Itchy feet and hands liver disease. Itchy Feet and Hands in Liver Disease: Causes, Progression, and Treatment Options

28.07.202327.06.2023 by alexxlab

What are the causes of itchy feet and hands in liver disease. How does liver disease progression affect itching symptoms. What treatment options are available for managing pruritus in liver conditions.

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Understanding the Link Between Liver Disease and Pruritus

Pruritus, commonly known as itching, can be a distressing symptom for individuals with liver disease. While not everyone with liver conditions experiences itching, it’s a significant concern for many patients. The exact mechanisms behind liver disease-related pruritus remain unclear, but researchers have proposed several theories to explain this phenomenon.

Which liver conditions are associated with itching?

Several liver diseases are known to cause itching, including:

Primary biliary cirrhosis (PBC)
Intrahepatic cholestasis of pregnancy
Chronic hepatitis B and C
Familial intrahepatic cholestasis
Alagille syndrome
Primary sclerosing cholangitis (PSC)
Cancer of the head of the pancreas
Biliary obstructive disease

Interestingly, autoimmune liver diseases like PSC and PBC are more commonly associated with itching. Additionally, intrahepatic liver diseases, which affect structures inside the liver, tend to have a higher incidence of pruritus compared to extrahepatic liver diseases.

Theories Behind Liver Disease-Induced Itching

Scientists have proposed several hypotheses to explain why liver disease can lead to itching. While no single theory has been definitively proven, these ideas provide valuable insights into the complex relationship between liver function and skin sensation.

Does bile salt accumulation cause itching in liver disease?

One prominent theory suggests that elevated levels of bile salts may contribute to itching in liver disease. As liver function deteriorates, bile salts can accumulate in the body and gather under the skin, potentially triggering pruritus. However, this theory doesn’t fully explain why some patients with high bile salt levels don’t experience itching, or why the severity of itching doesn’t always correlate with bile salt concentration.

How do other naturally occurring chemicals influence pruritus in liver conditions?

Research has identified several other substances that may play a role in liver disease-related itching:

Histamine: Levels tend to be higher in people with cholestatic pruritus, although the intensity of itching doesn’t always correspond to histamine levels.
Opioids: Some patients have reported improvement in itching symptoms after taking opioid antagonists.
Serotonin: This neurotransmitter may alter a person’s perception of itching. Serotonin reuptake inhibitors have shown promise in managing pruritus for some individuals.
Female sex hormones: Hormonal changes may influence itching sensations in liver disease patients.

What role do skin cells play in liver disease-related itching?

Recent research has shed light on the potential involvement of skin cells in liver disease-induced pruritus. A 2021 study found evidence suggesting that itching in primary biliary cirrhosis (PBC) might involve a nerve reaction in keratinocytes, which are cells in the skin’s outer layer. The study revealed that PBC patients have high levels of a lipid called lysophosphatidylcholine (LPC) circulating in their blood. When researchers injected LPC into mouse skin, they observed an increase in itching, leading them to conclude that LPC may trigger a reaction in the skin that results in pruritus.

Non-Liver Related Causes of Itchy Skin

It’s important to note that not all cases of itchy skin are related to liver disease. Many other conditions can cause pruritus, including:

Atopic eczema
Psoriasis
Dry skin
Heat rash
Allergies
Hives
Fungal infections (e.g., thrush, ringworm, athlete’s foot)
Parasitic infections (e.g., scabies, lice)
Hormonal changes (e.g., during pregnancy or menopause)
Other health conditions (e.g., thyroid or kidney problems)

The Relationship Between Itching Intensity and Liver Disease Progression

One of the most perplexing aspects of liver disease-related itching is the lack of a clear correlation between the severity of itching and the progression of liver disease. This has led researchers to explore alternative explanations for the varying intensity of pruritus among patients.

Can itching severity indicate liver disease progression?

Current scientific evidence suggests that the intensity of itching may not be a reliable indicator of liver disease progression, at least for some liver conditions. The absence of a direct link between itching severity and the levels of chemicals believed to cause pruritus has led researchers to consider other factors that may influence the perception of itching.

What factors might influence the perception of itching in liver disease patients?

