The liver sits on the right side of the abdomen, protected by the rib cage. The heaviest organ, it filters blood coming from the digestive tract before circulating through the rest of the body. The liver processes macronutrients–carbohydrates, proteins, and fats–and metabolizes vitamin and mineral micronutrients . This powerful filter also detoxifies chemicals, metabolizes drugs, and aids in the conversion of hormones.  

 

As part of the excretory system, the liver produces and moves bile pigments, bile salts, and cholesterol into the small intestine via the gallbladder. This is essential for the digestion of fats, absorption of fat-soluble vitamins, killing microbes, and neutralizing excess stomach acid. The organ also excretes waste products including bilirubin for elimination through the digestive tract.

Did you know that the liver also has a storage function? When the body has excess sugar (blood glucose) from food (would be good to hyperlink to Metformin article), the liver stores it in longer chains known as glycogen for use at a later time . The liver’s “pantry” also contains the fat-soluble vitamins D, A, K, and E; water-soluble vitamin B12; and the minerals Iron and Copper.

ExcretatoryStorageMetabolic
Bile pigmentIronCarbs, fats, protein
Bile saltsFat soluble vitamins D, A, K, EHormones
Neutralize stomach pHCopperDrugs
BilirubinGlycogenToxins
UreaB12Micronutrients
 

 

Things that Negatively Affect the Liver

 

Since the liver is our principle means of stopping toxins that enter the body, we should be aware of substances and activities that cause excessive wear and tear. Choices we make can keep the essential organ healthy.

1. Alcohol

Long term, heavy use of alcohol is the #1 cause of illness and death from liver disease in the United States (1). This makes sense since the liver is the primary site for the metabolism of alcohol. The enzyme alcohol dehydrogenase breaks down the ethanol, creating harmful byproducts including acetaldehyde, which is very toxic to the body, even in low concentrations. Fortunately aldehyde dehydrogenase rapidly oxidizes acetaldehyde to the less toxic and biologically useful acetate.

Keep in mind, it is the long-term, heavy consumption of alcohol and its toxic byproducts that damage the liver. The continued damage results in breakdown of liver cells called hepatocytes and eventual cirrhosis, or scarring, which impairs the function further (2)Metabolism varies by individual genetic variances, pre-existing conditions, diet, and lifestyle.

2. Drugs

Both prescription and illicit drugs must be broken down by the liver. NSAIDs (non-steroidal anti-inflammatory drugs) are well known to be hepatotoxic. This warning isn’t just for prescription medications either. The overuse of the NSAID acetaminophen, the active ingredient in Tylenol® and found in prescription drugs Vicodin® and Percocet®, can cause liver failure–even death in high doses. Never take more than the prescribed amount and avoid combining with alcohol. Anabolic steroids are another drug known to cause liver damage what taken in high concentrations.

Here is a list of the worst offenders for the liver:

1. Acetaminophen (Tylenol), and other NSAIDs such as Ibuprofen (Advil) to a lesser extent.
2. Amoxicillin/clavulanate (Augmentin)
3. 
Diclofenac (Voltaren, Cambia)
4. Amiodarone (Cordarone, Pacerone)
5. Allopurinol (Zyloprim)
6. Anti-seizure medications
7. 
Isoniazid
8. 
Azathioprine (Imuran)
9. 
Methotrexate
10. Antipsychotics r
isperidone (Risperdal) & quetiapine (Seroquel)

3. Sugar and Starches

In particular, high-fructose corn syrup (HFCS) should be avoided at all costs! Unfortunately, this dietary bane hides in many foods touted as healthy such as salad dressings, tomato sauce, peanut butter, fruit juice, and even yogurt. Sugar commonly contributes to liver disease in individuals who considered themselves healthy before diagnosis.

Fun fact, if you’ve read much at all about liver health, then you’ve heard of fatty liver. Many people mistakenly think they need to skip fatty, cholesterol rich foods to avoid this condition, but the term is somewhat of a misnomer. Dietary fat isn’t always the culprit. It’s usually sugar!

Sugar and starches turn on fat production in your liver via a process called lipogenesis. More than any other lifestyle choice, prolonged high-sugar intake, particularly fructose, fills your liver with fat deposits and triggers a cascade of health complications. These include inflammation and insulin resistance, which can lead to type 2 diabetes (another good place to link to metformin article). The tag team of alcoholic beverages mixed with soda or juice is a real “blow” to your liver health.

Perhaps most interesting, fatty liver results in elevated triglycerides and a harmful imbalance in your cholesterol levels–a drop in HDL and an increase in LDL. While so many with cholesterol issues focus on avoiding dietary cholesterol, they often accelerate their problems by opting for sugar rich-foods advertised as “Cholesterol-free.”

