The Different Types of Liver Disease (And How to Prevent Them)
Each part of the human body has a role that it plays to keep us balanced and healthy. We call this balance within the body homeostasis. Our liver is one of the main organs in the body that filters out harmful toxins and chemicals that we expose ourselves to.
The liver is located in the top right part of the abdomen, or the belly, and its functions include:
Breaking down toxins and chemicals
Digesting food and store energy
Working with the pancreas (another organ) to manage blood sugar
Producing substances that allow the blood to clot
Helping the body fight infections
Anatomy of the Digestive System¹
Because of its importance, damage to the liver can lead to many complications, including liver failure, liver cancer, and death.
There are several different types of liver disease, but the main types are viral hepatitis, non alcoholic liver disease, and alcoholic liver disease. Many types of liver disease are self-limiting, which means that they resolve on their own without treatment. However, some types of liver disease can lead to liver damage and the formation of scar tissue, which is referred to as cirrhosis.
Viral Hepatitis
Hepatitis essentially means inflammation of the liver. And while inflammation of healthy liver tissue can be caused by several things, it's most commonly caused by a virus. Each type of hepatitis is caused by a different virus, and they're all spread in different ways.
Click here for a quick summary on the five different types of hepatitis.²
Despite taking appropriate precautions, many healthcare workers, immunocompromised individuals, patients requiring blood transfusions, or those in underdeveloped countries may still develop hepatitis.
Fortunately, there are vaccines to prevent several types of hepatitis. And in those types that aren't preventable, there are now many treatment options, with the most recent one being a treatment for hepatitis C.
Non Alcoholic Liver Disease
While alcohol use is one of the primary risk factors for developing liver disease, there are other reasons that people develop liver disease. For this reason, liver disease is divided into two categories: non alcoholic and alcoholic.
And whether liver disease is caused by alcohol consumption or other factors, each one is progressive and can be divided into stages. Typically, the earlier stages can be reversible, but we'll go into further detail on this.
NAFLD - Stages of Liver Damage³
Non Alcoholic Fatty Liver Disease
This is also referred to as simple fatty liver disease, and it involves fatty deposits in liver cells. Non alcoholic fatty liver disease (NAFLD) is most common in individuals who also have these conditions:³
Obesity
Diabetes
High cholesterol
High blood pressure
Generally, this is a benign condition that doesn't lead to the formation of scar tissue, or cirrhosis, in the liver. It's typically reversible, and can be treated by losing three to five percent of body weight.⁴
Despite this, some people will go on to develop inflammation and damage to the liver.
Non Alcoholic Steatohepatitis
Non alcoholic steatohepatitis (NASH) is a severe form of NAFLD. It's a result of fatty deposits within the liver causing inflammation and damage to the liver cells.
While only a small percentage of people with NAFLD go onto develop NASH, the risk increases in those with:⁵
Obesity
Type 2 diabetes
Fortunately, these risk factors are ones that can be lowered with weight loss, a healthy diet, and exercise.
Sometimes it's possible to reverse NASH, but it depends on the severity of damage and inflammation, and if there's also an infection of the liver, called hepatitis. If you have NASH, losing seven to ten percent of your body weight can help improve inflammation in the liver.⁵
Alcoholic Liver Disease
Alcohol related liver disease can be broken down in a similar way as non alcoholic liver disease. Early in the disease, alcohol related liver disease is reversible. But if alcohol continues to be consumed, liver damage is unavoidable.
Alcoholic Fatty Liver Disease
Alcoholic fatty liver disease (AFLD) is a buildup of fatty deposits in the liver from alcohol use. 90% of individuals who consistently drink four to five standard drinks a day will develop these fatty deposits. And the risk is even higher in those who are female, obese, hispanic, or have hepatitis C.⁶
What Is a Standard Drink?⁷
Similar to NAFLD, alcoholic fatty liver disease is reversible. When alcohol consumption is stopped, the liver can return to its normal state of health within two to four weeks.⁸
Alcoholic Hepatitis
If heavy alcohol consumption continues, specifically for 10 years or more, the risk of developing something called alcohol hepatitis increases. This is basically a complication of AFLD and is described as generalized inflammation of the liver that affects functioning of the liver.
