Reversing Liver Damage
by Ken Babal, C.N.
The liver is our second largest organ. (The skin is the first.) Alas, it is not as romantic as the heart, nor as provocative as flesh. The heart has achieved centerfold status on Valentine's cards, and innumerable infomercials are devoted to beautifying the skin. Nevertheless, the liver has had its share of historical fame. Babylonian physicians made their diagnoses by examining it--not a patient's liver, but the liver of a slaughtered sheep into whose nose the patient had breathed. The sheep's liver was then compared to a clay model zoned by the priests into regions indicative of various diseases.1 Some ancient civilizations even held the liver to be the center of the soul.
Not including any as-yet unproven effects on our souls, the liver has as many as 500 vital functions. First and foremost, it's a detox powerhouse. With the exception of intestinal chylomicrons (minute fat particles that directly enter the lymphatic system from the intestines), all products absorbed during digestion initially pass through the liver. Once there, the liver removes or modifies toxic substances before passing the remains into general circulation.2 The liver clears compounds such as drugs and hormones from the blood in one of three ways: by secreting them into the bile, a derivative of cholesterol that aids in fat digestion and absorption; by phagocytosis (a process wherein the offending compound is literally eaten by a type of liver cell); or by chemically altering the compound to facilitate its elimination by the kidneys. Other toxic substances cleared from the blood include leftover histamines from allergic reactions and toxins released by bacterial infections.
The liver also stores blood and fat-soluble vitamins. Furthermore, it aids food digestion and metabolism by making cholesterol and bile, as well as by converting molecules absorbed from the intestines into various proteins, carbohydrates and fats. Therefore, after a carbohydrate-rich meal, the liver will convert some of the excess glucose into glycogen (a complex carbohydrate or starch) and triglycerides (a kind of fat). During fasts, the liver releases glucose into the blood by breaking down its glycogen stores. To further boost blood-sugar levels, it converts noncarbohydrate molecules such as amino acids into glucose.
Optimum health depends on a sound liver. When the liver falters, all other organs, to some extent, fail to function ideally. In most illnesses, health practitioners would do well to assess the status of a patient's liver. If liver function can be improved, the entire system will usually benefit.
Traditional Chinese medicine follows such a philosophy. This tradition teaches that a healthy liver establishes a smooth flow of physical and mental energy through the whole person.3 When the liver is harmonious, there is never stress or tension. People with vital livers are said to be calm and possess unerring judgment. On the other hand, congested energy flow in the liver manifests as emotional difficulties related to anger and an array of physical symptoms.
According to the American Liver Foundation in Cedar Grove, N.J., liver disease ranks as the third leading disease-related cause of death for Americans ages 25 to 59. Particularly common liver disorders include hepatitis and cirrhosis. Many investigators believe that liver damage follows a spectrum, progressing from inflammation and swelling to fatty degeneration, cirrhosis and cancer.
Because the liver can still function with up to 80 percent deterioration, symptoms are often vague and may not be noticed until damage is severe. In one study, blood tests and liver biopsies on people with no apparent liver problems showed that all had a degeneration of liver cells, a high degree of fat infiltration, much scar tissue and other abnormalities.4
When symptoms and signs do manifest they may include dinginess in the whites of the eyes, jaundice, pale stools, pain on the right side or under the right shoulder blade, loss of appetite, digestive disturbances, a metallic taste in the mouth, frontal headache, drowsiness after meals, intolerance of fatty foods and energy loss.
Since one of the liver's jobs is managing fats and cholesterol, liver function is a dominant factor in the development of fatty degeneration diseases--the appearance of fatty materials in places where they are not normally found, such as the arteries. Such deranged fat metabolism contributes to many diseases including cardiovascular disease, cancer, obesity and diabetes.5 High blood pressure, anemia and infertility may also arise from poor use of fats or fat-soluble vitamins caused by liver dysfunction and insufficient bile production. Many natural health practitioners believe liver detoxification and nutritional support are the cornerstones of treating fatty degeneration diseases.
