Multaq FDA : Fortunately, in America we have a free press. For the most part, people can write what they want. Publishers can publish what they like. There is a book called The Liver-Cleansing Diet. I must admit I have not read more than the first few pages of this book. But the tide alone cracks me up. On the first page of the book, the author, who is a medical doctor, writes: “excessive weight is a symptom of liver dysfunction.” She then claims to have treated more than one thousand patients “to improve liver function.” For all I know, the rest of the book goes on to describe a general healthy diet that may be good for all people. But “liver cleansing” has no medical or scientific meaning. And after reading the preceding chapters of this book, I hope you now understand a little about what liver dysfunction is and that “cleansing” is not a treatment. The point here is to beware of claims not based on science, even when the source has a medical degree.
Beliefs about diets to clean the liver or promote liver health probably derive from so-called alternative or holistic medical practices. Many alternative or holistic products include preparations for a healthy liver, healthy heart, healthy kidney, or other organs. Milk thistle or silymarin is considered by many to be a natural product that “strengthens” the liver or keeps it healthy. These diets or products have not been shown to be effective in any scientifically valid studies.
“While there are appropriate dietary interventions for some patients with certain liver diseases, particularly those with complications of cirrhosis, there is no general “liver diet” or any diet to keep the liver “clean” or “healthy.” For the most part, diet and a lifestyle that is conducive to general good health are probably good for the liver. All individuals, including those with chronic liver disease, should minimize fat intake and maintain ideal weights by watching what they eat and exercising.
What about vitamins? Excessive consumption of some vitamins, vitamin A in particular, can actually damage the liver. Some elements, such as excessive iron, are also probably not a good idea for people with chronic liver disease. My recommendation is that most people with chronic liver diseases—and most people without liver disease— should take a regular multivitamin each day (individuals with chronic liver diseases should probably take ones without iron). Excessive vitamins should be avoided.
Naturally, all individuals should use common sense and avoid substances and actions that can potentially damage the liver or other parts of the body. These include excessive alcohol consumption, use of illicit injected drags, and use of herbs or “remedies” that may be toxic. Ask your doctor about herbs and nonprescribed “remedies” if you really want to take one.
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Alcohol consumption in moderation will not hurt the liver. Perhaps it is even good to drink alcohol in moderation. Some studies suggest that one or two drinks of red wine a day decrease the risk of developing coronary heart disease. Using common sense about alcohol consumption is probably fine for one’s liver, assuming of course the individual has common sense.
What do I tell patients with chronic liver diseases, other than alcoholic liver disease, who ask about drinking alcohol? While there is no good scientific study on which to base a decision, except to say that excessive drinking is dangerous, and some liver specialists believe that patients with any liver disease should not drink alcohol, I tell such patients that reasonable alcohol intake is not harmful. The late Dr. Fenton Schaffner, who was a very distinguished liver specialist and my teacher, used to tell his patients with liver diseases not caused by alcohol abuse that it was OK to drink as long as they drank “only the good stuff.” His point was that responsible drinking in moderation is probably not harmful. A couple of glasses of wine with a nice dinner, a beer at a sporting event, a glass of champagne at a party, or an occasional cocktail will probably do no harm.
I can’t provide exact numbers on how individuals with liver disease should limit their drinking. Probably no more than one or two drinks a day on a regular basis is reasonable. My general recommendation is that moderate alcohol intake is safe for most individuals with chronic liver disease (again, other specialists may have different opinions). Patients with nonalcoholic fatty liver disease, especially nonalcoholic steatohepatitis (NASH), may want to limit their consumption a bit more because alcohol can cause fat to accumulate in the liver. It is also a source of excess calories. One absolute exception to being allowed to drink alcohol is the person with an alcohol or substance use disorder. People with alcohol use disorders should not drink, whether or not they have liver disease.
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Liver disease can affect the normal functions of the liver. However, abnormalities in liver function are usually not apparent in most individuals with chronic liver disease until the disease is rather advanced. Clinical and laboratory evidence of abnormal function is usually not present unless the liver is significantly compromised. Patients with clinically abnormal liver function usually have advanced cirrhosis or significant acute destruction of liver cells, as discussed in Chapter 3. Nevertheless, there are clinical findings and laboratory tests that can detect liver disease prior to significant deterioration in liver function. Before discussing these clinical findings and laboratory tests, however, it is important to distinguish acute versus chronic liver disease.
A critical distinction in liver disease is to establish whether it is acute or chronic. Acute diseases occur suddenly and are usually relatively short in duration. Chronic diseases are typically long-term and their onset may be insidious. A general definition of a chronic liver disease is one lasting more than six months.
The concerns in acute and chronic liver disease are different to some extent. An acute liver disease resolves itself, becomes chronic, or kills the patient. Some acute liver diseases can cause a severe type of liver failure known as fulminant hepatic failure. The therapeutic goal in acute liver disease is to keep the patient alive and, in some cases, to prevent the disease from becoming chronic. This involves either curing the acute disease or supporting the patient until – it spontaneously resolves.
By contrast, the therapeutic goal in chronic liver disease is to cure the disorder, prevent it from advancing, or control the complications. Preventing advancement of a chronic liver disease usually means stopping it from becoming cirrhosis. In an individual who already has cirrhosis, preventing further deterioration of liver function and controlling the resulting complications are the treatment goals.
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