Our Body's Multi-Tasker

The liver is not only the most underappreciated organ, it’s one of the most crucial
to staving off a number of serious diseases. Learn what you need to know to keep
this workhorse running on all cylinders for years to come.

By Susan Weiner

June 2006

While jilted lovers lament over broken hearts and intellectuals revel in praise for their singular brains, few wax poetic about the liver. Like a businessman climbing the corporate ladder, the oft-ignored and hardworking liver takes its job very seriously, rarely receiving the lyrical accolades it so deserves.

The sheer intricacy of this organ makes it susceptible to myriad diseases—most rare, others far too common. And though men may be physically sturdy, apparently their livers are not as resilient as those of the fairer sex, since liver disease claims proportionately more men’s lives than women’s at all ages; according to the Centers for Disease Control, it ranks as the 10th leading cause of death among men.

The American Liver Foundation reports that more than 25 million people—one in every 10—are afflicted with liver or gallbladder disease, with more than 360,000 Americans hospitalized at any given time with cirrhosis, in which scar tissue replaces healthy tissue and blocks the flow of blood through the liver. Symptoms of liver distress include fatigue, abdominal pain, loss of appetite, dark urine, nausea and jaundice—a yellowing discoloration of the skin and whites of the eyes caused by abnormally high levels of the liver enzyme bilirubin in the bloodstream.

It may be unclear statistically why men are more at risk when it comes to their livers, but heredity, male sex hormones, body fat distribution and socially sanctioned “male behavior” may predispose them to earlier deaths in general. Men are more likely to use illicit drugs and engage in casual sex, behaviors that can increase the likelihood of exposure to hepatitis C, which can culminate in cirrhosis. What’s more, with men accounting for more than 70% of the 75,000 alcohol-attributable deaths in the US each year, it’s no surprise that a significant number of men also suffer from alcohol-induced cirrhosis.

Still other circumstances can give rise to permanent liver damage, including hepatitis B and inherited diseases such as hemochromatosis, in which abnormal amounts of iron accumulate in the liver. Another ailment, nonalcoholic fatty liver disease (NAFLD), is associated with obesity and can also lead to cirrhosis. In a culture that embraces overindulgence, where two-thirds of adults and one-third of kids are classified as overweight or obese, future generations may bear witness to an epidemic of this potentially deadly malady.

All liver diseases may not be preventable, but lifestyle strategies can protect the liver and maximize overall health.

Live and Let Liver

Located beneath the rib cage and adjacent to the gallbladder, the wedge-shaped liver weighs in at about 2% to 3% of one’s total weight, making it the largest internal organ. Though it has two basic chores—processing everything that enters the body and ensuring that every other organ is supplied with sufficient fuel—its activities are far-reaching and complicated. “There’s no single active verb to describe what the liver does because it has so many different jobs to perform,” explains Melissa Palmer, MD, an internationally renowned hepatologist with two private practices on Long Island, New York and author of Dr. Melissa Palmer’s Guide to Hepatitis & Liver Disease (Avery). “The liver is an extraordinarily complex organ that controls virtually every aspect of your body’s daily functions.”

Like a miniature refinery, the liver processes many of the chemicals necessary for life and exports them to other organs, and converts carbohydrates, fats and proteins into substances the body can use. It modifies drugs taken to treat illness and cleanses the blood of toxins. In total, the liver performs over 100 separate bodily functions, among them regulating the blood’s ability to clot, controlling the production and excretion of cholesterol, breaking down alcohol, maintaining hormonal balance, storing iron and helping the body resist infection. “Virtually everything that enters the digestive tract—foods, drinks and medicines, for example—and everything that is breathed in or absorbed through the skin must pass through the liver in an attempt to be purified and detoxified,” explains Palmer.

Fat Liver City

With such an alarming rise in obesity in the US, it’s little surprise that NAFLD is the most frequent cause of abnormal liver function among adults. The malady, which can range from simple fat accumulation to life-threatening liver disease, is most commonly associated with obesity, insulin resistance and hypertension, components of a condition called metabolic syndrome.

To keep glucose levels in check, the hormone insulin pushes glucose out of the bloodstream and into cells that convert it into energy. Insulin receptors open and close to regulate
glucose levels, but among folks who are insulin-resistant, these doors don’t work properly and cannot utilize insulin efficiently. Unable to enter the cell, glucose accumulates in the blood, causing high levels of fatty acids (or triglycerides) to accrue and be deposited in the liver—which over time results in fatty liver disease.

