A range of conditions can prevent the liver from performing its vital functions. The one I see most in clinical practice is fatty liver disease and toxin damage. When our liver is not functioning optimally due to these situations we do not feel very well at all. In fact, it can so significantly impact our health that I have seen individuals completely debilitated by liver disease.
One patient in particular comes to mind. He was an otherwise fit gentleman of normal body weight but had found that, in recent years, he was overindulging in what he called ‘the good life’. Too much alcohol, caffeine and café lunches had led to some liver damage. His main symptoms were fatigue, itchy skin especially at night time, and an offensive taste in the mouth that he described as sometimes metallic. These symptoms were really starting to affect his quality of life to the point where he was taking time off work thinking he must be stressed. When he made some necessary lifestyle adjustments these symptoms largely resolved.
So what exactly are the functions of the liver and how do we restore and/or protect it so that it can continue to function well?
FUNCTIONS OF THE LIVER
The liver has over 500 essential functions to keep the body healthy. Some of those include1
- Toxins, medications and drugs including alcohol are filtered through the liver and neutralised or converted into other forms by specific enzymes.
- Bile, produced by the liver, is stored in the gall bladder and used to help break down dietary fats. Bile is also needed in order to absorb the fat soluble vitamins A, D, E and K.
- The liver converts carbohydrates into glucose for instantly available energy and converts glucose into its storable form (glycogen). When blood sugar levels drop, glycogen is converted back into glucose.
- It synthesises cholesterol and produces the lipoproteins needed to transport cholesterol throughout the body, including low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol. Hence, when the liver is not functioning effectively, cholesterol levels begin to rise.
- The liver is the major fat-burning organ regulating fat metabolism. A healthy liver metabolises rapidly, keeping weight A sluggish liver causes calories to be stored as fat rather than used for energy.
- Amino acids from protein are sent to the liver for the production of body proteins such as hormones.
- The liver changes ammonia (a toxic by-product of protein metabolism) into urea, which is then excreted in urine.
- It regulates blood clotting.
- It resists infections by producing immune factors and removing bacteria from the bloodstream.
COMMON SYMPTOMS OF LIVER DAMAGE
Symptoms of liver damage depend on the disorder, but can include:
- Fatigue
- General malaise (feeling unwell)
- Nausea
- Vomiting
- Itching
- Diarrhoea
- Appetite loss
- Bloated abdomen, swollen ankles
- Abdominal pain in the upper right side
- Easy bruising
- Jaundice (the skin or whites of the eyes turn yellow)
- Dark urine
- Fever
- Anaemia
- Changes in mental state – altered sleep pattern (awake at night), confusion, drowsiness.
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HOW CAN THE LIVER BE DAMAGED?
Some of the causes of liver damage include:
- Non-alcoholic fatty liver disease (‘fatty liver’) – results in fat accumulating inside liver cells, causing cell enlargement and sometimes cell The liver becomes enlarged, causing discomfort on the upper right side of the abdomen. Fatty liver can occur if we are carrying too much weight for our frame, have diabetes, or consume too much sugar.
- Alcohol-related liver disease – alcohol is a toxin that, when consumed in excess, damages liver cells. In time this can lead to fatty liver, hepatitis and eventually cirrhosis of the liver.
- Toxic effect of medications, as well as some herbal medicines.
- Congenital or inherited abnormalities of the liver – involving accumulation of iron and copper in the body and some rare enzyme disorders.
- Hepatitis virus infections.
- Conditions leading to liver-cell and/or bile duct (the 'plumbing system’ of the liver) damage.
The most common cause of liver damage is fatty liver disease (‘fatty liver’). Cirrhosis is the end result of many liver conditions and involves severe scarring of the liver (with liver nodule formation). It is associated with a progressive decline in liver function resulting in liver failure.
HOW CAN LIVER DAMAGE CAN BE DIAGNOSED?
Liver disease is diagnosed using a number of tests, including:
- Physical examination The liver may be enlarged
- Medical history Including medications and lifestyle factors such as diet and alcohol consumption, exposure to hepatitis viral infections, blood transfusions, tattoos or family history of liver disease.
- Blood tests To check the levels of liver enzymes and jaundice (‘yellowness’) and to assess the protein production capability of the Along with an elevation in liver enzymes, other markers also elevate as a result of liver damage, including ferritin (iron stores), cholesterol and blood sugar levels. Sometimes blood tests do not reflect the fact that liver damage is in its early stages. If you have any of the above listed symptoms consider following the liver ‘detox’ advice below to see if you feel better.