In general, 10 to 15% of those with AFLD will develop alcoholic hepatitis.⁶ This is why it’s so important to cut down on alcohol use before this condition occurs. If you develop alcoholic hepatitis, you’ll show signs and symptoms of liver damage, which we’ll discuss a little later.
Cirrhosis
Up to this point, we’ve talked about many treatable and reversible types of liver disease, such as NAFLD, AFLD, and certain types of hepatitis. Sometimes NASH is reversible too.
Cirrhosis, however, is not reversible. Cirrhosis is defined as permanent scarring of the liver, and it’s the 12th leading cause of death in the United States. When the liver is damaged over and over again for long periods of time, healthy liver tissue is replaced with scar tissue. The most common causes of cirrhosis are:⁹
Viral hepatitis
Alcoholic fatty liver disease (AFLD)
Non alcoholic steatohepatitis (NASH)
Those with cirrhosis typically don’t know they have it until their liver starts to fail completely. This is similar to other liver diseases we’ve discussed. Treating and reversing liver disease in the early stages is crucial. Because by doing so, you can prevent permanent damage to your liver and lower your risk of developing liver cancer.
Does Liver Disease Lead To Liver Cancer?
Whether or not you’re at risk of developing liver cancer as a result of liver disease depends entirely on the severity of damage to your liver, as well as other risk factors for cancer.
While there is a link between liver disease and liver cancer, the risk of developing liver cancer from NAFLD is pretty low. However, this risk greatly increases if liver disease progresses to cirrhosis.¹⁰
In my experience, liver cancer is most often diagnosed incidentally. Patients will come to the hospital for symptoms or complications of liver failure, and imaging will happen to find a suspicious-looking area on their livers.
What Are the Early Signs of Liver Damage?
Unfortunately, there are no early symptoms of liver damage. By the time symptoms of liver damage occur, permanent scarring and damage has been done.
Some of the symptoms I typically see patients have from liver damage include:
Loss of appetite
Yellowing of the skin and eyes (jaundice)
Poor immune system function
Weight loss
Fatigue
Bloating of the abdomen due to fluid build-up (ascites)
Easy bruising of the skin
While symptoms of liver damage occur late in the disease, routine blood work can often detect early damage to the liver. This is why it’s so important to get your yearly physical!
How Is Liver Disease Diagnosed?
In general, liver disease is diagnosed using a combination of blood work and imaging. Sometimes, a biopsy of the liver is needed to confirm more severe types of liver disease like hepatitis and cirrhosis.
The main blood work that is used to determine if there’s liver damage are liver enzymes. Those with liver disease will have elevations of their liver enzymes, and these show up on bloodwork under AST, ALT, and alkaline phosphatase.
To check for more advanced liver disease and damage, your doctor may order additional blood tests to see if other functioning parts of the liver have been affected. The main ones that are checked are prothrombin time (PT) and international normalized ratio (INR). These tests are used together to tell us how thin or thick the blood is.
Because your liver is responsible for making certain blood clotting chemicals, damage to the liver can cause increased thinness of the blood. On blood work, this will show up as an abnormally high PT/INR.
If liver disease has progressed and caused permanent damage, you may even see liver enzymes decrease on blood work. This isn’t because liver function is improving, but it’s actually because the liver has been damaged so much that it can no longer produce these enzymes.
The role of imaging in liver disease is used primarily to evaluate for cirrhosis of the liver. This can be detected on ultrasound, and this is typically ordered after liver enzymes are found to be high on blood work. Ultrasounds are often preferred by healthcare providers because they’re fast, safe, and affordable for patients.
If more detailed imaging is needed, a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) study can be done.
What Treatments Are Available for Liver Failure?
Liver disease is one of those diseases where prevention is key, as treatment of the disease itself can be quite limited.
In early stages of liver disease, dietary changes, weight loss, and cessation of alcohol use can greatly improve liver function. However, in those with more severe forms of liver disease, like hepatitis and cirrhosis, some medications and therapies are available.
If you have hepatitis or cirrhosis, your doctor will use something called the Model for End-Stage Liver Disease (MELD score) to calculate the severity of your liver disease. By doing this, your doctor will be able to see which treatment options you’ll benefit from the most.
