Liver Myths vs Facts: What Indian Patients Are Told, and What the Evidence Says

Most of what Indian patients are told about the liver is wrong. Sugarcane juice does not cure jaundice, protein restriction harms cirrhosis, and “detox” herbs are a real cause of liver injury: in the Indian DILI network’s 1,288 patients, complementary and alternative medicines caused 13.9% of cases. Fatty liver is not harmless, and no amount of alcohol is good for the liver.
— Dr Chetan Kalal, DM Hepatology, Gleneagles Hospital Mumbai

Every week someone sits across my desk at Gleneagles Hospital with a liver problem and a head full of advice. A neighbour’s sugarcane-juice cure. An uncle’s instruction to stop all oil and dal. A WhatsApp forward about a seven-day detox. Some of it is harmless. Some of it has put people on the transplant waiting list.

I do not write this to mock anyone. Most of these beliefs come from love — a family trying to help — and a few carry a grain of old wisdom. But the liver has been studied more carefully in the last twenty years than in the previous two hundred, and the evidence now contradicts much of what we were all raised to believe. What follows are the ten liver myths I hear most often in Mumbai, each answered with a fact you can check and the study behind it. Share the facts freely; that is the point of writing them down.

Jaundice and food

Myth 1: Jaundice is best treated with herbal remedies, a vaidya’s powder or jhaad-phoonk

Fact: Herbal and traditional remedies are the second-commonest cause of drug-induced liver injury in India, and they can turn a mild jaundice into liver failure.

Jaundice is a sign, not a diagnosis. Yellow eyes can mean hepatitis A or E, hepatitis B, alcohol, a blocked bile duct, a drug reaction, or a liver that was already failing — and a powder from the bazaar cannot tell them apart.

Worse, the remedy itself can be the injury. The Indian Network of Drug-Induced Liver Injury prospectively studied 1,288 patients between 2013 and 2018. Anti-tuberculosis drugs caused 46.4% of cases; complementary and alternative medicines came second at 13.9%, with a three-month mortality of 13.6%. During the pandemic I co-authored a 13-centre study of Giloy (Tinospora cordifolia), the “immunity booster” sold on every corner: 43 patients developed liver injury a median of 46 days after starting it, some with acute liver failure, and in several it unmasked a silent autoimmune hepatitis. More on herbal and drug-induced liver injury in India.

Myth 2: In jaundice or cirrhosis, eat only boiled food — no oil, no dal, no protein

Fact: Protein restriction harms people with cirrhosis; a randomised trial found a normal-protein diet just as safe in hepatic encephalopathy, and restriction only increased muscle breakdown.

Doctors used to teach this one, which is why it does the most quiet damage. Córdoba and colleagues randomised 30 cirrhotic patients admitted with encephalopathy to a low-protein or a normal-protein diet for 14 days. Recovery was no different between the groups; the low-protein group simply broke down more of their own muscle.

The 2019 European guideline on nutrition in chronic liver disease treats malnutrition as a complication of cirrhosis in its own right, one that worsens liver failure, infections, encephalopathy and ascites. A person living on boiled rice and khichdi spends every night consuming their own muscle. Dal, eggs, fish, chicken, paneer, milk, a late-evening snack and a sensible amount of oil are treatment, not indulgence. My guide to nutrition in cirrhosis sets out an Indian plate.

Myth 3: Sugarcane juice cures jaundice

Fact: No study has shown that sugarcane juice treats jaundice; roadside juice made with untreated water or ice can carry hepatitis A and E, two of the commonest causes of jaundice in India.

I understand why this one survives: most jaundice in young, otherwise healthy Indians is hepatitis A or E, which usually clears by itself within weeks, so whatever the family gives meanwhile gets the credit. Both viruses spread by the faecal-oral route, most often through contaminated water. A juice stall that rinses the cane in a bucket and adds ice of unknown origin is, quite literally, a way of catching the disease people hope it will cure. Have sugarcane juice clean, at home, for pleasure — not as medicine.

Fatty liver and alcohol

Myth 4: Fatty liver is harmless — everybody has it

Fact: Fatty liver affects about 30% of adults worldwide and roughly a third of South Asians, and in a minority it progresses silently to cirrhosis and liver cancer.

“Everybody has it” is half true, which is exactly what makes it dangerous. A 2023 meta-analysis in Hepatology pooled 92 population studies covering more than 9.3 million people and put the global prevalence of fatty liver at 30.05%; for South Asia the figure was 33.83%. One in three of the people reading this has fat in the liver.

Most will never develop serious disease. Some will, and the ultrasound grade cannot tell you which group you belong to; a ten-minute FibroScan can. The full picture is on my fatty liver page; what to eat is in my fatty liver diet guide.

Myth 5: Only people who drink get cirrhosis

Fact: A large share of cirrhosis in India occurs in people who have never touched alcohol — hepatitis B, hepatitis C, fatty liver, autoimmune and inherited diseases all scar the liver.

This myth carries a cruelty of its own. I have watched teetotal patients endure the silent judgement of relatives, and sometimes of doctors, because “cirrhosis” and “drinker” are welded together in the public mind. Alcohol is one cause among many: hepatitis B acquired at birth, hepatitis C from an old unscreened transfusion, fatty liver, autoimmune hepatitis, Wilson disease in the young. If you have cirrhosis and do not drink, the right response is not shame but a search for the cause — hepatitis C, above all, is curable.

Myth 6: A little alcohol is good for the liver (or the heart)

Fact: The largest analysis of alcohol and health ever conducted, covering 195 countries, concluded that the level of drinking that minimises harm is zero.

