Answers to Your Questions about Liver Health

Posted by Larry Blumenthal on Jan 30, 2017 3:30:00 PM


You may not be aware of it, but your liver plays an important role in your digestive system. Everything you drink or eat – including medications and supplements – passes through your liver, creating the potential for damage.

On Wednesday, January 25, 2017, hepatologist Jennifer Au, MD, and registered dietitian Danielle Zolotnitsky from Einstein’s Center for Advanced Liver Disease and Transplantation fielded questions about liver health and wellness live on Facebook. Below is a transcript of the questions and answers. You can view the event itself on Facebook.

Also, the Center for Advanced Liver Disease and Transplantation invites you and a support person to a free patient education program, Autoimmune Liver Disease and You. The program features Victor Navarro, MD, co-chairman, Department of Transplantation, Simona Rossi, MD, associate chairman, Division of Hepatology, and Eyob Feyssa, MD, director, Viral Hepatitis Program. Please join us on Saturday, February 11, 2017 from 9 a.m. to noon in the Gouley Auditorium at Einstein Medical Center Philadelphia to learn more about autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis and more.

Space is limited. Please register today.


Liver Chat Transcript:

Welcome. Dr. Au and Danielle are here to answer your questions. Let's get started.

What is a Fibroscan?

A Fibroscan is a bedside, ultrasound-based test that can help measure the amount of scar tissue in your liver. It is a quick test that can help us determine if you have significant liver disease.

Do I have to spend a lot of money on “super foods” to keep my liver in the best health?

Eating healthy does not equal spending a lot of money. This is a myth. Labeling something as a "super food" is usually done for marketing reasons. Most fruits and vegetables are excellent sources of nutrients. If you need help meeting your health goals on a budget, meet with a registered dietitian. Quick tip: buy produce in season.

I had hepatitis C over 10 years ago and was on the "Pegasus Cocktail" (a drink touted as a liver cleanse) for a year. After testing for the next two years, there was no sign of the virus. However, I'm still concerned that my liver is functioning properly. My stools are NOT dark brown, but more lighter in color like "brown mustard." Is this okay? How will I know if my liver is damaged at all and/or if it is fatty?Top of Form

Color of stool is hard to use as a marker of liver disease. Some patients who have cirrhosis will have very light "clay colored" stools. If you are concerned your liver isn't working well, please have your doctor check your liver tests to monitor.

I was diagnosed with fatty liver disease. Does that mean my liver is failing?

Having fat in your liver does not mean that there is damage. Some people have fat in their liver that never causes problems and others end up with cirrhosis (the gradual destruction of liver tissue over a period of time)

. To help determine, it can be helpful to monitor lab tests and in some cases we like to look for the amount of scar tissue in the liver. This used to be done with a liver biopsy, but now we have ways to check that are not invasive. These include the use of ultrasound, blood tests, MRI or Fibroscan (a bedside machine available in our liver office). 

I was going through my health food store and looking at herbal supplements. Are they safe?

We typically recommend that you avoid all herbal and dietary supplements. Sometimes these can be contaminated or contain products that are harmful to the liver, and we have seen people go into liver failure as a result of supplement use.

What warning signs should we look for that indicate we might have a liver problem?

Typically there are no obvious signs or symptoms of liver disease until it has advanced to cirrhosis. In general, I would recommend regular follow-up with your primary care doctor to monitor your liver tests, and if any abnormalities are noted he or she can follow up appropriately. Some signs and symptoms of cirrhosis are yellowing of the eyes and skin, swelling of the abdomen or legs, easy bruising and bleeding, and sometimes confusion.

But these signs are typically at the final stages of the disease, yes? These were the symptoms my mother displayed within those 13 days before she passed away. We never noticed it before on her, nor did she. What advances is technology/science looking to make that can help identify early on-set signs of the disease?

Those are the signs of cirrhosis (final stages of disease). A lot of times people will not exhibit any outward signs and symptoms. We often use blood tests and imaging to help us detect liver disease earlier in the course. I would recommend you follow up with your primary care doctor first. If you are obese, have diabetes and high cholesterol that puts you at much higher risk for fatty liver disease. I would recommend that you also have an ultrasound of your liver done.

Thank you for that. I will absolutely follow up with my primary doctor. I have had my liver enzymes monitored in my recent blood work, but I've never thought of having the ultrasound done. Will discuss it with my doctor to see what he thinks.

You are welcome.

So it sounds like blood work is the only "routine" examination that can possibly catch something, correct? Anything else you would need to request?

If you are born between 1945-1965 or have a history of IV drug use or tattoos you obtained from the streets, or blood transfusions before the 1990s, I would recommend you request to be checked for hepatitis C.

