Just as it sounds, autoimmune liver disease, formally known as autoimmune hepatitis, describes a physiological state where the immune system turns against and attacks certain tissues in the liver, one of our absolutely essential organs. Here we explore some facets of autoimmune liver disease and questions about whether toxins in the liver could be related to autoimmune disease, so that the reader better understands the liver and some of its autoimmune dysfunction.
Is there any evidence that “toxins” in the liver cause other autoimmune disease (lupus, RA, etc.), or that “detoxing” might remove the causes of these non-liver autoimmune diseases, thus reducing/eliminating symptoms?
Absolutely none. There is nothing in the respected literature that even points in this direction. It is difficult to prove this absence with only absence of proof, from a logic standpoint. One can’t provide much evidence supporting this contention, since there is nothing reported in any real journal or on an official and credible website. But you, the reader, can rest assured that if there was anything at all to this nonsense, it would most certainly be an area of interest and there would be studies with evidence to corroborate the notion. Certain groups and organizations have taken it upon themselves to thoroughly review such claims and have found nothing at all to support the toxin/detox theory such as SenseAboutScience and QuackWatch.
If anyone can provide information to the contrary, from a legitimate source, please feel free to share it with us. In fact, any proponent of this pseudoscience who can explain exactly which “toxins” are involved, or the specific routes of catabolism and elimination, is invited to reply with such evidence. The problem is that, as opposed to “autoimmune hepatitis”, when you type “liver toxins detoxification” into Google, all that comes up are non-medical websites spewing various forms of lies, conjecture and marketing for products you don’t need and which won’t help you.
Of course, “detoxification” is very much a legitimate medical practice, but is limited to the clearance of dangerous drugs and other real toxins (such as specific poisons like acetaminophen overdose or pesticide exposure) from the body, so that the patient can return to a normal physiologic state. The most well known examples are probably alcohol and heroin detox, each of which involves heavy withdrawal symptoms, and is absolutely brutal in its own way. This term has unfortunately been co-opted by quackery and turned into a marketing tool that bilks individuals out of tons of money every year and provides nothing in return.
There are many different detox schemes out there, but those addressing alleged liver concerns are among the most devious and troublesome. As just one example, let’s examine the liver cleanse that purports to result in many “gallstones” in the feces, which advocates and marketers claim were “clogging the liver”. This particular diet has many glaring flaws and inaccuracies, such as the fact that real gallstones frequently hurt terribly, are spherical in shape and also sink in water. Try taking one of the supposed “stones” from a cleanse and see if it sinks. QuackWatch.com debunks the liver flushes, explaining everything that contradicts these claims, and conclusively proves that these yellow globules are not gallstones, but instead are the result of a chemical reaction between the ingredients used in the cleanse.
The bottom line is: these “toxins” don’t really exist, and even if they did, the liver is pretty accomplished at removing most things by itself. Unfortunately, savvy marketers have convinced large chunks of a gullible public into believing otherwise. Buying into this junk science and purchasing products to cleanse your “dirty liver” will do nothing except lighten your wallet and give you false hope. Any apparent contradiction to this statement is most likely a placebo effect, which is totally fine if that makes you feel better, as long as you don’t mind throwing away your money. We may not understand many things within medicine, but we most certainly understand that this non-science of toxins and detoxing is completely fabricated in the interest of profit.
Ok so what is the function of a normal liver?
Most people have at least a rudimentary understanding of the liver and its purpose in our daily lives, at least as far as converting/removing substances that are incompatible with healthy living.
To this end, our liver processes various foods, drinks, drugs and other toxins (real ones such as heavy metals and poisons, not “toxins”, which is covered below). Usually it’s pretty good at its job in this regard – utilizing a series of enzyme pathways to accomplish its tasks – though when it encounters things it can’t process, it may lead to liver damage or damage elsewhere in the body.
But the liver also performs a host of other functions, including bile production, synthesis and breakdown of various materials (including carbohydrates, hormones and clotting factors), storage of a wide range of biochemically important materials, and normal immunological function via macrophages.
And what is autoimmune liver disease, and the related symptoms?
