Smart Guide to Liver Health

29 ways to protect the hardest-working organ in your body

Jeanne Dorin McDowell,

AARP

Reviewed by

Christine Hsu, M.D.

Comments

Published March 18, 2025

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Your liver might be the hardest-working organ in your body.

You know that one of its main jobs is to filter out toxins like alcohol from your body. But that’s just one of its more than 500 roles. Weighing about three pounds — with roughly the dimensions of a football — this spongy, reddish-brown organ nestled on the right side of your body under your ribcage works 24/7, helping to fight infections and regulate blood sugar levels, and producing hormones and proteins used throughout your body. And it can regenerate: If part of a healthy liver is surgically removed, the cells divide and begin to regrow tissue within days.

“The liver is incredibly resilient,” says Meena Bansal, M.D., director of translational research at the Division of Liver Diseases at Mount Sinai Health System in New York. “Evolutionarily, it had to be. The liver has to deal with everything we eat and protect the rest of the body. It’s the first line of defense. It is the detoxifier, it’s the cleanser, it’s the metabolizer of any drugs.”

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But the liver isn’t immune to the stresses of aging. While we all know that decades of heavy drinking or certain drug use can damage the liver. So, too, can weight gain and an unhealthy diet: An estimated 100 million people in the U.S. have a dangerous buildup of fat in their liver that's known as metabolic dysfunction-associated steatotic liver disease, or MASLD. A study published last year found that nearly 50 percent of people 65 and over have it.

Yet thanks to its superpowers of regeneration, the liver has extraordinary resilience; in many people, liver damage can be treated, sometimes even reversed. To find out how to keep your liver heathy, we reached out to top hepatologists who specialize in diagnosing and managing liver disease. Here is what they said.

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KNOW YOUR RISK FACTORS

1. How age affects your liver

By age 65, you’ve already sustained significant liver damage. The aging process can be tough on the liver. With aging, your liver is more susceptible to injury and scarring, also known as fibrosis. Damage tends to be more serious and takes longer to heal in older people, in part because our livers shrink with age: By the time you’re 65, your liver has lost between 20 and 40 percent of its original size, and blood flow has decreased by about 35 percent. “Our bodies are basically machines, and like machines they wear out over time,” says Anna Mae Diehl, M.D., a hepatologist and professor of medicine at Duke University. How quickly your liver wears out depends on how healthy it was to begin with, and how much stress it’s endured over your lifetime.

2. Obesity puts you at risk

The prevalence of fatty liver disease in the U.S. is closely tied to the epidemic of obesity. Being overweight doesn’t mean you automatically get fatty liver disease, but older people tend to be heavier — roughly a third of people 65 and over in the U.S. are obese — and that puts you at risk. If you’re eating too much, the excess calories from a high-fat diet are stored in your liver and interfere with how it functions. According to Diehl, at least 60 percent of women over 65 are overweight, resulting in a 60 to 70 percent chance of having a fatty liver. “If you have diabetes, that goes up to 80 percent,” she says.

But there’s good news: According to Grace Su, M.D., president-elect of the American Association for the Study of Liver Diseases (AASLD), fatty liver damage caused by obesity can often be reversed with weight loss and diet changes. “Not everybody over 50 has liver disease,” Su says. “But it’s a disease that manifests later on because the damage caused by liver diseases accumulates, so you may not see it until someone is older.”

3. Even moderate alcohol use causes damage

If you’re a heavy drinker or even a moderate one, there’s a good chance you have some liver damage or liver disease. When you drink, the liver’s process of metabolizing the alcohol creates byproducts that prompt the liver to make more fat while reducing the amount allowed to exit. As excess fat builds up, it then gets stored in the liver. This stored fat leads to injury of the liver cells, which can lead to scarring and cell turnover, which can increase your risk of cancer. Muscle can absorb extra alcohol as well — which is one reason why men can tolerate booze better than women — but as we get older, we tend to lose muscle mass. That’s why alcohol both affects us more strongly as we age, and causes a greater degree of damage.

