Alcoholic and Toxic Liver Disease: Overview and Risk Factors

The liver is responsible for detoxifying most drugs and toxins and eliminating them from the body. In the process, some of these toxins can damage the liver—a condition called hepatotoxicity. Common culprits include alcohol, illicit drugs, medications, herbs, and dietary supplements.

Drug– or alcohol–related hepatotoxicity is the most common cause of liver failure. Alcohol–related liver disease alone accounts for more than 12,000 deaths yearly in the United States, and alcohol abuse is the most common cause of cirrhosis.

Alcohol is the most frequently abused drug worldwide. Abuse results in a broad spectrum of liver disease, which can result in cirrhosis and end–stage liver failure requiring transplantation. The damage may be silent for years. Many alcoholics become symptomatic only when severe, life–threatening liver disease is already present.

Virtually any drug can cause some degree of liver damage, although certain drugs are more toxic than others. Common hepatotoxic substances include acetaminophen (Tylenol), aspirin, various antibiotics (e.g., tetracycline and isoniazid), and cholesterol–lowering drugs (“statins”). In high doses, vitamin A, arsenic, iron, and copper can be hepatotoxic. Further, hepatotoxicity may be the most common adverse effect of herbal supplements. Herbs with known potential for toxicity include kava, pennyroyal oil, ma–huang (ephedra), valerian, mistletoe, comfrey, chaparral, sassafras, borage, and germander.

The severity of liver disease varies greatly from person to person. Some people remain asymptomatic despite significant liver damage, while others have symptoms of a severe, acute illness. Nausea, vomiting, malaise, and profuse sweating are common symptoms. A syndrome similar to viral hepatitis may occur, including fever, headache, jaundice (a yellow discoloration of the skin), and right–sided abdominal pain.

Because of the liver’s regenerative ability, withdrawal of or abstinence from offending substances can result in significant reversal of liver damage, even in cases of advanced disease.

Risk Factors

• Gender: Females who drink alcohol have an increased risk of liver disease compared with men, and liver disease in women tends to progress more rapidly than in men.
• Genetics: There appear to be genetic predispositions to alcohol abuse and alcoholic liver disease. However, specific genes have yet to be identified.
• Viral hepatitis: Infection with hepatitis B virus or hepatitis C virus is strongly associated with risk of advanced liver disease in alcoholic individuals.
• Obesity
• Malnutrition. Inadequate nutritional intake in chronic alcohol abusers may worsen the severity of liver disease.
• Asian race: Many Asians have a relative deficiency of an enzyme that results in flushing upon alcohol intake, which may create an aversion to alcohol use.
• Acetaminophen: The combination of alcohol and acetaminophen (Tylenol) should be strictly avoided because they can both be toxic to the liver.