Filtering of Toxins The liver acts as an important filtering system that gets rid of our body’s impurities, toxins and waste products. An unhealthy liver if not treated, can lead to cirrhosis and hepatitis.^

Understanding Liver Disease

A Liver can be affected by several diseases; some of the most common diseases that affect the liver include alcoholic liver disease, non-alcoholic fatty liver disease or viral hepatitis. These diseases cause inflammation of the liver, leading to complications such as severe liver scarring or cirrhosis. Liver cirrhosis can further progress to liver cancer or liver failure. Symptoms of Liver disease are often overlooked because the liver has a remarkable capacity to regenerate that masks progressive scarring1

*Amarapukar DN, et al, for the Asia-Pacific Eorking Party on NAFLD

Alcoholic Liver Disease

Alcoholic liver disease is a common complication of excessive alcohol intake.2

Clinical Presentation

Individuals who are affected by alcoholic liver disease usually do not have any specific symptoms during the initial stages of the disease. In some cases, certain unspecific symptoms, such as abdominal discomfort, nausea (sensation of vomiting), vomiting or diarrhea may be present. In those with advanced liver disease, specific symptoms such as jaundice, ascites (accumulation of fluid in the stomach), encephalopathy (a brain disorder) or bleeding in the stomach and intestine may be present.2


Who are at Risk?

The following individuals are at high risk of developing alcoholic liver disease:3

  • Individuals consuming more than 60g of alcohol (ethanol)/day or drink excessive amount of alcohol during each session4. Over 90% of heavy drinkers will show higher risk of microscopic liver changes while 10-35% will have a higher risk of developing alcoholic hepatitis5
  • Binge drinkers
  • Women
  • Obese people, suffering from hepatitis infections, or have increased iron levels in blood

Subtypes of Alcoholic Liver Disease2


This condition is also known as ‘fatty liver’. In this condition, there is an abnormal accumulation of fat (lipids) in the liver and occurs in about 90% of all heavy drinkers. Avoiding alcohol consumption can reverse the condition, but continued alcohol consumption can further lead to cirrhosis.

Alcoholic Hepatitis2

In this condition, the cause for inflammation of the liver is prolonged consumption of alcohol. This condition occurs in 10–35% of heavy drinkers. Alcoholic hepatitis usually occurs after 15–20 years of excessive drinking. This condition is more severe in women than men.


This is the most severe form of liver injury that may be caused by alcohol consumption. The risk of cirrhosis is higher in continuous drinkers than in ‘binge drinkers’. Cirrhosis develops in 5-10% of all heavy drinkers.

Complications of Alcoholic Liver Disease2

Complications of alcoholic liver disease include ascites (an accumulation of liquid between the two membranes that separate the organs in the abdominal cavity from the abdominal wall) which is typically the first complication. Apart from ascites, other complications can include jaundice, variceal bleeding (bleeding due to rupture of blood vessels in the food pipe or oesophagus), infections and hepatic encephalopathy (a brain disorder due to failure in liver functions).

Non-Alcoholic Fatty Liver Disease

Fatty liver can also be found in individuals who consume little or no alcohol. It can occur in individuals of any age group or any ethnicity, and is prevalent in about 14–40% of the general population6

However, up to 15-21% of Asia-Pacific NAFLD sufferers are non-obese, i.e. with either normal BMI (17.5-22.4 kg/m2) or overweight (BMI 22.5-24.9 kg/m2).7

Clinical Presentation

Patients may present with jaundice, abdominal distension, gastrointestinal bleeding, and confusion (encephalopathy).

The stages of disease and complications of non-alcoholic fatty liver disease are similar to alcoholic liver disease.


Who are at Risk?     

Patients with insulin resistance (a condition wherein the body tissues have a low response to insulin) are more prone to non-alcoholic fatty liver disease than others. Hispanics and Asians have a higher risk than African Americans.8 It is common in obese individuals and those suffering from diabetes. However, up to 15-21% of Asia-Pacific NAFLD sufferers are non-obese, i.e. with either normal BMI (17.5-22.4 kg/m2) or overweight (BMI 22.5-24.9 kg/m2).7

Other conditions that lead to non-alcoholic fatty liver disease include high cholesterol levels, high blood pressure levels, malnutrition, hepatitis C infection, exposure to toxins and consumption of certain medications.9

Stages of non-alcoholic fatty liver disease and its complications are similar to that of alcoholic liver disease.

Liver Injury Due to Drugs

Medications can also cause injury to the liver in certain instances.

Clinical Presentation

The clinical presentation in patients with liver injury include with acute liver failure, encephalopathy and jaundice. Symptoms of hypersensitivity, such as fever, rash, lymphadenopathy and eosinophilia, are also pointers towards the cause of the injury and are typical for drugs such as phenytoin, sulphonamides and allopurinol.


