Integrative hepatology: Enhancing overall health to manage liver disease

Despite remarkable advances in diagnostics, pharmacotherapy, and transplantation, conventional hepatology often falls short in addressing the persistent symptoms, impaired quality of life, and broader health needs of people living with chronic liver disease. Integrative Hepatology—rooted in the principles of integrative medicine—offers a holistic, evidence-informed approach that combines conventional hepatology with complementary modalities to address the biological, nutritional, physical, psychosocial, behavioral, and environmental determinants of liver health. This framework emphasizes multimodal, patient-centered care aimed at improving both liver-specific and overall health outcomes. We outline three models for implementation: (1) foundational knowledge for all hepatologists, incorporating core skills in nutrition, physical activity, and mind-body practices; (2) collaborative referral networks to integrative health providers; and (3) specialized hepatologists with advanced training in integrative medicine. Examples of application to fatigue, cramps, falls, and mental health in chronic liver disease illustrate the potential for non-pharmacologic and complementary strategies to enhance patient well-being. Implementation faces challenges, including evidence gaps, limited training, time constraints, reimbursement barriers, and inequitable access, but opportunities exist through education, interdisciplinary collaboration, group medical visits, and digital health delivery. By expanding the scope of liver care to include whole-person health, Integrative Hepatology seeks not to replace established therapies but to augment their impact—supporting patients in achieving optimal health across the disease spectrum.