Alcohol is not the only reason for cirrhosis

Damage to the liver is due to indiscriminate use of antibiotics, a combination of herbal and allopathic medicines for common disorders and also the rising incidence of obesity and Non-alcoholic Fatty Liver Disease (NAFDL). All these factors combine to increase the incidence of liver cirrhosis.

The prevalence of NAFDL in India ranges from 9 to 32 per cent in the general population. Higher incidence is noted among obese persons, diabetics, type II diabetics and those with metabolic syndrome. These conditions are leading to advanced fibrosis and severe liver damage, explains Dr Sasidhar Reddy, Liver Transplant Surgeon at Apollo Hospitals.

What is the impact of obesity on the liver? Is it also one of the rising causes for the increasing cases of cirrhosis?
Obesity is rapidly overtaking alcohol as one of the major causes of fatty liver disease. NAFLD gradually progresses to Non-alcoholic Steato Hepatitis (NASH) which in turn progresses into cirrhosis. Interestingly, obesity also appears to be a significant and independent risk factor for liver cancer.

It is stated that over-the-counter medicines and herbal supplements also lead to the disease? What is the rate of this incidence?
Not exactly herbal medicines or supplements but digestive powders, over-the-counter vitamin powders and protein packs that are often taken, can be harmful. There is no scientific basis of any benefit from taking them. These do not come under medicines but are supplements which are found to contain heavy metals like arsenic, mercury, lead and highly volatile organic compounds that injure the liver. There is no medical advice sought before taking supplements.

In fact, herbal medicines have gained popularity as potential therapeutic agents for the prevention and treatment of NAFLD, due to their high efficacy and low side effects. There are certain studies confirming their efficacy. But here some people pass off indigenous medicines as herbal medicines which is wrong.

There are some people who take allopathic and herbal medicines. How does the drug interaction in the body occur? What is the effect on the liver?
Allopathy and Ayurveda work on the same principles, implementation is different. Every medicine system has serious side effects. So, taking allopathy and herbal medicines together will double the side effects. Moreover, a person is taking a double dose. Anything at higher dose is very serious and the toxins metabolise in the liver.

There are many people suffering from co-morbid conditions like hypertension and diabetes. They are on constant medication. Are there medicines which have side-effects that can cause cirrhosis due to the use of one type of chemical for a long time?
In diabetes, the medicines do not cause any effect on the liver, it’s the disease that causes injury to the liver in the long term. There are a lot of medicines which are toxic to the liver. Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) Aspirin, ibuprofen, and naproxen sodium can cause toxic liver disease if you take too much of the drug or take it with alcohol or take it for a long time.

Are the antibiotics which are used for infectious diseases also one of the reasons? There are people who regularly take antibiotics, so will they suffer in the long run?
Antibiotics are a common cause of drug-induced liver injury. Most cases of antibiotic-induced liver injury are idiosyncratic, unpredictable and largely dose-dependent. Some widely used antibiotics such as amoxicillin-clavulanate have shown to have a delayed onset on liver injury and recently cefazolin has been found to lead to liver injury 1-3 weeks after exposure of a single infusion. The other extreme is the nature of nitrofurantoin-induced liver injury, which can occur after a few years of treatment and lead to acute liver failure (ALF) or autoimmune-like reaction.

Given the severe consequences of the adverse liver reactions, it cannot be over emphasised that the indication for different antibiotics should be evidence-based and symptoms and signs of liver injury from the drugs should lead to prompt cessation of therapy. Regular usage of antibiotics is not advised without proper supervision.

How can liver health be maintained? Why is it important to maintain good health of the liver?
Maintain a healthy weight, eat a balanced diet, exercise regularly, avoid toxins, use alcohol responsibly, avoid the use of illicit drugs, get vaccinated (Hep B&C). These are a few tips to maintain a healthy liver.

The liver primarily processes nutrients from food, makes bile, removes toxins from the body and builds proteins. It’s easy to see how the inflammation of the liver, or hepatitis, interferes with these important functions and can lead to poor health. So, maintaining good health of the liver is important for an overall healthy life.