Several theories attempt to explain the variability in itching intensity among liver disease patients:

Nerve pathway theory: Some researchers propose that the same nerve pathways carry both itch and pain stimuli, which could explain why the perception of itching varies among individuals.
Separate pathway theory: An alternative hypothesis suggests that itch and pain stimuli travel along separate nerve pathways, allowing for more individual variation in the perception of itching.
Genetic factors: Individual genetic differences may influence how a person experiences and responds to itching sensations.
Dietary influences: Some patients report that certain foods or dietary habits can exacerbate or alleviate their itching symptoms.
Environmental factors: External conditions, such as temperature, humidity, and exposure to irritants, may affect the intensity of itching in liver disease patients.

Treatment Options for Liver Disease-Related Itching

Managing pruritus in liver disease patients can be challenging, as the underlying mechanisms are not fully understood. However, several treatment options have shown promise in alleviating symptoms for some individuals.

What medications are used to treat itching in liver disease?

Doctors may prescribe various medications to help manage itching symptoms in liver disease patients:

Bile acid sequestrants: Drugs like cholestyramine (Prevalite) can help reduce bile acid levels in the body, potentially alleviating itching.
Ursodeoxycholic acid: This bile acid helps the body remove other bile acids and may improve itching symptoms in some patients.
Rifampicin (Rifadin): An antibiotic that has shown effectiveness in reducing itching for some liver disease patients.
Opioid inhibitors: Medications such as naloxone (Narcan) and naltrexone (Vivitrol) may help alleviate itching by blocking opioid receptors.
Serotonin reuptake inhibitors: These drugs can potentially alter the perception of itching and provide relief for some individuals.

Are there non-pharmacological approaches to managing pruritus in liver disease?

In addition to medication, several non-pharmacological strategies may help alleviate itching symptoms:

Moisturizing: Regular application of emollients can help keep the skin hydrated and reduce itching.
Cool compresses: Applying cool, damp cloths to itchy areas can provide temporary relief.
Avoiding triggers: Identifying and avoiding substances or situations that exacerbate itching can be helpful.
Stress management: Stress reduction techniques, such as meditation or yoga, may help some patients manage their symptoms.
Dietary modifications: Some patients find relief by avoiding certain foods or beverages that seem to trigger itching.

The Importance of Proper Diagnosis and Management

Given the complex nature of liver disease-related itching and the variety of potential causes, proper diagnosis and management are crucial for improving patient outcomes and quality of life.

When should a person with itchy skin consult a doctor?

Individuals experiencing persistent or severe itching, especially if accompanied by other symptoms, should consult a healthcare professional. This is particularly important for those with known liver conditions or risk factors for liver disease. A doctor can perform the necessary tests to determine the underlying cause of the itching and recommend appropriate treatment options.

How do doctors diagnose the cause of itching in liver disease patients?

Diagnosing the cause of itching in liver disease patients typically involves a combination of approaches:

Medical history: The doctor will ask about the patient’s symptoms, medical history, and any known liver conditions.
Physical examination: A thorough examination can help identify signs of liver disease or other potential causes of itching.
Blood tests: These can assess liver function, bile acid levels, and other relevant markers.
Imaging studies: Ultrasounds, CT scans, or MRIs may be used to evaluate the liver and biliary system.
Skin biopsy: In some cases, a small sample of skin may be taken to rule out other skin conditions.

Future Directions in Research and Treatment

As our understanding of liver disease-related itching continues to evolve, researchers are exploring new avenues for diagnosis, treatment, and management of this challenging symptom.

What promising areas of research are being pursued for liver disease-related pruritus?

Several exciting areas of research hold promise for improving the management of liver disease-related itching:

Targeted therapies: Researchers are working to develop medications that specifically target the mechanisms believed to cause itching in liver disease.
Genetic studies: Investigations into genetic factors that influence itching perception may lead to more personalized treatment approaches.
Neuroimaging: Advanced brain imaging techniques are being used to better understand how the brain processes itch signals in liver disease patients.
Microbiome research: Studies exploring the relationship between gut bacteria and liver function may provide new insights into the causes of itching.
Novel drug delivery systems: Researchers are developing new ways to deliver medications directly to the skin, potentially improving efficacy and reducing side effects.

How might future treatments for liver disease-related itching differ from current approaches?

