Cirrhosis not necessarily caused by alcohol use

illnesses, all of which cause progressive destruction of the liver cells and cause fibrosis — a thickening or scarring — of the liver. Alcoholic liver disease is the single most common cause of cirrhosis referred for liver transplant, which may be why people tend to think of alcohol as the cause of all cirrhosis. The second leading cause is hepatitis C, a viral disease that is now curable. The third cause, as of this writing, non-alcoholic fatty liver disease, is very likely to be the leading cause in the next few years, as the liver can be damaged from the metabolic changes that occur in obesity, especially in people who have abnormally high blood sugar, both prediabetes and diabetes. Lesscommon causes include autoimmune hepatitis, hemochromatosis, primary biliary cholangitis (formerly called “primary biliary cirrhosis,” which you have) and primary sclerosing cholangitis.

Primary biliary cholangitis is, as you said, an autoimmune disease of the bile ducts of the liver. Most people have no symptoms early on. If people do have symptoms, they’re likely to be nonspecific symptoms like tiredness.

Making the diagnosis early is important, since treatment with ursodeoxycholic acid has been shown to reduce the likelihood of death or transplant in some studies.

Dear Dr. Roach: A friend told me that I should not drink milk after eating fish or any seafood. Is there any truth to that? —

A: That’s a new one to me, but I did research on it, and apparently a lot of people have been told that it can cause white spots (vitiligo) on the skin or that the milk can make the fish toxic. None of these is true.

As long as the fish and the milk are themselves wholesome, the combination of the two does not cause any health issues. Plenty of traditional dishes combine them (for instance, chowders).