseases of the liver.

Risk Factors for Liver Damage

Drugs/medications. Many of these substances, both prescribed and illegal, are potentially liver-toxic. Potential liver damage is a common warning found in prescription drug descriptions. Rezulin, Trovan and Arava were withdrawn from the market or subject to FDA warnings and label changes due to cases of liver toxicity; and ibufenac, perhexilene and dilevalol, all marketed abroad, were never approved in the United States. Isoniazid, labetalol, dantrolene, felbamate, pemoline, tolcapone, and trovafloxacin are among the many drugs that have had limitations placed on their usage due to liver toxicity concerns. Last year the maker of the antidepressant Serzone was compelled by the FDA to add a warning about rare cases of liver failure to its drug information. Many lawsuits are going forward on behalf of people injured by dangerous drugs.
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Birth control pills. There have been some cases where as little as two to three weeks of use have been documented to severely reduce the ability of the liver to detoxify naturally produced estrogen, especially in women with B vitamin/protein deficient diets.

Anabolic steroids. Liver damage is a major side effect of chronic steroid abuse by athletes.

Kava Kava. Recent evidence in Europe has led to restrictions on this dietary supplement in several countries.

Acetaminophen. Over the counter products include Tylenol, Anacin-3, Arthritis Pain Formula Aspirin Free, Datril Liquiprin Elixir, and St. Joseph Aspirin Free Fever Reducer for Children. Taking more than 15 grams can lead to irreversible liver disease in adults. Whether smaller doses over long periods of time (such as those recommended for relieving arthritis symptoms) harm the liver has not been determined, but prolonged use increases the risk of kidney damage. Taking acetaminophen while fasting (for example during illness) may contribute to liver damage. Those who also consume alcohol in large amounts are at the greatest risk for liver damage from acetaminophen.

Alcohol. The most common cause of chemical-induced liver damage.

Junk foods. Especially those cooked in hydrogenated fats (e.g., doughnuts and french fries). Fried foods are high in liver-toxic lipid peroxides (rancid fats, which are immune suppressive and damage liver cell membranes) and trans-fatty acids (which suppress the production of PGE1, an important liver-protecting prostaglandin.

Coffee. Coffee crops are sprayed with pesticides. Since most coffee is grown outside the United States, Americans have little information on or control over what pesticides may contaminate the coffee they drink. Also, carcinogenic hydrocarbons are produced during roasting and the highest levels are found in dark roasts.

Smoking. Tobacco smoke contains an array of toxins (benzopyrene, polycyclic aromatic hydrocarbons, cyanide, acetaldehyde, tars, etc.) which are extremely taxing to the liver.

Fuel exhaust. Auto and diesel exhaust contain dozens of liver damaging poisons such as lead, sulfur and nitrogen oxides, acetaldehyde, cadmium, and peroxyacetylnitrile.

Candida. Candida yeast ferments dietary sugars into liver-toxic acetaldehyde. Candida also appears to increase gut and urinary levels of ammonia, which is another liver toxin.

Pesticides such as PDT, Aldrin, chlordane, lindane, 2,4,5-T dioxin, and toxaphene can cause chronic liver damage even at levels measured in parts per billion because they tend to accumulate in body fat over a lifetime.


Diseases of the Liver

Autoimmune Hepatitis: a progressive inflammation of the liver associated with an abnormality of the body's immune system and related to the production of antibodies. Common symptoms include fatigue, abdominal discomfort, aching joints, itching, jaundice, enlarged liver, and spider angiomas (tumors) on the skin.

Cancer of the Liver: The most common primary malignant tumor of the liver is an hepatocellular carcinoma. Chronic carriers of hepatitis B or hepatitis C virus, particularly those with chronic hepatitis or cirrhosis, are at substantially increased risk of developing hepatocellular carcinoma.

Chronic Hepatitis: an ongoing injury to the cells of the liver with inflammation that lasts for longer than six months. Causes of chronic hepatitis are viruses, metabolic or immunologic abnormalities, and medications. Signs and symptoms may include fatigue, discomfort in the upper abdomen, loss of appetite, and aching joints.

Cirrhosis: a group of chronic liver diseases in which normal liver cells are damaged and replaced by scar tissue, decreasing the amount of functioning liver tissue. [link to cirrhosis page?]

Cystic Disease of the Liver (including choledochal cysts, Caroli's Syndrome, Congenital Hepatic Fibrosis, and Polycystic Liver Disease)

Fatty Liver: an accumulation of fat cells in the liver, common in overweight patients and diabetics. Fatty liver can also result from alcohol over-consumption.

Gallstones: this condition affects approximately 20 million Americans, and can cause severe and intermittent pain in the right upper abdomen, as well as chronic indigestion and nausea. The removal of the gallbladder due to gallstones is the most common surgical procedure performed in the United States.

Hepatitis A: inflammation of the liver usually caused by eating food or drinking water that has been contaminated with human excrement. Symptoms may be similar to the flu. Only rarely is this disease life threatening.

Hepatitis B: one of the most serious forms of hepatitis, this disease is more common and more infectious than AIDS. Chronic hepatitis B may lead to cirrhosis and cancer of the liver. A hepatitis B vaccine is available.

Hepatitis C: this disease affects approximately 150,000 Americans each year. The most commonly recognized risk factors for acquiring hepatitis C virus include the use of intravenous drugs, a history of blood transfusions, hemodialysis, and health care employment. Transmission may also occur through sexual contact.

Hereditary or congenital disease (including Alagille Syndrome, Alpha 1-Anitrypsin Deficiency, Galactosemia, Gilbert's Syndrome, Hemochromatosis, Tyrosinemia, and Wilson's Disease.)

Neonatal Hepatitis: inflammation of the liver that occurs only in early infancy, usually between one and two months after birth. Symptoms include jaundice, failure to grow or gain weight, and an enlarged liver and spleen.

Porphyria: a disease in which porphyrins, a chemical compound in the body, do not successfully perform their task of forming heme (the substance that makes blood red). Malfunctioning porphyrins build up in the body, causing a variety of symptoms ranging from abdominal pain and weakness to blisters on the skin.

Primary Biliary Cirrhosis: a chronic liver disease that causes slow, progressive destruction of bile ducts in the liver. The disease is 10 times more frequent in women than men, and is usually diagnosed in people 30 to 60 years of age. Many patients have no symptoms and are diagnosed through the appearance of an abnormality on routine liver blood tests.

Primary Sclerosing Cholangitis: a disease in which the bile ducts inside and outside the liver become narrowed due to inflammation and scarring. It usually begins in a person's 30s, 40s, or 50s and is commonly associated with fatigue, itching, and jaundice.

Reye's Syndrome: a rare complication of childhood respiratory infections characterized by vomiting that begins three to seven days after the onset of flu or chicken pox. Aspirin may contribute to the development of Reye's Syndrome. Other symptoms include listlessness, staring, and drowsiness.

Sarcoidosis: a systemic disease of unknown cause, in which nests of cells appear in many tissues, including the lung, lymph nodes and liver. Blacks are affected about 15 times more often than whites in the United States, with the highest incidence in the southeastern states.

Type I Glycogen Storage Disease: a deficiency of the enzyme glucose-6-phosphatase, which helps in maintaining normal blood glucose (sugar concentration) during fasting. Symptoms include growth failure, a greatly enlarged liver, and a distended abdomen.

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