As our understanding of the mechanisms behind liver disease-related itching improves, future treatments may become more targeted and effective. Potential advancements could include:

Personalized medicine approaches that take into account an individual’s genetic profile and specific liver condition
Combination therapies that address multiple aspects of the itching mechanism simultaneously
Non-invasive treatments that modulate nerve signaling to reduce the perception of itching
Immunomodulatory therapies that target the underlying autoimmune processes in certain liver diseases
Advanced topical treatments that provide more effective and longer-lasting relief from itching

As research in this field progresses, patients with liver disease-related itching can look forward to potentially more effective and tailored treatment options in the future. In the meantime, working closely with healthcare providers to manage symptoms and address underlying liver conditions remains crucial for improving quality of life and overall health outcomes.

Liver disease progression and other causes

Itchy skin, or pruritus, can be a symptom of liver disease. However, not everyone with liver disease experiences itching, and the specific causes of this itching are unknown.

This article looks at the possible causes of itching in people with liver disease and other possible causes of itching. We also cover how to treat it and when to speak with a doctor.

The liver is the body’s largest solid organ. It breaks down fats, detoxifies the body, produces cholesterol and proteins, and stores vitamins.

The Centers for Disease Control and Prevention (CDC) state that 4.5 million adults in the United States have a diagnosis of liver disease.

Some types of liver disease that involve itching include:

primary biliary cirrhosis (PBC)
intrahepatic cholestasis of pregnancy
chronic hepatitis B and C
familial intrahepatic cholestasis
Alagille syndrome
primary sclerosing cholangitis (PSC)
cancer of the head of the pancreas
biliary obstructive disease

Itching is also more common with autoimmune liver diseases, such as PSC and PBC, and overall with intrahepatic liver diseases, which refers to conditions affecting structures inside the liver.

In contrast, extrahepatic liver diseases affect the liver but occur outside the organ. Some of these can involve itching, such as PSC and cancer of the head of the pancreas.

Pruritus is less common with alcohol-induced liver diseases and nonalcoholic fatty liver disease.

Scientists do not know precisely why itching occurs with liver disease. Below are some theories that scientists have been investigating.

Bile salts

The authors of a 2015 research article suggest that liver disease can increase the levels of bile salts, which then gather under the skin, resulting in pruritus. The body makes bile salts from bile acids.

However, itching does not affect everyone with liver disease and high levels of bile salt, and scientists have not confirmed a link between the severity of pruritus and bile salt concentration.

Other research suggests that unusual levels of bilirubin stimulate peripheral itch sensory neurons. Bilirubin is a pigment of bile. People with liver disease often have high levels of bilirubin.

Other naturally occurring chemicals

Other substances that occur naturally in the body may trigger pruritus, according to some research.

They include:

histamine
opioids
serotonin
female sex hormones

Histamine levels tend to be higher in people with cholestatic pruritus, although itching does not appear to be worse in individuals with higher histamine levels.

Some believe that serotonin can alter a person’s itch perception, resulting in increased itching. Some people have found that taking serotonin reuptake inhibitors helps manage pruritus. Those who took opioid antagonists also reported that their itching improved.

Sensitive skin cells

In 2021, some researchers found evidence that itching with PBC might involve a nerve reaction in keratinocytes, cells in the skin’s outer layer.

People with PBC have high levels of a lipid (fat) known as lysophosphatidylcholine (LPC) circulating in their blood. When the scientists injected the skin of mice with this substance, they noted an increase in itching.

They concluded that as LPC reaches the skin through circulation, it may trigger a reaction that leads to itching.

Many other causes of itchy skin do not relate to the liver.

These include:

atopic eczema
psoriasis
dry skin
heat rash
allergies
hives
fungal infections, such as thrush, ringworm, and athlete’s foot
parasitic infections, for instance, scabies and lice
hormonal changes, for example, during pregnancy and around menopause
other health conditions, such as thyroid or kidney problems

Scientists do not know why itching occurs with liver disease. They believe some chemicals in the body may play a role, but there is no apparent link between the levels of these chemicals and the severity of itching.

This suggests that, as far as doctors know, itching does not indicate that liver disease is worsening, at least for some liver conditions.

Theories to explain why the itching intensity varies focus on the nature of the nerve pathways that carry the feeling or perception of itching.

In one theory, the same pathways carry both itch and pain stimuli. In other, they are separate. In this case, genetic, dietary, and environmental factors may play a role.