According to the Centers for Disease Control and Prevention (CDC), moderate drinking for women is now defined as one drink a day; for men, it’s two. By cutting down on your alcohol consumption or, better yet, quitting, you can halt the progression of liver scarring (called fibrosis), and your liver function may improve, depending on when you stopped drinking.

4. Look at your medications

Although one of your liver’s main jobs is to metabolize medications, some meds can cause drug-induced liver injury (DILI). “Believe it or not, almost any medication makes someone susceptible to develop liver injury. There is no good way to avoid it as we get older,” says Sammy Saab, M.D., medical director of the Pfleger Liver Institute at the University of California Los Angeles (UCLA). And we’re not talking Breaking Bad–style illegal substances. Even high doses of OTC pain relievers such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs); statins used to lower cholesterol; and prescription steroids are potentially harmful to the liver, mostly if you’re taking doses beyond what is recommended on the label.

People with liver damage should limit their daily intake of acetaminophen to 2,000 mg or even less if their liver disease is severe; those who drink alcohol regularly shouldn’t take acetaminophen at all. Some antibiotics, such as erythromycin and amoxicillin/clavulanate (brand name Augmentin), which are prescribed for sinus or urinary tract infections, can also damage the liver. While most of the damage is temporary, in some cases it can lead to more serious liver disease. Read the labels before taking any medications, and talk to your doctor to find out the best dosage for you, especially if you’re taking medications for other health conditions. Don’t be your own pharmacist.

5. Test for hepatitis

Hepatitis is uncontrolled inflammation in the liver caused by viral infections, alcohol or autoimmune disorders. There are five strains of hepatitis, but three — A, B and C — are most common in the U.S. Hepatitis A is highly contagious and generally contracted through tainted water or food contamination (you may recall news of tainted blackberries sold in grocery stores several years ago). But it tends not to be long-term and usually resolves without extensive liver damage. Hepatitis B and C, on the other hand, are spread through contact with bodily fluids — from things like unprotected sex, sharing needles, or poorly sterilized tattoo equipment — and can cause long-term liver damage. While hepatitis testing isn’t routine, your doctor may order a test — it’s done with a simple finger prick — if you have a history of high-risk behavior or are showing symptoms of liver disease. Diabetics are twice as likely to contract hepatitis B as the general population because it can spread by sharing glucose monitoring equipment, which puts older people living in long-term care facilities at a greater risk. Hepatitis C is especially problematic because it’s asymptomatic, and most people don’t know they have the infection. But if it goes untreated, hepatitis C can lead to cirrhosis, liver cancer or liver failure.

6. Environmental toxins hurt older people more

Pesticides, air pollutants and heavy metals can accumulate in the liver; older adults have a harder time filtering them out of the bloodstream. This can lead to inflammation, cell damage and potentially chronic liver diseases. Evidence suggests that exposure to toxins plays a role in liver cancer. While environmental toxins can come in many shapes and forms, using an air purifier in your home is one step you can take to reduce your exposure, especially if you live in an urban area or one with high levels of air pollution.

7. Family history can quadruple your risk

If you have a family history of liver cancer, you’re four times as likely to develop the disease than people without a history. Researchers have found that certain genes may make you more likely to develop fatty liver disease, which may help explain why MASLD is more common in certain racial and ethnic groups. Scientists are still studying the genes that may play a role in this. People with hepatitis B or C infections who also have a family history of liver cancer are at the highest risk of developing liver cancer.

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UNDERSTANDING THE 4 STAGES OF LIVER DISEASE

8. Hepatitis (inflammation) is the first stage

Liver disease is a progressive disease that begins with inflammation — hepatitis —caused by any number of risk factors described above, from viral infections to fatty liver to overuse of pain medications. Persistent inflammation from hepatitis can damage or destroy liver cells and gets progressively more serious as it moves into fibrosis.

