Liver injury is often silent until it shows as cirrhosis or cancer. Touted as “hepatoprotectors”, “liver protection”. These “substances” are nothing but marketing and often are toxic to the liver. Renowned liver diseases expert from Boston on how to ensure healthy liver. What can people do to protect against liver disease? Dr. Anton Titov, MD. You are a renowned liver expert, a Professor of Medicine at Harvard Medical School. What can how can people keep their liver healthy? Dr. Anton Titov, MD. Yes, that is a great question! Fortunately, there are two vaccines to protect against two forms of viral hepatitis. Hepatitis A, that does not lead to chronic liver disease and does not lead to cirrhosis of the liver but it can be severe. It can lead to a lot of debility. On rare occasions Hepatitis A can be fulminant. This means very severe, even leading to liver failure and the need for a liver transplant. We have a very effective vaccine against Hepatitis A. People who travel extensively, men having sex with men, people working with non-human primates and chimpanzees, either in the lab or the zoo, their food handlers. There are many indications for Hepatitis A vaccine. Dr. Sanjiv Chopra, MD. That is a very effective vaccine. The other vaccine that we have is the Hepatitis B vaccine. Seminal studies were done in Taiwan, now many years ago. In Taiwan, the prevalence of Hepatitis B, chronic hepatitis B infection, was 15% in the general population. Two decades of universal vaccination with Hepatitis B in childhood led to a decrease in the prevalence from 15 - 20% to 1,5%. But most dramatically, there was a reduction of 75% in childhood hepatoma, cancer of the liver, mortality. Dr. Sanjiv Chopra, MD. This is truly the first anti-cancer vaccine. This vaccine is FDA-approved. It is available in many countries. The Bill and Melinda Gates Foundation have helped many many poor countries get the vaccine at a nominal rate or even for free. Dr. Sanjiv Chopra, MD. One thing to protect against liver disease is to get vaccinated for Hepatitis A and B. Every chronic patient, every patient with chronic liver disease, we recommend should be tested for hepatitis A and B. If they don't have protective antibodies, they should be vaccinated. Sometimes they are unfortunate to get hepatitis A or B superimposed on their other chronic liver disease, it can be fatal. It can be fulminant. The other thing that is very important to protect against liver disease is to not drink alcohol in excess. That can lead to alcoholic hepatitis and cirrhosis. One has to be as close to ideal body weight as possible. Because obesity is linked to 20 different cancers. Obesity is linked also to diabetes, metabolic syndrome, hypertension, liver disease. I mentioned non-alcoholic fatty liver disease. It is a disease we call non-alcoholic fatty liver disease. Because under the microscope it looks just like alcoholic liver disease. But these are patients who are not drinking alcohol. They have diabetes, they have Type 2 diabetes and obesity. It afflicts 40 to 70 million Americans. We think that about 5 million are or will become cirrhotic. Hepatitis C afflicts 4 million at most in the United States. Half a million patients will become cirrhotic or are cirrhotic. Dr. Sanjiv Chopra, MD. From NAFLD [non-alcoholic fatty liver disease] 10 times as many people develop liver cirrhosis. It is now the second leading indicator for liver transplantation in our country. The estimate is that in the next 10 years NAFLD will become the dominant indication for liver transplantation. Dr. Sanjiv Chopra, MD. We need to do a better job. All of us who are custodians of health, who are passionate about this, can work with the American Liver Foundation or other societies. Go to high schools and middle schools and talk to the young people about the importance of exercise, importance of nutrition, not drinking alcohol in excess, getting vaccinated with the right vaccines. Exercising is crucial. Doing all those things to prevent this burgeoning epidemic. We need to get children involved. They are the future leaders not only in the Health Sciences, but in all the fields known to man.