Researchers have investigated various possible treatments for itching due to liver disease. However, there is no certain way of treating it, as doctors do not yet know why it occurs.

Prescription drugs that may help manage symptoms include:

bile acid sequestrants, such as cholestyramine (Prevalite)
bile acids that help the body remove other bile acids, for instance, ursodeoxycholic acid
rifampicin (Rifadin), an antibiotic
opioid inhibitors, such as naloxone (Narcan) and naltrexone (Vivitrol)
a serotonin receptor antagonist called sertraline (Zoloft)

However, some of these treatments can have adverse effects. With this in mind, scientists continue to investigate other options.

Another treatment possibility may be antihistamines, although an older review from 2010 concluded that topical antihistamines were ineffective.

Home remedies

Here are some other tips for reducing symptoms:

applying skin moisturizers
avoiding irritants, such as perfumed cosmetics
taking cool baths
applying a cold, wet cloth to affected areas
avoiding hot environments
wearing loose-fitting clothing
avoiding scratching where possible
wearing gloves when sleeping to avoid scratching
using an aqueous cream with 1% menthol to soothe and cool the skin

Itchy skin is typically harmless, but it can sometimes indicate liver disease.

Often, liver disease does not have any symptoms in the early stages. However, a person should speak with a doctor if they experience:

yellowing of the whites of the eyes, a sign of jaundice
fatigue and weakness
a loss of appetite, which may lead to weight loss
a loss of libido, or sex drive
nausea or vomiting

A person may also wish to seek medical advice if itching:

is severe or persistent
affects the whole body
leads to excessive scratching, resulting in secondary skin lesions or infection
occurs on the soles of the feet and palms of the hands
disturbs their sleep
affects their quality of life

People with an existing diagnosis of liver disease who experience itching may wish to seek medical advice. However, it does not necessarily mean that liver disease is worsening.

Itching is not unusual during pregnancy. It can result from hormonal changes or as the skin stretches. But, it can also result from a liver condition called intrahepatic cholestasis of pregnancy (ICP).

With ICP, bile acids do not flow properly, and they build up in the body, causing itching.

Symptoms of ICP include:

itching, especially on the palms of the hands and soles of the feet
dark urine
jaundice
pale stools

ICP typically disappears after delivery.

During pregnancy, the following may help manage itching:

wearing loose-fitting clothes
wearing cotton clothes
taking cool baths
avoiding using perfumes
moisturizing
avoiding spicy food, caffeine, and alcohol

Here are some common questions and answers about liver disease and itching.

Where does itching occur with liver disease?

It may occur anywhere in the body but notably in the palms of the hands and soles of the feet.

What kind of liver disease causes itching?

Itching is common in autoimmune liver diseases, such as primary biliary cirrhosis, primary sclerosing cholangitis, and obstructive biliary disease. It also occurs with cancer of the head of the pancreas, hepatitis, and drug-induced liver disease. However, it is less common with alcohol-induced liver disease and nonalcoholic fatty liver disease.

What are the signs that liver disease is getting worse?

Itching is not necessarily a sign of liver disease getting worse, but it may occur. As damage progresses, a person may experience confusion, easy bruising or bleeding, swelling in the abdomen, legs, and feet, and signs of jaundice, such as yellowing of the whites of the eyes.

There are many causes of pruritus, including some types of liver disease.

Experts do not know precisely why itching occurs with liver disease, although several theories exist. It is not a sign that liver disease is getting worse.

If a person has itching lasting more than 6 weeks, they should speak with a doctor.

Causes, Treatment, When to See a Doctor

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Avoid scratching

It’s important to avoid scratching that itch because it can make matters much worse. Keep your fingernails short so that if you do scratch, you’re less likely to break the skin and open the door to infection.

If you find yourself scratching too much, try to avoid temptation by keeping your skin covered. If you tend to scratch a lot during the night, wear gloves to bed.

Here are some other things you can do to prevent skin irritation and ease itching:

Use warm or cool water rather than hot water for showers and baths.
Try not to spend too much time in hot environments or in the sun.
Choose mild soaps that don’t contain added fragrances.
Use gentle, fragrance-free moisturizers to combat dryness.
Apply a cold, wet cloth to the itchy area until the urge to scratch eases up.
Avoid substances or materials that irritate your skin.
Wear gloves when using harsh products.
Wear loose-fitting, breathable clothing.
Use a humidifier during the dry winter months.