The “one peg a day is protective” idea came from studies that compared drinkers with non-drinkers — forgetting that many non-drinkers had stopped because they were already ill. The Global Burden of Disease analysis published in The Lancet in 2018 corrected for this across 694 data sources. Its conclusion: the amount of alcohol that minimises overall health loss is zero standard drinks per week. In people aged 15 to 49, alcohol was the leading risk factor for death, accounting for 12.2% of male deaths. For the liver there is no protective dose, only a dose below which most people get away with it — and for anyone who already has fatty liver, hepatitis B or cirrhosis, the safe amount is none. Read more on alcohol-related liver disease.

Tests and treatments

Myth 7: Liver detox drinks, cleanses and “liver tonics” flush out toxins

Fact: The liver detoxifies itself; no cleanse has been shown to improve liver function, and some “liver tonic” herbs are themselves documented causes of liver injury.

Detoxification is what the liver does, all day, without help. There is no residue inside it waiting to be flushed by lemon water, apple-cider vinegar or a sachet with a Sanskrit name, and I have never found a trial showing that any commercial cleanse improves liver tests, scarring or survival. What I have found, repeatedly, is the opposite: patients whose “liver tonic” was the reason they needed me. Giloy is only the best-known example. A liver that is well does not need a detox. A liver that is unwell needs a diagnosis.

Myth 8: My LFT is normal, so my liver is healthy

Fact: Normal liver enzymes do not exclude serious liver disease; in a biopsy study of fatty liver with normal ALT, 18 of 51 patients already had bridging fibrosis or cirrhosis.

The “liver function test” is misnamed. ALT and AST measure leakage from injured cells at one moment in time, not the scarring accumulated over years. Mofrad and colleagues biopsied 51 people with fatty liver whose ALT was entirely normal. Twelve had bridging fibrosis and six had cirrhosis — a third with advanced disease and a blood report that said nothing. Diabetes more than doubled the risk (relative risk 2.3).

A normal LFT answers one question only: is there active inflammation today? For scarring you need a FIB-4 score (from age, AST, ALT and platelets) and, if it is not low, a FibroScan.

Hepatitis and transplant

Myth 9: Hepatitis B spreads by sharing food, utensils or a hug

Fact: Hepatitis B spreads through infected blood, sexual contact and from mother to child at birth — not through food, water, utensils or touch — and a safe, effective vaccine has been available for decades.

Families separate plates. Children are kept from a grandparent. An engagement is quietly cancelled. All of this for a virus that does not travel in food, in saliva on a shared glass, or in an embrace. Hepatitis B needs blood or sexual fluids to pass: childbirth, unprotected sex, unscreened transfusions, shared needles and razors, unsterile tattoo or piercing equipment. What matters at home is simple — everyone tested, everyone negative vaccinated, no shared razors or toothbrushes, and the infected person under a hepatologist’s care. The vaccine is part of India’s routine childhood schedule; adults who missed it can still take it.

Myth 10: Liver donors are left disabled — donating a liver ruins your life

Fact: Across 11,553 living liver donor operations worldwide, the death rate was 0.2%; the liver regrows and most donors return to a normal life — but the risk is real and must be discussed honestly.

Living donation is how most liver transplants in India happen, so this myth decides who lives. The best data come from a survey of 71 transplant programmes in 21 countries, published in Liver Transplantation: across 11,553 donor hepatectomies, 23 donors died (0.2%), 5 (0.04%) needed a transplant themselves, and 24% had some complication, most minor.

I would never tell a donor the operation is trivial; these numbers are part of every consent conversation in our liver transplant programme. But “disabled for life” is false: the liver regenerates, and donors go back to office work, farming, pregnancy and sport. A small, well-counted risk, taken by one person, so that another does not die.

What I tell families

Respect tradition, but ask it for evidence. Eat your dal. Vaccinate your children against hepatitis B. Treat “normal LFT” as the beginning of a question, not the end of one. And when a relative with yellow eyes is handed a powder, remember that in this country the powder is the second-commonest reason a liver fails from something a person swallowed. None of this is secret — it is simply newer than the advice we grew up with, and the gap between the two is where patients get hurt.

References

1. Devarbhavi H, Joseph T, Sunil Kumar N, et al. The Indian Network of Drug-Induced Liver Injury: etiology, clinical features, outcome and prognostic markers in 1288 patients. J Clin Exp Hepatol. 2021;11(3):288–298. PMID 33994711. doi:10.1016/j.jceh.2020.11.002
2. Kulkarni AV, Hanchanale P, Prakash V, Kalal C, et al. Tinospora cordifolia (Giloy)-induced liver injury during the COVID-19 pandemic — multicenter nationwide study from India. Hepatol Commun. 2022;6(6):1289–1300. PMID 35037744. doi:10.1002/hep4.1904
3. Córdoba J, López-Hellín J, Planas M, et al. Normal protein diet for episodic hepatic encephalopathy: results of a randomized study. J Hepatol. 2004;41(1):38–43. PMID 15246205. doi:10.1016/j.jhep.2004.03.023
4. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol. 2019;70(1):172–193. PMID 30144956. doi:10.1016/j.jhep.2018.06.024
5. Younossi ZM, Golabi P, Paik JM, et al. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023;77(4):1335–1347. PMID 36626630. doi:10.1097/HEP.0000000000000004
6. Mofrad P, Contos MJ, Haque M, et al. Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values. Hepatology. 2003;37(6):1286–1292. PMID 12774006. doi:10.1053/jhep.2003.50229
7. GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018;392(10152):1015–1035. PMID 30146330. doi:10.1016/S0140-6736(18)31310-2
8. Cheah YL, Simpson MA, Pomposelli JJ, Pomfret EA. Incidence of death and potentially life-threatening near-miss events in living donor hepatic lobectomy: a world-wide survey. Liver Transpl. 2013;19(5):499–506. PMID 23172840. doi:10.1002/lt.23575