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Do You Love Your Liver Enough?

Are you taking care of your liver? Most Americans take their livers for granted. Coffee and soft drinks have different impacts.

Most Americans have no idea where the liver is located or what it does. They generally ignore this organ until something goes badly wrong, such as cirrhosis or non-alcoholic fatty liver disease. Admit it. You rarely spend any time thinking about this important organ.

The French, on the other hand, are obsessed with liver function and digestion. They are convinced that this is essential to good health. Perhaps people in the U.S. should take a cue from the French and pay more attention. Could drinking coffee help promote hepatic health?  Studies suggest it might (BMC Public Health, June 22, 2021). Even more critically, drinking sugar-sweetened beverages like soft drinks or fruit cocktails appear to contribute to hepatic disease.

Where Is Your Liver and What Does It Do?

It is on the right side of the abdomen, below the diaphragm and above the stomach. This large organ has a lot of work to do. Some experts have estimated that it plays more than 500 distinct roles in keeping the body operating.

All of the nutrients that you absorb through the wall of the intestine are carried to the liver first before they reach the rest of the body. Its role in digestion starts even earlier; it makes bile, which helps the intestine digest fats, cholesterol and fat-soluble vitamins.

The liver also helps in the digestion of proteins and carbohydrates. In addition, this organ monitors the amount of sugar in the blood. When there is too little, it makes more. When there is too much, your liver pulls glucose out of the bloodstream and stores it as glycogen. It also stores some important vitamins and minerals.

Another crucial job of the liver is to remove toxins. Some of these are ingested inadvertently with our food, while others may be consumed deliberately as medications.

To Care for Your Liver, Stay Away from Sugary Drinks:

In the US and throughout the world, chronic liver disease and liver cancer are important causes of death. Data from nearly 99,000 postmenopausal women shows that consuming sugar-sweetened beverages on a regular basis contributes to the risk for liver cancer and dying of liver disease (JAMA, Aug. 8, 2023).

The participants in the Women’s Health Initiative answered questionnaires early in the study about what they drank. Then they provided more than 20 years of follow-up data with periodic updates on their dietary habits.

Compared to women who drank fewer than three sugar-sweetened beverages a month, those who had at least one a day were far more likely to develop liver cancer or die from chronic liver disease. Women consuming artificially sweetened drinks did not have the same outcomes.

Coffee and the Liver:

It’s hard to believe that one of life’s little pleasures–a morning cup of joe–could be good for your detoxifying organ. But that seems to be the conclusion of a study that has been going on for many years (BMC Public Health, June 22, 2021).

People in the British Isles may prefer tea as their usual beverage, but a new study from the UK shows that those who drink coffee are helping their livers. Fatty liver may result from excess consumption of alcohol or sugar, and it contributes to chronic liver disease.

Incidence of liver disease has been rising around the world, including both the US and the UK. Now, analysis of data from nearly 500,000 volunteers in the UK Biobank reveals that coffee drinkers were 20 percent less likely to develop fatty liver or chronic liver disease than those who didn’t drink coffee.

The study lasted about 11 years. During that time, coffee drinkers were also 49 percent less likely to die of liver disease and 20 percent less likely to die of liver cancer. The benefits increased up to about four cups a day and included decaf and instant as well as regular brewed coffee. An observational study like this can’t establish cause and effect, but coffee drinkers can rejoice that their beverage appears to be beneficial. You can read about other health benefits from coffee at this link.

What Happens When Liver (Hepatic) Enzymes Rise?

One reader asked this crucial question:

“My last blood work showed elevated liver function results. My doctor wants to redo the tests in a couple of months. He also doesn’t want me to take any NSAIDS.

“That got me wondering what else could mess up liver function tests. What other medications? Herbs? Other things?”

There are quite a few compounds that can strain the liver and alter hepatic function tests. Probably the most common drug to do this is alcohol, which may be why the French are so concerned about their livers. They do like their wine.

Drugs That Can Harm the Liver:

Americans consume vast quantities of another potential hepatotoxin. Acetaminophen (Tylenol, etc.) is found in hundreds of over-the-counter and prescription medications. Not only can this drug amplify the liver-damaging effects of alcohol, it can also harm the liver on its own when taken in doses just slightly higher than recommended.

An Australian study reported that people taking acetaminophen were four times more likely to have abnormal results on hepatic function tests (BMJ, online, March 31, 2015).

An investigation by an organization called ProPublica noted that over 1,500 people have died as a result of taking acetaminophen. The majority of the deaths were attributed to hepatic failure.

NSAIDs and the Liver:

Nonsteroidal anti-inflammatory drugs (NSAIDs) are also capable of injuring the liver. That may be why your doctor asked you to refrain from drugs like ibuprofen (Advil, Motrin IB) or naproxen (Aleve).