I would like to know if the success rate for treatment for African Americans with hepatitis C is getting better. The success rate a few years ago was not that successful, something like 20 percent.

With the new medications that have been released within the past few years, cure rates are now above 90 percent. 

Wow, that's great. But are insurance companies offering assistance with the medications? I'm sure they are expensive.

The medications are very expensive. Here at Einstein we have a great team who deal with helping people get insurance authorization for treatment. We also work with specialty pharmacies to ensure that patients do not incur high copays, if any.

Is it still the practice that if you have the disease, but it's not bad enough for you to need treatment, you can't get treatment and just be done with it? Or do you have to be in a life or death situation to get treatment?

You do not have to be in a life or death situation in order to get treatment. We treat people with all stages of liver disease from hepatitis C.

That's good to know. I will have to follow up with my doctor there. It was frustrating to be told you don't need treatment yet because yours is not at the point where you would need it and because of success rate at that time. I guess now that treatment is more successful I should revisit the subject with my doctor. Thank you very much for answering my questions. I feel much more hopeful.

Glad we could help.

How important is drinking water to the liver? Sad to say I drink very little.

Drinking water is very important for overall health, as well as liver health. Aim for at least eight to 10 glasses a day.

Why do some people get fatty liver disease from drinking alcohol and some do not?

It depends in part on how much you drink and in part on your genetics. Some people can handle more alcohol than others.

What is considered excessive alcohol intake?

Excessive alcohol intake varies from person to person.

What general preventative measurements can we take to keep our livers in peak condition?

Make sure you are visiting your physician for your yearly checkups (this should include blood work). In the meantime, be physically active, follow a balanced diet (with plenty of fruits, vegetables, and lean protein), and avoid sugar-sweetened beverages. Avoid excessive alcohol intake.

I've heard that too much acetaminophen is bad for the liver. How much is too much?Top of Form

Typically, people with healthy livers should take no more than 4,000mg of acetaminophen (Tylenol) a day. If you have cirrhosis, you can safely use less than 2,000mg of acetaminophen a day.

Can fatty liver disease be reversed or cured with a specific diet?

Fatty liver can be reversed with proper blood sugar control, managed blood pressure, reduced weight, and a balanced diet. Try increasing legumes, fish and vegetables.

Thank you for your information.

In 2013, my mother passed away from non-alcoholics fatty liver disease in a matter of 13 days from diagnosis to death. How common is this? What signs were missed that we should all be aware of? I've never heard of this disease until my mom. What can be done to maintain a healthy liver? If there is any damage, can it be reversed?

Sorry to hear about your mother. Fatty liver disease is becoming an epidemic. We see fatty liver problems in up to 30 percent of the population but typically it results in significant liver damage in only a small percentage of those people. It is a good idea to follow up with your primary care doctor to monitor your liver tests. 
Some liver damage is reversible, but it is important to try to catch liver disease early before it is too late.

I've heard that using milk thistle is also very helpful to the liver. I recently purchased 1,000 mg milk thistle extract (pills). Is there any truth to this? Or is it simply a myth?

There have been a lot of studies looking into the use of milk thistle, but none of them proved to have significant benefit. We therefore do not recommend its use.

OK, thanks for that. I wouldn't want to use anything that would cause additional issues. It's such a difficult disease to work at preventing and/or discovering early on. It's very discouraging. Especially when you recognize that the only signs that do appear are when there is pretty much no time to correct or reverse.

It is true, it can be very tricky. To keep your liver healthy, we typically recommend that you avoid taking unnecessary medications, herbal or dietary supplements and eat a healthy diet. Commonly, primary doctors will pick up on liver disease early on because they check lab work yearly.

How can a water fast diet help the liver?

No, fasts are not suggested for liver health. Following a balanced diet with fruits, vegetables, lean protein, and whole grains along with physical activity and water consumption will help keep your liver in good health.

What are the complications of a liver transplant, if any?

Liver transplants are very complicated surgeries and can have many different problems. Some people have problems with infections, others with the new liver not working well, among other issues.

I have had a very large ulcer for approximately 10 months and am on at least six medications. My cirrhosis is auto immune (PBC). I was recently hospitalized for pain and burning and had steroids injected directly into the ulcer.

Thanks for joining our chat and sharing your experience. If you'd like to discuss further and get answers specific to your situation, please schedule an appointment by calling 1-800-EINSTEIN.

I take Lunesta 3mg every night. I just wonder if it can damage my liver?

Lunesta is typically safe for the liver.

I recently had a liver duct blockage where they had to perform a sphincterectomy. Can it occur again and how soon?

Bile duct blockages can reoccur. It depends on what caused them. I recommend following up with the doctor who performed the sphincterectomy to discuss further.

