The Liver: An Owner’s Manual

Damage to the body’s main processing plant can
often go unnoticed—sometimes for years—
before symptoms arise.

January/February 2018

By Lisa James

Structural Components

The liver is located in the upper right abdomen, right below the diaphragm. It consists of two lobes, which in turn consist of thousands of lobules, each of which contains liver cells plus blood vessels and ducts for bile, which the liver creates to help break down fats during digestion. The smaller bile ducts empty into the common hepatic duct, which meets up with the cystic duct from the gallbladder (a small sac under the liver that stores bile) to form the common bile duct, which empties into the small intestine.

 

Functions

The liver is a jack of all trades, performing hundreds of tasks. Among its main functions are:

> Processing, or metabolizing, everything you eat or drink. Bile not only breaks down dietary fats but allows the fat-soluble vitamins—A, D, E and K—to be absorbed. What’s more, the liver is the first organ nutrients encounter once they leave the digestive tract.

> Storing stuff. The liver stores glycogen, a ready source of energy. It also warehouses some vitamins along with iron, fat and amino acids, the building blocks of protein.

> Regulating cholesterol. It isn’t always evil: Your body actually needs cholesterol to create bile and things like cell membranes. In order to transport this waxy substance through the watery bloodstream, the liver makes cholesterol/protein packages, one called LDL (the type that under certain conditions can go “bad”) to deliver cholesterol to the body’s cells and another called HDL (the “good” type), which brings cholesterol back to the liver.

> Producing proteins. The liver makes proteins that help transport various other substances through the blood. One example is albumin, which carries thyroid and other hormones.

> Detoxifying harmful substances. It’s a poisonous world out there, and one of the liver’s most important jobs is protecting you from it. Noxious substances include environmental toxins and metabolism byproducts.

FAST FACT

Did you know that the liver is the only
organ that can regenerate itself?
This explains why living people can donate parts of their livers.

Potential Hazards

While the liver is subject to any number of disorders, the most common are caused by viral infections, alcohol usage and carrying excessive weight.

> Viral infections: Hepatitis refers to an inflamed liver, no matter what the cause, but the word is most often used in conjunction with a group of viruses identified by letter. The three major ones are hepatitis A, which spreads through food or water contamination and usually has no long-term consequences; hepatitis B, which spreads through bodily fluids and can become chronic; and hepatitis C, one of the most common causes of chronic liver disease. Hepatitis C is most often associated with Baby Boomers who were exposed to infected blood through transfusions and other medical procedures before 1992 (when widespread testing began), accidental needle sticks and similar occupational exposures or the use of injected recreational drugs. However, according to the Centers for Disease Control, a recent upswing in opioid drug use among younger people caused new hepatitis C infections to nearly triple between 2010 and 2015.

> Alcoholic liver disease: While drinking to excess can leave anyone prone to liver problems, some people run a greater risk in doing so. They include binge drinkers, those who down five or more drinks at a time; people who are overweight; and women, who are more susceptible than men to alcohol-induced liver damage. (Genetic factors may also play a role.) This damage is done by toxic substances, most notably acetaldehyde, produced when the liver breaks down alcohol.

> Fatty liver: About one of every three Americans is obese, defined as having a body mass index (BMI) of 30 or higher. This has led to an increase in nonalcoholic fatty liver disease (NAFLD). It starts as a simple buildup of fat (steatosis) within the liver; fatty liver occurs when the organ contains more than 5% to 10% fat by weight. That stage is often symptomless; often someone learns they have NAFLD when liver problems are found during routine blood tests. However, this condition can progress to nonalcoholic steatohepatitis (NASH), in which the fatty deposits are accompanied by inflammation and liver cell damage.

The Experts Say

Most who develop [alcoholic liver disease] have a history of drinking the equivalent of seven drinks a day, every day.
—Rich Snyder, DO
Author of What You Must Know About Liver Disease (SquareOne)


[Alcohol] abstinence has been shown to improve liver injury…This improvement can be relatively rapid.
—Kristin Kirkpatrick, MS, RD, LD, and Ibrahim Hanouneh, MD Authors of Skinny Liver (Da Capo)


While liver dysfunction may seem daunting, there are simple modifications you can make in your daily life to improve your liver’s health.
—Michelle Lai, MD, MPH, and Asha
Kasaraneni, MSc, RD, LDN
Authors of The Liver Healing Diet
(Ulysses Press)


Most people are unaware that having unhealthy eating habits or being overweight can take a toll on their liver.
—Kirkpatrick and Hanouneh

Damage Control

Part of the liver’s problem is that it’s the strong, silent type: It tends to keep pushing through dysfunction without symptoms until something is seriously amiss. The classic liver trouble sign is jaundice, a yellowing of the skin and eyes caused by deposits of bilirubin, a red blood cell breakdown product that builds up when the liver labors.