Shop for a humidifier online.

Apply anti-itch topicals

If you have a mild, localized itch, you can try aqueous cream with 1 percent menthol. Other over-the-counter (OTC) topicals, such as corticosteroids and calcineurin inhibitors, may also improve itching.

Follow label directions and be sure to tell your doctor you’re using them.

Find corticosteroid creams online.

Take prescription oral medications

Your physician may recommend oral treatments, such as:

Cholestyramine (Prevalite). This oral medication helps remove bile salts from circulation.
Rifampicin (Rifadin). This medication inhibits bile acids. Taken daily, it requires regular monitoring due to the potential for serious side effects such as hepatitis or renal impairment.
Naltrexone (Vivitrol). Taken daily, this medication blocks the effects of opioids. It requires regular monitoring.
Sertraline (Zoloft). This SSRI is also taken daily. It’s usually prescribed as an antidepressant. Other antidepressants, such as fluoxetine (Prozac), may also be used to treat chronic itch.

Try antihistamines (for sleep)

Antihistamines haven’t been shown to be effective in treating itch caused by liver disease, though they may help you fall asleep despite the itch.

Consider light therapy

Another option is light therapy, also known as phototherapy. This treatment exposes the skin to specific types of light to promote healing. It can take several sessions to start working.

Discuss a liver transplant with your doctor

When treatment doesn’t work and quality of life is severely affected, your doctor may want to discuss the possibility of a liver transplant. This may be an option even if your liver is still functioning.

Liver failure is sometimes accompanied by itching. But you can develop problem itching early on, before you even know you have liver disease.

In fact, pruritis can develop at any point in liver disease. This symptom alone says nothing about liver disease severity, progression, or prognosis.

That doesn’t mean it’s not a serious problem. When itching persists, it can contribute to:

insomnia
fatigue
anxiety
depression
impaired quality of life

Itching associated with liver disease tends to be worse in the late evening and during the night. Some people may itch in one area, such as a limb, the soles of their feet, or the palms of their hands, while others experience an all-over itch.

Itching linked to liver disease doesn’t generally involve rash or skin lesions. However, you can develop visible irritation, redness, and infection due to excessive scratching.

The problem can be exacerbated by:

exposure to heat
stress
menstruation
pregnancy
hormone replacement therapy

Because there are so many things that cause itchy skin, it’s possible that itching isn’t related to your liver disease.

A severe case of dry skin (xerosis cutis) can certainly lead to troublesome itching. Itching without rash can also be a side effect of certain medications, including opioids, statins, and blood pressure drugs.

Skin conditions such as eczema and psoriasis cause itching accompanied by inflamed, red, or scaly skin.

Skin itching can be due to an allergic reaction to such things as:

poison ivy
cosmetics
soaps
household cleaning products
chemicals
fabrics like wool or mohair

In addition to itching, an allergic reaction is likely to involve skin redness, rash, or hives.

Other diseases and disorders that can lead to itchy skin include:

anxiety
depression
diabetes
iron deficiency anemia
kidney failure
leukemia
lymphoma
multiple myeloma
multiple sclerosis (MS)
obsessive-compulsive disorder (OCD)
pinched nerve
shingles (herpes zoster)
thyroid problems

Itching is also associated with:

bacterial, viral, fungal, or parasitic skin infection
insect bites or stings
pregnancy

It’s not always possible to determine the cause of itching.

If you have liver disease, see your doctor whenever you have new or worsening symptoms. That includes itching.

While it may not mean anything as far as disease progression or prognosis are concerned, you won’t know that for certain without a thorough examination.

It’s especially important to tell your doctor if you’re having trouble sleeping and if the itching is affecting your quality of life.

Itching associated with liver disease may be due to a variety of factors. Severe itching can lead to a host of other issues, so it’s important to see your doctor for diagnosis and treatment.

A nocturnal symptom is named that can warn of serious liver problems

Health

Symptoms of liver disease do not always appear immediately, and sometimes they may not appear at all. About the warning sign that manifests itself at night, doctors said.