In a nutshell, as with all autoimmune diseases, autoimmune liver disease, which is formally known as autoimmune hepatitis, occurs when the immune system attacks liver cells known as hepatocytes, causing inflammation (“hepatitis”), and without treatment, progressive deterioration of these tissues and their functions.
It is a chronic disorder, which if left alone, will lead to cirrhosis and eventual liver failure in some cases. There are two types, with type I being much more common, and demonstrating a predilection for women, which is consistent with findings for most autoimmune conditions.
Causes or risk factors include certain infections or medications, genetic predisposition, being female and of course, as with many autoimmune disease, having other autoimmune conditions.
Autoimmune hepatitis often presents with symptoms that are similar or the same as those seen in other forms of hepatitis, such as viral or bacterial hepatitis. This requires blood work and sometimes further testing to distinguish it from overlapping disorders covered below.
Some of the most common symptoms are fatigue (almost always present to some degree), jaundice (yellowing of the skin and possibly eyes), liver enlargement (hepatomegaly), itchiness, gastrointestinal problems, joint pain, skin rashes/vascular issues, and either dark urine, pale stools, or both. Some patients with mild cases may display few or no symptoms.
There are two other related conditions, known as primary biliary cirrhosis and primary slcerosing cholangitis, which are generally grouped together pathologically with autoimmune liver disease, but impact mainly the liver bile ducts rather than hepatocytes themselves. Symptoms are very similar to autoimmune liver disease, with a few possible exceptions.
Primary biliary cirrhosis may also be a manifestation of Inflammatory Bowel Disease (Crohn’s or UC) in some cases. Sometimes these two conditions are found to overlap with each other or with autoimmune liver disease in a hepatic autoimmune cluster.
Finally, though autoimmune hepatitis, primary biliary cirrhosis, and primary slcerosing cholangitis the three main recognized forms of hepatic autoimmune disease, there are instances where other autoimmune diseases, such as rheumatic conditions, can have a negative impact on the liver. Conversely, liver disease from other sources, such as metabolic syndrome or infection, may precipitate or occur simultaneously with signs of autoimmunity outside the liver, and corresponding antibody profiles. Lastly, chronic liver disease can also have consequences outside the liver, especially in the joints and skin.
How is autoimmune hepatitis diagnosed and treated?
Diagnosis usually begins with the doctor noticing either hepatic or extra-hepatic signs of possible liver disease, such as those mentioned above. When this occurs, the next step is generally a liver panel that includes liver function tests, which measure specific liver enzymes, as well as protein and bilirubin levels. Then, if other causes are ruled out and autoimmune disease is suspected, another blood test, known as an autoimmune liver disease panel, looks for the presence or absence of several types of autoantibodies, including ANA and AMA. But the gold standard for diagnosing autoimmune hepatitis remains a liver biopsy, where a piece of tissue is taken from the liver and examined under a microscope.
Treatment options are relatively few, but can yield good results if started quickly and taken regularly. The first line treatment for autoimmune hepatitis is typically prednisone, azathioprine, or both. These are immunosuppressants that help keep the immune system in check and prevent autoantibodies from causing liver damage. Unfortunately, these medications can have serious side effects (particularly prednisone), including infection, diabetes, weight gain, hypertension (high blood pressure) and osteoporosis (weakened/thinning bones). If these drugs fail to work, other immunosuppressant may be used instead. In some patients with mild disease, treatment may not be necessary, and observation is all that’s required. Others with advanced liver disease – cirrhosis or liver failure – may need a liver transplant.
The American Association for the Study of Liver Disease (AASLD) offers a very helpful and detailed paper – though a decade old and designed for clinicians – explaining both diagnosis and treatment of autoimmune hepatitis.
Questions for your doctor:
- Should I be concerned about autoimmune liver disease, especially if I have other autoimmune conditions, or someone in my family suffers from autoimmune liver disease?
- If I have autoimmune liver disease, what type is it and what are my treatment options?
- What are the main concerns with therapies for autoimmune liver disease? Is no treatment an option for me?
- What else might be causing my autoimmune liver disease-like symptoms?
- What are your thoughts on liver toxins and detoxing? Is there any legitimacy to it? If so, what is the evidence, and what is the safest way to do it?
About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians. After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time. He may be reached at [email protected].