If you have AFLD and develop alcoholic hepatitis, the most common treatments include:⁶
Steroids, which decrease inflammation
Anti-cytokines, which decrease inflammation caused by the immune system
Vitamins, such as vitamin E
The biggest thing that can impact the treatment of alcoholic hepatitis is to stop drinking alcohol. After alcoholic hepatitis happens once, no amount of alcohol is safe for the liver. And this remains the same even if alcoholic hepatitis can be treated.
These treatments may help to treat alcoholic hepatitis. But it’s important to note that any scarring of the liver that’s occurred (cirrhosis) is permanent. The only definitive way to treat end-stage liver disease is with a liver transplant.
How Can Liver Disease Be Prevented?
Now that we know how harmful liver disease is, you’re probably wondering if there’s a way to prevent it. And there is! Prevention of NAFLD and AFLD is possible, and the main ways to do this focus on diet, weight loss, and lowering alcohol intake.
For NAFLD, weight loss of 3-5% of your total body weight can greatly decrease the amount of fatty deposits in your liver. Some studies have even shown that larger amounts of weight loss can reverse NASH.⁴
If you decide to lose weight, remember that slow and steady weight loss is much safer and sustainable than rapid weight loss. In fact, if you have NASH and lose weight too quickly, you can actually worsen your condition and put yourself at an increased risk of liver failure and gallstones.³
When it comes to diet, there are a couple of things you should focus on: carbohydrates and fatty acids. A diet that is high in simple carbohydrates is a big cause of NAFLD.
Simple and Complex Carbs - What is the difference?¹¹
This is because high amounts of simple carbohydrates and high fructose foods strain the liver and directly cause fatty deposits to develop. Consuming a diet like this also leads to weight gain and type 2 diabetes, which are also risk factors for developing NAFLD.
Because of this, it’s recommended that simple carbohydrate consumption shouldn’t be higher than 10% of your daily caloric intake, and foods with high fructose corn syrup should be completely eliminated. Here’s an article that goes into depth about certain foods with high amounts of high fructose corn syrup.
The other main part of the diet that’s been found to be helpful at preventing and also improving NAFLD is focusing on increasing omega-3 fatty acid intake. As odd as it seems, this specific type of fatty acid actually decreases fatty deposits in the liver.
The easiest way to get omega-3 fatty acids in your diet is to take a supplement. You can also eat more of the foods that are rich in omega-3 fatty acids, which include:¹²
Fish like salmon, mackerel, tuna, herring, and sardines
Nuts and seeds like flaxseed, chia seeds, and walnuts
Plant oils like flaxseed oil, soybean oil, and canola oil
By implementing diet changes and adding moderate exercise to your daily routine, weight loss and improved liver health can happen for you. And while alcohol consumption isn’t the cause of NAFLD, decreasing your alcohol intake can still improve your liver health.
But when it comes to prevention of ALFD, the best way to do so is to drastically decrease the amount of alcohol you drink. Or better yet - stop drinking altogether.
It’s important to remember that making lifestyle changes at this point in the course of your liver disease is critical when it comes to preventing permanent damage to your liver. If liver disease progresses beyond just simple fatty deposits, it can be permanent and life-threatening.
If you're concerned that you have a type of liver disease, make an appointment with your healthcare provider today. Getting basic blood work done can tell you a lot about your body, and if you have a form of liver disease, it’s better to get ahead of it.
To get more up-to-date, evidence-based information about health and wellness, make sure to check out some of my other articles.
Stay informed, stay healthy.
Works Cited:
1. Anatomy of the Digestive System – (saintlukeskc.org)
2. Hepatitis – (ochonline.com)
3. NAFLD and NASH - Symptoms, Causes, Differences, and Treatment – (pacehospital.com)
4. Treatment options for alcoholic and non-alcoholic fatty liver disease: A review – (nih.gov)
6. Diagnosis and management of alcoholic liver disease – (nih.gov)
7. What Is a Standard Drink? – (stuaff.mst.edu)
8. Fatty Liver – (emedicine.medscape.com)
9. Cirrhosis: Diagnosis and Management – (nih.gov)
10. Incidence of Hepatocellular Carcinoma in Patients With Non alcoholic Fatty Liver Disease: A Systematic Review, Meta-analysis, and Meta-regression – (cghjournal.org)
11. Simple and Complex Carbs - What is the difference? – (backinmotionfl.com)
12. Omega-3 Fatty Acids – (nih.gov)