In the industrialized world, it's nearly impossible to breathe and eat without taking in toxic chemicals. Dietary and environmental toxins place a great deal of stress on the liver as it works to detoxify air and food. The kind of food we eat can add to the liver's workload. In animals fed a diet high in refined carbohydrates and saturated fat (i.e., the standard American diet), massive areas of their livers were replaced with scar tissue.6 The fat intake of many Americans may exceed the liver's ability to metabolize it properly. And because toxins tend to concentrate in animal fats, dietary fat further increases the liver's workload. Regarding our daily caloric intakes, many researchers believe that the government recommendation for fat as no more than 30 percent is too high, and that 20 percent is a better target.7
Whereas excessive saturated fat poses a risk, insufficient essential unsaturated fatty acids and lipotropic nutrients (agents that hasten the removal of or decrease fat deposits in the liver) can also contribute to fatty degeneration.8 In addition, dietary fats of any kind can be damaging when rancidity, overheating and processing cause them to oxidize and create free radical damage in the body.
Overuse of drugs, tobacco and alcohol create an additional burden. Even commonly used medications such as acetaminophen can damage both the liver and the kidneys. Overdoses of these pain-relievers have caused liver failure and death. When taken in significant quantities, the combination of acetaminophen and alcohol is a dangerous brew.9
Liver, Heal Thyself
Fortunately the liver has a great capacity to regenerate, and optimum nutrition can help produce quick improvements.10
Normally, the liver needs protein to repair itself. During detoxification, however, it may be necessary for a patient to temporarily decrease dietary protein, especially if blood levels of ammonia are high. (Ammonia is a waste product of protein metabolism that can become elevated in advanced cases of liver disease, particularly cirrhosis.) In the absence of elevated ammonia levels, diets adequate in protein can hasten liver regeneration. The sulfur-containing amino acids methionine, cysteine and taurine are particularly important.
Methionine is a source of the body's major lipotropic compound, S-adenosylmethionine. It contributes to the formation of glutathione, an enzyme that aids detoxification by making toxins water soluble.11 Chronic exposure to drugs and other chemical toxins tend to deplete the liver's supply of glutathione. Supplemental N-acetylcysteine (NAC), another sulfur-containing amino acid and a powerful antioxidant, can also stimulate glutathione synthesis. NAC has been shown to provide a level of protection against a broad range of toxic hazards, including tobacco smoke, auto exhaust, herbicides, alcohol and drugs such as acetaminophen.12,13 In fact, NAC is used as an antidote to acetaminophen overdose.
Antioxidants also facilitate liver healing. Supplementing the diet with vitamins C and E and the minerals zinc and selenium can help protect the liver from free radical damage. In addition, the B complex vitamins, particularly choline, may support regeneration. Animals with choline deficiencies have been shown to develop liver damage similar to that induced by alcohol in humans. Studies on humans with alcoholic liver disease, however, have failed to find a therapeutic effect of choline.14
Phosphatidylcholine (PC), more popularly known as lecithin, is a phospholipid (a form of fat) composed largely of choline. Our cell membranes are made largely of lecithin. Lecithin not only maintains the integrity of liver cells but may also help regenerate damaged tissue and normalize bile function. Studies have demonstrated that PC can improve health in cases of alcoholic liver disease and viral hepatitis and can protect the liver against a variety of toxins.15
Several herbs can help protect and mend the liver. Of these, milk thistle (Silybum marianum) is perhaps best known. An extract of this herb can protect the liver from one of the most deadly liver toxins known, the death cap mushroom (toadstool, Amanita phalloides). Pretreatment of lab animals provided 100 percent protection against this normally fatal poison.16 Silymarin, a constituent of milk thistle, is a powerful antioxidant and lipotropic agent and has been shown to stimulate the growth of new liver cells.17 These properties account for its effectiveness against hepatitis18 and cirrhosis.19
Artichoke (Cynara scolymus) leaves contain caffeylquinic acids such as cynarin. Like milk thistle, artichoke extracts have demonstrated an ability to protect the liver and promote its regeneration.20 Dandelion (Taraxacum officinale), a nutrient-rich herb, has a long folk history as a liver tonic. The German Commission E reports that the root and leaves stimulate bile production, thereby diminishing liver congestion.21 Turmeric (Curcuma longa), from which is derived the active ingredient curcumin, protects the liver by its potent antioxidant and anti-inflammatory activity. It also increases bile output.22 Other liver-supportive herbs include fringe tree (Chionanthus virginicus), celandine (Chelidonium majus), garlic (Allium sativum), licorice (Glycyrrhiza glabra) and peppermint (Mentha piperita).