Can the liver heal itself? What is required to heal hepatitis C, if anything?

Yes. The liver can heal itself if whatever disease process that is hurting the liver is stopped. The only way to heal hepatitis C is to take medication that kills the virus.

This is a great, timely lecture. I've been inundated lately by liver cleanses and diabetes free websites. What are your thoughts?

Cleanses are not necessary for liver health. It is important to reduce your risk factors for diabetes, as it can increase your risk of liver disease. You are welcome to make an appointment to see one of our dietitians by calling 1-800-Einstein.

Interested to know about the meaning of high AST and ALT. What is going on there? NAFLD (non-alcoholic fatty liver disease), but not obese. Very low lipids (tot. cholesterol <100) in case this relates. Also, any credence to use of saw palmetto?

AST and ALT are known as transaminases, which are lab measures that reflect damage to the liver. It is not as common, but we do see fatty liver disease in people who are not obese and have normal cholesterol levels. Alcohol use is also a common cause of fatty liver. There are also some rare diseases that can lead to fat in the liver. Saw palmetto is not helpful for liver health.

My extremely low lipids (85-95 total cholesterol) would not be related to NAFLD? I drink only rarely and am not obese.

Your low cholesterol would not be the result of your fatty liver disease. There are some rare disorders such as lysosomal acid lipase deficiency that can also result in fatty liver disease.

Also, is low level NSAIDs use problematic to liver, e.g., one or two naproxen (220mg)/ day?

If you do not have cirrhosis, NSAIDs are safe to use.

I was supposed to start Harvoni (a chronic hepatitis C medication), however, was diagnosed stage 1 NSCLC (non-small cell lung cancer) adenoma of left lung. Planning radiation therapy. How long after can I have cure medications for my liver?

I would wait until you are done with your breast cancer treatment and then come back into the office to discuss. Typically, we try not to start hepatitis C medications if you need chemotherapy. If you need radiation alone, it is probably safe to start once your radiation treatments are complete.

I am on 5 different medicines for the past 13 years. How likely am I to develop liver disease?

It is very difficult to predict your risk to develop liver disease. Some medications are harmful to the liver and others are not. Make sure your primary care doctor follows your liver tests regularly to see if there are any concerns about your liver health.

What special diet can you have for fatty liver NAFLD (non-alcoholic fatty liver disease)

A Mediterranean-style diet can help reverse fatty liver. This is lean protein, vegetables, legumes, nuts, whole grains and water as a beverage. Physical activity is also very helpful.

Do you have recipes at all?

Feel free to make an appointment with our dietitian by calling 1-800-Einstein.

Where are you located?

You can find our locations here:

Can blood thinners cause liver diseases and, if so, can you take milk thistle?

Blood thinners do not cause liver disease. Milk thistle is not helpful in preventing liver disease.

Can you comment on liver cleansing, or ways to reduce triglycerides, cholesterol, and improve absorption of nutrients? Glucose metabolism?

Cleanses are not necessary and can be dangerous. Ways to reduce cholesterol are primarily diet-related and through exercise. Nutritionally, we recommend avoiding fried foods, a lot of red meat and sugar-sweetened beverages.

Is there a special diet for PSC (primary sclerosing cholangitis) patients and is there a low protein nutritional shake I can drink?

There is actually no need for a protein restriction. Your liver needs protein. You just need to follow a normal healthy diet. Avoid alcohol as well.

Thank you so much. I’ve been doing under 30 grams a day.

There is no reason to limit your protein.

We are going to wrap things up. 

  • You can learn more about Einstein Healthcare Network's Liver Disease and Transplantation on our website.

Thanks for joining us today to learn about liver health. 

Au.jpgJennifer Au, MD

Dr. Au oversees Einstein's liver health, wellness and metabolism program. She specializes in liver disease and transplantation and has a special interest in fatty liver and physical debility related to liver disease. She is a member of the American College of Gastroenterology and the American Association for the Study of Liver Disease. View Dr. Au's full profile


Danielle Zolotnitsky.jpgDanielle Zolotnitsky, Nutritionist

A registered dietitian trained at the Cleveland Clinic, Danielle enjoys helping patients recover from transplant and meet their wellness goals. She is especially interested in the nutrition therapy and prevention of fatty liver and sarcopenia. She completed her undergraduate degree at the University of Pittsburgh.


Topics: Liver

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Perspectives highlights the expertise and services provided by the physicians, specialists, nurses and other healthcare providers at Einstein Healthcare Network. Through this blog, we share information about new treatments and technologies, top-tier clinical teams and the day-to-day interactions that reinforce our commitment to delivering quality care with compassion. Here, you will also find practical advice for championing your health and wellness.

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