9. Fibrosis (scarring) begins as the damage accelerates

This is the gradual stiffening of the liver when scar tissue accumulates. The scarring reduces blood flow which, in turn, prevents nutrients and oxygen from circulating through the liver. Scar tissue can’t repair itself, and the liver’s ability to function decreases as fibrosis progresses. Over time, scarring replaces healthy tissue, and the scars fuse into bands called septa that suffocate the liver. People usually don’t experience symptoms, and so fibrosis often goes undetected until it has progressed to the more dangerous cirrhosis stage of liver disease.

10. Cirrhosis (severe scarring) means permanent damage

Cirrhosis is severe liver scarring, and the scarring accumulates as cirrhosis gets worse, with the liver unable to perform its many functions. At an advanced stage, cirrhosis can be fatal. But if it is diagnosed early and the underlying cause is treated, further damage can be limited and in some cases reversed.

“Early cirrhosis is treatable,” Bansal says. “But you may have cirrhosis of the liver for 10 or 15 years, and we don’t know the point of no return. The longer you have it, the less the chance of stopping it.”

Unfortunately, a stigma surrounding liver disease prevents many people from seeking the help they need to treat it early. “The average person is embarrassed they have liver disease, because they think you only get if you’re an alcoholic or addict,” Diehl says. “That’s not true. One out of every three adults in the United States has fatty liver disease, and most of them are not alcohol-abusing individuals.” Your doctor may suspect cirrhosis if you have a low platelet count and may recommend additional tests. Small red spots on the chest, back and upper arms, which are called angiomas, can also be a sign of cirrhosis.

11. Cirrhosis is a warning flare for liver cancer

Although liver cancer is not a stage of progressive liver disease, about 90 percent of people who develop primary liver cancer (meaning that it did not travel from another point of origin) have cirrhosis. Christine Hsu, a clinician at the Liver Diseases Branch of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), recommends that people with cirrhosis be screened every six months with ultrasound and blood work.

“With early detection, we can provide curative therapies, surgical resection or transplantation,” she says. “In people with advanced age, we can also use what’s called a radio frequency ablation, where we use a needle to burn out the cancerous tumor.”

12. Liver failure (end stage) often leads to a transplant

The end stage of liver disease is liver failure, which is when the body starts to break down and liver function stops. Someone with liver failure may experience severe water retention and abdominal bloating, mental confusion, blood in the stool or urine, or a loss of muscle mass. It can often be fatal. “Liver failure is usually the point of no return,” Saab says. “When the benefits outweigh any risks, we consider liver transplant.”

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MONITOR YOUR LIVER HEALTH

13. Regular checkups are crucial

As part of a routine checkup, your doctor will probably do a liver panel that checks your blood for levels of liver enzymes and proteins. If your liver enzymes are elevated, he or she may refer you to a hepatologist who specializes in liver care. If you have risk factors such as high blood pressure, high cholesterol or diabetes, you should also be tested for fatty liver disease. According to Saab, medical providers tend to discover fatty liver disease while they’re looking for something else. “A patient comes in for gallbladder pain and we find out the liver is injured,” he says. “It’s not very common for someone to come to me with symptoms of fatty liver disease.”

14. Noninvasive techniques can help detect early disease

Liver disease is hard to diagnose, because oftentimes you don’t even know you have it until it reaches an advanced stage. But a number of noninvasive screening techniques are now available that can help detect damage at an earlier stage, which is key to effective treatment. They include abdominal ultrasound, CT scan and MRI. Transient elastography (TE) is a specialized test that measures stiffness and fibrosis by sending low-frequency vibrations into the liver using a special ultrasound probe, then measuring how fast these vibrations move through the tissue. The faster the wave travels, the more extensive the scarring. TE results give your doctor an idea of the severity of liver disease without having to do a biopsy. Magnetic resonance elastography (MRE) combines magnetic resonance imaging (MRI) with low-frequency vibrations. This data is then used to build a visual map of the liver, known as an elastogram, which reveals scarring and changes in liver tissues.