“People who are overweight are more likely to show signs of insulin resistance than people who are of normal weight,” explains Palmer. “But keep in mind that a sedentary lifestyle and a diet rich in sugars and fat may promote insulin resistance, even among people who are not overweight. In fact, it is thought that most people with NAFLD have insulin resistance independent of weight.”

Given that more than 47 million Americans have metabolic syndrome, NAFLD represents a major health concern, reports the Journal of the American Medical Association. Like most chronic liver diseases, there is a long period with no symptoms, but NAFLD can ultimately lead to cirrhosis. Diabetes is also a risk factor, since the body becomes resistant to the effects of insulin or the pancreas doesn’t produce enough insulin to maintain normal blood sugar. In large urban areas, as many as one-third of adults may suffer from fatty liver disease, reports the American Association for the Study of Liver Diseases. Though prevalence of the disease varies among races, incidence among white men is twice as high as in white women.

The Hepatitis Alphabet

On occasion, news headlines announce a hepatitis A breakout at a restaurant or market. That’s because hepatitis A (HAV) can be transmitted to others by persons who fail to wash their hands before handling food. It can also be contracted by ingesting contaminated foods, such as raw oysters, that has had contact with human waste. Stopping the spread of HAV on a personal level is as easy as practicing good personal hygiene, thoroughly cooking food, sanitizing diaper-changing tables, avoiding raw or partially cooked seafood, and consuming only well-cooked foods and bottled water when traveling. Most people recover from HAV within one to two months after infection.

In the US hepatitis B (HBV) is a rarity; in parts of Asia and other less developed areas, hundreds of millions of individuals may be infected. HBV is transmitted via sex, blood and blood products (although the blood supply here has been screened for many years).

More than 4 million people in the US are infected with hepatitis C (HCV), yet 70% have no idea that they have the virus. While nearly 60% of HCV infections are a result of intravenous drug use, still others are caused by hemodialysis, blood transfusions or organ donations before 1992, infants born to infected mothers and relations with an infected partner. It is even possible to contract the disease through items such as shared or tainted razors, toothbrushes and tattoo needles.

In many cases, HCV remains silent for decades. “It is estimated that in the next decade, thousands of baby boomers will get sick from a virus they unknowingly contracted years ago,” says Palmer. “HCV can reside in the body for many years, clandestinely doing damage to the liver even though the person feels fine.” HCV remains the leading cause of liver transplants worldwide.

A Tipsy Liver

Drinking alcohol may be regarded as sophisticated and fun (and in the case of red wine, even healthy) but when done to excess throughout adulthood, it can ravage the liver.

“Most people do not know that the liver is primarily responsible for protecting itself and the rest of the body from the harmful effects of alcohol,” says Palmer. “When the liver has been damaged by alcohol and can no longer prevent dangerously high levels of this toxin from accumulating in the bloodstream, other body parts can become damaged.” By breaking alcohol down into less toxic byproducts using enzymes, the liver prevents dangerous levels from accumulating in the bloodstream. Liver damage occurs when this mechanism drowns in a sea of alcohol.

Since some people are more sensitive to alcohol than others, there’s no single right answer as to how much is too much; even moderate to social drinkers can develop cirrhosis and other liver damage. Based on current dietary guidelines, moderate drinking for men is defined as an average of two drinks or less per day, a standard drink being a 12-ounce beer, one five-ounce glass of wine or one 1.5-ounce glass of distilled spirits.

Even moderate amounts of alcohol can have toxic effects when mixed with prescription drugs and acetaminophen (found in such over-the-counter remedies as Tylenol, Motrin and Advil). “If you are taking over-the-counter drugs, be especially careful about drinking and don’t use an alcoholic beverage to take your medication,” advises the American Liver Foundation. In fact, acetaminophen itself, when taken in excess, can damage the liver; less than four grams per day should be safe.

Loving Your Liver

So what’s a guy to do if he wants to offer his liver a little TLC? For starters, drop those excess pounds; if your body mass index is above 25, a diet and exercise program may reduce the amount of accumulated fat in your liver, advises the renowned Mayo Clinic. Moreover, controlling cholesterol levels with diet and exercise can not only prevent liver disease but may actually stabilize or reverse it, as can limiting alcohol intake, taking medications only as directed and heeding precautions when using hazardous chemicals.

Even cirrhosis is reversible with the right treatments, reports Palmer. “Most liver diseases, if diagnosed and treated early, are either curable, reversible or at least progression can be slowed so that people can live long healthy lives with liver disease.”

So, come on guys, isn’t it time you showed your liver a little love? You are sure to find it a mutually beneficial relationship.

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