4. Genetic Conditions

No two people are the same, and likewise, your liver doesn’t function exactly the same. Listed here are some genetic conditions that you should be aware of. Exercise caution in your diet and lifestyle if they apply to you:

Hemochromatosis

Remember that the liver provides storage for Iron in a form called Ferritin. Classic hemochromatosis is an autosomal recessive gene causing a mutation in the HFE gene resulting in increased absorption of iron from food. Iron accumulation occurs over years and damages other organs such as the spleen, kidneys and heart. Common early symptoms of classic hereditary hemochromatosis include:

1. Joint inflammation and pain (arthritis) especially in the small joints of the fingers
2. Fatigue
3. Weakness
4. Abdominal pain
5. Unintended weight loss
6. Abnormally enlarged liver (hepatomegaly).
* An abnormally enlarged spleen (splenomegaly) may also occur. A reduction in iron rich foods and blood donations are the typical treatment for this mutation.

Wilson’s Disease

An abnormal accumulation of copper in the body can damage the liver, which under healthy conditions stores some copper itself. High levels building up in the liver, as in Wilson’s Disease, develop toxicity. In Wilson’s Disease, a genetic mutation allows a build-up of copper to occur throughout the body. The classic presentation demonstrates  brown/gold colored rings around the iris of the eyes called Keyser-Fleischer rings.

Implications of severe copper overload include brain and liver damage. Parkinson’s like symptoms, osteopenia, and liver cirrhosis may occur if left untreated. Treatment involves reduction of copper intake and, in some cases, chelation therapy, which utilizes binding agents to remove copper from the body.

Viruses

The hepatitis family of viruses are the most well known that attack the liver. The most common types of hepatitis include Hep A, B, and C. They trigger an acute immune response within the body against its own liver.

Other systemic viruses that indirectly affect the liver include herpes viruses (Epstein-Barr virus, cytomegalovirus [CMV], and herpes simplex virus), parvovirus, adenovirus, and severe acute respiratory syndrome (SARS)-associated coronaviruses (4). With the current COVID-19 outbreak, those with liver conditions should exercise caution as they are at higher risk for serious illness (5). This is an opportune time to remove habits that negatively affect this vital organ. 

How to Test Liver Function

Initial screenings for liver function consists of blood tests. The most common blood tests for liver function include AST, ALT, GGT ALP, Bilirubin, and Albumin.

ALT Test

The ALT test measures alanine transaminase (previously referred to as SGOT), which is used by your liver to metabolize amino acids. If the liver is under stress, ALT can accumulate in the blood.

According to the American College of Gastroenterology, an ALT above 25 IU/L (international units per liter) in females and 33 IU/L in males typically requires further testing and evaluation.

AST Test

The AST test measures Aspartate Aminotransferase. This eznyme is not exclusive to the liver and found in other parts of the body such as the heart, muscles, and kidneys. Since it isn’t specific to the liver, it is used in combination with other markers such as ALT and GGT.

An increase in this enzyme may indicate problems with the liver or muscles.

The normal ranges is usually up to 40 IU/L in adults.

GGT Test

Gamma-Glutamyl Transpeptidase is used to determine liver and biliary tree duress mostly from the metabolism of drugs and alcohol. GGT is also present in the gallbladder, spleen, kidneys and pancreas. The GGT test is the most sensitive enzymatic blood test of liver damage and disease (6). 

ALP

This enzyme, alkaline phosphatase, is run in conjunction with other function tests. It is not specific to the liver and found in the bone and bile ducts as well. High levels may indicate bone disease, damage to the bile ducts, or liver disease.

Bilirubin

When red blood cells are broken down by the spleen, the result is bilirubin. This is passed from the liver to gallbladder and then excreted out of the digestive tract. When the liver or gallbladder isn’t functioning properly, there is a backup into the blood. Bilirubin can further be classified as un-conjugated and conjugated (a discussion for another time). Gilbert’s syndrome results in elevated bilirubin but normal liver function 

Albumin

Your liver produces a protein called albumin essential for transporting molecules, such as hormones and vitamins, throughout the body. Albumin also plays a crucial role in blood vessel oncotic pressure, which prevents fluid from leaking out.

Diagnostic Imaging

If liver markers are out of range, your doctor may order imaging to gain insight into the pathology of your liver dysfunction. Keep in mind that even if a blood liver function test comes back “normal,” a problem could still exist. Ultrasound imaging is more sensitive and can be used as a follow-up diagnostic tool if the physician suspects a problem.

Dietary Recommendations & Supplements for Liver Support

Diet

No supplement can replace a balanced, nutrient dense diet. Clean sources of protein, fruit, and vegetables provide the building blocks for your liver to function properly. Avoiding excess sugar is the best thing you can do to avoid developing fatty liver.

Reduce Alcohol

Again, while supplements can help, over consumption of alcohol puts excess strain on your liver. Maintaining moderation is an important part of any health regimen.