15. A blood test can be as good as a biopsy

Another tool called the fibrosis-4 (FIB-4) index calculates the amount of scarring on your liver by using several measurements drawn from your blood test results and coming up with a value. Hepatologists say the FIB-4 index is a good potential alternative to the more invasive biopsy for diagnosing liver disease. A 2021 study published in Diagnostics found FIB-4 to be a more affordable way to identify liver fibrosis, and one that may be a “red flag” to doctors to conduct additional liver tests.

16. To protect yourself, know the symptoms

Early signs of liver disease can be hard to detect. In older people, they may be similar to symptoms of other health conditions, but you may feel some discomfort on the right side of your abdomen, or fatigue or nausea. More advanced liver disease manifests in symptoms such as jaundice, dark-colored urine, itchy skin, swelling in the legs and ankles, pale stool, constant tiredness, nausea or vomiting, loss of appetite, or bruising. You may also see changes in your nails and hands. Contact your doctor if you notice any of these.

17. Watch your diet and weight

Diet and weight loss are the first line of defense against fatty liver disease. Losing just 5 to 10 percent of your body weight can decrease the amount of inflammation in your liver. “Lifestyle modifications and diet do work,” says Diehl, who recommends a Mediterranean-style diet with plenty of fruits, vegetables, lean protein, nuts and whole grains for liver health. According to the American Liver Foundation, foods high in fat, sugar and salt should be avoided, so steer clear of fast-food restaurants. Also avoid processed foods and the high-fructose corn syrup found in many beverages in order to keep your liver healthy. “When in doubt, you can’t go wrong with lower-fat foods and smaller portions,” Saab says.

18. Exercise regularly for strength and endurance

Experts recommend about 150 minutes a week of mild aerobic exercise, resistance training and core work, all of which are important to rebuild muscle mass lost through aging. “Keep your core strong,” advises Su. “No matter what happens, you need it to fight liver disease. If you have significant liver disease, you will lose more muscle, and building your core strength may determine how well you do.”

A study published in the Journal of Hepatology in November 2024 found that diet and exercise “elicited significant and clinically meaningful treatment effects on liver health” in treating serious fatty liver disease. In October of the same year, a research team at the University of Missouri School of Medicine found that 24 patients with fatty liver disease who adhered to a restricted diet and a high-intensity interval training exercise program for 10 months dramatically improved their liver health over the control group of patients who received standard care. The message: Get moving.

19. Enjoy that cup of coffee

Two or three cups of coffee a day can benefit your liver. A study in the journal Nutrients suggests that coffee contains antioxidant properties that decrease inflammation and potentially inhibit the progression of liver scarring. Here’s the rub: Avoid a lot of milk, sugar or sugar alternatives. And skip those lattes and cappuccinos.

20. Focus on a vitamin-rich diet

Vitamin deficiency is often found in people with liver disease. A healthy diet rich in vitamins A, B, C, D, E and K can help support liver health. Excessive amounts of vitamins A, D, K, niacin and iron may cause damage. Talk to your doctor before taking supplements to ensure you take the correct dosages.

21. Avoid herbal supplements and “detoxes”

There are no alternative medicines that have proven effective in treating liver disease, though more research is needed. Dietary supplements and herbal products are not regulated and have not undergone rigorous testing for safety and efficacy. “One of the biggest problems is you never know what’s in them,” Su says. Additionally, some dietary and herbal supplements are known to harm the liver and should be avoided. More than 1,000 medicines and herbal products have been linked to liver damage. Some of the natural products that are known to be toxic to the liver include chaparral, comfrey tea, kava, green tea extract, skullcap and yohimbe, but there are many others, according to the American College of Gastroenterology. Anabolic steroids marketed as bodybuilding supplements may also produce liver injury. Check your list of herbs and supplements against LiverTox, an online public resource developed by the NIDDK’s Liver Disease Research Branch .

