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World Liver Day falls on April 19 each year. Let's take a look at how to keep your liver healthy through dietary and lifestyle changes, as well as at the common liver diseases and the treatment options available for them.



But first, let's take a look at what the liver really does and why it is so important to take good care of it. The liver is the largest organ in the human body, and carries out the most complicated functions. It purifies and detoxifies the blood that comes from the intestines after each meal, is involved in complex metabolic pathways (involving breakdown and synthesis of carbohydrates, proteins and lipids), is a storehouse of energy, is the manufacturing centre for many essential immune-related substances... we could go on and on!

The liver is also the only organ in the body that has the ability to regenerate fully. After transient acute insults, it can come back to its original. Chronic liver disease (cirrhosis) results when the insult persists and overwhelms the liver's ability to recover. What does cirrhosis do to the liver? It replaces healthy tissue with scar tissue. A slow process of inflammation leads to scarring (fibrosis), which over years compromises the liver's ability to function, leading to consequences such as jaundice, fluid accumulation in the abdomen, bleeding in the gut, and change in sensorium. Some will develop liver cancer.

Remember that the liver can maintain full functions (with normal liver blood tests) even at 30% capacity because of its huge reserve. So, you may have no symptoms and your labs may show normal till it is late.

Sadly, deaths from cirrhosis are rising every year. One reason is, paradoxically, rising affluence. With that comes what is called the price of prosperity: the metabolic syndrome – obesity, diabetes, hypertension, high lipid levels, high uric acid levels, and the consequent fatty liver. Not only can this progress to cirrhosis but it can also result in the Big C: liver cancer. Another major reason is increasing alcohol consumption and its increasing acceptability in society. There is no safe level for alcohol consumption, but increasing intake dramatically increases the risk, especially if it is coupled with the metabolic syndrome and with tobacco consumption. Women are at greater risk, with smaller quantities needed for damage – it's an unfair world!

Blood-borne infections (hepatitis B and C) are other major causes of liver cirrhosis, especially in India. Rarer causes include genetic and immune conditions.



Then there is the issue of acute liver diseases, commonly called 'jaundice' by lay persons (remember there are many other causes of jaundice). This most commonly results from water-borne infections such as hepatitis A and E; in most cases, recovery is complete, and the liver gets back to normal. But stay in touch with your doctor till full recovery.

Finally, some tips to keep your liver healthy:

Eat a balanced diet: Select foods from all food groups: fruits, veggies, nuts, cereals, pulses. It is much easier for the liver to handle vegetarian foods, although small helpings of animal products are OK (except in chronic liver disease – check this out with your treating doctor). Ask your nutritionist about cooking oils.

Keep fit: Exercise regularly, and be cautious about weight gain – prevention is much easier than later attempts at reduction.

Maintain hygiene: Make sure the food you have at home and outside is hygienic, cleansed well before cooking. Avoid raw foods when in doubt. Wash hands after using the washroom.

Say 'no' to tobacco, alcohol and drugs.

Practice safe sex.

Vaccinate: There are vaccines available against hepatitis A and B that are effective for a lifetime. Check with your doctor whether you need these. Fortunately, hepatitis B vaccination is now part of our national primary vaccination schedule for new-borns.

Take care with tattoos and piercings, and avoid blood transfusions unless essential: Make sure to check for proper sterilisation practices at establishments if you are keen on getting tattoos and piercings on your body. Have a high threshold for blood transfusions, even if all tests declare the blood as 'safe'.

Test: If you have ever received transfusion of blood or blood products, or had a tattoo/body piercing done, even if several years ago, get yourself tested for hepatitis B and C. You may not have symptoms for many years till the liver drops its functions.

If there is a near family member with chronic liver disease or cancer, ask your doctor to screen you too.



To conclude, you need to keep in mind that everything you eat, drink, breathe or even absorb through your skin is filtered out through your liver. Take positive steps to keep your liver healthy and seek timely treatment. Prevention is always better than cure, but there is effective treatment for many liver conditions, so meet the experts.

P. D. Hinduja National Hospital and Medical Research Centre has a panel of experienced gastroenterology physicians and surgeons who can guide you through these situations.