In sum, a healthy liver is essential to good health. As usual, prevention is key. The simplest path to a well-functioning liver is to breathe clean air and to eat an organic, whole-foods diet that is high in complex carbohydrates and low in fat. Avoid things that can disrupt the intricate biochemical processes of the liver: excessive fat, drugs and environmental toxins such as paint, insect sprays, aerosol cleaners, and pesticides. During times of liver stress, choose from the many nutritional supplements and gentle herbs that can speed healing.
Nutrients That Support Liver Regeneration
1. Pike, R., & Brown, M. Nutrition: An Integrated Approach: 515. New York: John Wiley & Sons, 1984.
2. Shils, M., Olsen J., & Shike, M. Modern Nutrition in Health and Disease: 1480. Philadelphia, Pa.: Lea & Febigen, 1994.
3. Pitchford, P. Healing with Whole Foods: Oriental Traditions and Modern Nutrition: 278. Berkeley, Calif.: North Atlantic Books, 1993.
4. Erasmus, A. Let's Get Well: 171. New York: Signet, 1972.
5. Erasmus, U. Fats and Oils: 302-09. Vancouver, Canada: Alive, 1986.
6. Davis, op cit., p. 172.
7. Erasmus, op cit., p. 150.
8. Davis, op cit., p. 168.
9 . ABC News. "Deadly mix: Tylenol and alcohol could cause death." "Prime Time Live", April 12, 1995.
10. Davis, op cit., p. 174.
11. Murray, M.T., & Pizzorno, J.E. An Encyclopedia of Natural Medicine: 80-81. Rocklin, Calif.: Prima, 1991.
12. Sprince, H., et al. "Protective action of ascorbic acid and sulfur compounds against acetaldehyde toxicity: Implications in alcoholism and smoking." Agents and Actions, 5: 164-73, 1975.
13. Lauterburg, B.H., et al. "Mechanism of action of N-acetylcysteine in the protection against hepatotoxicity of acetaminophen in rats in vivo." J. Clin. Invest, 71: 980-91, 1983.
14. Baraona, E., & Lieber, C. "Effects of ethanol on lipid metabolism." J. Lipid Res., 20: 289-315, 1979.
15. Kidd, P.M. "Phosphatidyl choline as an aid to liver function." Nutrition Science News, 1: 54, October 1996.
16. Schopen, R., & Lange, O. "Therapy of hepatoses: Therapeutic use of silymarin." Med. Welt., 21: 691-8, 1970.
17. Wagner, H. "Plant constituents with anti-hepatotoxic activity." In Beal, J., & Reinhard, E., eds. Natural Products as Medicinal Agents: 545-58. Stuttgart, Germany: Hippokrates-Verlag, 1981.
18. Berenguer, J., & Carrasco, D. "Double-blind trial of silymarin versus placebo in the treatment of chronic hepatitis." Muench Med Wochenschr, 119: 240-60, 1977.
19. Murray, M. Healing Power of Herbs: 247. Rocklin, Calif.: Prima, 1995.
20. Maros, T., Racz, G., et al. "The effects of Cynara colymus extracts on the regeneration of the rat liver." Arzneim-Forsch, 18: 884-86, 1968.
21. Bundesanzeiger. Cologne, Germany, Dec. 5, 1984.
22. Ammon, H., & Wahl, M. "Pharmacology of curcuma longa." Planta Medica, 57: 1-7, 1991.
Ken Babal, C.N., is a consulting nutritionist and a member of the board of directors for the Society of Certified Nutritionists. Babal is the author of the recently released book Maitake: King Of Mushrooms (Keats Good Health Guide, 1997).