"Ask the Doctor": Liver Disease/Transplants

February 29, 2000

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Beffie: How can heredity affect my chances of developing a liver disease/disorder?

Dr. Dyer: There are two common liver diseases that are inherited liver diseases. These are hemachromatosis, and Alpha-1 anti-trypsin deficiency. A rare disease is Wilson's Disease. In hemachromatosis, iron collects in the liver and other organs, and causes cirrhosis. In Wilson's Disease, copper accumulates in the liver and some other organs and cause cirrhosis and liver failure. In Alpha-1 Anti-trypsin deficiency, a protein called alpha-1 anti-trypsin, that is made by the liver cells, cannot get out of the liver cells, and accumulates in the liver cells. This can cause cirrhosis, also. There may be a poorly-defined inherited or genetic predisposition to liver disease from other causes. For example, only about 20 percent of people who drink "too much" alcohol will end up with significant liver disease from it.

Feenie: Do you ever recommend any vitamin or herbal supplements to people who have unhealthy livers?

Dr. Dyer: Generally, the answer is no. However, when your liver is very sick, and is not excreting normal amounts of bile into the intestine, this will result in poor fat absorption, because the bile acids in bile are so important for intestinal fat digestion and absorption. It is possible, in this situation, to become deficient in fat-soluble vitamins that will not be absorbed properly. In this situation, it is recommended to take fat-soluble vitamin supplements, such as Vitamins A, D, E, and K. I have no problems with people taking Milk Thistle, but it has not been proven to provide any meaningful benefit.

SCUgrad2000: If I were to already have a bad liver, what is the best thing to do?

Dr. Dyer: Obviously, avoid things that injure the liver, such as significant alcohol consumption. Eat a healthy diet, stay fit and active, and I would recommend you see a liver disease expert, to get his recommendations or opinion on how sick the liver is, and what measures can be undertaken to try and avoid problems, depending on the nature of the specific liver disease. And recommendations regarding whether in the near future you would need a liver transplant.

Sigmagirl: What are Liver Spots, and what are they a sign of?

Dr. Dyer: They're collections of small blood vessels under the skin that are called "spider telangiectasias." When you press on them with your fingertips, and suddenly release the pressure, the blood that has been squeezed out of the blood vessels by your fingertips will fill back into the blood vessels, and the blood fills in from the center, spreading outwards, as though the blood flow came from the body of the spider and spread out to its legs. These are caused by increased estrogen levels, the female hormone, and these are usually seen in cirrhosis, but can also be seen in women, especially during pregnancy.

Miss Q: How many different types of Hepatitis are there? Which are the most virulent?

Dr. Dyer: Hepatitis literally means "inflammation in the liver." Inflammation consists of white blood cells in your blood stream spilling out in amongst the liver cells themselves. This can be caused by many things - toxins, such as drugs, herbs, and alcohol; viral infections, especially Hepatitis A, B, C, D, and E, inherited liver diseases, such as hemachromatosis, Alpha-1 anti-trypsin deficiency, and Wilson's Disease; liver diseases though to be "auto-immune" in origin, and other less common causes of liver diseases. All forms of Hepatitis can be mild, and all can cause sudden liver failure or chronic liver disease, and eventually liver failure from cirrhosis.

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