22. Get tested for hepatitis

Hepatologists and the CDC recommend that all people over 60 be screened once for hepatitis B and C. “It’s one and done,” says Diehl. Baby boomers born between 1946 and 1964 are five times more likely to have hepatitis C than any other age group. That’s because blood donations weren’t screened before 1992, and boomers are more likely to have engaged in occasional or ongoing injection drug use during young adulthood, particularly in the 1970s and '80s.

23. Consider a hepatitis vaccination

The vaccination for hepatitis A is recommended for people over 60 with risk factors that include chronic liver disease, HIV and homelessness; people who work in research labs or have occupational risks for exposure; people who inject drugs; and men who have sex with other men. People over 60 with similar risk factors should be vaccinated against hepatitis B.

24. Stay hydrated

Higher water intake is related to a lower diagnosis of fatty liver disease. The American Liver Foundation says water helps your liver function properly by flushing out toxins and waste products. But how much? That can vary, but generally nine glasses a day for women and 11 glasses a day for men. Your urine will be pale yellow when you’re drinking adequate amounts of water, while a darker-color urine indicates you may be dehydrated. That said, it’s not one glass fits all when it comes to hydration; needs vary according to activity level, climate and diet.

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TREATING LIVER DISEASE

25. A new medication is FDA-approved

Until recently, there were no FDA-approved medications for fatty liver disease. But in March 2024, the FDA approved resmetirom (Rezdiffra), the first drug to treat non-alcoholic steatohepatitis (NASH), a more serious form of fatty liver disease. Resmetirom works by activating receptors in the liver that reduce inflammation and help break down fat. According to Saab, patients in their 70s and 80s tolerate the medication well.

26. Older drugs can help, too

Other drugs used to treat liver disease include vitamin E (for nonalcoholic fatty liver disease), pioglitazone (a medicine that improves insulin resistance to fatty liver disease by increasing the sensitivity of the liver, fat and muscles to insulin), and diuretics (water pills) like spironolactone for managing extra fluid in the abdomen, which is common in patients with cirrhosis.

27. Newer drugs are being explored

Drugs like emricasan are being investigated for their potential to treat liver fibrosis. Antiviral drugs can be used to treat hepatitis A, B and C. In clinical trials, researchers have found that a weekly injection of semaglutide, the compound used in weight-loss drugs like Wegovy and Ozempic, is safe and reduced the amount of fat in the liver by 31 percent in people with fatty liver disease and HIV.

28. Diseased parts of the liver can be removed

Up to two-thirds of the liver can be removed by surgery, and if the remaining tissue is healthy it will simply grow back. This procedure is called a liver resection, or hepatectomy.

29. A transplant is the last resort

When other treatment options have failed, a liver transplant is an option for some people with life-threatening liver disease. Studies show that age is not a major factor if a patient’s cardiovascular and respiratory health are good. A 2024 study of patients 70 and older found a five-year survival rate of 67 percent.

“We don’t have an age cutoff,” says Saab, who is also chief of transplant hepatology at UCLA. “We have patients who are 70 or 75 with cirrhosis in great shape, and we have people 45 who are on a gurney. It’s more about function than chronological age.” Saab says the oldest patient he has given a liver transplant was 80, but he urges all patients to undergo a vigorous evaluation process to ensure they’re in good shape to tolerate the surgery. “Any older and it may be hard for them to recuperate — but it’s not an absolute.”

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Jeanne Dorin McDowell writes about health, wellness culture and social issues for national print and digital publications. She was a correspondent for Time magazine for 20 years.

Christine Hsu, M.D., is a staff clinician and an assistant research physician in the Liver Diseases Branch at the National Institutes of Health (NIH) since 2022. She also directs the NIH Hepatology Fellowship Program. Prior to joining NIH, Hsu was an assistant professor at Georgetown University and the University of Pennsylvania. She remains a transplant hepatology attending, adjunct assistant professor at Georgetown University.