But for many liver diseases, first symptoms include fatigue, weakness, achiness, loss of appetite and fever—all of which can be caused by dozens of conditions. Even edema, a buildup of fluid in the legs and ankles, can be caused by not only a distressed liver but also by heart or kidney disease, or congestive heart failure (along with more benign causes,
such as standing or sitting for extended periods).

If untreated, liver disease can progress to cirrhosis, in which scar tissue forms, and even cancer. Cirrhosis can lead to intense itching, easy bruising and multiple clusters of tiny lines on the skin called spider angiomas (having one or two generally isn’t a problem). Mental confusion, caused by a buildup of toxins in the blood, and swollen, or varicose, veins in the esophagus may also occur.

Getting an accurate diagnosis is crucial. In addition to bloodwork, a practitioner may order various types of scans or even a biopsy, in which a small tissue sample is examined. A transplant may be needed if the damage is bad enough; however, the good news is that, for fatty liver in particular, early-stage disease may be treatable through lifestyle adjustments.

Preventive Maintenance

Diagnosed liver disease always requires the care of a trained practitioner. However, many of the lifestyle recommendations offered to people with disorders such as early-stage NAFLD can help prevent liver problems in the first place. These recommendations include:

> Avoiding alcohol: Limiting your alcohol intake, if not eliminating it entirely, will help make your liver happy. Reduce consumption by setting a limit before you go out and sipping drinks slowly, and find ways to socialize in which drinking doesn’t play a role. (Smoking doesn’t do the liver any favors either; quitting can only help.)

> Reducing sugar: Believe it or not, sugar is almost as bad for your liver as alcohol, promoting both inflammation and fat accumulation. (It’s no accident that fatty liver and type 2 diabetes often occur together.) Besides cutting out such obvious sources as pastry and candy, look for sugar hidden in processed foods. Any sugar you eat should come
from moderate amounts of fruit, which also provides fiber and valuable phytonutrients.

> Swapping out sat fat: Saturated fats, the kinds that are solid at room temperature, strain the liver. Going with mostly unsaturated fats, such as olive oil, is a good idea, as is reducing consumption of fatty meats.

STATISTICS

30 million Americans have some form of liver disease
(all stats from the American Liver
Foundation, liverfoundation.org)

20%–25% Americans living with nonalcoholic fatty liver disease

4 million
Approximate number of Americans living with Hepatitis C

> Going Mediterranean: One way to cut back on sugar and eat healthier fats is by switching to a Mediterranean diet, one that emphasizes plant-based foods, fish and poultry instead of red meat, and whole carbs—legumes, beans, chickpeas, etc.—instead of sugary stuff. (It does include red wine in moderate amounts; speak with your practitioner about balancing wine’s potential benefits against the potential harm caused by its alcohol content.) Two vegetables used in Mediterranean cooking are particularly noted for their role in liver health: Garlic has been linked to reductions in total cholesterol and LDL, both of which are associated with fatty liver, and artichoke, traditionally used to support an ailing liver, has been found to promote normal bile flow. (Other traditional liver remedies include the herbs dandelion root and milk thistle.)

> Getting more exercise (including liver-loving yoga poses): Modern living tends to limit physical activity, so make a conscious effort to move more. Getting a pedometer to count your steps helps, as does setting a reminder on your computer or smartphone to get up throughout the day; parking farther away from buildings and taking stairs instead of elevators are two easy ways to increase exercise opportunities. Yoga offers overall advantages in terms of stress relief, greater flexibility and enhanced muscle tone. What’s more, poses such as Wide-Legged Forward Fold (the chair version) and Seated Side Twist encourage better blood flow through the liver; consult a registered yoga teacher if you have any pre-existing conditions.

> Dodging liver-damaging chemicals: While some of the more noxious compounds—especially carbon tetrachloride, formerly used in dry-cleaning solvents and fire extinguishers, and extremely toxic to the liver—are no longer in common use, there are still plenty of harmful substances in the environment, including those found in the average home. Sidestep as many of them as possible by installing a high-quality water filter, using non-toxic cleaning agents (and properly disposing of old ones), hanging dry-cleaned items outside to air them out and not letting paints, solvents and similar substances come into contact with your skin.

> Cleansing your system: The liver is just part of your body’s total toxin-eliminating system but it’s a crucial one, and toxins tend to accumulate if it isn’t working right. That’s why some practitioners recommend cleanses to help “reset” the system (always check with your own practitioner before trying a cleanse, especially if you have a pre-existing condition). Besides dandelion and milk thistle, liver-supportive herbs include burdock, long used in Ayurvedic medicine as a blood purifier, and turmeric, which has been found in studies to have liver-protective effects. Probiotics, the friendly microbes that inhabit the intestines, and prebiotics such as prune powder, which help feed the probiotic microbes, promote proper digestive function, which helps carry cleansed toxins away.

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