Liver toxins to avoid are toxins coming from environmental pollution, petrochemicals, hydrocarbons, plant toxins and medications. Leading expert in liver disease discusses how toxins affect liver metabolism. How toxic insult to liver can lead to cancer in patients with diminished liver reserves? How to prevent liver toxicity from medications, especially acetaminophen / paracetamol (Tylenol), statins and commonly used antibiotics? Liver toxins to avoid: air pollution, aflatoxins and paracetamol (Tylenol). Dr. Anton Titov, MD. What are common liver toxins to avoid? Dr. Simon Robson, MD. Aflatoxins in peanut butter, especially home-made peanut butter. Fuel exhaust is very toxic to the liver. Monosodium Glutamate (MSG)and artificial sweeteners (Aspartame) are toxic to liver. Video interview with leading expert in liver diseases Harvard Medical School.. The How to avoid liver detox scam? There is no real liver detox regimen. There are many liver toxins to avoid. Pollution, aflatoxins and paracetamol (Tylenol) are most common ones. The key to healthy liver is moderate and healthy lifestyle and avoidance of toxins. Medical second opinion helps to make sure liver disease diagnosis is correct and complete. Medical second opinion also helps to choose the best treatment for liver failure caused by toxins in food and environment. Dr. Anton Titov, MD. Petrochemicals and hydrocarbons cause liver toxicity. Medications are very important source of liver toxicity. Dr. Simon Robson, MD. Acetaminophen, paracetamol, Tylenol are toxic to liver. Liver toxins to avoid also include acetaminophen and ibuprofen. Especially if liver functional reserves are low due to alcoholism or fatty liver degeneration. Acetaminophen is a leading cause of acute liver failure. Ibuprofen and aspiring can also be toxic to liver. Dr. Simon Robson, MD. Statins can cause increased liver enzymes and acute liver toxicity. High doses of statins can lead to chronic liver toxicity. Amoxicillin with clavulanic acid can cause acute liver toxicity. Erythromycin liver toxicity also happens. Avoid liver toxins. Dr. Anton Titov, MD. You mention the toxins that affect the liver - mushroom toxins, alcohol. What are some other common toxins that can damage the liver? there are also toxins called aflatoxins. Dr. Simon Robson, MD. Harvard Medical School. Aflatoxins tend not be damaging to the liver, but in the setting of liver injury from other causes they tend to promote development of liver cancers. Aflatoxins are the problem in developing world. Contamination of peanuts in peanut butter is probably highest level of aflatoxins you will find in the United States. But obviously it is very closely monitored. In parts of Southern Africa, like Mozambique. It is subtropical climate. A lot of peanut mill and seeds and nuts are stored. They can get moldy. In those situations that aflatoxin exposure plus hepatitis B can lead to onset of liver cancers at a much earlier age. Liver cancer starts earlier than one would completely anticipate. Dr. Simon Robson, MD. Certainly those liver cancers can develop in individuals who may not even have cirrhosis. They may not having much in the this of liver scarring. aflatoxins are a problem. But most of the food that we eat is safe. We mentioned the hygiene hypothesis this plays a role in many autoimmune gastrointestinal disease. One of the other benefits of having well processed food, fresh foods with expiration limits and so forth expression limits is that the levels of aflatoxins are somewhat limited. But clearly it is a problem in parts of the developing world. Dr. Anton Titov, MD. In the Western world what are other common toxins that affect the liver? Dr. Simon Robson, MD. Well, most the time you know the food that we selected, has been selected because it is not toxic to the liver, right? We have a whole series of enzymes in our liver. They are called cytochrome p450. These liver enzymes are involved in drug metabolism. these enzymes didn't arise for the purpose of detoxification of our pharmaceutical medications. Dr. Anton Titov, MD. Liver detoxification enzymes are there to remove potential xenobiotics, poisons, this are present in cabbage, cauliflowers, many root vegetables and so forth. these are potential toxins. Dr. Simon Robson, MD. But our liver takes them and inactivates them. Then liver excretes them. As I said, the food has been selected over many years to have much lower levels of these toxins. But certainly some agricultural products do have low levels of xenobiotics. But pollution, petrochemicals, hydrocarbons. Dr. Simon Robson, MD. All these things can cause potential liver injury. Chemicals in work places in patients working in chemical industries also can damage the liver. But we don't see those toxins very often, I must say. Dr. Anton Titov, MD. Most of the chemicals that we ingest are usually intentional. Most common toxins that affect the liver are pharmaceuticals. They can cause immediate toxicity. Back with Tylenol. We take a certain dose of Tylenol, and it is going to be detoxified