Dozens of other medications have also been linked to hepatic damage. They include methotrexate, prescribed for psoriasis as well as cancer and rheumatoid arthritis. Antifungal medicines like ketoconazole and terbinafine can also raise liver enzymes. So can statins to lower cholesterol, along with many blood pressure medications and antidepressants.

Some Other Drugs That May Affect the Liver:

  • Amoxicillin (Amoxil)
  • Amoxicillin + clavulanate (Augmentin)
  • Atorvastatin (Lipitor)
  • Bortezomib (Velcade)
  • Candesartan (Atacand)
  • Captopril (Capoten)
  • Cefuroxime (Ceftin)
  • Ciprofloxacin (Cipro)
  • Clarithromycin (Biaxin)
  • Clopidogrel (Plavix)
  • Dexmethylphenidate (Focalin)
  • Divalproex (Depakote)
  • Emtricitabine + tenofovir (Truvada)
  • Erythromycin ethylsuccinate (E.E.S.)
  • Esomeprazole (Nexium)
  • Ezetimibe + simvastatin (Vytorin)
  • Fluoxetine (Prozac)
  • HCTZ + triamterene (Dyazide)
  • Imiquimod (Aldara cream)
  • Infliximab (Remicade)
  • Interferon gamma-1b (Actimmune)
  • Lamivudine (Epivir)
  • Lamotrigine (Lamictal)
  • Levetiracetam (Keppra)
  • Levofloxacin (Levaquin)
  • Memantine (Namenda)
  • Modafinil (Provigil)
  • Naproxen (Anaprox)
  • Naproxen (Naprosyn)
  • Naratriptan (Amerge)
  • Nebivolol (Bystolic)
  • Olanzapine (Zyprexa)
  • Omeprazole (Prilosec)
  • Ondansetron (Zofran)
  • Pantoprazole (Protonix)
  • Paroxetine (Paxil)
  • Pioglitazone (Actos)
  • Ranitidine (Zantac)
  • Ritonavir (Norvir)
  • Rosiglitazone (Avandia)
  • Rosuvastatin (Crestor)
  • Simvastatin (Zocor)
  • Sulindac (Clinoril)
  • Sumatriptan (Imitrex)
  • Tacrolimus (Protopic)
  • Telmisartan (Micardis)
  • Valsartan (Diovan)
  • Venlafaxine (Effexor)
  • Zolmitriptan (Zomig)
  • Zolpidem (Ambien)

A Word of Caution:

Just because a medication has the potential to raise liver enzymes or affect liver function does not mean it should be discontinued. NEVER stop any medication without medical supervision. Some of the drugs listed above are essential for survival. But if you are taking one of these medications, you may want to make sure your health care provider is monitoring hepatic function periodically to avoid complications.

Watch Out for PPIs:

You will note that the proton pump inhibitors esomeprazole and omeprazole appear in the list above. Other PPI acid-suppressing drugs should probably also be included. Researchers report that PPI use changes the microbial ecology of the digestive tract (Llorente et al, Nature Communications, online Oct. 16, 2017). The resulting overgrowth of Enterococcus puts the liver at risk for chronic inflammation and disease, especially in the presence of alcohol. Heavy drinkers who took PPIs had a 20 percent risk of developing alcoholic liver disease in ten years, compared to a 12 percent risk for alcohol abusers not taking PPIs.

Herbs and Your Liver:

Even seemingly innocuous herbs can affect hepatic function. Aloe, comfrey, kava, safrole and senna are recognized as possibly harmful.

There are, however, a few herbs that appear to offer protection. They include milk thistle, licorice, astragalus, Ginkgo biloba and Angelica sinensis (Ali et al, Phytotherapy Research, online Oct. 19, 2017). L-theanine from tea also appears to benefit hepatic health (Gong et al, European Journal of Pharmacology, online Oct. 28, 2017). If you plan to take herbs for their health benefits, be sure to discuss your idea with your doctor and ask to have your liver function monitored.

A Final Word:

Perhaps it is time for Americans to respect their livers as much as the French. When taking certain medications, such as those listed above, periodic liver function tests may be appropriate. If you hate coffee, we certainly would not suggest that you start drinking it. But, if you are a coffee lover, rest easy in knowing that you may be doing something helpful. Relying on coffee or tea rather than cola or other soft drinks would definitely be better for your liver.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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  • Kennedy OJ et al, "All coffee types decrease the risk of adverse clinical outcomes in chronic liver disease: a UK Biobank study." BMC Public Health, June 22, 2021. DOI https://doi.org/10.1186/s12889-021-10991-7
  • Zhao L et al, "Sugar-sweetened and artificially sweetened beverages and risk of liver cancer and chronic liver disease mortality." JAMA, Aug. 8, 2023. DOI: 10.1001/jama.2023.12618
  • Machado GC et al, "Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials." BMJ, online, March 31, 2015. doi: https://doi.org/10.1136/bmj.h1225
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