How to Keep Your Liver Strong and What to Do When It’s Off

YOUR LARGEST INTERNAL organ is a master at multitasking. You can think of it as a refinery. Everything you consume—from your breakfast burrito to any medication you take—your liver filters, processes, stores, and/or turns into something new (it even makes cholesterol). The organ also puts in the hard work of regulating glucose, which involves holding on to that sugar and then deploying it when your body needs energy. And your liver helps handle the dirty work of sending whatever you don’t need out into the toilet.

What Keeps Your Liver From Working

ALL OF THE FACTORS below get in the way of your liver doing all of its jobs—and eventually prevent it from doing any of them. These drive the first stage of liver disease, which is inflammation. The second stage is called fibrosis, which occurs when chronic inflammation leads to liver scarring. In the third stage, cirrhosis, the refinery starts to function less efficiently. When cirrhosis goes too far, your liver begins to shut down, and eventually you’ll need a liver transplant.

Viral hepatitis

The five main types are lettered A through E. In North America, A, B, and C are the most common, but A is typically mild. You used to hear a lot more about hepatitis B and C because they can lead to cirrhosis and even cancer—but they’re not the threat they once were (see more about that below).

Alcohol-related liver disease

Your liver dies a little bit every time it processes alcohol. If you drink too much and kill too many liver cells, the liver has difficulty performing all its functions. Fat accumulates, and trouble is on its way.

MASLD

Formerly known as non- alcoholic fatty liver disease, metabolic dysfunction–associated steatotic liver disease is a fatty liver caused by things other than alcohol. The biggest culprits are obesity and type 2 diabetes. MASLD affects about 30 percent of people in the world, and cases are rising in the U.S.

How You’ll Know It’s Off

YOU’LL NEED A doctor’s help. The severe symptoms you associate with liver problems—including yellowing eyes and skin (jaundice), swelling of the abdomen, or confusion—show up only when your liver is failing, says Richard Sterling, MD, at Virginia Commonwealth University. Earlier symptoms, like fatigue, are so vague that liver trouble is tough to self-diagnose. A standard comprehensive blood panel, like the one you get with your annual physical, can measure the health of your liver and indicate a possible problem. The tests check liver enzymes (high is bad), platelet count (low is bad), albumin (you want high), total protein (low is bad), and bilirubin (high isn’t great). The panel should also include screenings for hepatitis B and C.

Good News for a Troubled Liver

“WHEN PATIENTS COME to see me, they’re really scared,” says Rohit Loomba, MD, director of the MASLD Research Center at UC San Diego, because they think liver trouble is a death sentence. That’s not true anymore. “In the last two decades, we’ve completely revolutionized the treatment of liver problems,” Dr. Loomba says. Four positives:

The liver can regenerate

Fibrosis that hasn’t advanced all the way to cirrhosis can be reversed, starting with removing the cause of the problem (by improving diet, avoiding alcohol). Even cirrhosis can be stabilized under the care of a liver specialist.

We’ve tamed hepatitis

Better screening plus vaccines for hepatitis A and B have made viral hepatitis less common. Now there are good drugs for hepatitis B and ones that can basically cure hepatitis C.

New drugs fight fat buildup

About a year ago, the FDA approved Rezdiffra, the first drug for treating an advanced stage of MASLD called MASH, formerly NASH. (Don’t ask.) And everyone’s favorite wonder drugs—GLP-1 inhibitors—may swoop in here too: Last year Dr. Loomba published research that shows Mounjaro can be effective in treating MASH. Ozempic might also work, but both need to get FDA approval.

Lifestyle matters

Liver cancer is one of the scarier cancers. But for the most part, you only develop the disease once you’ve done extensive damage to the organ. If you get screened when you need it and adjust your lifestyle to keep your liver happy, you can limit your cancer risk.

How to Keep Your Liver Strong

Focus on:

A Healthy Diet

Lean protein. Lots of produce. Little sugar. All easy on the liver.

Exercise

A recommended 150 minutes per week at moderate intensity can help reduce liver inflammation and rid the organ of fat.

Coffee

Antioxidants and other compounds in coffee (even decaf) can help protect against fibrosis. Studies show positive effects starting at two to three cups a day.

Weight Loss

If you’re carrying extra pounds, losing 5 to 10 percent of your body weight could reduce fat in your liver by about 30 percent.

Be Careful With:

Sugar

Consume too much and your body converts it to fat that can build up in your liver. (This plan helps you cut back painlessly.)

Meds

Don’t stop taking them, but work with a doc to determine which ones can hurt your liver, especially if you’re drinking alcohol. Watch acetaminophen too: Even when taken as directed, it can cause liver damage if you drink to excess, says Dr. Sterling.

Avoid:

Alcohol

The best amount of alcohol for your liver: none. Realistically, though, when you drink, keep it to one or two and try not to do it daily. Note: Larger bodies can’t necessarily handle more. People with extra weight likely already have some liver damage that makes their body worse at processing booze.

Herbal supplements

These are unregulated, and some can be toxic to your liver; kava and herbal weight-loss supplements are two of the worst. And by the way, a “liver cleanse” or “liver detox”? “That’s not something we as pathologists recommend,” says Dr. Sterling, “and I’m not aware of any data that say that that works.”