- Ultrasound scan of the liver This will assess the liver size, check for any structural abnormalities and will detect fatty liver.
- Other scans Including computed tomography (CT) scan and magnetic resonance imaging (MRI).
- Biopsy A small piece of liver tissue is removed and examined under the microscope in a laboratory.
Once liver damage is detected, or even if liver damage is not picked up on blood testing but you have symptoms consistent with liver damage, the best way to restore optimal liver function is to provide an environment that will allow the liver to heal. This is often called a ‘detox’.
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HOW TO REALLY DETOX YOUR LIVER
So how do you really detox your liver? There are many products available on the market that claim to help with detoxing the liver. There are also many diets that propose the same. The problem with many of these products and diets is that they are often expensive and not sustainable. As soon as you stop taking the product or following the diet and return to your usual lifestyle you will find the same problems occurring with your liver. To simplify the process of ‘cleaning out’ the liver I find the best strategy is to follow this 3-step process:
Remove Toxins The toxins that most often damage the liver are alcohol and common medications like paracetamol. Reduce the amount of these to within safe limits. The severity of liver damage will determine whether your physician will recommend you abstain from alcohol for a period of time to allow your liver to regenerate. Additionally, be cautious with the amount of caffeine you are consuming. In amounts up to 200 mg in adults (about 3–4 cups of coffee or tea) caffeine is a stimulant of liver function. Amounts of caffeine consumed above this, however, can also cause some liver damage.
Clean Up Your Diet Along with reducing alcohol, the other dietary change that you need to make to clear out your liver is to reduce the amount of processed foods and drinks you consume. Processed foods and drinks are often high in toxic fats such as trans fats and/or sugars, which are both equally damaging to the liver, but also contain preservatives, additives and artificial colourings. As these have no nutritional value at all but are seen as toxins, the liver has to work hard at eliminating them. Processed foods include items such as cakes, pastries, some cereals, biscuits, desserts, packaged fried foods and confectionery. Fresh is always best when it comes to the majority of foods we should be consuming. Processed drinks include soft drinks, energy drinks and flavoured milk drinks. Try and get used to drinking plain water.
Support Liver Function There are a few foods as well as natural medicine items that can help with supporting liver function.These include vegetables from the ‘brassica’ family – broccoli, kale, cauliflower, Brussels sprouts and cabbage2,3. The protective effect of the brassicasis due to their high content of something called ‘glucosinolates’. Once these vegetables are chewed and digested, glucosinolates are converted into two types of highly reactive compounds which work together as powerful stimulants of the liver’s detoxification pathways. Eating a serve of these types of vegetables regularly will help give your liver a boost. You can also purchase the brassica extract in tablet form. I feel, however, that nothing is a substitute for the real thing when it comes to food items, but this in an option for those who have significant liver damage and/or do not eat enough of these types of vegetables.
The other natural medicine item that is available with evidence indicating liver support is ‘silymarin’ (also known as St Mary’s thistle or milk thistle). This is an approved substance used in Europe for liver disease and can be taken even if you have mild liver disease. Always consult your physician, however, before taking any new substance, to ensure correct dosage and interaction with any other substances you may be taking.
Finally, as the liver and gut are intrinsically linked you cannot truly support liver function without supporting optimal gut function.
TAKE HOME POINTS
The liver is the key detoxification organ in the body.
- When your liver is functioning well you will find that you will feel well, your energy reserves will be normal and your metabolism will be able to work efficiently (provided there are no other medical issues).
- Signs and symptoms of liver damage include fatigue, nausea, general feeling of malaise, itching, easy bruising, anaemia and pain or discomfort in the upper right side of the abdomen.
- The liver may be damaged due to toxin overload, poor lifestyle choices, some medications, some viruses, as well as due to some inherited conditions.
- Diagnosis of liver damage involves clinical examination, blood tests, ultrasound scans and sometimes a liver biopsy.
- The liver has amazing regenerative potential and can heal if provided a permissive environment in which to do so.
- To allow the liver to regenerate follow a healthy diet low in processed foods and drinks, with low to moderate caffeine and alcohol intake, and high in fresh vegetables such as those from the brassica family (broccoli, kale, cabbage, Brussels sprouts and cauliflower).
- Silymarin is a herbal extract that may assist in supporting the liver and is available in various preparations.
- The liver must be supported with a healthy gut to function well.
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