N-Acetylcysteine (NAC)

NAC is an amino acid that has a thiol group and essentially a supplement form of cystein, which when combined with two other amino acids; glutamine and glycine forms Glutathione. Glutathione is considered the master antioxidant of the body and essential for phase 1 & 2 liver detox. In the emergency room, NAC has been used for decades as a proven counterpoisoin for acetaminophen (Tylenol®) induced liver toxicity if it is no reduced by glutathione (9). There is also evidence for NAC in supporting patients undergoing assisted reproductive therapy, suffering from chronic bronchitis, ulcerative colits, liver cancer, asthma, and neurodegenerative conditions such as alzheimer’s and parkinsons (9).

Glutathione

Glutathione is the body’s most abundant antioxidant. It’s been found to support a wide range of process including improving insulin sensitivity and increasing mobility in persons with peripheral artery disease (PAD). Specific to the liver, the antioxidant helps detoxification, digestion, and long term organ health. A 2017 study found glutathione effective in improving nonalcoholic fatty liver disease (8). It should be noted that glutathione is poorly absorbed orally unless in a liposomal format while the gold standard in intravenous administration. 

Milk Thistle

One of the main components of the milk thistle seed is silymarin, an ant-inflammatory antioxidant. Milk this has been shown to ease symptoms of jaundice, cirrhosis, liver cancer, and fatty liver. Amanita phalloides is a mushroom known as the death cap because it is the most deadly poisonous foraged mushroom in the world. Ingestion leads to liver damage and failure, but milk thistle exhibits protective effects that are currently being studied.

Core Restore Program

Ortho Molecular’s 7-day detoxification program is by far the most prescribed program in our office. The benefits of ensuring that the liver is in optimal function has profound, widespread health benefits for our patients. The program is based upon a diet that increases foods that help the liver while eliminating or reducing those that hinder it. In addition to the diet, the Core Restore kit provides three active formulas – Core Support, Alpha Base, and PhytoCore – which function synergistically to support Phase I and Phase II pathways of liver detoxification to help neutralize environmental pollutants, hormone disruptors, unhealthy estrogen metabolites, xenoestrogens (synthetic compounds that imitate estrogen), and other harmful toxins.

Support Your Liver NOW

My preferred first step is the Core Restore program. I prefer it’s simplicity in that it has everything you need in a simple kit and includes dietary recommendations, a shopping guide and sample recipes.  Although this is not a weight-loss program, more than 75% of patients report losing weight while on the program which makes if we support the metabolic processes of the body while supplying it with clean food and essential nutrients. The kit may be purchased online via the link below. If you would like to see me or another physician in our office to discuss your health concerns please contact us.

My preferred first step is the Core Restore program. I prefer it’s simplicity in that it has everything you need in a simple kit and includes dietary recommendations, a shopping guide and sample recipes.  Although this is not a weight-loss program, more than 75% of patients report losing weight while on the program which makes if we support the metabolic processes of the body while supplying it with clean food and essential nutrients. The kit may be purchased online via the link below. If you would like to see me or another physician in our office to discuss your health concerns please contact us.

References

1. Chronic Liver Disease and Cirrhosis. Center for Disease Control and Prevention (CDC). https://www.cdc.gov/nchs/fastats/liver-disease.htm

2. Osna, N. A., Donohue, T. M., Jr, & Kharbanda, K. K. (2017). Alcoholic Liver Disease: Pathogenesis and Current Management. Alcohol research : current reviews38(2), 147–161.

3. Adams, D. H., & Hubscher, S. G. (2006). Systemic viral infections and collateral damage in the liver. The American journal of pathology168(4), 1057–1059. https://doi.org/10.2353/ajpath.2006.051296

4. Greenough TC, Carville A, Coderre J, Somasundaran M, Sullivan JL, Luzuriaga K, Mansfield K. Pneumonitis and multi-organ system disease in common marmosets (Callithrix jacchus) infected with the severe acute respiratory syndrome-associated coronavirus. Am J Pathol. 2005;167:455–463.

5. Important information: The Coronavirus and Liver Disease. American Liver Association. https://liverfoundation.org/3-9-20-alf-statement-on-covid-19/. Accessed March 17, 2020.

6. O’shea, R. S., Dasarathy, S., & McCullough, A. J. (2010). Alcoholic liver disease. Hepatology, 51(1), 307-328.

7. Thoma, C., Day, C. P., & Trenell, M. I. (2012). Lifestyle interventions for the treatment of non-alcoholic fatty liver disease in adults: a systematic review. Journal of hepatology, 56(1), 255-266.

8. Honda Y, Kessoku T, Sumida Y, et al. Efficacy of glutathione for the treatment of nonalcoholic fatty liver disease: an open-label, single-arm, multicenter, pilot study. BMC Gastroenterol. 2017;17(1):96. Published 2017 Aug 8. doi:10.1186/s12876-017-0652-3

9. Mokhtari, V., Afsharian, P., Shahhoseini, M., Kalantar, S. M., & Moini, A. (2017). A Review on Various Uses of N-Acetyl Cysteine. Cell journal19(1), 11–17. https://doi.org/10.22074/cellj.2016.4872