Why Your Tap Water Concerns Might Be Affecting Your Liver—Even If You Don't Realize It

A new study of 272 adults in rural West Virginia found that people who distrusted their tap water had significantly higher rates of elevated liver enzymes, suggesting that environmental concerns and beverage choices may silently affect liver health. Among those with low water safety perceptions, nearly 59% showed elevated alanine aminotransferase (ALT)—a key marker of liver stress—compared to just 31% of those who trusted their water. This surprising link reveals how infrastructure problems and community mistrust can ripple into unexpected health consequences.

How Does Water Mistrust Connect to Liver Health?

The relationship isn't as straightforward as contaminated water directly damaging the liver. Instead, researchers believe the problem lies in what people drink when they don't trust their tap water. When residents perceive their water as unsafe—often with good reason in regions with aging pipes or unregulated well systems—they may turn to alternative beverages. In West Virginia, where some communities faced boil water advisories lasting over a decade, this mistrust runs deep.

The study examined 272 adult patients at a primary care clinic in rural West Virginia, asking them to rate their home tap water safety on a seven-point scale and report their beverage consumption patterns. Researchers then reviewed their medical records for liver enzyme levels and metabolic dysfunction-associated steatotic liver disease (MASLD)—the medical term for fatty liver disease not caused by alcohol.

What Did the Research Actually Show?

The findings paint a striking picture of how environmental perception shapes health outcomes. Among the key discoveries:

• ALT Elevation: 58.82% of participants with low water safety perception had elevated ALT levels above 40 U/L, compared to 31.47% of those with higher water safety perceptions—roughly a threefold increase in odds.
• AST Elevation: A similar pattern emerged for aspartate aminotransferase (AST), another liver enzyme marker, with those distrusting their water showing 3.73 times higher odds of elevation.
• No Diagnosed Disease Yet: Interestingly, while liver enzymes were elevated, most participants didn't have a formal diagnosis of metabolic dysfunction-associated steatotic liver disease, suggesting these enzyme changes may represent early warning signs.
• Water Consumption Paradox: Despite concerns about tap water, 68.5% of participants still drank unfiltered tap water at least occasionally, and most reported moderate or low sugar-sweetened beverage consumption.

One-third of all study participants rated their home tap water safety as low, reflecting the real infrastructure challenges facing rural communities.

Why Should Rural Communities Care About This?

Metabolic dysfunction-associated steatotic liver disease has become the most common liver disease worldwide, affecting an estimated 37.8% of the global population as of 2022, up from 25.5% in 2005. Most people with this condition don't know they have it because it's often silent in early stages. Without intervention, it can progress to more serious conditions including non-alcoholic steatohepatitis, fibrosis, cirrhosis, and even liver cancer.

Rural and minority populations face compounded challenges: limited access to safe drinking water, fewer healthcare resources, and economic hardship all contribute to health disparities. In West Virginia specifically, adults report among the highest rates of daily sugar-sweetened beverage consumption in the United States, with 39.2% drinking these beverages every day. While the study didn't find that people were substituting sugary drinks for tap water at high rates, the combination of water mistrust and existing beverage habits may still influence liver health.

The researchers emphasize that these findings should be interpreted as exploratory but important. The elevated liver enzymes suggest that perceived or actual environmental stressors may coincide with hepatic changes—meaning the stress of living in a community with water quality concerns might itself contribute to liver problems, independent of what people actually drink.

What Comes Next for Public Health?

The study authors call for community-centered public health interventions that go beyond simply telling people to drink more water. Effective approaches should include:

• Transparency Initiatives: Improving water quality reporting so residents understand actual safety levels rather than relying on fear or rumors.
• Affordable Filtration Access: Making home water filters accessible and affordable for families who distrust their municipal systems.
• Infrastructure Investment: Addressing the aging or unregulated municipal water systems that fuel legitimate concerns in the first place.
• Psychosocial Support: Recognizing that environmental stress itself may affect health, not just the physical exposures.

Meanwhile, a broader global call to action from the Global Think-tank on Steatotic Liver Disease emphasizes that research into fatty liver disease should prioritize person-centered care and work toward reducing disease burden and economic costs. This means understanding how local conditions—like water infrastructure—shape health outcomes and designing solutions that fit real communities rather than one-size-fits-all approaches.

For people living in rural areas with water quality concerns, the takeaway is clear: your liver health may be more connected to your environment than you realize. If you distrust your tap water, consider exploring affordable filtration options, staying informed about actual water quality reports, and discussing liver enzyme screening with your healthcare provider—especially if you have other risk factors like diabetes or obesity.