Dr. Charles S. Lieber, at 78; showed alcohol was liver toxin

Dr. Lieber's findings upset the conventional medical belief that cirrhosis was caused by poor nutrition, not alcohol. (Rubenstein communications)

NEW YORK - Dr. Charles S. Lieber, a clinical nutritionist who upset scientific dogma by showing that alcohol in excess can cause cirrhosis despite an adequate diet, died March 1. He was 78 and lived in Englewood Cliffs, N.J.

The cause was stomach cancer, his daughter Sarah said.

Dr. Lieber devoted much of his career to promoting alcohol research as a legitimate science, countering a prevailing perception among doctors and the public that little could be done about alcoholism. He made many of his fundamental findings at the Veterans Affairs Medical Center in the Bronx.

In a classic experiment in 1974, Dr. Lieber and a team of researchers reported that alcohol was toxic to the liver of baboons who had been fed the equivalent of a fifth of liquor every day for up to four years. The findings upset conventional medical belief that cirrhosis was due to the poor nutrition commonly linked to alcoholism, not alcohol.

In other experiments, Dr. Lieber deciphered some of the ways alcohol can affect the liver and showed that it could convert various compounds in the body into highly toxic ones. The findings are still debated, but they help explain why heavy drinkers and even some social drinkers seem more vulnerable to pain relievers like acetaminophen (Tylenol, for example), anesthetics, and industrial solvents.

"He was a giant in his field, probably the most eminent in the world in alcohol and the liver," said Dr. Steven Schenker, another such specialist at the University of Texas Health Science Center at San Antonio.

"His concepts put him under a lot of pressure, but he defended his positions brilliantly," Schenker said in an interview.

Charles Saul Lieber was born in Antwerp, Belgium.

After World War II, he returned to Belgium, where, as an 18-year-old pre-med student, he had part of his stomach removed after nearly bleeding to death from an ulcer.

He earned his medical degree in 1955 at the University of Brussels, where his ulcer led him to study factors causing such bleeding. He did research there until 1958, when he used a Belgian fellowship to study at Boston City Hospital and Harvard.

In a conversation published in 2001 in the scientific journal Addiction, Dr. Lieber said his first significant discovery was using antibiotics to reduce the stomach's ability to convert one compound, urea, into another, ammonia, which has a deleterious effect on the brain. In the 1950s, studying patients with alcoholic liver disease, he showed that reducing the amount of ammonia produced in the stomach paralleled their clinical improvement.

The findings also supported his thesis that antibiotic treatment of an unknown type of stomach infection caused the changes. Like other doctors before him, Dr. Lieber saw bacteria in the diseased stomach. But he failed to persuade American bacteriologists to try to culture and identify the microbe, he said in the Addiction article.

"The medical community did not believe our bacterial explanation," he said, "because the dogma was that bacteria could not survive in" the stomach's acid environment.

In the 1980s, two Australians, Dr. Barry J. Marshall and Dr. J. Robin Warren, identified the bacteria as H. pylori and found that it was a cause of stomach inflammation and ulcers. In 2005, they won the Nobel Prize for their discovery. H. pylori has also been strongly linked to stomach cancer, from which Dr. Lieber died.

"A well-known saying in medicine is that we die of the diseases we study," Schenker said.

In Boston, Dr. Lieber was intrigued by the lack of a satisfactory explanation of how alcohol caused liver disease. The prevailing dogma at the time was that liver disease seen in alcoholics resulted from malnutrition and not the toxicity of alcohol. The codiscoverer of insulin, Dr. Charles H. Best, citing his rat studies, contended that alcohol was no more toxic than sugar water.

But Dr. Lieber recalled many Belgian alcoholics suffering from cirrhosis who had a good diet and no malnutrition.

He advanced Best's studies to show that alcohol in excess was a liver poison.