Prevention In Liver Disease

Smokers are at an increased risk for liver disease.

Liver disease has many causes. All chronic liver diseases can progress to cirrhosis. Some liver diseases are preventable while many are not. Unfortunately, many of the causes of liver disease are not preventable, as they are caused by hereditary or autoimmune factors. There are factors which can be modified to prevent progression of any liver disease.

Alcohol is known to cause liver disease. Excessive alcohol intake over a long period of time can lead to the development of fatty liver, cirrhosis, liver failure and even cancer. In people with liver disease of any cause, alcohol is even more dangerous. Small amounts of alcohol taken on a daily or weekly basis can lead to more rapid disease progression. People with hepatitis C, hepatitis B, fatty liver or any other type of chronic liver disease who drink alcohol are at a greater risk of disease progression than those who minimize or abstain from alcohol use.

What constitutes alcohol intake? I am often surprised when people tell me that they do not drink alcohol, but only drink beer and wine. It is a common misconception that hard liquor such as whiskey and vodka are the only alcohols that are dangerous to a person with liver disease. Beer and wine are alcoholic beverages. To prevent liver disease progression, alcohol intake must be minimized or eliminated in those with liver disease, especially in women who are at greater risk of disease progression with even small amounts of alcohol ingestion.

Cigarette smoking has also been associated with the development of increased fibrosis of the liver. People with liver disease who smoke are more likely to progress to cirrhosis. Liver disease now joins heart, lung and cerebrovascular diseases as being adversely affected by cigarette smoking. To take this to the next level, we still do not know the effect of secondhand smoke on liver disease progression, although it likely may lead to increased scarring. Just being around people who smoke may be detrimental to one’s liver health. To prevent liver disease progression, it is important to stop smoking.

The use of marijuana has been associated with greater amounts of liver scarring and disease progression. For similar reasons as with cigarette smoking, people with liver disease should avoid the use of marijuana, whether inhaled or ingested.

Diet is perhaps the most important factor that can be modified to prevent liver disease progression. Weight gain and obesity are independent risk factors for the development of liver disease. Any liver disease will be worsened by weight gain and poor dietary choices. More than 60 million Americans have fatty liver disease and many others with all forms of liver disease have fat deposition in the liver. This fat may lead to inflammation, fibrosis and cirrhosis. A good heart-healthy diet, low in fat and high in fruits and vegetables, is best for the liver. Avoidance of high carbohydrate desserts and avoidance of alcohol will lead to a healthier liver. Exercise is critical to mobilize fat and burn calories.

In people with chronic liver disease, medical intervention can also prevent acute worsening of disease. Vaccination is the key to this. Vaccines are currently available to prevent hepatitis A and B. All children are currently vaccinated against hepatitis B. The current recommendation is that all people with any type of liver disease be tested for immunity to hepatitis A and B.

While we cannot always control being affected by chronic liver disease, simple modifications in diet and exercise coupled with avoidance of cigarettes, marijuana and alcohol may slow disease progression and prevent the development of cirrhosis and liver cancer. These modifications are not only good for the liver, but may also lead to an overall improvement in general health.


David Bernstein, MD, is chief of gastroenterology, hepatology and nutrition at North Shore University Hospital and Long Island Jewish Medical Center.

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