October 25, 2022

Source:: iStockphoto

Liver – is the main filter organ in our body, and are the most patient. Even if we force the liver to work in an enhanced mode — we load it with pills, alcohol, smoking, fatty and processed foods — then it will “silently” endure for a long time and not show its displeasure in any way. There are no pain receptors in the body. Some discomfort may appear only when the liver enlarges. Then the capsule surrounding it is stretched, and a person can feel it – as heaviness, discomfort in the right hypochondrium.

But still there are a number of non-obvious signs and symptoms that indirectly indicate that something is wrong with the liver. One of them can appear at night – and if it repeats regularly, you should seriously think about the health of the liver, ProNews writes with reference to medical practitioners.

Night symptom

— If before going to bed, at night, when discomfort in the body is more noticeable, you start to itch intensely, feel itching, then this may be due to liver disease, — doctors explain. “After all, one of the tasks of the liver is to break down and excrete substances unnecessary for the body with bile. If for some reason the liver cannot do this, then the next secretory organ that will try to take over this work is the skin. That is why these symptoms appear.

Itching associated with liver disease usually does not cause a rash, physicians note. Most often, the palms and soles of the feet itch, the expert notes. And this is what distinguishes “liver” itching from itching that appears for other reasons.

– Itching due to liver problems is more common on the arms and legs, worse at night and aggravated by heat, menstruation, hormone replacement therapy, pregnancy and contact with wool clothing or blankets, doctors explain.

Symptoms that the liver is sick

Doctors note that itching may not always speak of problems with the liver, there are other reasons. But at the same time, if the palms and feet itch in the evenings, this may be the only sign of liver disease.

If you notice that your skin has become yellower, the color of the whites of your eyes have changed, you should immediately seek immediate medical attention.

In any case, the appearance of a recurring symptom in the form of night itching requires a visit to the doctors. They will pinpoint the exact cause. After all, if liver problems are detected on time and treatment is started, then you can cope with the disease, delaying diagnosis is fraught with serious problems.

If liver function is impaired, the first stage of obesity develops – steatosis, when fats accumulate in the liver cells. Over time, this leads to their death. If timely measures are not taken to treat steatosis, over time this will lead to the death of a large number of hepatocytes. At this stage, cirrhosis of the liver is already beginning to develop, which is practically untreatable.

7 alarms of contaminated liver

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The elimination of fats from the body is one of the main roles of the liver. As you might guess, her work directly affects harmony. Toxins can interfere with the absorption of fats and their removal from the body. The result – the weight creeps up even with a moderate diet. Other unpleasant “companions” can join weight gain: shortness of breath and problems with the cardiovascular system.

Feel tired and depressed even after rest

Metabolic processes are disturbed due to the fact that the liver is overloaded and cannot fully perform its work. You feel tired and depressed almost all day long. Fatigue can be a precursor to the development of more serious processes (for example, non-alcoholic fatty disease (NAFLD)). With prolonged weakness, it is necessary to consult a doctor.

Sweat more and body odor changed

Excessive sweating and body odor can also be signs of liver problems. In the fight against accumulated toxins, the body seems to be participating in a race, it is on its last legs, overheating and trying to cool itself down. In addition, the substances secreted by the body change their composition, you can smell something similar to the smell of boiled cabbage.

Have noticed a deterioration in the condition of the skin and hair

The appearance of painful acne and other inflamed lesions on the skin may indicate the accumulation of toxins – the body is trying to bring them out, as a result – the skin ceases to look healthy. Almost all liver problems also lead to hormonal imbalance, which affects the condition of the skin and hair, which can begin to fall out intensively.

Allergic reactions have become your constant companions

The liver cannot cope with the regulation of the level of incoming antigens. The immune system has to release its “army” to deal with the enemy. The production of histamine increases: skin rashes, itching, peeling, swelling, headaches and runny nose appear.

Heartburn

Violations in the liver lead to a change in the pH of the blood and the appearance of excess acidity in the stomach. This irritates its walls and interferes with the normal functioning of the sphincter – as a result, acid is released into the esophagus. You may also feel bitterness in your mouth and notice a yellow coating on your tongue.

Breath has lost its freshness

Alas, not only the smell of the body changes, but also the smell of the breath. The blood is filtered poorly, the stomach does not cope well with its function, harmful bacteria multiply more actively. An unpleasant taste may also be felt in the mouth, for example, metallic (indicates an excessive accumulation of metals in the body), breathing may resemble a hangover despite the fact that you did not drink alcohol.