Who are at Risk?10

Following people are considered to be at high risk of developing drug-associated liver injury:

  • Elderly individuals and children
  • Women
  • Individuals who consume multiple medications
  • Individuals diagnosed with conditions such as HIV or diabetes

The term ‘hepatitis’ refers to inflammation of the liver. Most often, it is caused by any of the hepatitis virus (hepatitis A, B, C, D or E), wherein hepatitis A, hepatitis B and hepatitis C are the most commonly occurring hepatitis infections. Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.11

Risk factors, symptoms and mode of spread of hepatitis A, B and C are mentioned in Table 1:

Table 1: Risk factors, symptoms and mode of spread of hepatitis A, B and C

Hepatitis A12
Risk Factors
  • Travelling to or residing in countries where hepatitis A is common

  • Sexual contact with hepatitis A-positive individual

  • Use of recreational drugs

  • May not be present in all cases, but can appear 2–6 weeks after infection

  • Fever, vomiting, dark urine, fatigue, abdominal pain, joint pain, loss of appetite, grey-coloured stools, nausea, jaundice

How does it spread?
  • Faecal–oral transmission (ingestion of contaminated food or water and contact with objects contaminated with faeces from an infected individual)

  • Sexual contact16

Hepatitis B13
Risk Factors
  • Sexual contact with Hepatitis B-infected individual

  • Living with hepatitis B-infected individual

  • Infants born to mothers with HBV infection

  • Undergoing haemodialysis (procedure for removing metabolic waste products or toxic substances from the blood)

  • Healthcare workers handling blood and tissue samples

  • Usually occur very late in the course of disease

  • Fever, fatigue, abdominal pain and jaundice may occur and are usually associated with advanced liver disease

How does it spread?
  • Individual–individual transmission through blood, semen or other body fluids (e.g. sexual intercourse or sharing needles with a hepatitis B-infected individual, or from infected mother to child during childbirth)

  • It does not spread through touch or through contaminated food/water

Hepatitis C14,15
Risk Factors
  • Drug use through injections

  • Long-term haemodialysis

  • Healthcare workers

  • HIV infection

  • Symptoms may not appear commonly after initial infection

  • Fever, fatigue, reduced appetite, abdominal pain, dark urine, grey-coloured stools, joint pain and jaundice may be seen in acutely symptomatic patients

How does it spread?
  • Exposure to infected blood (contaminated blood transfusion or organ transplantation, sharing infected needles, infected mother to child during child birth)

Liver diseases are also associated with the development of other disorders, which include diseases of the heart,17 diabetes18 and cancer.19 These diseases have a high prevalence in individuals with liver disease, especially non-alcoholic fatty liver disease.17–19


1. Amarapukar DN, et al, for the Asia-Pacific Eorking Party on NAFLD

2. Walsh K, Alexander G. Alcoholic liver disease. Postgrad Med J. 2000;76:280–286.

3. European Association for the Study of the Liver (EASL). Clinical practical guidelines: Management of alcoholic liver disease. J Hepatol. 2012;57:399–420.

4. Mandayam S, Jamal MM, Morgan TR (August 2004). "Epidemiology of alcoholic liver disease". Semin. Liver Dis. 24 (3): 217–32.

5. Dasarathy S, et al. Alcoholic Liver Disease. Schiff’s Diseases of the Liver 10th Edition. 2007 Lippincott Williams & Wilkins.

6. Amarapurkar DN, et al, for the Asia–Pacific Working Party on NAFLD. J Gastroenterol Hepatol 2007;22:788-93

7. Liu CJ. J Gastroenterol Hepatol 2012;27(10):1555-60.

8. Puri P, Sanyal AJ. Nonalcoholic fatty liver disease: Definitions, risk factors, and workup. Clin Liver Dis. 2012;1(4):99–103.

9. Adams LA, Angulo P. Treatment of non-alcoholic fatty liver disease. Postgrad Med J. 2006;82:315–322.

10. Chalasani N, Björnsson E. Risk factors for idiosyncratic drug-induced liver injury. Gastroenterology. 2010;138(7):2246–2259.

11. Available at: Accessed on: 24 May 2013.

12. Hepatitis A. October 2012. Available at: Accessed on: 24 May 2013.

13. Hepatitis B. June 2012. Available at: Accessed on: 24 May 2013.

14. Hepatitis C. FAQs for health professionals. Available at: Accessed on: 24 May 2013.

15. Hepatitis C. Available at: Accessed on: 24 May 2013.

16. Refers particularly to oral-anal contact

17. Ahmed MH, Barakat S, Almobarak AO. Nonalcoholic fatty liver disease and cardiovascular disease: Has the time come for cardiologists to be hepatologists? J Obesity. 012, Article ID 483135.

18. Blendea MC, Thompson MJ, Malkani S. Diabetes and chronic liver disease: Etiology and pitfalls in monitoring. Clin Diabetes. 2010;28(4):139–144.

* Demonstrated in 25 in vitro and 145 in vivo experiments with 43 different types of models and 8 different animal species Gundermann K-J. Pharmacol Rep 2011;63(3):643-59

** Liver Health Facts *** How the Liver Works # + ^ Tips for Healthy Liver 

Essentiale is 300mg essential phospholipids. Always read the label. Use as directed & if symptoms persist see your healthcare professional.