adequately. This adequate dose can't cause liver injury. But they are also subsets of patients, for example, with alcoholism. Alcoholics already have some degree of liver injury. They could be totally hungover after binge drinking. they are very susceptible to acetaminophen, Tylenol, paracetamol poisoning. It is because their liver has no resistance to paracetamol. the enzymes to metabolize the Tylenol are switched on dramatically. These hyperactive enzymes can generate toxic intermediates. there is no safe level of Tylenol exposure for somebody who is a chronic alcoholic. Dr. Simon Robson, MD. It is particularly true if they are also chronically malnourished. other medications can cause idiosyncratic disease unpredictably. Statins this lower cholesterol can cause high levels of liver enzyme elevation. But typically statins do not cause serious liver disease. The rates of liver transplantation after statin toxicity are very low. Among patients who take statins, only one or two per million per year need liver transplantation because of statin liver toxicity. But lots of medications can potentially damage the liver and we look out (for those side effects). Dr. Anton Titov, MD. Statins are very widely used medications, and they are being used more and more. Dr. Simon Robson, MD. Yeah, so they not only damage muscles, but can damage the liver. Among the drug toxicity cases that we see in an outpatient clinic. Probably over half of liver toxicity (50%) are related to the statin usage. It is very difficult sometimes to work out whether liver toxicity is it due to the statin. Or if liver toxicity happens because of the fatty liver disease. This is associated with a hyperlipidemia. In many instances there we may rely on a liver biopsy to actually determine if there is, in fact, drug toxicity. Or it is just a fatty liver disease. Dr. Anton Titov, MD. Is there a this to predict the statin toxicity on the liver? At least is statin liver toxicity dose dependent? Dr. Simon Robson, MD. There is some evidence that statin liver toxicity is dose dependent. We do not give statins to patients with more advanced liver disease. But that patients with liver disease tolerate statins reasonably well. Problems we see are in patients with massive increments in statin dosage. These statin liver toxicity cases happen maybe after the patient had a myocardial infarction. Because the effects of statins are not in just lowering lipids. Dr. Anton Titov, MD. Statins also prevent inflammation and thrombosis at the actual vascular level. Statins have direct effects on the endothelium. Dr. Simon Robson, MD. This is anti-inflammatory effects as well as lipid-lowering effects of statins. Some of our cardiology colleagues do increase the doses of statins quite high. Then we can see liver toxicity. What we do know is that patients who have had liver toxicity with statins can be treated with statins again. We typically use a lower dose of statins, or maybe an alternative form of statin. We then monitor those patients closely. Dr. Anton Titov, MD. When the statin has been discontinued or patient is switched to a different statin, is this toxicity not permanent? Does statin liver toxicity disappear? Dr. Simon Robson, MD. Statin liver toxicity does seem to be reversed, it reverses. But the problem is that a patient may develop a very severe toxicity from statins. This can result in acute liver failure and require a transplant. Most of the liver toxicity we see in the North America is caused by acetaminophen (Tylenol). Antibiotics also cause liver toxicity typically. Sometimes INH [isoniazid], this is used here to treat patients who have been exposed to tuberculosis, can cause a lot of problems. Dr. Anton Titov: Isoniazid. Dr. Simon Robson: Yes, isoniazid. then there are other antibiotics this can cause problems ampicillin, clavulanic acid, its combinations. Dr. Anton Titov, MD. Ampicillin with clavulanic acid are one of the most commonly prescribed antibiotics. Dr. Simon Robson, MD. Yes, and one of the most common forms of liver injury from antibiotics. Curious, right? Erythromycin and many other medications can cause toxic liver injury. Sometimes it is predictable, sometimes it is not predictable. Sometimes it is not predictable. It may be from aberrant metabolism. Dr. Simon Robson, MD. Maybe metabolism in that patient is different. Or maybe the immunology of a response to the altered drug is different. We call it “immunoallergic". So they are both immunological features as well as allergic features. Dr. Anton Titov, MD. Clarithromycin and amoxicillin are one of the most commonly prescribed regimens against Helicobacter pylori. Dr. Simon Robson, MD. Yeah, so there can be liver toxicity from that, as well as GI intolerance with the PPIs. PPIs are medications of "proton pump inhibitors' class, such as Nexium and similar medications. Liver toxins to avoid: air pollution, aflatoxins and paracetamol (Tylenol). Dr. Anton Titov, MD. Video interview with leading liver disease expert. Mushrooms, amoxicillin, erythromycin, statins.